Student midwives say Mumsnet posters on the birth forum just peddle horror stories about birth and midwife bashing WTF?

[Ushy]

This is the link and it made me feel really upset.
They have no idea how traumatic birth can affect people. This forum is one of the few places people can share their experiences without being judged.
www.studentmidwife.net/fob/mumsnet-and-the-promotion-of-medicalised-birth-thoughts.69784/
Not at any point do any of them question whether their apporach is wrong. No - it is all WE need 'empowering' 'educating' 'encouraging' to do things their way.

I did it their way once - big mistake and PTSD. Subsequently went for caesarean and epidural.

What scares me to death is that if I ever had another child, then I could fall into the grips of this lot and I just think that is scary.

Anyone else feel the same?

Singing "Are you aware that pregnancy alone is the cause of most UI and pelvic floor repairs? I don't have the stats to hand but can post a link once I get it. Vaginal birth is the highest cause of this."

???? Perineal trauma is almost only the result of planned vaginal birth. Urinary incontinence is significantly worse after VB as well. That's why NICE adjusted for the additional cost of urinary incontinence after vaginal birth.

Do you ever feel that some of the 'evidence' you are taught might be a bit biased?

Sorry, my mistake, NICE says a caesarean costs £84 more than a vaginal birth after adjustment for downstream urinary problems.

I put it the wrong way round.

Caesareans are only marginally more expensive overall partly because you have to factor in the small but non-zero number of babies suffering disastrous birth injuries during a VB, each of which will cost the NHS several million pounds in compensation and/or treatment.

Interesting thread - wish I'd seen it earlier!
Can't read the second link, probably wouldn't want to from what I've seen on here but it seems to require a log in now to read it.

But the first thread - didn't read all 10 pages, just the first couple and last couple - as someone said upthread, you can find threads to justify your position on here easily enough if you search for them, but there are many threads that would counter your position as well. I've seen threads where people have had good and bad experiences of MWs/elCS/VB/VBAC, you name it. I "know" one of the posters who was torn to bits and had lots of surgery and will never have another baby because of the damage that was done (I don't know whether she could physically but she couldn't do it mentally).

I think that people tend to post when they've had a bad experience, much in the same way that it appears people on MN only have really shitty relationships - people in general don't tend to discuss the banal, the ordinary, the non-eventful.
So just as if their relationship is ticking along nicely, there's nothing to say, so if their birth went ok, no real dramas, there's nothing much to say. People aren't going to post "oo, I'm mildly anxious about giving birth but it will probably be ok" or they'd get a lot of and faces as to why on earth they were bothering to post!

It's important to remember, I think, that people do only tend to post about the more extreme events and that this obviously skews the "norm" on forums like this.

I think the maternal-request ELCS debate ties in with the whole issue of combining NHS/private care, 'topping up' etc, especially when you start talking about costs. e.g. I'm sure many women would more than gladly pay £84 (or indeed £800) to have the birth of their choice, especially as the alternative would be paying £10k+ for consultant-led private care and ELCS. Same for epidurals.

I know this is a wider debate and applies probably to other areas of the NHS. But while we're lucky that we have and NHS, and free maternity care for everyone who needs it, and it does do a great job in safely delivering the vast majority of babies, the setup does tend to foster this attitude that you'll get what you're given and you should be grateful, if you demand more you're taking funds away from cancer patients etc etc.

There's probably also an untapped market in more affordable private maternity care (or more options for combining NHS and private), and insurance companies covering more maternity-related costs.

Just some vague thoughts really, about how we could structure maternity care so that women have more real choice about their birth plan, are treated respectfully as individuals, and have better post-natal care. If that means paying for some of the improvements, I wouldn't necessarily have a problem with that. Though admittedly I say that as someone lucky enough to be able to pay.

Ephiny you make a good point. My set up is that I am paying for a private antenatal care package but will have my section done on the NHS. Will also have my 6 week check privately. We simply could not afford to pay £10000 for a private section nor should we have to!

The one thing I very rarely see on MN is a pro-epidural stance. Any conversation about epidurals is dominated by people saying a) I couldn't get one although I asked or b) I had it but it didn't work properly c) I had it and it left me with nasty side effects d) I had it and it worked fine but slowed down labour and led to a cascade of interventions (my personal experience). The very few people saying "I had it and I had a perfect "natural" birth with zero pain" are visibly in a minority.

So that goes against the midwives' perception of MN as pro-medicalisation, and pain-denying.

Thambwitch That is definitely so true but I think what we are getting at is not which experience is best so much as how can we persuade midwives to accept our choices if they are different from theirs.

If midwives are trained to believe that physiological birth is always best how can we change that view if we know personally that that is not what we want.

In labour you are vulnerable and they are in control. That is incredibly frightening if the people caring for you don't understand what you need because their ideology stops them from listening or hearing what you are saying.

Sorry Ushy, I was sort of responding to the initial link to the thread on the student midwife board.

I agree that it is very important that "listening to the patient" should be top priority - not as in "do whatever the patient wants" but "listen and take on board their concerns, however you feel yourself about them".

Probably it would be beneficial for trainee HCPs who deal with the public all the time to do a stage 1 counselling course. I did one of these, and you learn very quickly that listening in a non-judgemental fashion is the most important thing you can do; that and not imposing your own values/ viewpoints/ feelings onto them. If you can't get that basic point, then you don't pass your competency as a counsellor (I didn't complete the training because of cost and time reasons).

Singing, a midwife that delivers you baby will meet you when you are in no fit state to have a discussion and plan your birth care.

There is time to explore the causes and solutions of other conditions with doctors, and often a doctor WILL know you and your past history to some extent.

I disagree thumbwatch as I've seen lots of threads on here where other posters have given positive advice/stories of their experiences.

Yes you get the gory stories as well but that's the reality isn't it, good experience for some and bad for others. Unless its being suggested that the only women who have difficult birth experiences post on MN and therefore MN gives a biased view of childbirth which is obviously nonsense whatever someone's motivation for participating.

This should be reported to the Royal College of Midwifes.

Ushy - yes, I think on both of those threads (and sometimes on here, too) there are views expressed along the lines of 'a vb with no drugs is the BEST for you and your baby, and you are going to have one whether you like it or not. And any woman who begs to differ is a deluded ignorant fool who only thinks that way because she isn't as educated and enlightened as me. So I have licence to ignore her.'

I understand being a mw is a tough job, and not every patient is going to be sweetness and light. But on those threads there is approval of the Good Woman (shares mws views, does what she's told, etc) and disapproval of the Bad Woman (wants epidural/other anaesthesia, does awkward things like ask for drinks of water!) - and this attitude MUST affect the care they give to the women they are supposed to be looking after.

The only negative experience I had after my cs, while I was still in hospital, was with a couple of mws, one of whom who had reacted in a hostile way to the phrase 'maternal request' in my notes (she rolled her eyes and pulled a face at the mw standing by my bed. As if I couldn't see her).

They 'missed' a dose of my painkillers, leaving me to manage on paracetamol alone, 24 hours after my cs. They weren't busy, btw - when I finally struggled out to their desk, after they had ignored repeated requests from my dp to please give me my painkillers, three of them were standing around looking at someone's holiday snaps and chatting.

They had told dp that 'a caesarian hurts, you know' - and that sometimes 'giving painkillers can mask something that turns out to be a real problem'. I was just on the standard post cs painkilling protocol, btw. That had been written out by the consultant.

Anyway, with much rolling of eyes, they eventually gave me tramadol (for which there would have been no need if they had actually kept on course with the painkillers I was supposed to be taking).

that was the only point when pain was a problem for me, post cs. When some horrible, horrible mws WITHHELD the painkillers I was supposed to be getting.

I complained about them to my (excellent and caring) community mw when I saw her post birth. She was really upset and raised it with the consultant mw (who was also fab). It still makes me angry that when I was in pain and vulnerable they chose to treat me like that. I was, despite my politeness and compliance on their ward (dp was there most of the time, they never had to bring me water or anything), in their eyes, a Bad Woman.

btw, after ds was born I made sure I wrote cards and got a couple of small 'thank you' gifts for the 2 mws who mainly dealt with me, and who I was very grateful to. One way and another, I left it so late, I was wondering if it was worth it still, as the moment had 'passed' somewhat! But I did, and the more I think about the awful mws on those threads, the more glad that I am that I got to express my thanks to them and tell them specifically how they had helped me.

You have doctors, some of who seek to over-medicalise birth, and midwives and the NCT, who want you to use aromatherapy and breathe through the pain . I'm not overly keen on either approach but planned c sections are safer for the baby.

Both sides think they know better than the mother but one side has a lot more years of education under their belts. I don't trust midwives to recognise that a baby is in distress/that there are problems with the labour and call in the doctors at the earliest opportunity.

Exactly Fruity. Many of them have an agenda - they believe there's a right way and a wrong way to give birth. Even the ones who aren't slagging off mothers on the linked thread are basically saying, 'It's not their fault, they've just been misled!' They can't see that they're just as patronising and arrogant as the 1960s male surgeons who would do a hysterectomy at the drop of a hat because why would you care if you've finished having DCs?

Fruity another story that makes me really angry :( I'm so glad you made a complaint.

planned c sections are safer for the baby

Safer than what?

EMCS or all births? I thought more babies born by CS ended up in SCBU than born vaginally - which doesn't suggest that it's safer. Of course, as always, we need to dig a bit deeper. Do we know whether they are planned CS or emergency, and do we know if the CS was done because the baby needed to be got out asap?

LaVolcan not sure who you are quoting but I am assuming they might mean ELCS are safer than EMCS? Certainly much lower rates of breathing difficulty, infant nicks etc with planned section at 39 weeks compared to emergency. Which makes sense really as usually emergency sections are due to early arrival or a very distressed baby post labour.

Certainly my consultant is adamant that an ELCS is now as safe as a straightforward VB (ie no forceps etc required).

Wow.

I've found MS a really useful place and very balanced really (as apposed to some of the other forums I read).

Considering it is my body giving birth, I pay my NI contributions and I am a grown women I do consider it my right, once I have been given the appropriate information by my midwife / Dr. to have access to the birth choices I want! FFS.

ELCS is safer than vaginal birth for the baby. It carries higher risk for the mother.

The advice in the latest NICE guidelines is that planned c sections are not safer for the baby actually. La Volcan is correct about the SCBU thing. It was the only thing that they came up with as making an ELCS more risky/safe than a planned VB - which included the more negative outcomes of a operative VB and an EMCS.

There is research that says operative VBs and EMCS are far more risky than a ELCS for a baby but you shouldn't be treating them separately from the possibility of a perfectly good VB without problems. The shoddy methodology thing goes both ways.

I do think you have to judge all stats on PLANNED method of birth primarily. If your personal risks are more likely to push you towards a more difficult birth then looking at risks associated with an operative VB or EMCS might be an appropriate consideration in your individual case. So increased risks for SCBU admission might be worth worth it, in that trade off.

Thats the big issue. All this business about natural VB doesn't really bare out when there are groups who are disproportionally more likely to end up with the shitty end of the stick an operative VB or EMCS. THAT is ultimately what everyone should be focusing on. Not whats 'best', but being able to accurately predict those who are most at risk of negative outcomes. To my mind, since fear does seem to be one of the biggest influences in this and CAN be measured prior to birth, why the hell we aren't focussing on that is completely beyond me. Fear absolutely should be being put on the map on a par with blood pressure, obesity etc, and its just completely disregarded and completely taboo.

Instead we have a situation where ELCSs tend to be vilified instead. The key should be about looking at the worse outcomes and tackling those - not tackling the issue of wanting an ELCS as THE problem.

narked possible higher risk depending on the individual mother.

I consider the risk to my continence far greater than the risks of ELCS and therefore see section as the safer choice for me individually.

I should also point out though that the NICE guidance is severely lacking when it comes to woman wanting more than one child though. Risks are different in subsequent pregnancies and this message isn't really getting across in the pro-elcs debate. Which does make even the NICE guidance questionable in places.

"All this business about natural VB doesn't really bare out when there are groups who are disproportionally more likely to end up with the shitty end of the stick an operative VB or EMCS"

ITA. I have previously had three malpositioned babies with bad labours, resulting in 2 operative VB, 1 EMCS and three lovely babies.

Based on this history, I requested an ELCS for my current pregnancy. This request was rejected, as the consultant thinks I could have a normal VB ! How on gods green earth am I going to have a 'normal VB', I have more chance of winning the lottery (and I don't buy tickets).

It's not straightforward to compare - in studies ELCS generally comes out as higher rate of 'morbidity' for the baby overall compared to planned VB (though it's very safe in absolute terms, especially if not performed before 39 weeks). However there are certain risks (stillbirth and brain damage, IIRC) which are actually significantly reduced in ELCS. It comes back to the thing about risk being a function of two variables - likelihood and severity. There also isn't much data on maternal request ELCS specifically, though ELCS for breech makes a good proxy.

It's been suggested also that the increased ELCS admission rate may be an 'artifact' at least in part (it's a bit of a paradox because in some cases the same studies found that ELCS babies actually have higher APGAR scores on average), i.e. more medical professionals attending a CS birth 'just in case' may mean the threshold for SBCU admission is slightly reduced.

Absolutely agree that you have to compare intended rather than actual mode of birth to get any useful data for making a decision, i.e. planned ELCS vs planned vaginal, where the latter category includes EMCS and forceps/ventouse (and the former may contain the occasional vaginal/EMCS due to labour starting before the scheduled date!). More recent studies tend to attempt to do this.

Oh Babies . It's all about £££ and policy and not actually looking at what's best for you in your situation. Can you go back? Or at least ask for them to produce stats to back up their opinion (for women with your history?)