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?

Sorry, correct name isWhite Ribbon Alliance

Childbirth is "inherently risky" in that maternal and infant mortality rates would be very high if nature really was allowed to take its course. Death in childbirth was not at all unusual before the advent of modern medicine.

Here are some comments I came across on the Internet-

"I know how to work my body to give birth. I didn't need interventions"

"I want an unmedicated, natural birth. It's what I was made to do"

"Elective ceasarians are for lazy, vain women."

"My mother always said, epidurals are for wimps. I promised myself I'd be brave and put up with it."

Of course it is risky. Loads of women in developing countries regularly die in childbirth. Are these women stupid?

I mean the women who said it is not risky.

Inherently risky means that if you removed all the controls (ie hospitals, midwives, drugs etc) then there would be risk. It is a bit of an artificial concept because those things are in place, and you can't really use the third world as a comparator because there are so many confounding factors like poverty and nutrition (which would be just as true if you looked back in time - things like rickets had a terrible effect on maternal death) and also because it's not true there is no birthing support. Traditional midwives had/have many skills too, some of which were lost in the push to medicalisation.

In truth you don't need to make the risk 'inherent' for childbirth to be risky. Even in the UK mothers and children still do occasionally die, and sadly there is plenty of associated morbidity too. However you need to define what you mean by risk. If the only outcome you are concerned about is death, then modern childbirth is relatively low risk. If you are also concerned about child and maternal well being during and after birth, then I think that you could argue that childbirth is very high risk indeed. Many many women find their birthing experience painful and frightening. Now you can balance that with the positive risk of experiencing a empowering and rewarding birth, sadly I think that's probably fairly low risk (ie few people can expect to experience that side of birth).

I had a fantastic NCT leader, who supported our group through a variety of experiences, from exciting (one home birth straight into transition) to very traumatic (long labour, complications, crash section). I think it is a real problem when women aren't given the full picture, but techniques to help women maintain a modicum of control can be very helpful, and the campaigns the NCT has led to try and make birth more women centred are very important. I had my children more than a decade ago but the evidence that women did better with one on one care for example was pretty strong at that time.

I am interested to hear what people would like to be told before they give birth, eg in an NCT class. Would you think it would be useful to be told that childbirth is almost always appallingly painful, and hear some of the tales people are telling here? There is plenty of evidence that fear does lead to greater pain, but even if you don't believe that ("hippy shit"!), do you still think that you would want to hear this in antenatal classes? Do you think this would have helped you cope better?

I agree about one to one care but it doesn't make birth much less painful IMO.

Although the NCT is a great organisation for making friends, I have seen lots of people who have been sucked into their 'beliefs' about interventions and 'medicalisation' and have been left feeling a complete failure when they didn't 'empower' themselves to 'birth' the NCT way and ended up with emcs.

Its stance on breastfeeding has been too militant in the past and it has had a 'one size fits all' approach - home birth water birth good, epidurals, caesareans bad which has left lots of women feeling miserable failures.

I know there are individual teachers who are very good indeed but the organisation generally pushes natural childbirth and doesn't represent all women. They also don't understand that there are lots of women who aren't bothered about 'empowering ' birth - just a safe one and as far as possible a painless one.

So I think NCT is good for some women with some approaches to childbirth but their approach is, I think, part of the problem rather than part of the solution to what the OP is talking about.

stranded yes actually I'd rather antenatal classes were honest. Women are adults, not children who need to be shielded from the truth.

@strandednomore
I believe in the saying 'Hope for the best and prepare for the worst'.
I cope better with situations when I've accepted and understood the ins and outs and when I know what to expect.

We also have to realise that we are dealing with grown women here, not little children. We can't tell then it'll only be a pinch dear, even when it's false.

After suffering a through a 73 hour labour that resulted in a fourth degree tear and severe bladder injury, my SIL said "Why didn't anyone ever tell me it could be like this? I'd have made different choices had I known."
So many women refuse certain interventions and ask for others without actually understanding the real repercussions of their decisions. Going into detailed horror stories is not required, but Withholding information from them is incorrect.

Doubleglazing is right. If you aren't honest, people may not explore things like pain relief options properly and make the right decision without feeling they are being judged.

Very interesting thread. I have a question however; my midwife says I should prepare myself for not getting an epidural even if I request it from the outset and I am going to the delivery suite. Surely if I want an epidural, it's medically suitable to proceed and I ask for it ahead of time, I have a 'right' to that epidural?

Otherwise I'm going to fucking wreck the joint, frankly.

Garlic pain relief in labour should be a human right shouldn't it? It is totally wrong that you are being told this BUT I wonder if it's true?

Why don't you send a letter of complaint to the head of obstetric anaesthesia to see what he/she says. You may get a different story because NICE says epidurals should never be denied.

stranded, interesting question. I did NCT and really enjoyed the classes, although they ended up being a total waste of time for me (sudden severe pre-eclamptic liver failure = emergency induction which hurt so much I wailed for an epidural and bugger the cascade of intervention!) I personally am the type who wants to know everything, downsides and all, no matter how grim - it's not knowing that I can't cope with. (Whatthehell put it exactly - "prepare for the worst and hope for the best".) But other women do better not knowing how bad it could be.

Having had a pretty horrible birth experience, I'd still agree it can be beautiful - I will remember until I die the moment they put my son on my chest. But without the epidural, I seriously don't think I could have coped.

Our classes were excellent. I thought our leader was fantastic. She had been doing it for a while and had a really good idea of how each of the local obs units worked (there was very little information easily available at the time), talked to us about natural birth and pain killing options, home birth and c-sections. We were going for a home birth and ended up having a c-section and we still felt prepared, knew who all the people there were and what they did etc. She also really supported those in the class who had a really traumatic time, listened to their birth stories, explained how they could ask for a review at the hospitals and was generally there for all of us. Perhaps that was why she took quite a pragmatic view - I think it would be hard to sell a sweetness and light vision of birth after listening to all the stories of how it went wrong. NB the most positive birth story in our group was from the person who had done hypnotherapy (and some other things too) because she had a needle phobia and knew she couldn't cope with an epidural.

I didn't want to be told my labour could be 73hrs, result in a 4th degree tear and bladder injury. I did my research and was aware that it happens to some women, and am surprised that some women aren't aware of the potential outcomes of childbirth. Focusing on the positive doesn't mean denying that the negatives can happen, that's where the feeling of failure comes in.

I have no idea what would prepare women better if they have major complications - would they really want to go into the final days of their labour believing that they are going to go through days of agony and sustain serious injury?

If the NCT is written off by so many pregnant women as having nothing to offer them, then where else do women get information and support to get the best possible birth for their circumstances. The NHS certainly didn't give me anywhere near as much information and support.

Ushy you would assume so, but the line I'm getting from the community midwives is that you'll only get your epidural if the anesthetist is around and can do so in time. I just don't accept that as a good enough response and I plan to insist, and cause a fuss if need be. (ie: I'll be such a pain in the arse if I feel it isn't being sorted they'll probably give me a general).

I wonder if anyone else had experience of not getting an epidural because of deliberate stalling?

I personally don't see any pain as a 'positive experience' and am most comfortable not in an ABC but surrounded by lots of medical equipment! While I think, ideally, no one should be judged on how they choose to deal with the pain of childbirth, I have gathered disapproving looks from the MWs for my insistence on planning to deal with it medically. Thankfully, I have been collecting disapproving looks for most of my life so this is just another phase.. :o

I must say, this is an excellent thread, with some intelligent and insightful views.

Hmmm, not sure what I think.

I suppose I don't believe that it's all just about the miracles of modern medicine and "luck, luck, luck" if you have a great birth or that things like hypnobirthing can't make a difference.

My first birth was classically medical - induction post-dates, drips galore, epidural, delivery on back, low on behold dc got stuck (surprised?) and then the whole crash-bang-wallop/run to theatre/have him hoiked out with forceps/oops/didn't work/cut him out instead.

I don't believe it would have been like that or that he would have got stuck if I had had a different labour. So I am going to try hypnobirthing this time because I feel that actually, there's a good chance that being calm might make a difference. Though I am accepting it might not... I just don't think dismissing either point of view makes sense. There's sense in both the idea that childbirth is inherently risky and painful and that perhaps there are situations where what you do can make it less so.

It seems quite simple to me. Having a positive attitude and knowing about coping techniques like visualisation, water for pain relief, etc., is a great way to go into a birth and should allow you to manage fine if you have a straightforward, easy and short labour. If labour is protracted or complicated in one of the myriad ways it can be, then these will not be enough to endure without intense pain and trauma, and you need to understand about what options and solutions are available to you.

Surely the best way to educate women is to teach them this: how to maximise the changes of labour being smooth, but how to cope with and manage it if it is not. In the western world, this doesn't need to be a scary lesson, because pain relief and EMCSs are available when they are needed.

I think some people are misrepresenting the NCT view. Certainly in the class I went to, we talked about epidurals, caesareans etc and there were no judgemental comments at all from the teacher, just a straightforward account of what they entailed and why you might need them. Also if you read materials produced by NCT nationally, they do promote "normal birth", not because they are anti-caesareans, but because they think they are sometimes performed unnecessarily. NCT would say unequivocally that there are always times when forceps, caesareans and other forms of intervention are necessary.

Women's experiences of childbirth seem to vary widely, from those who have long excruciatingly painful labours to those who have short, relatively easy and even relaxed ones. And there are lots of different factors contributing to those different experiences.

For me childbirth was exhausting first time, painful but exhilerating. 2nd time I thought just before birth, can't do this again, far too painful but it was very quick and lovely too. Both at home, both very supported.

Seems strange not to say as body is going thru birthing experience that you will not feel pain - still can be beautiful. Seems terribly unrealsitic to not say it will have some pain and possibly some difficulties.

I was lucky.

Saw the thread title and only came up with 'it's a squash and a squeeze' (Possibly related to doing bedtime stories for my dds??) The next person asking me what giving birth was like will get this answer ...

I just think women should be able to say what they want about childbirth as long as its not untrue. We are all different and our experiences likewise. For me it was not too painful, sorry but the truth. All 3 were also very quick so too late for pain relief except gas and air. Ist was 2 hours, 2nd 90 mins, 3rd was 30 mins. I had more pain having my hair pulled through the holes in the cap they used to use to streak hair. I have friends who endured days in labour and much pain, others having emergency sections. We all should feel free to say what we like, especially if asked our opinion or about our experiences.

I agree with every single word of Charlie Brooker's take on it

Garlic the responses from your community midwives seem perfectly reasonable to me. If the anesthetist is not available you will not be able to have an epidural, as no one else can do them. If it is too late it is too late. There may be circumstances where one or the other factor might come into play, what you need is an understanding of is how likely either of those scenarios are (probably pretty small). I think going into birth with a fixed idea of what will happen (whether hippie lovely or intervention heavy) is a bad idea, as things don't always play out the way anyone expects, and if you have a very strong idea of how things 'should' go it can be very much more upsetting if they don't. However being assertive is really important too.