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?

"You said you had two home births. You are aware that they have a threefold risk of neonatal mortality right? But you still chose them because of your individual priorities."

No, they really don't. That's the kind of statistic that Dr. Amy Tuteur bandies about, and while it may be a relevant statistic in the US, there is no evidence whatsoever that home birth in the UK carries that sort of increased risk.

LaVolcan. I'd like to know where that figure comes from too. I've always read on MN that it's safer to have a baby at home.

DS2 was born at home. He was 10lb 5oz and it was fine. It was a 12 hour labour probably due to his size. MW said that I I had been in hospital I would have probably ended up being induced as it was my 2nd and shouldn't take so long.

DC3 will be born at home to all being well.

Ushy - epidurals are associated with higher rates of forceps. Forceps are a severe aggravating factor with s/d, increasing the risk if severe injury to the baby. Google forceps and shoulder dystocia.

Supine births increase the likelihood of s/d because they reduce the space available for the baby to rotate and descend. It's basic physiology innit!

Ushy - I think it's very poor that you choose to put your faith in randOm articles you have found on the Internet rather than NHS Choices and the BMJ. It is also the case that the main findings of this study replicate earlier large scale studies which have formed the basis of NHS advice on place of birth for the past decade. The only new information is the increased risk of a poor outcome for first time mums giving birth at home. The reason why previous studies have failed to identify this is because poor outcomes overall are rare, and because previous studies have not looked at low risk primips as a separate group.

Shag the reference I gave was for the actual study - the only thing I could not find was the article about it.

It's the same study that found homebirth riskier but ONLY for first time mums.
www.bbc.co.uk/news/health-15861280

Shag "Ushy - epidurals are associated with higher rates of forceps. Forceps are a severe aggravating factor with s/d, increasing the risk if severe injury to the baby. Google forceps and shoulder dystocia. "

Why don't you write and tell the Royal College Obstetircians that they have got it wrong then? They do not say that shoulder dystocia is caused by epidurals.

Large babies cause a lot of pain and more women request epidurals but it is the large baby not the epidural that causes shoulder dystocia.

Yes it is inherently risky. But I personally believe we have been conditioned to believe it is more dangerous than it is and there is evidence to suggest that fear complicates and slows down birthing. So films, tv shows etc that only ever show terrible births are causing a real issue in actual births by creating a fear of the birth experience.

Lots of women have unmedicated, uncomplicated deliveries. We don't hear enough about that and the 'NCT brigade' ate just trying to redress the balance.

Jnice that's a good point but how do you know that the terrible births on OBEM are actually caused by conditioning - it could also be that women are having babies at an older age and babies are getting bigger.

There are also women saying we are conditioned to believe that we should have to give birth naturally and it is bloody agony

Perhaps let people draw their own conclusions - some wanting 'unmedicated' birth and some wanting caesareans and epidurals.

People should be left to do what ever they want.

what the hell the large study of 60000 women published year found no statistically significant variance in stillbirth dependent on location, even for for first time mothers.

good news for everyone - that outcome was so rare in all groups that no conclusion could be drawn.

Childbirth was not at all painful for me.

Nor was i scared about it, and nor did i think it was risky, as for the whole history of time people have given birth.

However, i realise for some (most?) people it is painful, and i would never dispute that people feel pain. (Im certain they do.... i seem to be the odd one out there!!!)

But im also convinced that the reason it wasnt that painful was because if my state of mind (I didnt expect pain) and because of my natal hypnotherapy...

I do realise that other people in "the same" mindset have painful horrendous births though.

I would consider referring to childbirth as painful to be normal though.... I think i was the odd one having a wonderful pain free home birth

(the following week and breast feeding etc etc most certainly was painful though!!!)

"The reason why previous studies have failed to identify this is because poor outcomes overall are rare, and because previous studies have not looked at low risk primips as a separate group"

actually shag i think -

1. previous studies only looked at stillbirth (no change on that: there is no alteration in risk dependent on location)
2. previous studies did not post-control for the same factors (the National birthday trust, eg, did isolate-out primips - but tried to benchmark like with like, still had a slight variance (HB group slightly older, wealthier, better educated than 'matched' CLU mothers) which was not post-controlled out. 3)that specific set of 'adverse outcomes' had not been examined in that way before. Some of these were ones without lasting ill-effects for the baby, though undeniably serious.

this actually makes for my major criticism of the Birthplace study: how do they know they have chosen their control variables correctly? Have they controlled for everything they should? hard to know when here are no similar benchmarking studies.

otherwise it's a bloody good study.

Every single literary and oral culture afaik holds the belief that childbirth hurts like fuck; and quite a lot of women over the years have died in childbirth.

So yes, I'd say both painful and risky. Deffo.

(And yes, I've had a home birth.)

One thing that really stands out for me (having just read the whole thread) is that we don't do a good job of hearing individual women's experiences, and we have a marked tendency to view others' experiences in the light of our own. It seems to me that this is flawed when dealing with childbirth - it isn't right to say 'of course childbirth bloody hurts and anyone who says otherwise is lying', just as it isn't right to say 'I don't know what all the fuss is about, it's a natural process and your body is designed to do it.' The reality is that there is a spectrum of experience/outcomes, and each woman will end up somewhere on it. There are many factors influencing how a woman feels, how birth progresses and how she views the experience afterwards: these are medical, physiological, cultural, social... too complex to entirely break down I think.

I speak as someone who has had three births that I would describe as painless. Paracetamol, TENS, pool. No G and A, pethidine or anything. First one, 6 hours, home water birth, stood up after delivery and said to midwife 'if that's what it's like I can definitely manage another one'. Second one similar. Third time I said to SIL, who remarked it didn't seem too arduous (had baby at home while she was and brother were out to dinner) 'running a marathon would be ten times worse for me'. Now I can believe I'm unusual (and lucky, to be far down towards the pain-free end of the spectrum) - but I'm not lying.

I don't assume that my experience invalidates those of others. So I believe passionately that people in pain should get pain relief, people in need of medical assistance should get it and that women should be properly cared for during pregnancy and birth. But it doesn't do anyone any favours to talk in absolute terms when such a range of experience exists. Just remember to put the 'for me' on the end on those sentences. Childbirth was not painful, for me.

Did you not read the OP, shagmund? She says that the people her friend spoke to criticized her for describing childbirth as painful. That's who I'm referring to in my statement that something that is natural is not necessarily pain-free. Did you not read the OP or something? Or are you assuming I'm referring to you for some reason? If so, lighten up and don't be so oversensitive.

SuseB, completely agree with you and very eloquently expressed, too!

PS I actually came back onto this thread to recommend Dr Amy Tuteur's blog: fantastic stuff!
Skeptical OB

I love that she is so forthright in refuting some of the utterly misinformed garbage that is out there. She reminds me of the obstetrician that I saw privately when I lived in the UK because I didn't trust the midwife-led care system that is imposed on everyone there: very professional, articulate and deeply passionate about the welfare of women and children in birth.

I did NCT, I swallowed the whole hypnobirthing jasmine scented whale music home birthguff in it entirety. I had such powerful PMA about the whole experience that it was going to be empowering I would breathe my baby out. Boy oh boy wasn't I surprised when I ended up being induced 16 days overdue, 36 excruciating hours later, 3 forceps attempts, one EMCS, a blood transfusion and a 9.5lb baby daughter later I was also surprised to find I had PND, PTSD and birth trauma.

I have a narrow birth canal, unfortunately I also do large babies. My DH was so scared he went out and bought a steriliser, bottles and formula because he honestly thought he would have been bringing up a baby on his own. The surgeon said to my husband that 50 years ago he would have lost us both.

It wasn't empowering, it was earth shattering and changed me forever.

I went on to have a ELCS with a 13lb baby almost 3 months ago. That was empowering, I was in control going through the experience again in a planned manner helped me heal a lot of hurts from before. It was also painful and recovery was terrible.

I think the NCT have a lot to answer for. Yes women need to be supported and encouraged to have birth choices. But they also need to be told the facts not the fairy tale.

Shag and Bue you asked about about the higher stillbirth rates in midwife units - it was explored and below is the link.

again, no evidence of this in the UK - Birthplace study. in fact no increase in 'adverse outcomes' either.

a MLU, attached or freestanding, is, by this large and reputable study - the safest place to have your first baby for the baby, and for yourself. (there were significant benefits to babies in terms of lower-end variables, less likelihood of neo-natal admission etc..)

for low-risk women, midwife-led care is better.

to be fair, over 50% of women birthing in a CLU only see midwives whilst in labour ..which isn't surprising given that fewer than 8% of CLUs have consultants on ward cover for more than 60 hours pw. Only there if called otherwise...

i digress.

@NapaCab
I think you've referred the wrong person to the blog ;) shagmundfreud is in all likelihood a midwife herself and I can hardly see her being receptive to what a forthright obstetrician like Dr Tuteur has to say. She's busy trying to convince us that we aren't safe unless we deliver at home or with midwives. I'd say most people I know have the opposite view, but whatever.

Does anyone else ever feel that, if the medical professionals can't agree between themselves what the best thing is for women and their babies wrt pain relief, MLUs, CLUs, CSs etc, then how the hell are first-time mothers supposed to know? You are offered choices based on a guess about how you will feel/what you will need. And actually, on the day a lot of those choices can suddenly evaporate anyway.

actually the RCM, RCOG and NCT all pull in the same direction pretty much.

individual practitioners may beg to differ of course.

This is where I got my statistic from LaVolcan
linkinghub.elsevier.com/retrieve/pii/S000293781000671X?via=sd

onlinelibrary.wiley.com/doi/10.1046/j.1523-536X.2003.00218.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=

Almost every study I've read indicates higher mortality rates for home births.

Nevertheless, irrespective of the overall mortality rates, some people hold the view that home births can be risky and lead to a loss of precious time in case of emergency hospital transfers.

Recently, the biggest home birth advocate in Australia died herself while giving birth at home. It was a terrible story. :(

Of course people are free to choose this option if they like, but it isn't helpful to pretend that it's a risk free option.

@Edless

What direction would that be?

OMG, havent bothered reading this thread other than the opening post but I have to say that having been through labour twice, once resulting in a vaginal birth and the other a emergency section that

YES CHILDBIRTH HURTS
YES IT IS RISKY

Of course it hurts, even at the NCT classes that I attended the group teacher admitted as much. I personally dont know anyone who has been through labour and doesnt think it hurts.

And yes there is a risk involved. If I hadnt had the emergency section my baby would very likely have died.

I would have loved a natural birth, preferably a water birth but alas not to be. There is always next time ...... :)

fishandlilacs same here. Did and learned all the "right things" - perineal massage, hypobirthing preparation, etc. and was very relaxed and prepared, yet still had a very long labour and various unexpected complications.

While I think this thread has gone way O/T on the debate over MLUs vs CLUs etc - shag et al, you may be interested/saddened to hear that at my local hospital (where I will be popping DC2 out at some point in the next 3 months) they can't raise the midwife staffing levels sufficiently to always open the MLU, which was brand new about 2.5 years ago.

So, I will be having a doula, if only to ensure I have someone vaguely experienced with me throughout.