Childbirth- inherently risky or inherently safe? Painful or not?

[WhatTheHellJustHappened]

My friend recently made the fatal mistake of saying in the company of some female colleagues that childbirth was the most painful, horrifying thing she had experienced. An argument ensued and majority of the ladies there believed it was wrong to call childbirth risky or painful. They said they pitied women who looked at such a beautiful and empowering experience in such a negative manner. They said that even sitting on a lawn was risky but sensible people didn't spend time fretting over it. My friend asked me later "When did it become a crime to call childbirth painful or risky? ".
While I personally agree that childbirth can be very empowering and rewarding, I also do agree that it is painful and potentially risky.

What are you views? Do you think childbirth is painful? Do you think it is inherently risky or safe?

No, gourd, for many women it is an extremely painful experience. We are all wired up differently! My labour pain is extreme pain from the cervix dilating. Imagine the worst period pains you've ever had and multiply that by 100. That was my experience. It was the same pain both in my 50 hour labour and my 4 hour labour. Even a whacking great dose of induction drugs and strong (but doomed to uselessness) contractions in my fourth labour yielded no pain at all. Nothing whatever to do with tiredness or ability to shift positions etc...

yup tiredness and also your genetic preprogrammed ability to down regulate pain signals using endorphins and the like....

turns out that if your receptors aren't particularly interested in your own pain relievers they tend to be not that interested in external applied pain relief either...talk about fucked over coming and going...

My advice for a trouble free 'high satisfaction' labour is do not be a red head.

I think childbirth is painful and risky. I don't think it's beautiful, and I can't decide whether it's empowering, but I had EMCS so guess I would never have had the completely natural birth to be proud of anyway.

I never planned to go through labour without pain relief. I take pain killers when I have a headache, I willingly submit myself to the dentist's injections when I get a filling. Taking the pain doesn't in any way make the experience more beautiful or empowering for me and if I can avoid pain then I will.

I've been really angry watching OBEM in the past when women were denied or discouraged from using pain relief during labour. For such a horrible and scary time (which it is, despite the excitement and romance of it all), I would never want a woman to suffer trauma or even trigger PND or PTSD due to a labour or childbirth that was more painful than it could have been if she'd been granted her request.

If a woman wants to go through it without the pain relief then that's her own choice, but I get angry that any woman would try to push those views on another person, particularly not in a pack vs. one as described in the OP. And "pitying" someone for not feeling beautiful and empowered during childbirth is a bit daft. Everyone has their own experience.

Entropygirl - don't get me started on midwives and opioids.

They should be giving evidence based information about pain relief. They don't (well, not all of them).

What you describe is poor practice and lack of individualised care.

Doesn't change the fact that labour pain IS natural in the sense that it's UNIVERSAL and generally not pathological. And anyone who knows anything about female physiology would tell you that actually we ARE designed to give birth, otherwise none of us would get our babies out at all! In saying this I'm not denying that birth is harder for some than for others though, and that's where individualised care is so important.

Re: requesting an epidural and delay in getting it - surely women giving birth in MLU should be just as likely to find the pain of labour unbearable as similar women giving birth in a CLU? Given that we can't predict how we will feel in labour or how it will progress? Women in MLU's are even more likely to experience a delay in getting an epidural. Why then are women who give birth in these units more likely as a group to be happy with their births than women giving birth in a CLU? By your reasoning they should be much less happy - they have to wait much longer for an epidural should labour pain become intolerable.

Spanner girl - there's a growing body of medical evidence, and a mass of anecdote attesting to the value of hypnosis for labour. Don't be put off!

Babylann totally with you - I've felt the same way when I have seen OBEM. I think it is so cruel to treat people like this at one of the most vulnerable points in their life.

Babylann - the conditions women in OBEM often have to endure in labour do definitely make unmediated childbirth seem positively cruel.

The programme is the best possible advert for home birth.

Sorry 'unmedicated' not 'unmediated'.

Women who go to midwife only units know they are not going to get an epidural. They are choosing that kind of birth because that is what they prefer.

Can you not see it from the other side? Women who choose to go to consultant hospitals go there because they know there will be all the trappings of modern medicine including epidurals. That's their choice as well. We're all different.

My labour was not painful, it was quick and easy. I do realise however that that is not the way for the majority of women. I count myself lucky. I'm also aware that if I'm lucky enough to do it again I may not have the same experience.

Bollocks to that, Entropygirl - I am a redhead!!! Arse

Thanks for all the positives, everyone - I am fairly calm, considering my rather pathetic pain threshold, but who knows how I'll deal with it when the time comes. Rest assured, I'll be back on here with a postpartum perspective at some point!

shag I agree with the longer waits idea...but if the pain level you can tolerate is generally genetically determined (plus or minus psychological scarring from previous births) then there is a large selection bias going on here.

I had no choice about being consultant led but even if I had I would certainly have been consultant led as I have had 30 odd years of life to ascertain that I am not at all tolerant of pain. For me the only possibility for not needing pain relief was that labour was not painful for some reason, or that it was so fast there was no time.

So there is the fact that people who fear pain, who are likely to be people who feel it more keenly are likely to choose CLU and are also more likely to have shitty birth experiences.

Pain tolerance is not something that is included in the assessment of health of mother/baby when studying outcomes, but is certainly something that will be used as a criteria by mothers.

spannermary don't worry it is not even the majority of redheads with this problem! It is just more common in red heads than in the general population.

If you already know you have a low pain threshold then there is still hope that it will be a non-painful process for you (does occasionally happen - sod knows why) or that it will be over quickly (small baby helps with that one).

Just know your limits and know your rights! I know that whatever you do was the right thing to do to the best of your knowledge in the heat of the moment!

I wonder if there is one out there...

Entropy girl I don't know about a graph but severe pain during childbirth is linked to adverse outcomes - post traumatic stress disorder and depression.

@shagmundfreud
You keep insisting that women who give birth in MLUs are happier. Where is your proof? On what basis are you making this claim? Are you a midwife? Is that why you are so militantly against epidurals and CLUs?

As Ushy pointed out, most women who go to MLUs prefer unmedicated births and have most likely had smooth deliveries in the past. They know what they're getting into. Women who go to consultant led units want epidurals, elective caesarians, and the security of emergency care to hand. Send them to MLUs and see the level of satisfaction drop.

"Women who go to midwife only units know they are not going to get an epidural. They are choosing that kind of birth because that is what they prefer."

Actually 21% of first time mothers who book a home birth end up tranferring in and having an epidural. As do 23% of first time mums in alongside midwife led units.

They are going IN HOPE of being able to cope without an epidural. I suspect this is also true of the majority of healthy women who choose to labour in a CLU.

"Can you not see it from the other side? Women who choose to go to consultant hospitals go there because they know there will be all the trappings of modern medicine including epidurals. That's their choice as well. We're all different."

Yes - I have acknowledged this to be the case!

But if many if not most women labouring in a CLU would prefer not to have an epidural, and if clinical outcomes for CLU's for low risk mothers are worse (they are), then surely there is an argument for building more birth centres and encouraging (not compelling or coercing, note) women to use them?

"but if the pain level you can tolerate is generally genetically determined (plus or minus psychological scarring from previous births) then there is a large selection bias going on here."

Sorry - I don't understand how the selection bias works here. Most first time mothers who chose to give birth in an MLU have no experience of extreme pain so have no idea of how they'll respond in labour.

'Is that why you are so militantly against epidurals and CLUs?"

AAAAARGHHHHHHHH!!!!!!!!!!!!

I am NOT 'against' epidurals OR CLU's!

OK!

They are very important and make a huge difference to the safety of birth for many women in the UK.

Shag fewer interventions in CLUs but also lower deaths. The evidence is what you'd expect. Set your threshold for doing interventions lower and you do a lot more caesareans but have a slightly smaller number of deaths.

So its a close call - depends how you look at it but since parents are going to live with the consequences, let them choose.

At the moment, lots of women do have the choice of a birth centre but some are closing because they are underused so I can't see the point of buidling more - just have enough for the women who want them.

If they start building more of them you can be guaranteed women WILL be coerced into using them.

Sorry - more interventions in CLUs but also lower deaths.

"But if many if not most women labouring in a CLU would prefer not to have an epidural, and if clinical outcomes for CLU's for low risk mothers are worse (they are), then surely there is an argument for building more birth centres and encouraging (not compelling or coercing, note) women to use them?"

I have a problem with this 'encouraging' thing. Women who haven't given birth before are not really in a position to know what they need/want beforehand (unless they have spent a lot of time on MN ). I know I took every midwife's word as gospel when I was pregnant, thinking 'well they do this all day, they must know what they are talking about'.

Much better to give them all the facts (ie a REALISTIC picture of how things might work out) so that they can make a choice without being 'encouraged' one way or the other.

Oh and I also have a problem with the terms 'low risk' and 'healthy' - NOBODY knows how things will work out in the actual birth until it happens.

Re evidence - I can't c+p from it because it's an adobe document, but the info comes from the MIDIRS 'Place of Birth' professionals booklet, which is fully referenced.

"As Ushy pointed out, most women who go to MLUs prefer unmedicated births and have most likely had smooth deliveries in the past.@

Not in the case of first time mums.

"Women who go to consultant led units want epidurals, elective caesarians, and the security of emergency care to hand."

You are simply wrong. Many women want to go to MLU's. Most will end up in a CLU because that's where the beds and the staff are.

My local unit handles about 500 births a month. They only ever have two midwives on in the birth centre. Most women end up in the CLU by default. And at least in my local hospital, most women in the CLU don't request an epidural.

In my experience many healthy women who choose a CLU do so in the belief that they will be safer there. (because there are doctors present)

They need to know that there is no evidence to suggest that they or their babies will be safer there. And actually quite a lot of evidence to suggest that they are more likely to come home with a significant wound.

I did NCT, had a straightforward birth in a pool for DD with no pain relief. It was the most painful experieince of my life.

I did hypnobirthing in a pool at home for DS with gas and air (what an amazing invention!). Again, 2 &1/2 days of complete agony.

It made my blood boil when people say I had an 'easy' birth because I just can't believe there's any such thing, it is one of the most dangerous things our bodies have to go through. I was incredibly lucky to have no complications and two beautiful children. I still say childbirth must be on a par with having a limb slowly sawn off. I was just fortunate to have wonderful home birth midwives the second time round. I think this makes all the difference, my baby's head was stuck sideways for quite a while (no idea what medical term is) but she got me through it with a birthing ball just because she was wonderfully calm and supportive and very experienced. (obviously I was lucky the baby moved before it was critical or I would've been taken to hospital).

Hypnobirthing and pools are liberating and relaxing and it annoys me when users are labelled as hippy freaks. That stigma did almost put me off using them and many of my friends thought I was mad but I'm glad I did as it was right for me personally.

Obviously everybody is going to have a different experience and, apart from obvious medical complications, I think the main depending factor on getting through without trauma is the kind of support you get.

"Much better to give them all the facts (ie a REALISTIC picture of how things might work out) so that they can make a choice without being 'encouraged' one way or the other."

I so agree with you. Tell women - "if you go to a CLU you are less likely to get one to one care, and about twice as likely to have an emergency c/s or a forceps delivery. You are no more likely to come home with a well baby than if you go to an MLU."

That would have been fairly persuasive for me had I had a chance of going to a birth centre myself (I didn't - my hospital didn't have one until a 5 years ago). Especially knowing that I could still be transferred for an epidural if I couldn't manage without one.

"Shag fewer interventions in CLUs but also lower deaths"

Sorry - can we have a reference for this? NHS Choices reporting of the Place of Birth study didn't find statistically significant higher rates of neonatal deaths for homebirth, FMU or AMU for second time mums, or for FMU or AMU's for first time mums.

Or are you referring to the higher rates of poor outcomes for first time mums giving birth at home?

"If they start building more of them you can be guaranteed women WILL be coerced into using them."

What - like women are currently coerced into going into CLU's by lack of alternative provision?