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?

Sioda I agree with the inherent contradiction and you put it very well. To me, it is no one else's business how I choose to bring my baby into the world and doctors and midwives are there to assist in keeping me and my baby safe during that process. Safe for me means not just at that moment but in terms of how my life will be after birth. I don't want to be left with continence issues and with my medical history there is a high probability that I would be. Why should I have to defend this decision to professionals who are supposed to be caring for me? (In fairness my booking midwife totally agreed with me and referred me to consultant care rather than midwife care).

A colleague of mine was to quote 'ripped to pieces' giving birth to her first child. Pregnant with her second, even larger baby she begged for a section and was fobbed off repeatedly. During a very long and difficult labour she again demanded a section and was told she was too far along by the midwives 'caring' for her. Her baby was born 'naturally' and left my colleague facing months of physio and surgery to restore her toileting functions, a stress she could have done without when trying to care for two children. It is disgusting that her wishes were overruled, DISGUSTING. The midwives 'cheering her on' in labour and telling her what a good girl she was were NOT the ones pissing themselves and not even feeling it for the next six months.

Let women live with the consequences of their own choices, NOT someone else's choice.

Ushy I agree. Do you have a link for that thread?

Is there a name for the fear of being in hospital? I am not being flippant - for me this fear was the predominant one, and telling me how wonderful the staff would be if things went wrong, far from allaying that fear, only reinforced it. I needed support now, for my health as it was then, not a lot of 'if this goes wrong, or that goes wrong...'

What comes across to me in this thread is that our system doesn't allow women to be listened to and given appropriate support, and this isn't just physical conditions. How we would be supported varies between women - some want an epidural and CS, some run a mile from this and want as little intervention as possible but being attended by someone you have never seen before makes it difficult to match the care to the woman.

In my opinion the problem is our conveyor belt system. If we could get away from this, so that the woman was normally seen by a person she knew, (midwife/obstetrician as appropriate) then some of these problems wouldn't arise. So instead of going to the next appointment, seeing someone completely different, saying the same things as you said the last two times, have someone scrabble through your notes and find out that yes you did say that last time, or no, nothing recorded about that ... instead of this, you had 'last time Mrs LaVolcan you were concerned about.... how is it now?' this would be a lot better.

kazb4 It only takes one comment to completely destroy a woman's confidence and trust. I understand in a sense why midwifes feel attacked by comments that might be made here. HOWEVER there is a difference in that midwives are in a position of power and responsibility. One bad midwife undoes all the work of all the good ones.

I have to say that there is a fundamental problem in the uk with the relationship between doctors and midwives and this natural v medical stuff. Midwives often do have a professional biased and I think patients are all too aware of that. Comments here kinda of reflect that. Indeed, one of the remarks by the OP on the student forum was that midwives were being attacked but doctors weren't so much. When you start expressing a such a strong ideological preference of your own, rather than being a lot more unbiased in the way you word things, I think it affects how others see you. Talk of "vested interested" is worrying. I know its about your profession, but it is important to be a lot more neutral I think. I do think that knowing strong ideological preferences, means when pain relief isn't readily available, perhaps because there is so genuine medical reason why you shouldn't have it, that women just aren't going to believe that. Its not good to see posts suggesting that women shouldn't 'have a right' to epidurals or CS.

A lot more needs to be done to bridge that divide and to make women feel they are getting information and treatment that doesn't have a hidden agenda. I know there was an initiative a while back at one hospital to get doctors and midwives working together better which ended up having astonishing results. I can remember the details, but I will try and pull it out and post it later.

Too much that is written about child birth has a particular bias. Its the case for both side. A big problem for the pro-natural lobby is the use of certain words and ideas that create the idea of 'failure' within its context. For the pro-medicalised, it is very often 'if you don't do it this way you will die or your baby will die!". When people talk about the system or targets and budgets and not caring about individuals this is where it is coming from.

Then there is complete ignorance. In the run up to when the NICE draft guidelines came out for the c-section in September last year, there was a flurry of well publicised cases of hospitals announcing that they were stopping all maternal requests, as they were aware about what the guidelines were going to say. You had The head of the NHS Alliance publically quoting a bunch of out dated figures and things about targets for CS and you've got politicians sticking their oar in saying women should pay.

With such inequality of policy that goes directly against the new guidelines, the situation it has created is frankly a complete mess and has really frightened and frustrated women. Its a battle and its a lottery of where you live, not just the staff you come up against. I think its great that NICE have recognised the problem, its just extremely disappointing and worrying the way that politics are blocking and are actively being obstructive. Women really are concerned that targets over CS are more important than individual care. Blanket bans are a disgrace to everyone concerned and I do feel it leaves both doctors and midwives in a dreadful position as they are clearly under pressure not to allow maternal requests because of it regardless of the circumstances. There have been women talking about travelling 200miles to get a CS in utter desperation on here fgs.

In that context there has been a debate on MN about why women don't even trust counselling. Because of the way it is framed. If you are afraid, you are pushed towards counselling if you request a CS, if you want a homebirth, you don't get anything. One is ''good" one is "bad". One you need to be "cured" for.

The way risk is presented to patients is also enormously important. As is options when they are presented as something where a patient has no choice in. (eg internals or being booked in for an induction). The way risk is presented influences decisions. I know there is a big study going on at the moment about how doctors present it to patients. There was an experience that was shown on Bang Goes the Theory that illustrates the point (Series 4 episode 4 - google it. Experience on politicians assessing risk. Its only about 5 minutes long but it really does show an important idea) Absolute risks and increased risks can often show very different things. If people have risk presented in a certain way and then find out contrary information on the same thing but a different angle I do think it affects the trust people have in what they are told and can feel lied to or even manipulated.

Net result. Who the hell can you trust to serve your own interests as a patient?

Answer. No one. If you don't turn into some kind of googlemonster and have a good understanding of how to assess the quality and bias of research out there, you are completely at the mercy of the lottery. And people are wondering why there is a disproportionate balance between middle class and working class women starting to appear in ELCS figures and its being put down to being too posh.

I honestly don't think you can made a fully informed decision purely on what you are told by HCP professionals in maternity at this moment in time and have full confidence that what you are being told is actually in your best possible interests.

Oh dear. Another rant. Sorry... ARgghhh!

Angel It was last year and the 'tricked out of epidural' thread got so many posts in a short space of time it got reported in the BBC and Woman's hour. The thread got so long Mumsnet had to start a second one after the first 1000 posts.

This is it

www.mumsnet.com/Talk/childbirth/1147361-Anyone-else-tricked-out-of-epidural/AllOnOnePage

La Volcan

Fear of doctors is Iatrophobia
Fear of hospitals is Nosocomephobia

Doesn't appear to be a word for fear of midwives!

Hmm far from a rant ....you've hit the nail on the head!

Kazb4 Sun 10-Jun-12 10:31:29
Fruitybread, perhaps I should have put that Tocophobia is the extreme of the fear of labour. the "just" was unwarrented and accidental. As a person with a less recognised Phobia, that is all consuming and controls my life at time, I certainly do not want to down play the seriousness of Tocophobia. But I do believe that the term Tocophobe, should only be used on people that have been truly diagnosed as such by the appropriate practitioner.

I have certain views on self diagnosis on this one. There are a lot of consultants out the who don't want to diagnose it for whatever reason or are just dismissive about it. There is weird thing where you have to 'prove' how afraid you are. Spend a couple of weeks here, and read the posts from women who feel they have been dismissed by consultants.

I could be wrong on this, as I've struggled to fully get the information, but the Swedish model of care seems to be to actively screen for fear as there are common traits that can be identified as making a woman more likely to have extreme fear of childbirth or tocophobia. It doesn't seem to be something thats particularly hard to do either.

Fear of hospitals is Nosocomephobia Thanks, I never knew that.

Thanks Ushy. Had to stop reading before end of first page because it makes me so fucking ANGRY.

Thanks for all your replies. This is a really interesting discussion and it has certainly made me think.

I just have a few points to make in response:

You say that the ideaology of natural birth being 'best' is a belief- but physiologically, it does have the better outcomes. This is not the same for every woman- horror stories exist with long term emotional and physical problems associated with natural birth and the intensity that goes along with it. This can also be the same for medicalised birth. When I talk about physiological birth, I mean when labour begins naturally, progresses with no intervention, and where there is an absence of pharmacological pain relief, where the woman stays relaxed enough to let her endogyenous hormones do their work Calmness, control- the loss of which is most often reported as the course of PTSD- is perhaps the key factor here. Some women may require pain relief to achieve this- this shouldn't be denied, or judged, or criticised, but it cannot be denied that doing it without is the most 'desired' outcome in terms of pysiological benefit.

Childbirth is such an emotive topic and there will always be those who have horror stories- from both sides. The prevailing point is, however, that studies have shown that women who have a physiological birth, as described above, are more likely to have a positive outcome- in terms of both physical and emotional health. This consensus is unanimous, though, as in all things, it is not always that black and white. I acknowledge this and try and work daily with this challenge.

I realise that not everyone wants these things- and that labour and birth is just as small part of a much wider concept. But does that mean I should stop informing, educating or discussing? There are things we'd rather not hear, particularly when they traverse our own viewpoint, but it doesn't mean that they aren't valid or shouldn't be discussed. My job is much more than just a way to make a salary- I'm passionate about women's experiences- all women's experiences, and actively try and give them tools that will assisst them to have the most positive birth they can possibly achieve. I have a vested interest in normal birth, as humans I believe we all should, particularly given the rising use of routine intervention and all of its associated issues, but I share in the joy of the birth of every baby, no matter how they come in to this world, and I am fully aware of what a privelege that is. My first concern is always the safety of mother and baby- from a physical and emotional point of view.

I fear that possibly when I say 'educating' and 'informing' the idea springs to mind that we stand in front of women wagging our fingers about how they shouldn't have this or that. This is not the case. I always attempt to facilitate open and honest discussion and try to address any fears or concerns regarding pregnancy, labour, birth and afterwards (I'm currently a community MW) I offer a full discussion to all women at least once in their pregnancy (I agree this isn't enough, but there often, sadly, is just not the time or the opportunity) of the labour process and of the options that are offered- that includes types of pain relief, pharmacological or not, the pros and cons. Perhaps it is difficult to offer unbiased discussion, or perhaps I just don't shy away from talking about the realities of these things- the bad, but also the good. I have no qualms about telling a woman that an epidural does aim to offer complete pain relief, that it is the only type that does so and that for many it is a positive experience, but I offer the flip-side too.

I'm not trying to be deliberately argumentative, but my point regarding epidural anaesthesia and bonding was to do with the increased use of interventions such as IV oxytocin when epidurals are in use, which has a known impact on naturally produced oxytocin, which can effect bonding. NICE guidelines are held up as a 'gold standard' yes, but they are also not gospel and are meant to be used in conjunction with individual clinical judgement, and more importantly, individual women's choice. There have also been cases where NICE have produced guidelines which have been based on research with poor methodological quality, so it must be taken on an individual basis and used in conjunction with all of the information. Midwives and Doctors are often constricted by individual unit policy which doesn't always line up with NICE- so there are other factors to take in to consideration too.

It is difficult to get a balance- I have a responsibility to individual women's care, yes, but the cultural and political nature of birth also interests me, as it does most midwives. This doesn't make me less caring- in fact I like to think it makes me more so, especially when confronted with the collective voice of women who are saying 'you're failing us'. I actively want to do better- as you say we cannot serve two masters easily, but our ability to question, to have opinions, to discuss openly and to want to promote safe options whilst also giving choice, makes us the autonomous practitioners that we are. Without it, we are voice-less obstetric automatons, and with it comes the removal of choice, much like the American maternity system- and that is a dangerous route to be travelling down- for women, babies, and midwives.

x

'But in the same veign, everyone is afraid of labour, Tocophobia is that fear in the extremis.'

I'm not afraid of labour. I'm afraid of short-staffed, undertrained, non-listening midwives who are an unknown quantity, making decisions for me on my behalf without knowing me when I am at the most vulnerable time of my life.

Very interesting thread, and respect to the midwives who've come on and made their case.

I think the thing about MN is that it's one of the only places where anyone talks about birth injuries due to VB, and once your eyes are opened to how bad they can be and how common they are then ELCS suddenly seems like a much better option though obviously with its own significant risks. I don't think that's scaremongering or Daily Mailism, it's just bringing something into the open that is never discussed by HCPs (except when they are thinking about their own births), and only really discussed in the mainstream media in trivial "keeping honeymoon fresh" terms.

Also, since MN's bias to always talk about the statistics and evidence, any VB vs ELCS thread will always feature someone saying that CS is the safest option for the baby, which is not something that gets said upfront by midwives. (I know that that's an oversimplification btw - CS minimises the risks of catastrophic injury or death, but perhaps at the cost of a range of more likely and subtle disadvantages, and of course a risk to subsequent pgs).

Have been reading this thread with interest and a fair share of . Slightly off point, but at our first meeting my doula expressed the firm opinion that tales of birth injuries on MN were likely exaggerated, and possibly even made up. I was new to MN and new to childbirth and believed her [ashamed face emoticon]. I suffered serious and multiple birth injuries (that were avoidable if I'd been appropriately assessed and had the ELCS that my gynae team patching me up say I should have had) and am heading for my second major operation next week. I now post about my experiences - to ask for help and advice and to provide it where I can. I am still too ragingly furious at her attitude to contact her and tell her how wrong she is. Rather off point, I know. Just needed to say it .

"Midwifery philosophy supports only SOME women - those who want to avoid medical intervention"

Ushy, can I put another perspective here. I have defended women's rights to make their own decisions about how they birth on this thread and would always do so. As I said in one of my first posts, I for myself want as little intervention as possible. This is the the point that I do not want VEs in labout -in fact I'd rather not be touched. I don't want anyone talking to me or 'encouraging me' as my baby is being born and I don't want hassling to get the placenta out within X time or else I'll be transferred to hospital. I suspect I couldn't be further in my thinking from someone who wants an ELCS or an epidural on arrival .

However, Starlight's post also hits the mark for me personally:

"I'm not afraid of labour. I'm afraid of short-staffed, undertrained, non-listening midwives who are an unknown quantity, making decisions for me on my behalf without knowing me when I am at the most vulnerable time of my life."

I too am afraid. Here I am, heavily pregnant with DC4. I've had 2 normal problem-free homebirths, relatively quick with zero complications. Yet, I am beginning to get into a complete state about the thought of trying to arrange this birth.

My philosophy is probably far closer to many of the midwives on SMNET than other people's on this thread (and I do stress, this is my philosophy for me not anyone else). Yet my experience has taught me that it is also very hard for me to get what I want and many midwives I encounter come across to me as unsupportive of my choices too, even if I charitably assume that they are simply bound by protocol and local policies.

For my last two births all I wanted was someone I had met before and who would respect my wishes as written by me in my birth plan. Yet still in labour I found myself having to re-state my wishes "no, that's right I really don't want any VEs and I do not wish to discuss it". And, at the most vulnerable points my wishes were overidden by midwives who either thought they knew better or had not paid attention to my written wishes. Directing me how to push when I asked for silence, or attempting cord traction when the placenta was slow may seem like very minor things, but to me they were a big deal, and if those midwives had known me or genuinely understood me they would have understood that. Last time I met the SOM before my birth to discuss my needs, and was assured all would be fine. Yet when the day came I still had to ring someone on delivery suite who knew nothing about me, thought I wasn't in labour, etc etc. How on earth am I supposed to have confidence that I have any hope of getting the support I need this time? I have yet to see the same midwife twice this pregnancy, and none has had time to discuss my concerns. I cannot afford an independent midwife, and actually there aren't any local to me. I await my homebirth visit with interest. Will they care what my wishes are, or will they just want to run through their list of doom with me? I have a feeling that they certainly won't understand that my preferences are informed by hours of careful research over several years and that I am not making uninformed decisions.

It seems to me that the women who will get the support they want are the ones who fit with hospital protocols, don't mind some intervention (but not ELCS for example), and that anyone with more individual needs is doomed to a stressed pregnancy arguing with people in positions of power over them, and then quite likely having to rehearse those arguments all over again (with no guarantee of success) on the day they go into labour.

Sorry, that was very long, but I wanted to point out that you do not have to be pro-medical intervention to feel dreadfully unsupported.

Lulla interesting post so thank you but can I take you up on this point

"You say that the ideaology of natural birth being 'best' is a belief- but physiologically, it does have the better outcomes..."

First, I don't doubt for one minute that women who pop a baby in two hours with minimal pain have good outcomes - that is self evident. So do women who plan and get elective caesarean. But this only tells us that women have good outcomes when their choices are respected and things go well.

Women who develop complications and need instrumental delivery and emergency caesarean more commonly have very poor outcomes. Humans aren't that well designed for childbirth and babies get stuck. Babies are also getting bigger so they get stuck more often.

Where is the clear quality evidence that a woman being 'relaxed enough to let her endogenous hormones do the work' prevents these complications? It results in women feeling it is their fault when things go wrong.

My personal reason for opting for c/s and epidural was my rational assessment of risk. I don't give a toss about having a wonderful experience - I want to avoid a horrific one. Yes, planned natural birth can result in positive experiences but it also results in more profoundly traumatic ones. That is what I want to avoid.

Would I 'risk' a natural physiological birth if I get pregnant again? Never. ever, ever.

I should add, in response to Dilys comment

"I think the thing about MN is that it's one of the only places where anyone talks about birth injuries due to VB, and once your eyes are opened to how bad they can be and how common they are then ELCS suddenly seems like a much better option though obviously with its own significant risks."

I had significant birth injuries following my first birth, which was in hospital. It took months to recover. My choice for myself is to opt for the most natural births possible to avoid these risks (and if I were high risk for a real reason or had significant problems in labour I would push to move straight to CS). So it just goes to show, that we are all different .

I had a horrendous first birth due to lack of care NOT due to horrible midwives I might add, just the process, the policy, the staffing issues etc etc. as well as complete lack of empowerment.

I spent the next pregnancy fighting for a c/s which was hard because according to my notes my labour and birth was 'textbook' regardless of the emotional state it left me in.

I was eventually granted my C/S which empowered me enough to consider all my options equally and I eventually settled with a homebirth (which for one reason or another turned into a standalone MLU birth but....)

The thing is, I had all options available to me, and being an agreed C/S for trauma meant that I was truly cared for when changing my mind to a low intervention birth.

I'm on my 3rd. Planned homebirth. Will only transfer into a hospital environment for a c/s.

Question to MWs - how do maternity units define and record a good (or bad) birth outcome (whatever the mode of birth)? I ask this, because I am concerned that maternity units may only be using evidence that is not long term enough to give an accurate indication of outcomes. In my own case, I am convinced that my birth been marked down as a complete success. I was a 39 year old primip. Transferred from the MW led unit to the labour ward, had a prompt and successful epidural. PROM, but only by about 30 minutes. No forceps, ventouse, or episiotomy. Only a second degree tear. Slight PPH, but only 1 night in hospital. Healthy baby with APGAR of 9. I am sure this was recorded as an unremarkable birth and a successful outcome.

The real picture, that unfolded over the months to come was displaced coccyx and severe trauma to pelvic bones, grade 2 cystocele, grade 3-4 recotcele, grade 2-3 uterine prolapse, and whilst the tear was only second degree, it went through my urethra, compromising sphincter muscle function and involved complete detachment of the puborectalis muscle that resulted in faecal incontinence.

I opted to be treated privately for these injuries and for the PTSD. But, even if I had gone through the NHS, I would have been referred to a different hospital from the one I delivered at.

So how do maternity units audit their births? Where does the evidence come from?

(have more to say, but DD kicking off and can't concentrate....)

What strikes me most is all the MWs over there claim midwives are caring reasoned people who want the best for women etc.

Why do women then consistently have to fight for what they feel will suit them best against midwives who insist that they are experienced and they know best. You're not in my head, you can't possibly understand the depth of my fear. If I have your reassurance that you respect me, listen to the research I have done and don't patronise me we'll get on fine, but threads like the first one linked to do come across as patronising.

I hope you get the birth you want Starlight. I didn't mean to imply anything about your personal beliefs/choices by my post quoting yours .

Oh and the last thing I read on their about how phobias can be overcome - YES!

But....

It takes resources, it takes time and above all it takes sensitivity to reassure the woman concerned that after all she still is terrified she will get a CS and that counselling isn't just a devious way to c

It angers me that women aren't offered proper help for tokophobia and that the only chance is to play the system when the system has a chance to, in some cases, work with the woman and explore that fear.

Oops random cutoff.

A devious way to con her out of getting what at that moment she genuinely believes she needs.

Lulla, again it's about the woman 'staying relaxed enough'. This pervasive idea that labour pain isn't real pain but merely fear helps no one. It becomes about maternal effort, about how much a woman tries, about values. I like Juju Sundin's take in it. This pain is real and it can be healthy and you can match it, but it is not a construct of the mind.

No female member of my family in three generations has ever spontaneously gone into labour, all had sections and my grandmother lost a baby at term as she was encouraged to wait til nearly three weeks over. Women's risk factors are not always easy to predict, there's a lot that's individual and hidden until that pelvis is tried. With this variation why is it assumed intervention and drugs are key variables vs individual difference that is poory accounted for? Maybe some people are relaxed but still feel pain? I was... But it didn't stop a Kielland's forceps delivery that left me crippled for months and heightened my PND but that staff were pleased was so 'straightforward and non traumatic'. And I am categorised as having achieved vb!! Achievement was not my experience despite my hypnobirthing and relaxed first stage. My baby's head didn't want to come out and that unpredictable last minute development after a cnt