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?

Ushy: "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."

I think this is an important point. I agree with a great deal of what Shag says, but when it comes to the costs of epidurals, I think you also have to consider the cost of not giving people epidurals when they want them. That cost comes in the form of PND and PTSD and the related medication and counselling when women have laboured through an intensely painful labour without adequate pain relief.

I agree women should be informed about the risks that come with epidurals - a greater risk of forceps or ventouse and of episiotomy, and the longer recovery time. But you have to weigh that against the distress of a woman in pain who has been refused an epidural.

LaVolcan - my understanding is that the advice about putting baby on their front came from Dr Spock. I may be wrong, though - it may already have had wider currency in the health professions at that time.

They do apparently still put premmie babies on their tummies to sleep.

Ushy - maybe no one agreed with routine episiotomy and all women agreed they were bad practice, but talk to women who gave birth 30 odd years ago and you will find that it was rare not to have one! So how come?

As far as I can see Shagmund has consistently argued for flexibility so that all women get a better service.

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

You are implying that it's not a suitable subject for people to have campaigning views on.

"they were universally seen as bad practice by all women."

They weren't! It was midwives primarily who campaigned for change based on new evidence about the efficacy of this practice. I should imaging that many women shared the common belief that episiotomy protected the pelvic floor and protected women from severe tears. Actually this view still holds sway in much of the rest of the world. And among some doctors in the UK.

Supine births are still the norm in hospital. In my local maternity unit 2 years ago 18% of women were still giving birth in stirrups. (and this is a London teaching hospital... But hey - that's better than the national average of 26.6%!)

"So what you should be arguing for is more flexibility"

Well at the moment the 'flexibility' is all going in one direction: the VAST majority of women are giving birth in CLU's, and while all women are aware of the benefits of giving birth in this type of unit (doctors, epidurals, operating theatres) I'd suggest that most aren't aware at present that in making this choice they appear to be doubling their chance of having a difficult labour, and not improving their chances of coming home with a well baby.

That's what I've been arguing on this thread:

• we need to tell women what is known about how birth environment can impact on labour outcomes
• we need more alternative provision
• women need to know that birth outside hospital can have significant advantages for them and their baby and is safe
• we need better homebirth provision: more caseloading teams, better training and experience for midwives

And actually if we had many more women giving birth in birth centres the emergency c/s rate would come down, based on current evidence. And that would free up the services of anaesthetists to care for those women who need surgery and those women who want epidurals.

Everyone would win.

You'd think I was arguing for unassisted birth and the banning of doctors and epidurals judging from some of the responses I've had!

As I said before what we need is a properly integrated service to meet women's needs in labour and around this time (in pregnancy and preparing for birth, and in the early days of caring for their babies)

I think it's quite wrong that women are expected to make such early decisions about what kind of birth they will have - there should be much more room for flexibility, whilst listening carefully to women's experiences, feelings, and ideas approaching the birth of their baby.

There shouldn't be this great divide between MLU's and CLU's.

• Though my experience at Tooting hospital in 1999 was not bad in this respect.

I was able to plan to use their water pool where I was looked after by a team of midwives and yet I also had the opportunity to have a pre-birth meeting with my consultant where I remember asking him if I'd be able to use essential oils in the birthing pool, amongst other things ! (sadly answer was "no" to that one) - but I was glad to have the opportunity to share my hopes for the birth with him, and to feel that I had both midwives and doctors in MY birth team !!

"I think you also have to consider the cost of not giving people epidurals when they want them."

Sadly it doesn't cost much to refuse women epidurals as many women can't access appropriate treatment through the NHS for PTSD following a difficult birth.

Nobody on this thread, least of all me, wants women to be denied epidurals when they've requested them.

I just want women to have access to optimal care in labour so they are less likely to get to that point of desperation where a delay in getting an epidural or a refusal becomes an emotional catastrophe.

My argument is that hospital is not always the best environment for providing optimal care in labour for healthy women and that women who go there are more likely to have unnecessarily long and difficult labours because of this.

Hackmum - whoever was responsible for babies being put on their tummies the point still stands - it was a lay person who publicised the dangers.

Juggling, there used to be a caseloading practice attached to Kings. The mothers using this practice weren't made to book for home or hospital birth - they would call their midwife out (the midwife they had seen all the way through their pregnancy) and see how what the situation was when they went into labour.

If the mother had health issues (or simply wanted a hospital birth) the midwife would take her to hospital, work with the doctors and staff at the hospital to safely birth the mothers baby, then settle her back home for postnatal care.

I would love to see this system more widely available. It's called 'Domino care'

here

Yes, I think that's the way forward shagmund

• Just that extra little bit of resourcing so a woman in labour has 1 to 1 care with a midwife she has got to know in pregnancy would make such a huge difference to women's experience of birth, and to early family life for her, for baby, and for her family and society as a whole.

Maternity care in this country - and around the world - is so woefully under-funded. It is such a short-sighted approach. I am still shocked at the level of support I received, especially after the births of my two - even though I had two good experiences, and some of the staff were very good. But it was so patchy !

Shag as long as you support women having choice of where they give birth - including the choice of a consultant unit with epidurals and doctors - I don't have a problem.

Tell me, though, why can't you have consultant units with the same kind of homely environment and ethos as midwifery units but all the advantages of having doctors and pain relief on hand?

Why do women have to choose? Why not both?

@shagmundfreud

It's great that you want to inform women about the pros and cons of home birth and hospital birth. It's great that you want to tell them about the risks associated with CLU (assuming there are any).

I'm all for empowering women to have intervention free births and to deliver at home if they so desire.

But I suspect your drive to 'inform' women stops at home births and midwifery. I don't see you including the benefits of say, a planned Caesarian (yes, they exist) in your attempt to inform women. Nor do I see you including the risks of home births(yes, those exist too) and the long term complications associated with natural deliveries. If your purpose really is to inform women, you need to look at all sides of the story, not just the side you feel is right.

Also, how is the system we have right now all that different from Domino care? Anybody who wants a home birth can have one as long as there are no complications. The only difference is that we don't have the same midwife caring for us throughout the pregnancy.

I'm finding it very strange to be talking about routine episiotomies, enforced lithotomy and other such outdated practices. Everyone can refuse these interventions as a routine practice. They are usually enforced when medically necessary.
What will we criticise next? Routine enemas? Oh wait, that doesn't happen any more either.

Ushy '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 ...'

i agree with this but this attitude is not exclusive to natural birth advocates. My experience was scorn and sneering from other women at my desire to have as little intervention as possible. Several times I was told 'Just have the epidural.' Another comment was 'don't be a hero' but usually I just got a raised eyebrow and a 'ha! you'll learn' look.
Of course, I knew that I might not get that water birth, I'm not stupid and I was prepared for it.
As it happened, I had an induction because I went 12 days past my EDD and an EMCS. Afterwards the ward sister told me: 'Anyway, you have a healthy baby and that's the important thing.'
She's right of course. I'd have that horrible birth 100 times over to have my son. But that prevailing attitude- you have a healthy baby, your experience doesn't matter, it's meant to be awful- means that I don't feel able to talk to anyone about my feelings about having an induction that I didn't want and felt unable to refuse, having contractions on induction ward and trying not to cry out for fear of frightening the other women, being forced to lie still on the bed when my body just wanted to move, to come round from a GA being the last to know I had a son, not to be the first person to bond with him.
I don't feel stupid for having wanted a more natural birth, even though that's how people want me to feel. I wasn't brainwashed, I was unlucky. But now I feel I have to keep my mouth shut for fear of being branded the silly naive girl who thought she could breathe through the contractions (actually the breathing and visualisation did help, but I digress).

I can't understand why some women feel so threatened by other women choosing something that they didn't, especially where mothering is concerned.

"Tell me, though, why can't you have consultant units with the same kind of homely environment and ethos as midwifery units but all the advantages of having doctors and pain relief on hand?"

Exactly - it does seem mad to have this MLU and CLU divide. Why should it be one or the other - makes no sense.

@Conchita

I'm so sorry to hear about your experience and I'm even more sorry to hear that your trauma was belittled and your preferences ridiculed :(

Every woman has different expectations from the birthing process and they must be respected. An ideal birth for one person can be a nightmare for another. A home birth or water birth is not something I'd ever want, but for others it's the best choice! Some women don't want to give birth naturally and request caesarians while others consider a Caesarian to be the worst case outcome. I don't see why we can't have a system where women are free to choose home births, caesarians, epidurals, water births, or anything else they want (within reason!) without being subjected to medical politics and judgement.

'Exactly - it does seem mad to have this MLU and CLU divide. Why should it be one or the other - makes no sense.'
To me it would make most sense to have MLUs attached to CLUs- then you're only down the corridor if you decide that actually, you would like an epidural. At present you feel as if you are effectively closing down your options when you write your birth plan. If you've never had a contraction before that's a big, and blind, decision. I think that's one reason why women come out of the other side feeling betrayed by the advice they got in their antenatal class.

I have never understood and probably never will understand why childbirth can be such an argument.

I will never ever have an epidural or CS through choice. If I need to have a CS then so be it but I don't want one. it would be my worst nightmare as I don't cope we'll with needles and hospitals.

Same as someone else would consider a home birth with no pain relief in a pool as their worst nightmare. When it is my dream birth.

Surely providing both mother and baby arrive safely is the only important factor.

I will never give another woman grief about how she gives birth.

I really feel this thread is getting somewhere with posts like Glendragons

I hope it's being widely read by those who might make positive changes.

@WhatTheHellJustHappened
Thanks for being sympathetic. Before I became pregnant I had no idea about the politics of childbirth. We are lucky to have so many choices but informing yourself to make those choices is difficult. It's a lot for women to take in at a time in their life when they feel quite vulnerable and often pretty scared too. I wish we could all be a bit kinder to one another and respect each other's choices.

Conchita - agree about politics of childbirth, I wish I had had more idea about it before I gave birth. It is unfair for vulnerable women to be caught between 'the system' and people's agendas, which are often incompatible.

My experience was similar at the start to yours (though yours sounds like it got much more difficult as it progressed ) A hospital ante-natal ward at midnight is a really shit place to go into labour - no birth partner, being treated like you are a total inconvenience to the staff, and trying not to wake everyone else on the ward up whilst writhing in agony.

You'd think they'd be a bit more prepared for the possibility of a woman going into labour on a hospital ante-natal ward ? (eyebrow raise at life !)

You would really, especially since they have just given you a pessary to, er, induce labour

Apparently these are supposed to work to a timetable where everyone gets a nice untroubled night, then you go into labour at a convenient time at some point during the next day. Any time before that and you 'can't' be in labour apparently.

Glendragon- I'm sorry to hear that. At least mine happened in the daytime and DH was able to be there.
I've heard other women say they've been encouraged to fight the system in some way or another- refuse this drug that they say is safe, demand that drug that is too expensive to hand out, don't accept the sweep/induction etc, insist on that CS or epidural. 40wks pg or in labour is just not a good time to be fighting for your rights. I'm not saying that those rights should not be fought for, or that choices should be narrowed, but it's a big burden on the individual woman to fight for these things herself.

Glendragon, my first labour was like that. After half an hour of arguing that my then DH couldn't get home at 1am they let him stay. We were told to be as quiet as possible, so spent most of the night wandering around the hospital. Then I got moaned at as my waters broke in the foyer.

And people wonder why I had a home birth and planning another.

juggling my MW failed to spot I was in labour despite the fact that I had been given a pessary. I was sent walking round the corridor to 'start things off'. I remember being collapsed on the floor outside the ward because nobody was answering the intercom to let me back in
I also don't know that I would have been taken off the ward anyway? Would they still make you wait until you were further along even if they knew you were in labour?

Blimey - what century are we in ?

Surely all these things must have happened in the last millenium ?!!