'the only thing that matters is a healthy baby'

[RevoltingPeasant]

I was talking to a friend about ttc and wanting a homebirth recently (whooooole other thread there) but in the midst of trying to dissuade me, she said, 'Birth isn't an experience, it's a process, and really the only thing that matters is a healthy baby'.

Okay - I'd agree with the first bit. I don't expect to go into it and have a Magical Experience Which Will Last A Lifetime. I think it'll hurt and large part of it will be boring and literally shit.

But - it occurred to me that the second bit is something I have heard lots of people say when discussing birth, inc HCPs. And tbh, it really gives me a chill. There are two people involved in birth and the mother counts as well. I do think the mother has the right to think about herself too when negotiating interventions, choices etc. AIBU to think this attitude is really horrid and totally devalues women?

Or is that just because I don't have DC yet?

OK, extra long post, so apologies. An interesting thread!

There are a lot of studies that compare risks of HB/MLU/hospital but there are a couple of points that need to be taken into consideration when looking at the end numbers. It is easy to say there is more intervention in a hospital birth - yes, because it is available, but also because generally only the low risk pregnancies go for HB/MLU so therefore the proportion of high risk pregnancies at hospital will be greater and therefore the amount of intervention required will also be greater.

A lot of the HB vs hospital studies also don't take account of the intended place of birth - ie only consider where birth occurred. This means that mums transferred to hospital in labour have the birth outcome recorded as being hospital and not home, which can skew the results.

I would agree that giving birth is potentially dangerous. The reason it is generally safe in the UK is because we have a good healthcare system. Was shocked reading the BMJ this week to see stats on maternal mortality around the world per 100,000 - for Africa was around 900. Pretty horrendous. So yes childbirth is natural, as is having a poo (as someone pointed out upthread), but not every natural process is safe.

There is a lot to say for the skill of the person attending the mother - I too would love to have my midwife helping me give birth to be the same lady I see regularly when pregnant. But this depends on when she is on shift, when I go into labour and how long I am in labour for - I wold rather have a change of midwives than expect someone to stay extra hours both for them (they may have children to collect) plus me (why do I want someone to deliver my baby who has been on duty for an excessive number of hours?).

Most people having a HB are fine because they are classed as low risk plus all the benefits of being relaxed etc (which is not only achievable at home you know). When things go wrong though it generally happens quickly - that 20 minutes to hospital is never that as you need to wait for the ambulance to be called, to arrive and to transfer you.

It is generally a mothers choice where to have a baby and if there was a MLU right next to ITU etc, I would go for that everytime. As our MLU is a minimum of 30 minutes from hospital (and doesn't have an ambulance on site) I will be at the hopital again.

A lot of the HB vs hospital studies also don't take account of the intended place of birth - ie only consider where birth occurred. This means that mums transferred to hospital in labour have the birth outcome recorded as being hospital and not home, which can skew the results.

I believe that all recent UK studies e.g. the Place of Birth study as the most recent, have considered the intended place of birth. Mums transferred to hospital in labour have their births recorded as MLU/home so the results have not been skewed. These show that overall homebirths/MLUs are as safe for the baby and safer for the mother.

'High risk' women were excluded from that study and as far as I am aware no recent studies about the place of birth for high risk pregnancies have been done. Back in 1980, the statistician Majorie Tew analysed the results and found that even for high risk women the outcomes were more favourable outside Consultant Units. So much has changed since then that I doubt that we could draw any inferences from those studies now.

Some women considered high risk do go on to have babies at home, perfectly safely. I do agree that it is the quality of attendants which matter. Don't assume that being in hospital means that you will get more attention than you would at home or in a MLU or more rapidly because in many cases you won't.

I think YANBU it is a terribly callous approach to have.

The mother matters, her health and life are important.

Anyone who would look at a dead mother and a healthy baby and think that was a satisfactory outcome has got a bit of a screw loose IMO

I would also not want to be attended at birth by someone who thought that the only thing that mattered was a healthy baby.

missingmymarbles I was the one who said birth is a process!

I have not many no illusions about childbirth. But Dontbugme do you really think the mum should have only a say? I don't know about that. I'm really not sure of the ethics there.

To be clear, I am not after some magical birth experience. I am talking about avoiding birth injury and/or PND or MH complications. And bodily sovereignty. I think those things are really important.

I'm sure my friend didn't mean the mum doesn't matter. My point was about the phrase and the kind of thinking it can lead into.

Amen, Revoltingpeasant on avoiding birth injury, psychological trauma and bodily sovereignty being crucial, not the Magical Birth Experience. I find it more than slightly sinister that some people I've ecountered seem to view a pregnant woman also considering these things important is some kind of 'Birthzilla'.

ah yes, op, i now see you did use the word 'process' as your friend described it, and i agree; although, i think i was thinking about and perhaps confusing it with theITgirl's reference to 'goal' ie baby at the end of that process.

but yes, i do believe that the mothers health is important, as i said in my post, both mental and physical, but perhaps it read badly. someone has already pointed out that the nhs considers mum before baby until baby is here, and rightly.

i do think though, that with better education of risk/problem/solutions/interventions etc, mental health could be better cared for. and anyone who believes it is baby at all cost and above the mother does have it very wrong. better education would enable women to have a say in the management of potential complications also, because in the heat of it, is not the time to make any decision, and medics have the unenviable and impossible task of trying to predict an outcome; they can only calculate risk and make an informed judgement call. they only make that decision on the basis of the actual situation and that risk management and their education. at some point, that decision, sadly, may be the wrong one. i am not offering that as a get out clause by any means, and obviously errors need to be dealt with, but i think it would be helpful, if we as the general public realised that most of us are lay people who are not aware of many of the risks to mother and/or baby, and at some point we have to trust our medics. and actually, i think often if we are aware of the risk, we rather naively believe that they happen to other people rather than ourselves.

Missingmymarbles, I would caution against relying on 'medics' to make you aware of risks and handle them appropriately. I certainly wouldn't write off medical advice but many doctors are trained and aware of only birth as a medical event and view it as inherently risky.

They may also not always be the best and only source of advice in relation to 'high risk' pregnancies and births and I'd recommend women always also educate themselves.

i agree that some medics only view birth as medical and risky, cervix, and i also agree that women should educate themselves. my concern is, that they don't, preferring only to see the risks as minimal in a 'unlikely to happen to me' way. obstetrics is a specialist area, and as such we should expect that the people working there are experts in their field, although i appreciate that doesn't always happen. i am talking about life-threatening medical emergency risks. it is these things that make births traumatic, and often because they come out of left field. medical intervention becomes necessary to save mother and child, and the shock is traumatic.
i am all for keeping childbirth as intervention free and natural as possible, and would have chosen that but that choice was taken out of my hands, whether i liked it or not. neither myself nor my dd would be here with out medical intervention and i am very grateful.

if the only thing that matters is a healthy baby, then that's more reason for a homebirth.
As homebirth is statistically safer for healthy pregnancies x

To all those who only want a healthy baby, when my ds was born we were told he mightnever crawl or walk. It wasn't what I wanted, but by god I loved him so much, I used to hold him and say, it doesn't matter, you're here now we will look after you as best we can. If you had given me the choice of a healthy baby or ds I would have chosen ds.

As someone who just had an emcs for horrible complications I would have done anything to protect my baby. Anything. My life was definitely not more important and I trusted the doctors to make the right decision for the baby.

Lunatic I'm so sorry to hear about your loss. Sympathies.

Mary, your birth also sounds horrific.

But. Respectfully. You are saying the only thing I cared about was getting him out alive.

That is fine; it is your body, your baby, your feelings. My point is about other people having that attitude to you.

A registrar sees that a 1st time mum has been labouring for some time and pushes her into induction + epidural and forceps delivery. She sustains a 3rd degree tear.

Maybe leaving her alone would have been okay. Can she not be hacked off about her injuries and the potential damage to her baby from the forceps? It is this type of situation I am thinking of: where someone decides to intervene just in case because it'll speed up labour or whatever.

The baby is not more important than the mother.
It is right that HCPs do not work on that basis.

If DH had a choice between me and the baby he would choose me.

I don't think anyone I know thought they could plan a 'magical birth experience'. I think, like me, they just thought about lowering the risks to themselves and the baby and reducing the pain and fear involved if they could - which means very different things to different women.

ninjasquirrel i think you've hit the nail on the head - it means different things to different people. i'll admit, op, that i homed in on the interventions argument, rather your direct question. to answer that, a healthy baby is not the only thing that matters, but it is higher on my priority list than prevention of birth trauma due to certain interventions/failed expectation if it means that we are both safe.

maryz has explained better than me what i was trying to: 20:20 hindsight is a wonderful thing. if all is well with mother and baby, then i haven't heard of induction purely to speed things up.

I think once you have children you end up in a situation where one person's needs (the mother's) are always going to have to be balanced against another person's needs (the child).

And in almost any situation the right answer will not be who is more important but who will come to most harm.

Therefore, I think ds' needs to be whisked out by emergency caesarian trumped mine to have a vaginal birt- because he risked dying and I risked being disappointed, perhaps even traumatised. And dying is worse than being traumatised.

If the situation had been different: say I had risked dying if a certain course of action had not been taken, and he had risked a minor injury e.g. a dislocated shoulder, then my needs should have taken precedence.

In the same way, I accept that the tear from my first labour, which was probably due partly to induction, was a reasonable price to pay to avoid the risk of dd detertiorating in the womb until she might not survive the birth. Because a tear though nasty is not as bad as being dead.

But I wouldn't have been prepared to risk dying to save her from a similar kind of wound.

My conclusion would be that we are both important and that the optimal solution would be the one that causes the smallest sum total of risk to anyone.

Really I think she was just saying it a bit thoughtlessly, a lot of people have a habit of saying things because they think it sounds good without really thinking too deeply about what it actually means. If all that matters is the baby then following from that it wouldn't matter if the mother died so long as the baby was ok. But most people don't say that. And they wouldn't like to get caught up in trying to answer that either, for good reason. Just think of it as a sound bite that most people say as an easy way to devalue your opinion without having to put too much thought into it. And shrug it off as such.

OP, I think you have misunderstood your friend. The trouble is having had a baby you can't possibly go back to that innocent state where you can imagine labour as something you can control/ 'experience'/ enjoy. Nor can you tell someone who has not had a baby just how far their ideas might be from reality. That wouldn't be fair or kind. I find it really difficult talking to pregnant first-timers about labour/ birth. She was probably trying to tell you, gently, that after you have been through it all, you will be glad the baby is healthy and (hopefully) none of the rest of it will matter.

I agree, the OP has misinterpreted her friend's meaning. I'm sure she is also concerned about the safety and health of the mother, but her overall point is that she feels that a hospital is the safest place to go through an inherently risky process.
I wonder how many women in third world countries would turn down world class medical facilities if they were on offer? I have to say that I share the friend's concern about choosing not to take the safest possible path for the sake of "the experience".
I know lots of people don't share that view and that's fine - I'm just pointing out that I think the OP's friend's wording sounds less "off" if you agree with her fundamental point IYSWIM?

I don't think RevoltingPeasant is being unreasonable at all - I think she is being very sensible to think about things before ttc. It will give her chance to make sure that she is as healthy as she can be, which is a good foundation to start with, and then make informed choices about the best place for her, based on her own health and circumstances. I suspect that the OP's friend doesn't realise that Consultant units are not the safest place for a low risk woman to have a baby.

I do wonder how many women in third world countries would be glad of basic health care and skilled attendants, clean water, access to antibiotics for a starter - stuff which we take for granted? These are arguably as important, or more important than 'world class medical facilities' which as far as I can tell, the OP has no intention of turning her back on anyway. (Home birth is not the same as unassisted birth, although a number of people seem to think it is).

I made it perfectly clear to all and sundry that my health and life were to take priority over the baby's. I also had it noted that I wanted DNR for a 29 week baby.

I insisted on an ELCS for both pregnancies, to avoid prolonged labour, foetal distress/hypoxia, forceps, birth damage and PTSD. If midwives were involved in any way in the post-natal care of birth-damaged women months/years into the post-natal period, then they might not be so casual with regard to instrumental births.

As it was, I felt I was treated like a piece of meat during pregnancy. No-one seemed interested in my opinion governing my own body. I did feel like a baby incubator.

Do you remember a recent episode of One Born Every Minute? The episode where a woman had a baby with shoulder dystocia that took an age to deliver, and the baby had to be rescusitated. Afterward, the midwife commented to the doctor whatba rough time mum and baby had, and she hoped the baby's arm hadn't been broken during the delivery. The doctor retorted, "who cares?! Mum and baby survived".

I was horrified. It was exactly the sort of attitude that I had predicted if I'd had a VB with the DSs.

Yeah, who cares if the woman is now doubly incontinent. Who cares if the the baby has a hypoxic brain injury and a broken arm.. Who cares........