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 - you don't know what percentage of those who didn't get completely satisfactory pain relief requested an epidural and didn't get one. The survey doesn't make that clear. You have to remember that 1 in 10 women who have an epidural don't get adequate pain relief from it. About half of women who opt for pethidine don't find it reduces pain significantly.

And no - it's not acceptable that there isn't enough anaesthetist cover to ensure all women who request an epidural get one. But in my view it's more unacceptable that there aren't enough midwives in the UK to ensure one to one care in labour, as lack of one to one care is putting women and babies in danger in this country.

So personally - in an NHS where women are dying from lack of basic midwifery cover on labour wards, and old people are becoming malnourished from poor nursing care, I think there are other priorities which are more pressing than increasing access to epidurals, particularly as in the UK they're not associated with better clinical outcomes for mothers or for babies.

Actually there is one answer to the problem - encouraging healthy women to stay the fuck away from obstetric units UNLESS they know they want an epidural.

Women who go to obstetric units are much more likely to request an epidural in labour, no matter what their feelings about this type of pain relief are before the birth. Just being in a CLU appears to make labour longer and more likely to go shit-shaped, thereby increasing the need for epidurals.

But that would mean spending more money opening midwife led units, more birth pools, more homebirth. Which of course would take money out of maternity services in general. Money which many of this thread would like to be spent NOW on having more anaesthetists on labour wards.

Shag How could you say this?
"in an NHS where women are dying from lack of basic midwifery cover on labour wards, and old people are becoming malnourished from poor nursing care, I think there are other priorities which are more pressing than increasing access to epidurals

Sorry Shag this is the same old mysogyny. What are you suggesting?
Women should learn they are bottom of the pile, unimportant, their pain doesn't matter...they should be grateful they aren't left to die ..pain relief ..their pain doesn't matter they are only women....

Aarghh..

And by the way, most women go to consultant units because a) they don't want to be loaded into an ambulance and carted off to another hospital if the baby gets stuck b)they like to know doctors are around if things go wrong c) they like to feel epidurals are on hand even if they don't plan to necessarily have one d) they like to know there is a scbu or blood services if the baby is ill or they have a haemorrhage. Yes, of course women who go to obstetric units ask for epidurals more often - they aren't available anywhere else.
No that doesn't mean there should not be home birth or pools or one to one midwifery.

"Women should learn they are bottom of the pile, unimportant, their pain doesn't matter..."

Their pain does matter. But not as much as their safety and their babies' safety in childbirth.

Sorry - but if there is FINITE cash going in to maternity services and we currently have a situation where women are being put at risk by a lack of midwifery cover on wards then I would rather maternity services cash go towards improving this.

Honestly Ushy - you are trying to be on the side of the angels on this one. I'm sure you're not arguing that access to pain relief should take priority over the safety of women and babies in childbirth are you?

Are you making a case that the money available to maternity services should be increased to cover the costs of BOTH improved access to one to one care in labour AND good postnatal care AND access to waterbirth AND access to out of hospital birth AND increased anaesthetist cover so that more women can have epidurals (and the assisted deliveries that in the UK are associated with this type of pain relief)?

If the money is there for all these things - brilliant.

But if choices HAVE to be made? (and at present they do).

What are your priority?

Safer birth? Or better pain relief?

Both.

If you go in for your appendix you don't get asked whether you want a safe operation or an anaesthetic. You get both.

Would men accept the either or? No they wouldn't.

While we can support an army in Afghanistan, a nuclear arms programme, billions wasted on daft NHS IT schemes that never see the light of day, then we can afford both safety and pain relief.

Are you a midwive?

meant midwife?

I found giving birth to be very painful. As for risky it still is, but much less so than in the olden days. But we are all different and maybe some women really do find it a pleasureable experience! Good for them. Hope I feel that way next time :) I do think some women go on about the pain excessively though - all that matters is that the baby and mother are well and healthy at the end.

Yes, childbirth is painful. Anyone who says it doesn't hurt is lying.

But if you read the earlier posts Princess some of the women who have posted here have not ended up well and healthy. Someone who is psychologicallly traumatised, perhaps suffering from a 3rd or 4th degree tear and terrified of a future pregnancy isn't healthy. The pain and suffering women experience during and after birth does matter and more needs to be done to address it - it has always been a very low research priority - largely because women themselves have not pressed for it.

"Both"

Oh well, if we can have EVERYTHING then hurrah! I'm right there with you!

But if choices have to be made (and it appears they do), then I'd vote for more midwives rather than more obstetric anaesthetists.

Actually there are a long list of things in the health service I'd prioritise over increased access to epidurals for labouring mothers:

• increased access to palliative care
• more hospices
• improved access to mental health services for everyone, but especially children and adolescents

I could go on. The NHS is deficient in so many ways. Our survival rates for some forms of cancer are some of the lowest in the western world because of late diagnosis.

I would be all for a massive increase in the healthcare budget to improve on all these things. But if I had to CHOOSE, then more epidurals for labouring mothers wouldn't be at the top of my list.

"If you go in for your appendix you don't get asked whether you want a safe operation or an anaesthetic"

If the majority of people got through an appendectomy fine without pain relief and weren't traumatised by the experience, and if pain relief actually made the outcomes worse for many of the people undergoing this operation I'm not sure that I would expect it to be routinely offered to everyone, and certainly not encouraged.

Oh by the way, that doesn't mean I'm ignoring the fact that birth is a terrible ordeal for some women, and that we all deserve sensitive, appropriate and responsive care before, during and after having our babies.

I just don't think pouring resources above all into improving access to epidurals is the route to decreasing rates of birth trauma, especially not in a maternity system where current levels of under staffing are endemic and harmful to women and babies.

Are you a midwife?

Pain relief if a human right. NICE says women should not be denied epidurals when they ask for them. NICE takes cost into account so your cost argument doesn't stackup.

Therefore women should not be denied pain relief. If you don't think it's important don't ask for one when you have a baby.

Let the rest of us make our own choices.

"NICE says women should not be denied epidurals when they ask for them. NICE takes cost into account so your cost argument doesn't stackup."

NICE also recommends that all women should be told that giving birth outside hospital and having a female birth partner reduces the likelihood of an emergency c/s!

It recommends that all women should have access to a birth pool if they want one!

NICE can make as many recommendations as it likes.

But they're recommendations. Not rules.

And the reason they're not being adhered to is because of a lack of resources.

So no - women shouldn't be 'denied' pain relief. But they will be if there aren't the resources to provide it. And there aren't.

Labour wards are often understaffed. How can you guarantee a mother an epidural which necessitates one to one midwifery care afterwards, if there are other women on the labour ward who also need the attention of a midwife? What would you do as a midwife working on a ward like this? Or a manager? The resources simply aren't there to provide epidurals for all who request them. Or one to one care. Or birth pools for all. Choices ARE being made and they will continue to be made until there is a MASSIVE increase in funding to maternity services. Which will happen - well, never, as far as I can see.

And while choices have to be made - as they do at present - I would prefer the safety of mothers and babies to be prioritised above increased access to epidural pain relief.

"Therefore women should not be denied pain relief. If you don't think it's important don't ask for one when you have a baby."

I didn't think we were discussing our individual choices.

I thought we were talking about how money should be spent in maternity services, right now.

You think that access to epidural pain relief should be a priority.

I think the safety of women and babies in childbirth should be a priority.

We'll agree to differ.

"NICE says women should not be denied epidurals when they ask for them. NICE takes cost into account so your cost argument doesn't stackup."

I'm not sure you're right here.

There is no analysis of cost attached to this recommendation.

I said both are a priority.

Care that leaves women psychologically traumatised or terrified of giving birth again is NOT safe care.

Yes, let's agree to differ.

Just because something is 'natural' it doesn't mean it's pain-free and empowering and beautiful. Stillbirth and miscarriage are as natural as childbirth, because statistically a certain proportion of pregnancies will end that way. Doesn't mean those experiences are a walk in the park. Cancer is natural. So is a brain aneurysm. Menstruation, pregnancy, childbirth and breastfeeding are all perfectly natural but most women, except the luckiest, find some or all of these experiences to be painful in some way.

My miscarriage at 12 weeks was 'natural' as it happened before I could get booked in for the ERPC. It was excruciating and terrifying - but completely natural.

@shagmundfreud
Are you a woman?

I had a water birth and gas and air. Once in the water pool with that it didnt really hurt that bad and definitely was nowhere near as bad as I thought it would be. I always used to worry as I have teeny hips and am very petite but it was all fine. The midwife aftercare was crap though but I actually enjoyed the birth.

I also personally wouldnt have an epidural as I know 2 people who have had persistent back problems from them months/years on. I am looking forward to, and also quite excited as I am hopefully having another water birth hopefully in the next couple of days as I am over my due date. I found it a nice experience in the dark in the water.

If a developed country can't guarantee both safety and pain relief to women giving birth, then we shouldn't call ourselves developed. Women are not bottom of the pile especially when we are bringing the next generation into this world.
Ive rarely heard of people being left without epidurals (if requested) in any other developed country.

By the way, great article by Amy Tuteur WhatTheHell. Imagine, childbirth policy based on science and medicine! What a novel concept!!

I think there are few areas of medicine that are more politicized and meddled with than childbirth. The utterly pointless WHO mandate that C-section rates should be less than 15% is a good example of that. They freely admitted they had no scientific basis for that and yet the NHS was pressurizing all its Trusts to comply with that random and pointless target.

@NapaCab
I'm glad you liked the article! I found it very interesting and I simply had to share it. The WHO target was completely random and I'm glad they've admitted it.

Perhaps we could wheel Amy Tuteur in to explain why it is that in the UK, healthy women giving birth in CLU's have double the rate of c/s, with no improvements in neonatal outcomes, compared to women giving birth in midwife led units with no obstetric facilities?

"If a developed country can't guarantee both safety and pain relief to women giving birth, then we shouldn't call ourselves developed"

Unfortunately it seems that women have to compromise. Want immediate access to epidural analgesia? Then you have to go to a CLU. Go to a CLU and it appears that you're nearly doubling the likelihood of having an emergency c/s just by stepping through the doors.

Go figure.

"I think there are few areas of medicine that are more politicized and meddled with than childbirth"

I SO agree with you. And how many decisions are made without a good evidence base. Like the one to move all births into a hospital setting in the 1970's, despite any evidence that it was safer or better for women and babies, except those whose pregnancies were complicated by health problems.

The history of obstetrics is littered with examples of harmful and inhumane practices, all done in the name of safety and science.

(routine forceps and episiotomy; Scopolamine birth; routine x-rays for pregnant women; routine induction at term; routine use of lithotomy... shudder)

NapaCab - I'm wondering who your comments about pain and nature are directed at.

I don't think anyone on this thread, myself included, has characterised childbirth is intrinsically painless and easy, or without risk.

Or maybe you're referring to something specific that you've read elsewhere?

"great article by Amy Tuteur WhatTheHell. Imagine, childbirth policy based on science and medicine"

Is Amy Tuteur holding up the US system of obstetric care as a model of good practice?

A system where nearly one in three women end up having a c/s?

Is that something we should be aiming for here?