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?

Most women wil not be guaranteed an epidural because it depends on manpower. An anaesthetist needs to be available and enough midwives to provide a higher level of care.

My 3rd DC I was definitely 'stalled' to avoid the extra work for the staff.

The midwives I'm friends with are all quite open about the amount of extra work/monitoring an epidural will require so will 'encourage' a woman to hold on and hopefully avoid one.

Who ever said you don't have to choose between a safe operation when having your appendix out or pain relief was spot on. I don't see why women should have to when giving birth..

I also feel my midwife friends have been brainwashed into thinking childbirth is natural, so natural=woman should cope with the pain. They do throw out the old chestnut 'women have been giving birth for thousands of years' blah blah. I was also told that avoiding epidural was 'better for baby'. The ultimate guilt trip!

I have had 3 'natural' labours. Nothing natural about them just absolute agony and distress.

Women must be told the truth and should be provided with adequate pain relief and respect for the agony and physical damage they are experiencing.

I have two babies, the first birth was painless, lots of people won't believe it but it was, the second was a bit painful so I had gas and air. If it had felt very painful I perhaps would have asked for an epidural. I agree with OP, that childbirth is varied and can be viewed as a spectrum rather than from polarised veiwpoints.

Shag "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?"

Wrong... double the death rate in midwifery units for first time mums - what's more women who go to consultant units have more risk factors even though they are technically low risk. There was an article about this in an online magazine (hunting for the link) but basically a recent study concluded only no STATISTICALLY significant link between death. You need large differences for rare events to show statistical significance.

Hardly surprising really - when time counts a very small extra number of babies are going to die because of the delay in getting them to a consultant unit for a caesarean.

I think, though, there is another factor. Even if you are low risk, you are more likely to choose a consultant unit if you have a suspicion you might hit problems e.g. big baby, trouble with previous birth. So I don't think population of women who choose consultant units is the same as those who choose midwifery care.

@shagmundfreud

I think I can explain why CLUs have a higher section rate. Because all high risk women deliver at CLU (women with multiple pregnancies, previous caesarians, preeclampsia, heart disease etc) and we know that their chances of ending up with sections are greater.

Did it also strike you that some women wouldn't consider an emergency caesarian the end of the world? Consultants are overly cautious at times and would rather section early than let things go from bad to worse, whereas I presume midwives would prefer to avoid sections as far as possible. Neither approach is wrong, it's just different. I think everyone is free to choose which approach they'd prefer and make a decision accordingly.

To imply that women avoid CLUs and hence epidurals because you think that consultants tend to perform more caesarians is strange.

You clearly seem to be wary of consultants, epidurals and caesarians and that's OK. Just realise that others don't necessarily share your views.

With respect though I love, in a system where funds are finite (as in the NHS) don't the powers that be have a responsibility to promote practices that result in the best clinical outcomes, as they do in relation to all other areas of healthcare?

At the moment what we know is this: women giving birth in settings where there is restricted access to epidurals (in MLU's) have the best clinical outcomes and the highest satisfaction ratings afterwards.

Which suggests to me that the sensible option is to expand the provision of this service rather than focus on expanding obstetric services for healthy women.

This would lower the over all c/s rate - the happy side effect of this would be to free up the services of obstetric anaesthetists to provide care for high risk women or for low risk women who are willing to trade an improved chance of a straightforward birth for that of one which is largely painfree.

Win win!

@Ushy
I agree with you. Even if I was classed as low risk, based on my medical history, my family history and my desire for adequate pain relief I'd certainly choose a CLU. I know the chances of being in an emergency and being transferred to a CLU from a MLU are probably small but it's not a situation I'd want to risk being in.

"Women giving birth in settings with restricted access to epidurals have the best clinical outcomes and highest satisfaction rates"

Proof please. Where are you sources?

I cannot understand how you can suggest that 'healthy women' be given restricted access to epidurals and consultants. I guess you don't agree with the concept of choice. Pity.

I am sure many women who choose midwifery units are women who share your views about natural childbirth and generally don't want access to epiduralls. I think that is fine but EXPAND midwifery care? Only to cope with women who CHOOSE to go there.

I personally would rather go to a hospital where they intervene early when things go wrong and where epidurals are a choice. I would hate to see midwifery units expanded so we are forced to go to them and choice is taken away from those of us who believe that whilst childbirth might be natural it definitely isn't always nice.

Here here Ushy! I agree.

"Women giving birth in settings with restricted access to epidurals have the best clinical outcomes and highest satisfaction rates'

What like Afghanistan? I suppose it means that women who strongly believe in natural childbirth and that giving pain without pain relief is 'empowering' might well have high satisfction if that is what they wanted in the first place.

That doesn't mean women who DON'T share that view would feel the same - I think they would feel very very angry and discriminated against.

menat giving birth without pain relief

I chise to give birth in hospital and not a midwife unit so I would have the option of an epidural. I had one in the end and it was fine, got rid of the pain, no back problems. I agree all women should have access to pain relief.

Ushy of course you are right that some women have traumatic births - I just meant that the safety of baby and mother was the most important thing - would rather have a traumatic birth and the baby be ok than an 'easy' birth and the baby have problems. Also some women do spend ages going on about how awful their birth was - I don't mind if their birth really was awful but often they are just over dramatising. Am sure childbirth very painful for 99% of women including myself!

What - no, the latest research (Place of Birth Study 2011), like most previous good quality research CONTROLS for risk status at the start of labour.

It found that Low risk women giving birth obstetric units had nealy DOUBLE the likelihood of having an emergency c/s and of having a forceps delivery when compared to similar mothers giving birth in freestanding midwife led units. And no better outcomes for their babies.

Actually the study found that women birthing in a CLU had 4 times the risk of needing to be admitted to high dependency care or ITU than women giving birth in FMU, but because the overall numbers with this outcome in the study was so low it wasn't considered statistically significant.

I'm fundamentally in favour of obstetrics by the way. Modern medicine has saved the lives of many mothers and babies. I just feel very strongly that the time and talents of surgeons shouldn't be squandered on doing surgery which could have been avoided without compromising the outcomes, if women are given care which supports the normal physiology of birth.

Also think epidurals are one of the wonders of modern obstetrics. We no longer need fear colossally long labours or a birth which is too painful to bear, even with the best and most compassionate care in the world.

We are very lucky to have it!

"Women giving birth in settings with restricted access to epidurals have the best clinical outcomes and highest satisfaction rates" - personally I would have panicked and been in a lot more distress had I known from the onset that pain relief via an epidural was out of the question. As it happened, with DS I had an epidural and gas and air and with DD just gas and air, though I was being scrubbed up for an epidural when I felt the urge to push, the pain was that bad for me.

Every birth is different, every mother is different, and certainly in my case the pain thresholds for each baby is different. You don't know how you are going to feel until the actual moment, despite birth plans and best laid intentions.

For me, giving birth hurt and the after pains with DD were very painful. That said, they weren't that painful that I wouldn't have another baby if we could afford to.

Ushy -

I'm not talking about unassisted birth or women being denied access to obstertric input if they need it or desire it.

You know this but you don't have an answer for the points I've made so you are distorting my argument and misrepresenting my point of view.

It's really unhelpful to do this.

No they didn't control for risk properly that's why the study got criticised. About a fifth of women who developed major complicatioins at the start of labour got shipped off to the consultant unit so it isn't surprising that more ended up in ITU - they were ill to start with.

You know this but you don't have an answer for the points

Which points Shag

I think it's easy to be on the side of the angels with this one - to refuse to acknowledge the REALITY of the situation.

The reality is that many healthy women in the UK are having avoidable interventions in birth and that this is putting a strain on obstetric services.

Increasing access to epidurals in labour for low risk mothers won't make birth better overall in the absence of massively increased midwife numbers and increased MLU provision. Women who have epidurals have longer hospital strays and need more obstetric and midwifery input.

In our current situation the losers will be those women with complex health problems who desperately need the expertise of doctors but are sometimes not getting this because the doctors are too busy doing emergency c/s on healthy women, women who the research suggests might have got through labour without needing obstetric input had they been in a setting which was more supportive of normal birth.

Can you link me to this particular criticism of the Place of Birth study please Ushy?

Ta!

It's funny, I've never met anyone in RL who went on about how traumatic their birth was. Most people skirt over it, even in those first few months when it is a huge topic of conversation at mum and baby groups.

This thread has made me cry all over again....

A wonderful experience? I still get nightmares....and cry when I read about birth.

shag Regarding the cost of more epidurals, I would like to point out that as with many cost benefit analysis done you are missing the big point that the lack of proper pain relief in my case has cost the NHS far more money in the long term with hospitalisations after the birth etc.

Paying for more anaesthetists may be cheaper than dealing with the mess that the lack of adequate pain relief leaves behind....and yes I do think of myself as little more than a mess in need of dealing with at the moment.

thunk good grief I talked about little else...coping strategy I think....

So we sit tight, grit our teeth and just scream for pain relief which never comes?

Shag we live in a democracy and in a democracy you get what society sees as a priority. A MINIMUM standard of maternity care is that women should have safe care and access to pain relief. That is not a luxury that is the minimum. We should stand together and call for that.

If we cannot reach that standard of care then the NHS has failed. Women being denied pain relief and having terrible traumatic labours that leave them psychologically damaged is indefensible.

Women who gravitate to what you call 'low risk settings' are more often low risk women who have had a previous straightforward labour. No problem with that if it's their choice. Do you really feel that women who want to feel that doctors and pain relief are close at hand will feel safer in an environment where neither are present?

Of course not - they will feel more frightened and have worse outcomes.

You either believe women have a right to the safe care and pain relief or you don't.

I think it's a shame there's often such a divided system between midwife led care and consultant led care. Can't all HCPs work together much more closer so that flexible, high quality care can be offered and given according to the developing needs of women in labour.

closely