Hmmmm.... I'm in a weird position. I get where shag comes from, but I agree that the way she comes across, does seem militant at times, but I don't think its her intention at all.
She's passionate about trying to avoid medically unnecessary interventions which have long term effects on both mother and baby. Thats a good thing, for the most part. The fact she's so strongly in favour of one to one midwife care as a solution to many problems is based on pretty sound logic tbh.
I personally am in the ELCS camp for my own reasons over fear. Something that I would have regardless of how many midwives you'd give me. That puts me in a very different place to her.
But I think that listening to Shag is interesting and she's VERY well read on the subject and has a lot to offer, if you give her the chance even if you disagree with elements of what she says. For the most part she's not as biased as you might think. She's certainly not wrong on the stats on MLU with regard to outcomes. You CAN find evidence that is contradictory, however the place of birth study was by far the largest and most comprehensive of its type and fairs very well in methodology and scope, especially compared to other studies. She'll give you a more balanced response and accurate response with regard to research than many others here will. Not something thats easy to do when you have strong opinions one way or the other on the subject.
Whilst I really disagree with her over the finance debate I think we do share common ground on how fear affects birth from opposite ends of the argument. Its interesting how the two schools of thought divide but share similar principles. If fear effects the hormones you produce and that in turn has effect on your ability to give birth, and indeed feel pain, then I do think it should be looked at a lot more closely and for that reason many of Shag's points here really shouldn't be ignored. The idea we share is, if you are more afraid, you will have a worse experience.
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.
Nope, but there has been research in places like Sweden on fear. They have developed a way of identifying which women have above average level of fear and that is used to try and give more support to women who fair badly. There are common and predictable patterns that have emerged. Whats interesting though is that some of the initial research that fear gives worse birth outcomes, and that this is AFTER counselling. So it suggests that at least some psychological techniques have no benefit whatsoever to some women. If this research holds up and can be explored more, it has great potential to tackle problems from new angles and cater for women's needs on a more individual level. Perhaps this includes looking at other types of counselling or coping strategies for different types of people. Or indeed early recommendation of pain relief where appropriate.
I certainly do not think anyone asking for pain relief should be denied it for that reason. As its not just about how much pain they are in, but I personally think that also reflects the level of fear they are experiencing because of that. And because fear is directly related to hormones in birth then... well yeah... they are all interconnected. I think that rather than severe pain during childbirth being linked to adverse outcomes - like post traumatic stress disorder and depression - I'd question what the cause of the PTSD actually is and whether its pain or fear at the root.
I would guess, that where women have a choice about giving birth in a CLU, MLU or a Homebirth and they pick a particular one, they do so for a reason and a lot of that reason would be related to their fears.
It would be really interesting to see where women who develop trauma symptoms give birth and how it fits with the data we already have.
Many women choose a homebirth because they fear hospital and think they will be more relaxed at home and this will be beneficial to them. Certainly the stats seem to back this up and judging by the anecdotal response to HB, on balance, I think its fair to say they are more relaxed. Which absolutely supports Shag. And therefore, I think its right to encourage MLU or HBs to some women for this reason. It WOULD be beneficial to them and they probably would have a better experience for it than they would in a CLU.
On the other end of the scale, women who are very strong in their choice of CLU perhaps do have more fear of something going wrong and this equally could be playing a part in why CLU faired particularly badly in the birth place study. Its a variable that is largely unexplored but would tie in with the Swedish research on how fear can be an important factor in worse outcomes. I'm not entirely convinced, its entirely down to clinical decisions within a CLU. And perhaps the culture of a CLU which deals with more high risk cases, lends itself even more to creating an environment that actually encourages fear as part of the course.
If you start treating fear as a risk factor, then it starts to make more sense. And if fear is a risk factor, you should start looking at a variety of ways for a variety of different types of women to control that in someway. There certainly isn't a one size fits all policy and I don't think that anyone, including Shag is suggesting that. Indeed, I think that not listening to some of what she says could well be to your detriment. You don't have to agree with her to understand some of the principles she bases what she thinks on.
In that respect, fair from being militant, I think she'll strongly opinionated, based on pretty good logic and research. It doesn't mean she's right on everything, but I also don't think she's got rose-tinted specs on either.