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?

fishandlilacs you had a very complicated and traumatic birth but you (and others who had similar experiences) write as if it was the NCT's fault somehow. You feel let down and probably/possibly want to place blame somewhere which is totally understandable but is it really the fault of the NCT or your hypnobirthing teacher/book/cd? My NCT and hypnobirthing instructors never denied that complications could happen, and did nothing to suggest that they could be prevented by breathing and relaxing.

Edlessallenpoe" Free standing midwife units do have higher stillbirth see page 77. Go to the back of the Birthplace study and find figure 8, 9 and 10 around page 179 www.netscc.ac.uk/hsdr/files/project/SDO_FR4_08-1604-140_V03.pdf

The trend for first time mums to have a bad outcome is higher for midwifery units .... but not much higher. For second time mums, alongside units have slightly higher risks as well.

So midwife units ARE low risk but not quite as low risk as consultant units.
It's what you'd expect and anyone with any common sense would guess.

Fishandlilacs exactly my feelings. I ended up being induced with both my sons and due to unexpected complications had emergency section just 4 weeks ago. It still bloody hurts now and I was in shock for the first week as it was so unexpected and I just hadnt prepared myself for the possibility that I would ever need a caesarean. Especially since my first son was born naturally. NCT dont even touch on caesarean births and make it out like women are failures for not having a natural birth.

In my experiance the NCT were not supportive of caesarean sections at all.

naturalbabyNo i am not blaming the NCT in general-they do a lot of good work. I think it very much depends on your specific NCT teacher. Mine was a lentil weaver by any other name (I say that lightly because i'm a bit woo too) and in hindsight she was actually pretty irresponsible in some of her opinions. She nicknamed our group her "intervention class" because none of us achieved the births we wanted in the end. But they didn't support c section at all-even though we had a set of twins and a breach who knew they were going to be having c sections. She came to visit me afterwards and said "oh you were too posh to push" I was devastated.

The Wax study has been discredited. The second study WhattheHell references is about Washington State. No conclusions about the safety of homebirth in the UK can be drawn from American studies. They have an entirely different maternity care system, often with homebirth midwives who have much less training than our own, as well as no OB backup and a less than ideal emergency transport system. It's not the same thing at all.

fishandlilacs how rude! it's just I'm hoping to work with the NCT soon and had 'pain free' briths so have no idea how women who have had your experience would have been better prepared or supported. I spent a lot of time wondering why some of the other mothers had such a hard time and I didn't, a few of them did hypnobirthing too but had complications that needed medical intervention.

I watched a hypnotherapy demonstration on t.v where a dentist performed a procedure that would normally require local anaesthetic, but the patient used hypnotherapy instead and at the end of the procedure said he felt no pain. The most common issue doesn't seem to be whether childbirth is painful or not, but how that pain is managed.

fishandlilacs "She came to visit me afterwards and said "oh you were too posh to push" I was devastated."

What an insensitive dope In fact, in the insensitivity stakes, I reckon that scores 10 out 10.

What did you say to her? (Or is it unrepeatable )

Whathe - if there was clear evidence that it was more risky for healthy mothers and babies to birth at home then it would be very irresponsible for the NHS, the RCOG and the RCM to recommend it as a safe option. You seem to think these organisations are either lying to women or are not in receipt of crucial evidence which you've managed to obtain by spending ten minutes googling.

Have to say - it doesn't seem likely.

As for the poor mother who died at her homebirth - she had a heart defect. She was not low risk. And the majority of really serious morbidity and mortality in the uk is linked to emergency surgery.

Major surgery has risks - serious risks. Of the 10s of 1000's of emergency c/s that are done a small number will end in a severe bleed, a thromboembolism, a an unplanned hysterectomy.

Hospital birth puts healthy women at double the risk of needing surgery. That fact remains.

Shag Whatthe is right. It was all over the news last year and there was mumsnet thread on it.
www.mumsnet.com/Talk/childbirth/a1350672-Birthplace-study-Homebirth-more-risky-for-first-timers

Shag the risk is only for first time mums having homebirth (about three times the increase in bad outcomes) - subsequent births were safe.

Should add - I have no issue with women making an informed choice to have a hospital birth.

We all have our own comfort zones when it comes to risk.

I had three gas and air births (and not much of that in the middle one) but I would tell my daughters to have epidurals.

I read that whole article straight from BMJ

not a newspapers interpretation of it...... and what that study actually concluded, was that it is maginaly safer to be in a MLU than at home.....
and that being in a hospital was far more dangerou!!!

and also that is just 1 study.... there have been many many many studies done (i researched a LOT before i chose a home-birth) and it is less risky to give birth at home (even for a 1st timer) than in hospital....

you and baby are more likely to be alive, less likely to get infections, and more likely to breastfeed successfuly, so more health benefits for baby.

Home birth is NOT nearly as dangerous as most people assume, and the way that study was reported is simply not accurate.... dont read the daily mail... read it direct from BMJ

For a start you have 2 midives (highly experianced, not who passed their exams last week) devoted 100% to you.... not 1 shared between you and the lady next door.

I have acknowledged further back in this thread that first time mothers appear to have worse outcomes for homebirth.

It is interesting that the outcomes for 1st births are just as good for freestanding MLU's are as good as CLU's, despite the fact that no additional obstetric input is available than is available at home. Suggests to me the problem is a lack of expertise among some homebirth midwives. Hardly surprising when some may only do half a dozen homebirths a year. We have a dedicated caseloading homebirth team in my area. The midwives ONLY do homebirths so are much more experienced and have really good relationships of trust with the women they care for. I really wish someone would look specifically at outcomes for caseloading practices - I bet they are better than non-caseloading practices.

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

I am not at all surprised that that is where you got them from. That study was roundly criticised for having unsound methodology and cherry picking data. Some rigorous research was excluded, while some very small studies were included. Not only that, there was no attempt to compare like with like - data from different countries with different systems of maternity care were all lumped together. See e.g. www.straightstatistics.org/article/home-births-unjustly-maligned for one critique.

I would much prefer to rely on the Birthplace study. It was rigorous, with a large sample population, and concluded that homebirth/MLUs were safe. It did highlight a slight increase in adverse outcomes for the baby at a homebirth in first time mothers, but as far as I remember (it's some months since I read the survey) said that it was an area which needed further research. As far as I am aware, no UK survey has been able to show that CLUs are a safer option for low risk women, but I am willing to stand corrected. The Birthplace survey did highlight that there was a greater risk to the mother in a CLU without offering greater safety for the baby.

The majority of women give birth in a CLU, (whether it's by choice or whether it's just the default option, because there is no real choice locally) and there are real differences in the quality of care between them. We had audits for children's heart services and those offered in Bristol were found to be substandard. In my opinion, we sorely need the same audit for CLUs.

To try to go back to the OPs original post, some women don't find birth painful, many do. Some people sail through birth, others need help. What we need to acknowledge is that one size doesn't fit all, and find a way to match the appropriate care to each woman.

nannyl but it says it in the BMJ

"For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes."

www.bmj.com/content/343/bmj.d7400

@shagmundfreud
Where did I say these organisations were lying? But unfortunately, I don't see it plastered over the RCOG or the NICE website that home births and MLUs are safer. Safe, perhaps- safer, not necessarily.

Different studies on home births have shown different results. I've read at least 5 studies which conclude that the maternal and neonatal mortality is higher. It's still a good option for those who beileve in it. I personally wouldn't forgive myself if my baby needed urgent care and we were too late getting to hospital.

Your assertion about the lady who died in Australia was wrong. She was a low risk pregnancy throughout.

And For the last time- I know major surgery has risks. Only, why do keep mentioning that? Moreover, your statistics on EMCS are outdated. Read the latest NICE guidelines on sections. They have quoted research within their guidelines and it clearly shows that women are not at a higher risk of pph, DVT or hysterectomy after a Caesarian.
In fact, for planned caesarians the mortality rates, pph, DVT and hysterectomy rates were all close to zero. The statistics for emergency caesarians are also nowhere near as alarming as yours. It's possible that the website you referred to hasn't updated the latest research.

Here are the updated statistics - www.nice.org.uk/CG013

I noticed that a lot of pages on the RCOG website haven't been updated since 2004.

I don't honestly understand what your problem is. First you turned the topic around to a midwife v/s consultant tdebate. Then you had issues with epidurals. Now, you're targeting caesarians by droning on about major surgery. What exactly are you trying to achieve?

@LaVolcan

I could post several more studies outlining the many risks of home birth but I'd like to remind you that this isn't what the thread is about.

In the meanwhile you may wish to take a look at Ushy's link from the BMJ.

I'd be willing to bet good money you're a midwife like shagmundfreud as well? I don't know why else you'd launch into an attack against CLUs and epidurals and speak so passionately in favour of home births.

I'm sure home births are great for those who want them, but it's reckless to portray them as risk free. I'm sure you realise that there is no hard evidence to prove that low risk pregnancies always end in uncomplicated deliveries. Anything can happen. And when it does, most people are grateful to have emergency care two seconds away.

It is a bit risky, but not as risky as driving.

The nearer you live to a hospital, the less risky it is, whether HB or hospital birth.

It is a painful at times, but not the most painful thing humans go through, by any means.

Nearly all people survive, recover, and the majority do it more than once.

@boffinmom
I'm curious, are there any studies which have actually concluded that childbirth is less risky than driving?
I ask because I know dozens of women with birth injuries and long lasting complications, but only one person who has ever been in a car crash.

As for it not being the most painful thing people go through, I'd say that's relative. If someone has been through an amputation, serious accident etc then she may find childbirth less painful. Others often insist it's the worst pain they've ever experienced. I think it's very subjective.

I agree that nearly all survive (thank god!) and that majority do it more than once, but 'recover' is again a relative term. If you have ongoing issues with your pelvic floor, back, tailbone etc. for instance, I don't think you've actually recovered.

@WhatTheHellJustHappened

I could post several more studies outlining the many risks of home birth

Good quality research has been thin on the ground until the recent Birthplace Study.

but I'd like to remind you that this isn't what the thread is about.
No, and each posting I have made I have tried to pull it back to what the OP originally said.

In the meanwhile you may wish to take a look at Ushy's link from the BMJ.

I had already read it, but have just reread it.

I'd be willing to bet good money you're a midwife like shagmundfreud as well?

No I am not, and as far as I am aware, neither is shagmund.

I don't know why else you'd launch into an attack against CLUs and epidurals and speak so passionately in favour of home births.

I can't see anything wrong in saying what I did, which is that some CLUs are not as good as others. I would like to see them brought up to the standards of the best. I didn't mention epidurals. I have had one home birth and one CLU birth. The CLU birth was OK but the homebirth was the safer one for me. I would like to see other women being able to choose the option that they feel is safest for them. I am very much against a one size fits all policy.

I'm sure home births are great for those who want them, but it's reckless to portray them as risk free. I'm sure you realise that there is no hard evidence to prove that low risk pregnancies always end in uncomplicated deliveries.

I am not aware of having said that they do.

Anything can happen. And when it does, most people are grateful to have emergency care two seconds away.

Again, I am not aware of having said otherwise. Although I would question how many people do have care 'two seconds away'.

@LaVolcan

I did a search of your username and found that you had admitted to being a midwife in another thread. Perhaps you aren't one anymore?
If shagmund isn't a midwife, she must have some complicated agenda. A search of her user name revealed that she argues doggedly against CLUs, caesarians and epidurals in almost every thread she participates in and that she is evangelical about natural birth and the benefits of midwifery.

Anyway, it's always convenient and tempting to dismiss research that doesn't suit your individual beliefs.

Don't take everything I say (I'm referring to the 'two seconds' comment) so literally. I'm sure you realised that I meant the care would be close at hand.

I did a search of your username and found that you had admitted to being a midwife in another thread. Perhaps you aren't one anymore?

I am not, and never have been, and am mystified as to where you read that.

Sorry, maybe I have you confused with someone else.