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?

Epiphany 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.

That's exactly what I understand as well.

There is one important fact that health professionals ignore. Over half of all planned caesareans are because of risk factors including breech presentation, placenta problems or maternal ill health (high blood pressure). These all (including breech) have higher incidence of bad outcomes.

To compare these with a group of women with no complications is really bad science but it suits the message - natural birth good, interventions bad.

And if what we get told is biased, how can there be informed choice?

Back to midwives and doctors needing to be on the same page.

And we need more resources for more midwives across the board, which I'm sure no one is going to disagree with.

Its no good to turn someone like Babies down for an ELCS with a "no", and to not offer emotional and MH support for her anxiety. A request for an ELCS is a red flag. You only get it, if you get a "yes". Thats a failure. Plenty of people to blame for that one.

I tend to share pe

Oops
I tend to share people's scepticism about the meaning of the rates of admission to SCBU. DD, who was a hulking great thing with an APGAR of 10 and a yell like Lulu after treading on a Stickle Brick was whisked off to SCBU after our EMCS was whisked off to SCBU because one of the 17 attendees in theatre thought her breathing "sounded a bit funny". I'm not saying they were wrong to be cautious, given that her heartbeat had been slowing in labour, (because she was a muppet and holding onto the cord) but I'd be very surprised if a similar VB baby had been admitted.

Don't worry I have a plan, I'm waiting until I am '10 days late'. Which I should get to without going into labour as my due date is 10 days out and then I will gracefully accept an ELCS (which TBH also terrifies me but as I am not going to have a good experience anyway, I would rather choose the 'safest to my baby' option of entering the world IYSWIM)

If I go into labour early, I am screwed, so I am jamming my head in the sand and determined not to think too hard about that pathway.

Sadly all the effort I am putting into not breaking down about this is coming out at night as I am grinding my teeth so badly that I need a special night gum shield to try and prevent further damage and to stop my face from aching.

On the bright side, I bet my hospitals ELCS rates are lower this year and that is all that truly matters to the hospital so well worth my stress

I have read this thread with great interest and sadness.

What comes across to me most of all is the passion that midwives and women have for the same subject.

Could you imagine what we could do if we worked together? The positive birth experiences we could bring for women and their families as well as midwives. So lets open a dialogue, go to your Labour Ward Forums, Maternity Services Liaison Committee, take a print of this thread and lets engage. I for one will be going to see our Head of Midwifery and asking for ways of engaging with our service users

I wonder if anyone told midwives that they were to cease having uncharitable thoughts the moment they received their registration?

Seriously, who doesn't have uncharitable thoughts from time to time?

I really think that hospitals have got the wrong end of the stick with getting their CS rates down. It seems perfectly reasonable to me that a woman who has had a long labour (2-3 days sort of thing) which ends in an EMCS wouldn't want to go through that experience again, and I think we would nearly all agree that an EMCS is the least safe sort of birth to have. Cutting the CS rate by cutting down on EMCSs would seem a better approach than trying to push a VBAC on a woman who doesn't want it. Prevention is surely better than cure? Are hospitals asking is why so many EMCSs happen in the first place?

I do often wonder how many are due to failed inductions where the woman is 'overdue' (40 +10/12/14 depending on your particular hospital, so doesn't exactly seem to be evidence based) and whether the woman would have had a perfectly straitforward VB if left alone for a few days. I can't remember if it was said on this thread or another, but someone said that inductions should be banned altogether, and I think I would agree. I certainly think that it should require a reason other than a date on a calendar.

I can't get my head around research which factors in later costs for continence issues for women planning planned v/bs but doesn't factor in the costs of consultant care and the growing risk of serious morbidity in labours and births following planned c/s.

I also think that if the same amount of money was allocated to women having planned v/bs which is allocated for a planned c/s (so that women could have case-loading care and guaranteed one to one care from a midwife they know, in an environment which optimises their chance of a straightforward birth) we'd see the morbidity rate of v/b plummet and planned c/s would no longer appear comparatively safe for low risk women.

I've just been reading about gap junctions! Interesting!!!!

La Volcan, I think all the wrong questions are being asked by policy makers.

I think both midwives and doctors need to be more wary of research and be prepared to be critical of methodology rather than just hearing the message they want to hear. Hearing things that are at odds with your core beliefs is crucial to actually being able to understand how to improve things.

I think we need to be very careful of prevention rather than cure in maternity - it could lead to defensive practise which isn't a good option either. It is essential to do, but it needs to be done right. What we need is actually better understanding and being able to accurately predict birth outcomes. Which I think to a degree we are currently unable to do with the research we have - because too much of it is flawed.

In order to get those answers we need to start asking the RIGHT questions and identifying the REAL problems.

We need more midwives and we need to put money into maternity care. Good care from the outset, I'm sure has benefits further down the line. Less malpractice, less women having a bad experience and subsequently developing secondary tocophobia, less women influenced by horror stories of friends, less long term complications... it all adds up, but because its not tangible and can't easily be counted especially since a lot of these costs end up in other departments of the NHS, its not seen as worth investing in.

I think a lot of policy makers are deeply ignorant of problems on the front line, the latest information and don't want to educate themselves. If the Chair of the NHS Alliance isn't fully up to date on the latest WHO recommendation on CS he should not be doing an interview on national radio. I think a lot of policy makers simply take advantage of tabloid headlines and public outrage on a number of subjects - not just maternity care.

I think inconsistant and different policies from hospital to hospital which are often very different to NICE guidelines are incredibly confusing and frustrating. As is a lack of flexibility in hospital policy.

Trying to cut ELCS rather than EMCS is the perfect example.

Gap junctions StarlightMaJesty?

Also, in response to NarkedRaspberry's comment "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"

I had a VB with DS, which seemed to be progressing normally. I was keeping active to help me cope with the pain from contractions, so no continuous fetal heart monitoring. Midwife checked his heartbeat about 3 hours after I arrived in labour ward (not for the first time), and in under 5 minutes had got an obstetrician, a senior midwife and 2 paedatricians into the room, as DS's heartrate had started dropping during contractions.

She certainly called in the doctors at the earliest sign of trouble, and I don't believe for one minute that her reaction was unusual under the circumstances.

StrandedStarfish

Could you imagine what we could do if we worked together? The positive birth experiences we could bring for women and their families as well as midwives. So lets open a dialogue, go to your Labour Ward Forums, Maternity Services Liaison Committee, take a print of this thread and lets engage. I for one will be going to see our Head of Midwifery and asking for ways of engaging with our service users

It's fantastic that MWs like you are open to change and are prepared to listen.

To add to your message, I think the media has a big role to play as well - in particular the 'too posh to push' denigration of women is ing - it is based on ignorance and rank mysogyny.

I hope that these student midwives develop more empathy by the time they qualify.

I had a positive birth experience despite the behaviour and actions of some of the midwives I met. I also wrote a very long, dreadfully TMI account on here of what happened to me during childbirth. I found it a wonderful, cathartic thing to do and I would love to read other women's birth stories. Midwives should encourage discussion of what happens during labour as a way of coming to terms with it, not complain that women are telling horror stories because generally we're not, we just want to share our momentous experience.

Blimey! This thread has moved on a lot since I posted this morning...

There are a few things which I have picked up on and would like to respond to.

Firstly, that many of you appear to think that midwives have an agenda - based upon the many midwives I know through work and through SMNET, I know that this is not the case. We really couldn't care less about the c-section rate for our units. Every single midwife I know would never withhold analgesia if it was requested, however the majority will discuss analgesic options, but will not "offer" pain relief. In fact, the comment about a midwife not offering pain relief made me laugh. I wonder how many women, if offered any kind of analgesia by their midwife at any point in their labours would feel that their midwife had faith in their knowledge of their own bodies and coping mechanisms. I don't believe my role is to tell women what to do. My role is to share information, discuss options, listen to what women want and try my very hardest to ensure that that woman gets what she needs/wants at the time.

However, (and this links to another point I wanted to make) as a midwife it is not part of my role to decide whether a woman has a caesarean section or forceps delivery. This is the domain of obstetricians, and is catagorically based in the antenatal period upon risk factors, or in labour by deviations from the normal process of labour (sometimes caused iatrogentically by our interference in said natural process - hence my dismay at times at medicalisation).

It's also important to consider that NICE guidelines are just that: guidelines. They are also used in conjunction with guidelines published by other groups such as the Royal College of Obstetrics and Gynaecologists. These guidelines are also used alongside trust and hospital policy, which are also mainly written in order to reduce the risk of litigation, rather than to improve care and outcomes. Midwives, as doctors, are trained to critically evaluate research and then to relate that research to their practice, but to also comply with what their trust and what they're told to do by groups such as CNST. It's a minefield at times and it's really saddening that research and protocols have overridden good patient care.

Some have said that midwives withhold epidurals. This really upset me as some analgesics (namely pethidine and epidural) can increase risk of harm in mum and baby in certain situations and the timing of these procedures/drugs does have to be considered. This is something which should be discussed with all women antenatally and also at the point of request. When discussing epidural, we also have to consider availability of the anaesthetist. Most maternity units have one anaesthetist per shift. This means that should that anaesthetist be already with a patient or in theatre, an epidural will not be forthcoming at that time. I personally have been distressed myself at the time wait between a woman's request for an epidural and her actually having it sited. I hate to think that women feel that the midwife is just withholding it for her own agenda. There are often other factors involved.

Someone asked how midwives can be champions of normality and then also care for those having (for whatever reason) medicalised birth. The answer to this is that yes, there is confusion, but the role of a midwife has expanded exponentially since 1904 when midwifery became a regulated and recognised profession. The advent of the NHS, the inference from government pushing all births from home into hospital, the 1960's where medicalised birth and routine episiotomy was the only way to give birth and the 90's drive for home birth have all contributed into a profession which at times is muddled.
I work on both consultant and midwife-led (low risk) maternity units. One day I have my low-risk, normality hat on. The next I'm wearing my obstetric one. I regularly straddle both camps, and I'd like to hope that I do it well. That's what makes my job so rewarding and challenging and what ensures that I can recognise deviations from normal.

As a midwife I often struggle with the ideological view of midwifery and the reality. The reality is that the service and politics surrounding it are in a mess and it is heartbreaking that midwives are being given a bad name because of a system that's failing and because of a handful of jaded and unprofessional midwives.

I'd also like to mention that the comments regarding C-section being safest option for baby are a little misguided. The risk of babies developing respiratory distress syndrome and requiring admission to neonatal units are higher with even elective C-sections. It's all about evaluating and balancing risk - if you asked 100 people to risk assess a situation, there would be many classifications of the perceived risk and severity.

I don't honestly think that this thread should really be mums vs midwives justifying their beliefs or decisions, but mums and midwives working together to overcome the barriers and actually improve our maternity services so that women are getting the experiences that they want.

Well if there are horrorstories then people will tell them...most of my friends have had bad experiences with midwives...mine was so bad i have opted for private care with a consultant so a midwife isnt making decisions on my birth...i am sure there are great ones out there but under the nhs they are so stressed with too many patients at a time...

i have had midwives riducule me and made me feel guilty for wanting a c section this time and for not being able to breastfeed last time due to low supply ...

Excellent post MissRiri.

In answer to Billy11 I had bad care from the 'Consultant' i.e. whichever junior doctor I happened to see, and I eventually ended up telling one of them exactly what I thought of her, (best thing I ever did!). One of the midwives I saw was an absolute cow, but the others were wonderful, so I don't think you can say midwives bad, Consultants good.

I am not sure what exactly good care boils down too - getting the appropriate care for your own circumstances and not care based on protocol would be a good start. A lack of say in who you get to see doesn't help and nor does a postcode lottery.

Levolcan : Just to clear sth: junior docs aren't consultants. They are junior docs with very very small experience to consultants .

And forgot to say junior docs aren't specialised yet in anything . So if you want help and advice about preg and birth it's prob best to see the midwife or obstetrician /gyno if present.

LaVolcan - did you pay privately for your consultant? Because that's what/who you should have got if you did, at a pinch maybe their registrar instead - but you certainly shouldn't have been fobbed off with a junior in that case.

missRiRi' I appreciat you posting here and your tone is very reasonable! so thank you.

Can I with the greatest of respect point something out please. In your post, you respond to posters who have said that cs is safest for the baby by saying they are misguided, and mentioning the risks of breathing difficulties at birth and admission to a SCBU as being increased risks to babies born by planned CS.

You don't mention the info that comes from NICE, and was discussed in the consultation document revising the cs guidelines which said there was LESS risk to a baby born by planned cs of birth injury and serious trauma than there is with a planned vb.

People here have been pointing out that an advocate of one kind of birth chooses to present a skewed picture of risk. You just aren't given the full picture.

Which is what you have done there. I'm sorry, as the rest of your posts have mostly been quite balanced, I think - but that kind of partial info is exactly the kind of problem we are talking about.

You are right that women will attach different values to the same set of risks. Someone might be very alarmed by the thought of breathing difficulties - someone else might be more concerned by the increased risk in a vb of serious birth injury.

But if you only give them half of the picture, they are not informed or empowered to be able to make a decision.

InspectorGadget Sun 10-Jun-12 21:17:43
"I wonder if anyone told midwives that they were to cease having uncharitable thoughts the moment they received their registration?

Seriously, who doesn't have uncharitable thoughts from time to time"

No, but maybe someone should have told them that not all thoughts need to be vented on a public forum. It looks unprofessional and may well damage the relations of women with their midwives.

Interesting to see how the thread has moved on over the weekend. To be honest I'm not surprised that some of the midwives got upset, some of the things that have been said about them are horrible.

Personally I'm glad that midwives champion natural birth, would we really rather have a service who's core ethos was that women are incapable of giving birth naturally therefore we must drug them up and cut them open for their own good? Drugs and intervention have their place in childbirth but I view the assumption that they will always be needed as a response to the negative perception if childbirth that exists in general.

This negative perception isn't the fault of mums net or the people who post here, I'm not sure where it comes from. Generally there are a wide of views and some very supportive women posting here. I think there have been quite a few threads relating to ELCS recently and i think the original post on the original thread was written on the back of looking here over a very short period of time. Had she looked on a different day she may have ended up writing about the forum being a great home birth resource.

That said on both 'sides' for want of a better expression posters are shaped by their own personal views and experience. Childbirth is an emotive topic and the need to feel like you're making the right decision for yourself can make even the most rational and understanding woman feel slightly fundamental about their choices. The hideous 'too posh to push' view, has a cousin in the 'the too interested in the experience to care about the health of their unborn child view' of women who wish to have a home birth (admittedly it's not quite as catchy) which I've come across a lot.

There is a rising problem, these days, with professionals who fail to handle social media in an appropriate manner; they forget that what you post is there for the world to see and it will affect how they think of your profession.

There was a bit in the paper the other day about a priest who had been posting all sorts of silly things about his attitude to his profession and his behaviour when off duty- he genuinely didn't seem to see that this would affect his ability to work with his parishioners when he was on duty (I believe the diocese is on his case though).

A website which suggest that many midwives may be looking at labouring women in pain and despise them could damage the trust between women and midwives quite severely: I could imagine myself lying there looking up at my midwife and wondering if that's what she was thinking and being afraid to tell her if something felt strange.