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.

Yes a lot of it rings true I hate to admit. There were a series of 'funny' yet equally disturbing satirical video sketches on You Tube about birth about a year ago - can't seem to find them tonight but will post link if I do.

I think the information should be written and combined with guidance on birth options. I have no idea what the NHS gives though....

Then women should be able to raise any questions they have during appointments.

AN classes vary so much from midwife to midwife let alone trust to trust

Someone has set up a charity called MAMA Academy with it's main aim to

"help equip healthcare professionals with vital knowledge and education to aid the consistency of maternity care right across the UK. We also inform mums about health in pregnancy and when they should call their midwife for advice"

presumably they variation in AN classes is something that perhaps needs to be looked at???

Don't know if there is anything on the website that could help you

www.mamaacademy.com/midwives.html

re cord prolapse, i was induced with all 5 of mine for going more than 2 wks posts, dates, i opted for exepectant management for no2 and no3 but once i got to 18days overdue i was fed up. anyway i am allergic to the prostin gel pessary so they have to induce me my breaking my waters not ONCE did they tell me cord prolapse was a risk! it was only because i had done my own research that i questioned them on it!

as it was breaking my waters worked fine and i have had 5 normal 'easy' deliveries, my easiest being 10lb 13oz ds4 who i had in the birth pool. rather ironically when preg wtih no 5, i had a consultant who when he met me (had an app as i had post natal psychosis after no4) insisted that as i am small 5 2 and petite with size 4 feet that i should have a section as eh thought my baby was likely to be 9lb and i wouldt NOT be able to deliver a baby that big vaginally! had he read my notes he would have seen that ALL four of my previous babies were 9lb+ and all had been delivered vaginally, easily infact! when i pointed this out to him, he told me i had 'just got lucky' and he didnt think i would be lukcy the next time! i did then tell him my app with him was becaause of my pnp and regarding any extra care i would need after the birth. i also told himt he baby wasnt that big (having carried 4 big babies i KNEW my 5th wasnt as big) he basically laughed at me and was annoyed that i didnt agree to be booked in for a c section.

my 5th baby was also induced by breaking my waters, despite being back to back my labour was 3hrs, with 3 pushes and she was a teeny 8lb! i had numersou drs in each labour try and get me on my back on the bed, for NO reason, thankfully my partner and midwife were supportive and politely told them to get lost! but you shouldnt have to fight to labour int he position you want!

oh and with dd i was taking citalopram in preg, 10mg as a just in case after my previous pnp, anyway when it came to discharging me after the birth the dr was HORRIFIED i had taken it during preg, despite the fact the midwife, a previous consultant and a nicu team in conjunction with my mental health team ahd decided it was fine. he was also insistent i couldnt bfeed whilst taking citalopram and wouldnt discharge me as i was bfeeding, he wanted to call social services as i said i would leave. (ironic as my dp works for ss!) the midwives were all aghast at this dr and int he end a dr from the nicu unit came and discharged us, she also told me to complain to pals about the dr that had been such an idiot! the thing is i was clued up and knew i was fine, many mothers would have taken his word as gospel!

i have to say all the midwives i have had have on the whole been great, apart from when i was having ds1 and i asked about pros/cons re section (as i was offered a section for spd) the midwifes answere 'well i would rather have a cut in my tummy than down there' helpful...NOT!

No - second baby. Baby's head was very late to engage. Was in very advanced labour when i reached the hospital which was when the prolapse was discovered - I had no idea beforehand. Nothing anybody could do by that stage......

That AIMS document is incredibly biased against C-sections. I'm currently reading this book (to prepare me for the ELCS I shall be having to deliver my third child in March) and it contradicts a lot of what the AIMS document says about C sections. Quite apart from the fact that the AIMS document doesn't make any reference at all to the risks of vaginal birth.

Quite apart from the fact that the AIMS document doesn't make any reference at all to the risks of vaginal birth.

This leaflet is quite old now. I saw this as something of an answer to the blackmail pressure that women often receive when they ask for a home birth. Lots of dire warnings about things going wrong with home births, and a very rosy picture painted of hospital births which are fully staffed and immediately able to offer help.

I suspect if AIMS wrote that today, it would have more about being turned away because the hospital is heaving, one midwife trying to attend three women at once, postnatal wards which are so badly understaffed that it's beyond a joke.

Thanks for link to the book Treats...I will be buying it asap.

I wish someone had told me about urinary retention as a side effect of the body getting confused after epidural. You hear over and over again about urinary incontinence but not retention.

This is what happened to me and I was so shocked when it happened.

In talking about AN classes, it might be good to get an idea of which women and how many women have access to them. I have had 4 pregnancies and I have never, not once, been given information or invited to attend any form of class for the birth. And I live in a city within minutes from two hospitals so physical access is not an issue. In my last pregnancy, the birth wasn't discussed at all until I was 35 weeks and after a lot of emotional blackmail (involving my children who were present and heard everything and very much frightened which still infuriates me) I was given one week to decide what I wanted to do with no information but a video to see how pretty the new birthing suites were vom . It was a disgrace.

In discussing translation problems, a book that could be well translated would be best -- including such information in sex ed or a sex education guide would be amazing, I wouldn't certainly get it for my kids when they're older.

That should be would buy it for my kids (don't know where the n't came from!).

I think with antenatal courses being so short (3 or 4 sessions, one devoted to breastfeeding) then the finer detail needs to be available and easily accessible elsewhere. The purple NHS pregnancy book needs more info about complications, even though it might be a scary read, and should be backed up with statistics about the risks. It should also be available online with links to research so women who want to know more can easily look it up, and, importantly, this should all be available in many different languages.

For example, the idea of 'no forceps' has been mentioned many times above, presumably because people have heard of bad outcomes with Keillands forceps. But, through lack of knowledge, this could lead to women going for c-sections when a simple use of wrigleys forceps could facilitate the birth with a lot less trauma and distress all round.

Also, you listed the risks for big babies, but there is no way of accurately knowing size before birth. My scan at 36 weeks predicted 2nd centile, and the baby was 10 and a half pounds at birth.

Flomaba

"The NHS is primarily money driven."

Is it?

Panorma " Health Tourism?".......................

The many many ways in which our NHS in the UK is exposed to fraudulant use from all over the world and within Europe highlighted a positively lax attutitde to money?

The many many ways in which our NHS in the UK is exposed to fraudulant use from all over the world and within Europe highlighted a positively lax attutitde to money?

which they then try to recoup (as it seems) from other services...

"Quite apart from the fact that the AIMS document doesn't make any reference at all to the risks of vaginal birth."

it refers to several risks from a hospital VB, an emcs being one of them. it could include forceps and episotomy rates too...probably would if written now.

i don't see how you can say it is presenting a rose-tinted picture of VB, as it is thoroughly negative about hospital VBs!

I agree with BedHog about predicting big babies not being an exact science. Ds1 was 9lb11 and ds2 was 9lb12. I had a scan at 38 weeks with ds2 and was told by the sonographer that he was 7lb8 at that stage. I laughed and she got all huffy. He was born 6 days later, I don't think he gained more than 2 lbs in that time. AT no point in either pregnancy was I told my babies would be larger. If HCPs can't accurately predict foetal weight, how can they warn of the risks

My experience is different to 5madthings My midwife has told me, you've delivered 2 big babies already, I'm sure you can again. Although, as with 5madthings this one feels a bit smaller. I'm sure I wouldn't be offered a section for this reason in my area. Why are things so different in different places?

Can't remember who said, but I couldn't even see a consultant about a section for SPD, let alone offered one.

I'm another one whose birth plan wasn't read, I realised this when the student tried to give me the injection for a managed third stage, which I didn't want. She had to be stopped by dh, who had read it.

I would have liked to have seen the consent form for different procedures during ante-natal classes e.g c-section, epidural. I've never needed any intervention, but if I had, I'd have liked to have thought about consent, when I hadn't been awake for 36 hours and in labour for 27 of those.

The trouble is, risks are given based on what SHOULD happen and NICE guidelines, rather than what DOES happen.

I was told I was carrying a large for dates baby and should not consider. Homebirth in case of SD. However, my own research about my local hospital told me that a) I was less likely to have SD at home in the first place and b) it would probably be managed better at home.

The argument they were using against me is that should either me or the baby need urgent medical attention post birth or an EMCS, then I would be safer at home, but they completely failed to ensure I realised that I was much less likely to NEED urgent medical attention or even have SD if I stayed we'll away from the hospital in the first place.

The argument they were using against me is that should either me or the baby need urgent medical attention post birth or an EMCS, then I would be safer at HOSPITAL but they completely failed to ensure I realised that I was much less likely to NEED urgent medical attention or even have SD if I stayed we'll away from the hospital in the first place.

Agree with Bedhog The purple NHS pregnancy book needs more info about complications, even though it might be a scary read, and should be backed up with statistics about the risks. It should also be available online with links to research so women who want to know more can easily look it up, and, importantly, this should all be available in many different languages.

This would be especially useful for women who have trouble getting a place on an antenatal course, or who don't manage to complete all the antenatal classes because the baby's turned up before the classes are complete - my NHS antenatal classes were over 3 weeks, and one of the women was 38 weeks at the first class.

And incidentally, given that hospitals and medical staff require patients to give informed consent before most types of medical treatment (with exceptions for things like emergency life-saving treatment), how come there isn't more of an effort being made around resolving issues of consent in childbirth?

I mean, the use of interventions like ventouses, forceps, episiotomy, emergency caesarions in childbirth isn't uncommon. Surely it should be possible for a midwife or doctor to sit down with a pregnant woman, explain common interventions, benefits vs risks, and find out in advance of labour whether or not she's willing to have these interventions if the medical staff think they're needed during labour for whatever reason?

I had DS1 in May: the purple books weren't available then for pregnant women in my trust. Neither has there been any post natal sessions as they've cancelled the course (although our HVs redefine useless so I'm not upset about this particularly...). Ante natal courses were available but very quickly booked up. This is the day to day reality of budget cuts.

I had VB, meconium, dodgy heart rate, back to back. I came within an hour if a c section and 10 minutes of forceps. At no point did I think my consent was being asked for these procedures but I have to say that every internal I had was prefaced by a very polite request. Labour ward staff were much "nicer" than post natal ward staff in this respect.

lonelycloud maybe drs and midwives think its like in the US where basically when you step into the hospital and sign the admission form, that is taken as consent for them to do whatever they think is best without asking for individual consent for each intervention.

thing1andthing2 - if the drs & midwives do think that, it'd be nice if they were open enough to say so beforehand!

And I didn't sign any admission forms, or even get admitted to the labour ward properly when DS was born. I didn't get logged into the hospital systems as even properly being there, until I got to the post-natal ward, and the midwife asked me where my wrist-band was. She looked a bit shocked when I said no-one had given me a wristband. She told me that I hadn't officially been in the hospital when she came back with one, and said that the midwives on the labour ward had been wrong to offer me pain relief

There are no excuses for the way you were treated and I think the US system is shocking. Consent is very poorly acquired very often during labour (so I understand, I had my 2 at home, but that has its drawbacks too).