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?

Getting back to the opening post, I think the main problem is the attitudes of other women...sneering nasty controlling behaviour like fishandlilacs met below - do it my way or you're a loser ...

Its controlling women and old grannies who have kept women in the dark ages for centuries - they campaigned against the vote in case the stress upset women's menstrual cycles , they have kept female genital mutilation going in Sub saharan Africa, they conspire with forced marriages and they are trying to keep their controlling little dabs on how women give birth. They claim women need to 'educate' themselves about birth - 'educating' meaning swallow their propaganda.

Yuk, yuk and yuk. They are just revolting human beings - women should be able to do what the hell they want and give birth where and how they want.

This is what fish wrote:

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

I hope what she said was unrepeatable.

Just - if the RCM and the RCOG and the NHS are telling me that 'hoe birth is safe for low risk mothers' and that 'for everyone except first time mothers there is no evidence of poorer outcomes than for women giving birth in CLU's' and 'women who give birth at home and in MLU's have half the rate of forceps deliveries and emergency surgery' then I don't think it's unreasonable of me to hold the view that birth outside of a CLU is as safe for babies as within a CLU and is SAFER for women as they are less likely to need emergency surgery.

Because the thing is - these large organisations have teams of researchers who are medically trained, who spend their time REVIEWING all the evidence in a systematic way, and analysing it using appropriate models in order to weigh up its relevance. What you are doing is googling at random, reading abstracts and the odd letter or paragraph of a letter sent to a medical journal and looking for the information in isolation which will back up your view that birth outside hospital is dangerous. It's not unreasonable for me to reject your view because it's not been arrived at in a balanced, neutral or systematic way.

And by the way - I will say it again because maybe if I repeat it enough you'll stop misrepresenting my views: obstetric input into childbirth has saved the lives of many many women and babies over the years and I'm hugely grateful for it. CLU's are absolutely crucial for many women and c/s is a life saving operation. Epidurals are one of the wonders of modern obstetrics and I'm glad they exist.

But it's also the case that all choices have pros and cons and going on current best evidence many CLU's are not providing optimal care for healthy women, and this is resulting in very high levels of intervention in birth without corresponding gains for babies.

And I appreciate that modern c/s is generally a safe operation - but it is still surgery and all surgery carries risks, some of which are extremely serious.
These risks are acceptable if surgery is unavoidable because the alternative - a damaged baby or a dead mother is incomparably worse - but if it's possible for the mother to have a straightforward and healthy vaginal birth.....?

[delurks briefly]

WhatTheHellJustHappened since you're doing searches on user names, you read to me as being the same poster as PeaceandHope - this is the first thread you've appeared on and your "@username" style of responding, as well as the content of your posts, seems very similar. If you're name changing then it's good form to say so.

[relurks]

Wanted to add, one thing I find irritating is the absolute dogged refusal by some of the posters on this board to register or respond to the concerns raised about the fact that healthy women in CLU's have nearly TWICE the rate of forceps deliveries.

Over the last few years on mns there have been dozens of threads by women raising major concerns about this type of instrumental birth.

Is NOBODY here willing to question why so many women in CLU's are having this type of delivery - as many as 20 years ago despite a doubling of the CS rate over that period?

UShy - what are your thoughts on this?

I honestly couldn't give a flying fuck how anyone else gives birth or how that experience made them feel . It really isn't that important , its a couple of days out of someones life , days that they will never have to repeat again . What does matter is that mother and child get through the experience alive and hopefully well.
Nobody gets pregnant just to experience the wonder of birth , we do it because thats the way to have a child and birth is a teeny tiny aspect of the whole process that is being a parent . No child has ever said to their mother , ' oh thanks for not succumbing to modern , brutal and misoyginistic medical techniques and for going natural all the way , i am definately a better person because of your efforts' , because they dont care how they got here .
My last birth was a home birth , had a few puffs of G&A at 8 cms dilated and then bled like the proverbial stuck pig , blue light to hospital , got to 9 cms with just the gas and then crash section , so you could say i wimped out for the last cm . My son is no different to my other two who were vbac , because it really doesnt matter how they get here .

Shag was that addressed to me?

The study I referred to was the actual one. I never said that birth outside a hospital is dangerous either - birth is pretty safe in UK whereever you choose to go.

I said people can look at the evidence and make their own minds up.

There is less intervention outside hospitals but also less access to epidurals and the death rate for babies is higher but not statistically significantly so.

I really, really really do not care where you or anyone else chooses to give birth.

I can see you have a strong preference for home birth and midwife units and no intervention. Fine I have no wish to convert you to my view.

I prefer consultant unit and epidural and if things go haywire - early not late intervention. OK..big world, lots of different people who see the world differently.

Let's all live in peace.

frumpet My son is no different to my other two who were vbac , because it really doesnt matter how they get here .

Great post!

Whatever, as they say.

I kind of thought we'd moved the argument beyond what we personally feel comfortable with (which actually has very little to do with the evidence or rationality and far more to do with the culture surrounding birth we've grown up with, also our own personal idiosyncrasies) and were having a general debate about the wider issues of maternity care in general.

My preference is for the largest number of women having the healthiest and happiest births possible because I think this is good for families. That's why I'm concerned about the very high levels of avoidable physical damage healthy mothers are experiencing in our hospitals while giving birth.

I think it's sad that as a society we have so little concern about women being damaged in childbirth. If any other group of people - children or the elderly - for example were being subject to thousands of avoidable surgeries every year we'd think it was a terrible scandal. But when it happens to mother we don't seem to care.

I've had too much contact with post-operative/post forceps women over the past few years and seen them struggling to cope with the aftermath of a difficult birth while simultaneously trying to meet the needs of their new baby, to see this as simply an issue about consumer choice in birth.

It really does matter that such high levels of avoidable intervention are happening in birth with no gains for babies, and I'm saddened to see so many women here defending the status quo.

@ FlipFantasia

I did a search of Peaceandhope after you mentioned it. I don't see similarities in my style of posting with her's, nor does she use the @ that I do. Maybe you have me confused with someone else?
It's possible because I confused LaVolcan and laluna. :)

Each entitled to their own view obviously but at the same time, I wonder if the process of childbirth would be dealt with differently if it were men who went through the actual labour. Just a thought.

How birth happens doesn't matter?

It does.

This whole board is witness to that.

Wiggy "I wonder if the process of childbirth would be dealt with differently if it were men who went through the actual labour"

How true! Pain relief in labour would have had more money pumped in than quantitative easing...

But shagmund if you see that comment in the context in which it was written - by a woman, frumpet, having a home birth but then needing to be blue lighted to hospital for an emergency C/S, then it is so completely understandable that she would feel that the main thing was that her baby arrived safely. And to look at him and his brothers and feel/ hope that his more dramatic entrance to the world has made little difference to him.

Of course I agree with you too, that the experience women have giving birth is very important, and well worth discussing to see how improvements can be made, and to campaign for them.

@ shagmundfreud

On the issue of forceps, I'm in agreement with you. I find the excessive, indiscriminate use of forceps very concerning myself. The USA has a forceps delivery rate of 0.8% and Canada 1%. The rate in UK is higher at about 10%. In many more countries the use of forceps is fizzling out in favour of caesarians and vacuum extractions when needed. I'd like to see that trend here as well. I'd like to remind you though that that isn't what my thread was about.

Nobody here is defending unnecessary interventions in birth. Don't know where you got that from?
If we feel more comfortable in a CLU as opposed to at home or in a MLU, it doesn't mean we are happy with needless interventions. That's where the concept of patient rights comes in. Just because they want to strap you to a bed throughout labour doesn't mean you must comply. Just because they're wanting to use forceps doesn't mean you must agree. There is the concept of informed refusal and we can all excerise it. The more informed we are, the more questions we ask, the better we will be placed to refuse needless interventions.

I've also already explained why there may be more surgical births in CLUs. High risk women always deliver there. These include women carrying multiples, women with previous caesarians, macrosomic babies, preeclampsia, and other complications. They are much more likely to need interventions as opposed to other women. I don't see why something so obvious doesn't convince you?

If I didn't know better, I'd say you were Cathy Warwick, president of RCM. She made an identical speech recently.

Shag birth matters to some of us as individuals and it matters more to some people than others.

What would be good is if people could just stick to what they want to happen for themselves without trying to convert everyone else to their view.

Sorry to be blunt.

I accept the way you see things and what is important to you i.e. avoiding intervention, midwife units etc. Those things are not my priorities - I would prefer consultant unit and epidural.

I have had a horrific natural birth without epidural - the psychological after affects were harrowing and destroyed months of my life. That was a million times worse than a forceps delivery or 'intervention'. Subsequent deliveries were in a consultant unit with every available pain relief intervention and a much much much better experience.

What I would not do is try to convert you to wanting to give birth in a consultant unit with an epidural. I have my experiences which drive my choices you have yours but let's stop trying to convert.

@BoffinMom

You never did share the statistics that conclude driving is riskier than childbirth. I'm very interested to know more about this....

@wiggy29
My mother insists that if men were to start giving birth, epidurals would become a human right and caesarians under general anesthesia would become commonplace

On a serious note, the appalling state of maternity care across the world is an important feminist issue.

What the Hell so true Wasn't that there an earlier post saying that the right to epidurals had been challenged as a human right?

About time too

That's where the concept of patient rights comes in. Just because they want to strap you to a bed throughout labour doesn't mean you must comply. Just because they're wanting to use forceps doesn't mean you must agree. There is the concept of informed refusal and we can all excerise it.

In theory yes. In practice, (unless you have a good birth advocate), it can be very difficult to say no, or to say, 'what happens if we wait?'

Dont get me wrong , i do believe how we give birth is important to us , women, for many reasons other than health . That is why i chose a homebirth , i was totally up for the whole happy clappy whale music deep breathing visualisation experience and i got it , up to 8cms ! What happened to me wasnt as a result of my choice to homebirth or any other factors other than scar tissue on my cervix which stubbornly refused to stretch the last and vital cm . Yes i was traumatised about the whole experience and have only recently been able to really talk about it fully . Did it make the slighest iota of a difference to my son ? nope it did not . He was born alive and well , thanks to an amazing and experienced midwife and a whole host of medical professionals without whom i would no longer exist.

That is their job though frumpet - bottom line a successful outcome for mother and baby. Not that that means they aren't amazing too !

"What would be good is if people could just stick to what they want to happen for themselves without trying to convert everyone else to their view"

If nobody speaks up to try to right what they see as a wrong, or to point out flaws in the system, then the status quo holds sway.

Almost everything that's happened in the UK to improve the experience of birth for women, babies and families has happened because of outside pressure from interested groups and individuals shouting 'look at the evidence!'.

50 years ago women were routinely separated from their babies after birth

Poor hospital practices damaged breastfeeding beyond repair for many, many women. The repercussions of that are still being experienced two generations on.

Men weren't allowed to be with their partners for the birth of their child.

Women were induced at term, given routine episiotomies and refused 'permission' to get off the bed during labour.

Women were made to feel that homebirth wasn't in any way a viable option.

These things have ONLY changed because of the pressure put on the government and on maternity services by committed and radical midwives and doctors, by special interest groups and charities, and by women themselves.

I don't accept that we should all just 'shut up' about it and focus on our own choices. That's not how progress happens!

Shag no-one is telling you to shut up at all.

No-one agreed with routine episiotomy or having to ask permission to get off the bed etc etc - they were universally seen as bad practice by all women.

When it comes to things like where to give birth, there are different views - not everyone wants what you want. So what you should be arguing for is more flexibility so ALLwomen get what they want not just the group that agrees with you. That's not improvement - that's just improvement for some at the expense of others.

Shagmund - you could also add the advice to put newborns to sleep on their stomachs. This was common advice 30 years ago, and it took Ann Diamond, (a newsreader, not an HCP), having suffered with a cot death, to publicise research showing that this was dangerous advice.

Where did the original advice to put babies on their stomachs come from? I once heard that 'they' found that it was better for premature babies, and hence therefore, it was decided that it must be better for full term babies too. However, I have not been able to find any confirmation about this.

The generation prior to that (so 50-60 years ago) were told that in no circumstances should they put babies to sleep on their backs, in case they choked.