'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?

Thought this post is a really useful reminder of why a healthy baby isn't the only thing that matters
talkbirth.me/2012/02/10/all-that-matters-is-a-healthy-husband-or-why-giving-birth-matters/

Thanks Squiggley for that

Highlander - 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.

Are you for real? That is horrible! What kind of mother puts her health and life before her baby's? And DNR for a 29 week baby? You seem almost proud of your awful attitude, your poor baby. Shame on you.

Toomanycakes - it was a very personal decision, made after consultation with the consultant regarding 'worst case scenarios'. I also spoke to a good friend who is a consultant paediatrician. The last thing I wanted was to push for rescusitation of a baby who would undergo painful procedures to achieve a poor quality of life.

The obstetrician says that part of her job is (not very often thankfully) sometimes to choose whose life gets priority in an emergency. Ninwanted to be part of that decision making process before the emergency arose; by then I might not be competent to make a decision, or indeed there may not be time for a discussion.

It's obviously not easy for some of us to be eloquent in internet discussions.

I don't think having a DNR for a very premature baby is an awful attitude at all, just means the parents have considered all the possibilities.

My DS was born at 27 weeks and wasn't expected to survive due to long pprom (from 22w). My husband and I were 100% sure that we didn't want him kept alive at any costs. I would have rather have had him die on my chest at an hour old than die in an incubator after weeks of procedures or to live an awful life. As it happened he exceeded expectations and, although he did need a lot of support in nicu, he was never ventilated. While that isn't a DNR as such we made it perfectly clear were didn't want him aggressively treated and would make the same decision again and I am pregnant again so might well have to. I don't believe in life at any cost and having seen what premature babies can go though and what quality of life they can have at the end of it i feel i have enough experience to make that decision myself. I never thought for a minute that i, or anyone else making that decision ought to feel "shame" what a ridiculous and ignorant thing to suggest

I also know that if my DH had to choose between me and our unborn child he would choose me. We have an older DD so that would be the right decision.

I always think on these kind of posts that anyone arguing that anything apart from a healthy baby is even remotely important has obviously never had a sick baby.

As I said, I'm expecting again and this pg will no doubt be highly medicialised.. I genuinely don't care what happens to me or how this baby gets out - they can pull it out of my right nostril if they want as long as it's not before 36 weeks.

The birth and all that Jazz is not important in the grand scheme of things. Of course it would be nice to have the birth you want but it isn't important. At all.

This phrase really grates on me. I think because it's used to manipulate women into compliance with hospital practice by implying that dissent indicates a lack of concern for their child's welfare and even life.

It does this because in the majority of cases there is no actual conflict between the mother's needs and those of her baby. The needs of the labouring woman are important because the safest birth is usually where she, and not the HCP's, does most of the work.

Of course sometimes interventions are necessary. And, yes, these may carry short term or even longterm implications for the mother's physical health. But compared with the grief of losing a baby or having a disabled child whose disability could have been prevented, we go with the intervention. Hence the phrase.

BUT in these cases the wellbeing of the mother has also been served by the intervention. So there really is no conflict.

I am writing this from an Irish perspective where "routine intervention" is extremely high. Overcrowding and lack of privacy are chronic. Homebirth is almost unheard of, and my local maternity hospital which caters for 9,000+ births a year has only one birthpool. Pressure on beds and increasing staff shortages make managed labour more attractive to hospital management, but it is, of course, sold to women as "being careful" as after all, "the only thing that......"

Obviously, it matters if women are given a terrible time during their birth, that should be avoided - but where do you draw the line?

Take for example this case - where a baby ended up dead because the mother decided to go ahead with a footling homebirth, and who says she'd do it all again, even if she knew the outcome, because she finally had the labour she wanted? I'm usually fiercely pro-choice, but the sacrifice of a baby's life for an idealised experience, makes me shiver.

Did that case really happen? I wouldn't put it past Amy Tuteur to have made it up. She is vehemently anti-home birth, for reasons best known to herself and will ignore rigourous surveys which show that homebirth is safe for the baby and the mother in the majority of cases.

LaVolcan - she links to the original post jeubfamily.com/2012/02/23/home-birth/ scroll down into the comment section.

Ok, it turns out, she'd do it all again, not because of she found the experience so great, but because she thought it was the will of the Lord. Still it's a story of mother's choice resulting in needless death of a healthy full term baby.

The reasons why Tuteur is against homebirth are not only known to herself, but explained over and over again in her blog. I don't agree with everything she says (especially her stance on circumcision), but her arguments against homebirths which are poorly supervised by badly trained midwives (which are not comparable to the midwifery care in the UK) are in my view not badly argued.

Anyway, this is not a homebirth thread. I just linked to the posting as an extreme example of mother's choice over baby's health, which I find difficult to agree with.

I echo LaVolcan's opinion. Her blog isn't exactly what I would call "unbiased". Im fact the words I'd use are "misleading and scaremongering".

I've come across it on more than one occasion, and its a shame shes so unconcerned about the accuracy and tone of her blog and only seeks to post things that support her opinion rather than looking at their validity and strength at the same time. It makes her arguments and case studies weaker and less than believable when she might actually have valid points.

In short she's one of 'those' nutjobs...

I guess I should have linked to the story where it was first posted, rather than Amy Tuteur's posting on it - sorry about that.

Ok, it turns out, she'd do it all again, not because of she found the experience so great, but because she thought it was the will of the Lord. Still it's a story of mother's choice resulting in needless death of a healthy full term baby.

That was an extreme example . We don't really know whether it was the woman's choice of place of birth or the quality of her attendants or a rubbish hospital which resulted in the death of the child.

We could surmise that the same woman giving birth to a baby with a congenital defect would say that it was the Lord's will and for her, the only thing that matters would be to obey the Lord's will and if He gave her a baby who wasn't healthy then so be it.

I tend to agree with lovetomatoes that the statement 'the only thing which matters is a healthy baby' is used as something of an excuse when overcrowding, staff shortages, rigid application of protocols etc. lead to a birth which goes OK but not as well as it could or should have done.

"We don't really know whether it was the woman's choice of place of birth or the quality of her attendants or a rubbish hospital which resulted in the death of the child."

She had a footling breech at home. Instead of transferring immediately she continued to labour at home for another 3 hours until there was a cord prolapse. You really can't blame that one on the hospital no matter how hard you try.

I think most women would not so callously disregard their babies needs in such an emergency, so she is extreme in my opinion. But I thought it's a good example to bring up when it is argued that the woman's experience matters more than the child's right to life (and an undamaged brain).

I agree with you LaVolcan. I think the trouble is that too many women don't question and have blind faith in HCP. Its not a healthy situation to assume that doctors always know right and not to ask, why was this decision made or why is this policy different from that hospital or why are there such different rates of intervention for different places.

We have a situation with a number of different aspects of maternity care where policy differs so differently from hospital to hospital (for example listing a couple that have been discussed on here in the last few days - wound drains, induction, ELCS on request) that the statement that the "only thing that matters is a healthy baby" really needs to be challenged and ripped apart and shown for what it really is about.

I honestly think there is far too much emotional blackmail, withholding of information, misrepresentation of risk, and coercion going on to simply ignore that there is an issue here and that the phrase is a cover for a lack of funding and lack of political will in improving maternity care.

"I honestly think there is far too much emotional blackmail, withholding of information, misrepresentation of risk"

I think that one is true for both sides. I deeply regret having read too much about the dreaded cascade of intervention and therefore foregoing pain relief for way too long at the birth of my first child.

....there is an issue here and that the phrase is a cover for a lack of funding and lack of political will in improving maternity care.

I so agree and this is what we should be concentrating on. The health of both the mother and the baby matter and our present system is letting both down too often.

I always think on these kind of posts that anyone arguing that anything apart from a healthy baby is even remotely important has obviously never had a sick baby

I agree. Also, when people argue that it is wrong to have DNR for ex-prem babies or "micropreemies", they haven't seen how ill and how much suffering some of these children endure.

I don't know what I would do if I were to have my baby now (26 weeks) but my initial instincts are that I would be cautious about aggressive treatment when it seemed to be failing, as awful as that would be. I can't say for sure because I haven't been there, and perhaps in the moment I would do anything to have my baby live.. it is impossible to judge anyone's decision when faced with that choice, it is not as straightforward as people might imagine.

I also agree maternity care needs to improve but I do feel there is slight paranoia about why women have some interventions. Yes, the NHS is a conveyor belt and there are things that are not ideal. I wish my first birth had been less medical and it did have repercussions for me physically and mentally for months after the birth. However, in the end of the day, I would be very careful about going against hospital protocols personally unless I felt they were really not at all in my or my child's interests. Induction can be unpleasant and painful and hospitals in general are not very conducive to natural labour in many respects, but if I come home reasonably healthy and my baby is healthy and well I will be happy to endure whatever it takes really. It has taken me a long time to come to thinking like this, I felt very differently a few months ago.. but I really, truly just want a healthy baby and a healthy me and to get on with the rest of my life post-birth.

"but I do feel there is slight paranoia about why women have some interventions. Yes, the NHS is a conveyor belt and there are things that are not ideal"

Where is the paranoia when in some hospitals ONE in THREE women is ending up with a surgical birth? And another 10% ending up with ventouse and forceps?

I think 'not ideal' is incredibly euphemistic.

It's a terrible situation, and for some women has serious repercussions (look at poor Amanda Holden).

What is terrible is when babies and mothers die, or have life-long consequences from birth (either mother or child). However, I don't think that surgical births and/or ventouse/forceps deliveries in and of themselves are a major travesty. I say this having had a very difficult birth myself with a significant forceps injury and a lot of aftercare required. I don't quite feel that all's well that ends well but the NHS is in dire, dire straits and yet no one wants to pay anything into it above and beyond their tax contribution. I thin this board goes on a lot about cascades of intervention that frighten the crap out of people when, actually, an amazing birth isn't that important to everyone. I would do my forceps birth again, and/or have surgical intervention, if I knew we would both go home reasonably well, particularly the baby.

"However, I don't think that surgical births and/or ventouse/forceps deliveries in and of themselves are a major travesty."

So you don't think it matters than hundreds of thousands of women are having AVOIDABLE major surgery?

"I thin this board goes on a lot about cascades of intervention that frighten the crap out of people when, actually, an amazing birth isn't that important to everyone."

You don't have to have an intervention free birth to have a happy and wonderful experience. That's not the point. It's about quality of care.

If poor or inappropriate care is leading to large numbers of women having surgery they could have avoided with a different pattern of care, then that's not acceptable.

No, I'm saying I don't care personally about my birth experience as long as we both emege alive and without permanent disability. I think people are unreasonable in expecting highly personalised amazing births for a pittance and frankly there should be adequand safe care which is what.the overwhelming majority of women get.

Actually many many women DON'T get one to one care throughout labour - which is what is usually needed for a safe and happy birth.

I don't think it's unreasonable to expect health professionals to care for you in such a way as to optimise your chance of having a safe birth - and that includes YOUR safety as well as your baby's.

I think it is unreasonable to expect HCPs to provide one to one care where there isn't adequate funding for staffing ratios to allow this to happen, yes, I do. The NHS tries to minimise broad general risks and probabilities, and right now, that will probably lead to more medicalised births for many. Most will have perfectly functional births with reasonable outcomes in this climate. Some will not. That is tragic for those women, but the reality is that the vast majority of people do not want to pay more money into the healthcare system than they already contribute through taxation.

To read this board it sometimes seems as though there is this notion that cost-saving is a dirty concept, but actually, the NHS is in a grave financial situation and it is a necessity with population changes and increased health demands. There are a lot of women having babies. Many many more of them have gestational diabetes and other complications than before. There are increasingly women who are obese giving birth. Demand is outstripping capacity. These issues reduce care for straightforward birth and probably some women end up having instrumental or surgical deliveries where it could have been otherwise avoided. However, to expect that things can be radically different right now seems terribly, terribly naive. There are constant calls for services to improve yet little will to provide additional funding to do so, and the government seems to enjoy perpetuating the myth that if you reduce the workforce and management costs etc everything will run more smoothly, with better care at less cost. Anyone working in the NHS knows that actually, while there may be elements of truth to this and inefficiencies, what will happen will be a reduction in the aspects of care that are most needed and a sidelining of services that are about the "best care for all" vs "good enough for most".

I just find it tiresome that so many posts on this board create the impression that the entire health service is Out To Get Women. I certainly believe that there are women who have had unacceptable experiences, but I don't believe that continuous fetal monitoring or induction at 42 weeks or early induction for GD are just misogynistic tortures designed to Keep Women Down, as it would sometimes appear on this board. I see post after post where women are advised not to trust health care professionals, refuse induction, refuse VE's, told that advice they have been given is inaccurate despite there being limited information on which to base that judgement etc. I think it actually creates a climate of fear, especially for first-timers.

I didn't enjoy my first birth. It had repercussions for months after the birth. However, the care I received was adequate if not optimal and neither I nor my child were permanently disabled, nor did we die. I can't get worked up about it, even if I wish it were different - it was good enough in terms of outcome. It was acceptable but not ideal. I hope that I get similar this time and I think it's important to be educated about birth to self-advocate. However, if people want one to one care and highly individualised, personalised delivery guaranteed no matter how many women give birth in their area on the night they deliver, they are best placed to consider paying for this additional service if they have funds available to do so. I understand Doula UK provide support for women who don't have much money.

Sorry but you are making excuses.

You DO realise there IS the money.

But the dickheads don't know how to spend it properly. You DO realise how much money is going on compensation due to poor care. So if money had been spent in the first place it would not only have saved the people who claim, but also all the others who don't because of the emotional crap of "the only thing that matters is a healthy baby".

It is in NO WAY acceptable for so many women to be reporting PTSD following birth or in need of counselling because of the poor care they were given. Diagnosed cases of secondary tokophobia have rocketed. Not just because of more awareness of the condition but also because so many more women are having births that are highly medicalised. Part of that is due to a change is demographics and overall health of women, but a hell of a lot of it isn't.

The issue of properly informed consent is being blatantly being ignored. Which is a key part of the problem and has nothing to do with cost at all. It costs nothing to present choices and risk properly rather than tell a woman what will happen to her (for example induction).

This is on a par with the ill treatment of elderly patients on the NHS. Its about dignity and respect, but throw a baby into the mix and you have the perfect excuse to justify UNACCEPTABLE practises and behaviour.

The climate of fear is justified. Why? Precisely because of the amount of successful claims, the closure of some wards and damning reports of incompetence which are all too frequent. Not to mention reports about how single women without a birth partner or non-english speakers are particularly at risk of a more medicalised birth and a negative outcomes purely on the basis of the fact that they don't have an advocate to speak for them during childbirth.

There are some things you need to spend money on, as they have knock on effects for downstream costs of healthcare. Maternity care is one of these. It doesn't take a genius to work this out, but there are plenty of people putting obstacles in left right and centre to do this.

You have to be a fucking idiot to think that high induction rates which result in more medicalised births, just to suit hospital policy are a good idea. You are ignoring the costs of the surgery, the costs of any repair surgery, the costs of mental health care etc etc. If there is a risk to the baby then yes, but as the other thread clearly demonstrates its got very little to do with risk and is about connivence for the hospitals. Its a total false economy.

Stop making excuses and wake up.

If you really want me to quote figures for how much it would cost for base cost for ELCS per percentage rise (that neglects downstream costs) which everyone was getting upset about a few months ago when the new NICE guidelines were published and then compare them with the overall over cost of claims against maternity, I'll pull them out. (They are more likely and cost more with a botched VB than a EMCS or a ELCS btw).

So yeah whilst everyone's getting lathered up about the cost of ELCS on demand, which are a drop in the ocean they are ignoring why women are opting for them in the first place and the scandalous cost of maternity negligence.

Can anyone else see the problem with this picture?