How much should women be told about complications in labour or birth?

[Flomaba]

Hello I am a midwife who does ante-natal classes and am studying medical law. I would really appreciate any feedback on whether or not women think we should tell them all of the risks all of the time, some risks all of the time, or any other variations so that women can choose whether or not to take that risk. Many thanks and best wishes.

I know flomaba! I I do have more dcs hopefully I'll have more luck getting my views across. I am now a lot better at making sure people know what the can and can't do to me!

Junior doctor should have phoned the consultant if you said that

Hmmm. I spent 2 week on the ante-natal ward with transferral lie and too much waters awaiting a elcs. Then send home on the very morning, as baby had gone head down. Only to be induced 2 weeks later and ended up with emcs. Stop the faffing. That would be my advice. I would have MUCH rather had an elective cs on the day - the day they trotted out the stats and scared me half to death. Personally, I would NOT have wanted to know about my birth in advance, I would not have slept for weeks.

My birth plan was controversial (apparently) yet they only wanted to persuade me out of it at the last minute when I had been trying to bring it to their attention since my first appointment..

transversal lie....even.

Yes - it is money driven. But it is money driven in an extremely local and short-term way. According to the St Mary's Urogynae website, treating women's prolapse and bladder problems takes up 1.5% of the NHS budget. Plus there will be some colon stuff in there as well, for women who are particularly badly effected. And some psychological therapies to deal with the trauma. And all the GP appointments and prescriptions. How does that compare with the cost of some extra c-sections?

If they don't take notice of your birth plan refuse consent to be touched until they discuss it with you fully in relation to the birth plan. Keep a copy for your partner to put under their noses. I'm so sorry this is such a battle for women.

Even if you're quite bolshy and informed, which I was, getting answers can be hard. I had to ask three times why the older MW wanted to use a ventouse, while having almost non-stop contractions. Up until she told me the truth, she was making out DS was in danger. Just plain lying. I mean there's not much you can do if the people who are supposed to be caring for you are dishonest, is there?

Or get it tattooed on your fanjo as that is all they seem to want to look at! :o

If you think your birthplan is going to be controversial first suss out your own midwife. If she's not helpful you can phone the hospital switchboard yourself and ask to speak to a supervisor of midwives on call. It's unlikely that they would be able to go through it at that time but ask if you can arrange a meeting with a midwife supervisor. If not,contact, the London LSA www.londonlsa.org.uk/

I know it all sounds like a faff and it shouldn't be like this but it is and all of us like-minded people have no choice but to stand up, make a fuss, annoy people and hope for change for next generations (sorry for the soapbox!!)

If I hadn't have gone 'overdue', the first any midwife would have seen my birth plan would have been when I was in transition. Hardly a time to 'discuss' anything.

It was fine actually because refusing a sweep led to being questioned about it and the mw panicking on the realisation that I meant no internals at all and subsequent raising me to more experienced midwives who were subsequently excellent. But I have no idea what would have happened if senior midwife hadn't changed her shift when she'd heard I was in labour so she coukd accompany a very junior midwife that was sent to me.

Aha! In 3 pregnancies I have never seen the same midwife more than once.

Doesn't make any sense my last post.

The mw I see always seem to want to do BP, measure bump, listen to hb, all as speedy as possible, hope you've forgotten your wee sample and get you out ASAP. Any mention of birth plan is 'let's worry at the time shall we?'

I insisted on a names MW (against policy) and started talking birth plans at 6 months. I had a spreadsheet and everything. --I know I'm obsessive and controlling, that's why my psychologist is probably retiring early-

It's amazing how differently midwives conduct their AN's. One of my colleagues once commented that she didn't know what those midwives who always ran behind the appt schedule did. I didn't like to state the obvious that some midwives do actually talk to women and answer their questions which can delay things slightly.

Here is a fantastic document created by AIMS which sets out the risks entailed in hospital birth (mostly produced for people who are having to fight for their right to a homebirth).
www.aims.org.uk/Journal/Vol19No4/InformedConsentHospital.pdf
I'd be interested to know what you think, flomaba.

Haven't read the whole thread - sorry - but just wanted to add that we should be fully informed of all the risks and alternatives WHERE WE HAVE A CHOICE ABOUT HOW TO PROCEED.

I say this - and in capitals - because I lost a baby last year because of a cord prolapse during the delivery. I had literally never heard of it before and - reflecting on my experience - it wouldn't have made any difference if I had. There was nothing I could do. There was nothing the doctors could do. It couldn't be predicted or prevented. So what would have been the point of scaring myself in advance of the possibility.

I DO think that women shouldn't be kept in the dark about the more manageable risks of delivery. I think going through scenarios during ante natal classes would be helpful - spending more time on the ones that are common but also covering the ones that are less so. Say "If your waters break before your contractions start, the hospital may want to induce. You can request to delay for a day or two if you want to see if labour starts by itself". Or "if labour slows down, the doctor may want to try a forceps delivery. You have the option to refuse but you must remember that the longer the baby takes to deliver the greater the risk to the baby".

The worst thing is to pretend that natural childbirth is easy and everything in the (lady)garden is rosy. Working through scenarios beforehand is less likely to make women feel panicked and out of control.

OMG!!!! Horrified

So sorry to hear that Treats - was that your first baby?

Ok I read the document again and it's very anti medical birth which isn't great as I think a full and balanced set of information should be given. But it at least outlines some of the risks which are usually never discussed.

Yes it does - horrified at its factual basis

Sorry to read that Treats, clearly it was missed during your delivery, I certainly know someone whose baby was saved with a prolapsed cord - Midwife realised that the heart beat was dipping at a certain time during the contraction which is the indicator. Before I had ARMs I was warned of the heightened risk of cord prolapse and that I would be rushed off for a c-section if they detected that issue.

Are the facts wrong? Or are you horrified because its true (genuinely interested).

Cord prolapse is very rare in a first baby when the head has engaged. Although I do mention it to first time mums if baby's head is high after 36 weeks and also to 2nd/3rd timers as head doesn't always engage before labour. Problem is usually if waters go before contractions start.

Does anyone know specifically when they'd like the information? Is it acceptable to restrict it to antenatal classes given that they're optional and could never be facilitated if every woman chose to book on them? I can't see a appropriate window in the low-risk midwifery care appointment schedule! Would drip feeding written info with encouragement to ask any questions relating to it at the next (longer than ATM) antenatal appointment work? Or displays/ info in waiting areas for AN appointments? Having one of the scheduled appointments at the hospital as opposed to in the community and combining it with a 'complicated birth talk'?