Alice Roberts' article today on evidence based childbirth (HB/MLU/hospital)

[VinegarDrinker]

Not sure if this has been discussed elsewhere?

m.guardian.co.uk/lifeandstyle/2013/mar/10/alice-roberts-on-science-childbirth-risks

Seems a fairly balanced article to me, but I am an evil patriarchal obstetrician.

Defining a process by the exceptions seems a bit pointless to me. For the vast majority of women, birthing is uncomplicated. It is not normal to lose the baby - if it was our species would have gone extinct long before now. Death might be a natural consequence of poor fetal positioning, or poor maternal health etc but it is in no way 'normal'.

Phobias of birth are by definition irrational fears. What I dislike is what I now see as a 'consitutional' fear of labouring and birthing. Even my electrician has an opinion on whether I should have had an epidural . Wrt pain, I was genuinely surprised that the pain I had in cb was endurable. Painful, yes, but not overwhelmingly so. We are led to believe that all labouring pain is too painful, that the pain is bad (i.e. non-productive) and should be stopped. THAT is now the norm for births in Western Europe and I feel it is this 'normal' that needs to be questioned and challenged.

This is why I don't like the term 'physiological' birth. It may be less loaded from one perspective but from another it is just as loaded - labelling women who have straightforward births as different - equating the word 'physiological' with whale music and the like. We shouldn't be ashamed to point to the norm and label it as such. For me this should be just the same as with bf.

It's not labelling women, it is a label used to indicate a function of the body. There are no moral or cultural values attached to it if we are using it in a medical sense.

If we pee without help, this is known as peeing - it isn't called anything else. If we need help to pee because the normal process does not work then a catheter is placed - one might call it assisted urination. Giving a process a name neccessarily labels it. With labels come prejudices/associations - this is inevitable. If the majority of births happen spontaneously and without medical intervention we are being a bit precious giving it a special name. We don't talk about natural peeing, unassisted peeing or, god forbid, physiological peeing.

We don't talk about natural peeing, unassisted peeing or, god forbid, physiological peeing.

No, but if it got to the stage where only 41.8% didn't pee without some sort of intervention, then we almost certainly would. The 41.8% BTW comes from BirthChoiceUK stats.

I have a problem with people who were talking about HB as a safer option ON MUMSNET not giving it even a sentence.

It's nearly always been discussed in terms of medical or health needs, which is where the expertise of HCPs lie. They are not experts in whether the woman's environment is a safe one. As you said yourself, DV increases when a woman is pregnant. What would you expect HCPs to be able to do about that?

Newspapers are in a different position: it could be seen to be part of their remit to raise issues. The Observer could have written an article about that instead of Alice Robert's article, but obviously in this case chose not to. They could be asked why they didn't.

And so we go full circle. Because of the medicalisation of cb, we view an interventionist birth as the new norm. We need to change the way we think about birthing and the vocabulary we use to describe it. As you say LaVolcan, normal birth is no longer the norm in the UK...both the reasons why normal births are no longer the norm and our cultural attitudes to cb need an overhaul.

Ime most discussions about home birth on Mumsnet are begun by women who are planning or considering a home birth. Rocking up on one of those threads to say something about DV might be considered a little odd or even patronising in that context.

I also can't recall any thread where home birth has been suggested as a safer option. Admittedly I'm not on the boards all the time but I have been around long enough to know if that was the norm and ime it is not.

If the phrasing of stuff has a medical impact on people's well being, it needs to be looked at and considered a great deal more.

Phobias of birth are by definition irrational fears.
I think there are a lot of women who would argue the toss on that one and say their fears are completely rational for a lot of reasons. Fears cover a wide spectrum; some are irrational. Some are completely rational. Or are we going to say that women who want an unassisted vb are irrational in their fears about intervention?

It is normal in this day and age to have an assisted birth. Yes, its is. Accept it. You might want to make it less normal, and thats fine, but that is the reality.

But in trying to do that you shouldn't penalise or use prejudice against women who actively choose that or indeed are compelled to do so by others 'in their best interests' (which may or may not be the case). Its not fair.

Its the women who end up bearing the cross, not the medics and not the natural birth evangelists.

By all means think about other strategies, but not ones that create this sense of failure.

It is normal in this day and age to have an assisted birth. Yes, its is. Accept it.

Why? 50 years ago shaving and enemas were considered an essential part of childbirth. Women didn't accept this, and they no longer are. Surprise, surprise it hasn't made birth any less safe.

Let's take modern examples:

Obesity causes more problems. Do we just say, accept it, it's one of those things? Or do we say, what can we do to tackle obesity?

Certain groups are low users of ante-natal clinics. Do we just say, accept it and deal with the problems when they arise. Or do we say, what can we do to go out and meet these women, to prevent as many problems as we can arising?

LaVolcan, I think its pretty clear that being insensitive in your approach to dealing with obesity adds to the problem. Language is as important here as in child birth. If its aggressive or confrontational, it just alienates and hurts and is counter productive to the very thing you are trying to achieve.

Some obese people avoid going to the doctors, generally, because they fear they will be nagged or bullied about their weight in the process. Why do you think that certain groups are low-users of ante-natal clinics? I suspect I can think of a few answers...

"I don't have a problem with Alice Roberts not mentioning DV in her article. I have a problem with people who were talking about HB as a safer option ON MUMSNET not giving it even a sentence."

Sorry - people who discuss hb on mumsnet are generally very clear that it's not suitable for EVERYONE.

Is that not good enough for you?

There is no 'category' of women who are excluded from having a homebirth in the uk. Some disabled women will have their babies at home, and some women who have experienced dv. It goes without saying that individual circumstances -whatever they are, are always taken into account when assessing the suitability of home birth.

RedToothBrush - yes to all those, but to take it a step further back do accept that this is just the way health professionals are? Or do you say, no I am not prepared to accept being talked to like that? (It's hard to do, I know: right now my DH is avoiding the Dr because he expects to be nagged about his blood pressure).

IMO there is usually scope for questioning. We could question things like: are these interventions happening,(or in some cases necessary interventions not happening) because our staffing levels are inadequate? Why does your protocol dictate that I 'must' be induced at 40+ 10/12/14 - how does it apply to my circumstances? What are the alternatives?

Personally, I am very glad that there are people prepared to question and not to 'just accept'.

"HB advocacy that doesn't consider the safety of the home= bad because it ignores women whose homes are unsafe"

And hospital birth doesn't consider the issue of safety in relation to infection issues, something no particular study has looked at, and something which is absolutely endemic in UK hospitals.

Really - this is a slightly pointless discussion, and I think I'm going to check out of it.

RedTooth: there are fears and phobias - these are two very different things. I have very much talked about fears surrounding cb rather than tokophobia for example. I think the fears come from a cultural idea of cb - one that involves pain relief and hospitals. It's so prevalent that the majority of UK births follow this model.

As in any righting of a societal norm, the side proprosing change may go too far in their evanglising, or perhaps be seen to be undermining the other side. Following the bf analogy: I live in France where ff is the norm. I've never seen promotion of bf like in the UK - my MW said this was so ff mothers wouldn't feel guilty. Whether true or not, the point is, it's very hard to promote physiological births without immediately feeling like we're aleinating others who can't/don't want these sorts of births. Should this ultimately stop the debate? I think that would be unfair.

LaVolcan, I've had very bad treatment by a GP before. I don't/didn't accept it.

I appreciate questions being raised; but my experience was far from that.

Discussion of certain things, has to come from the patient, on their own terms and in their own time. A doctor can mention it, but can not push it beyond a certain point.

It might not be what the doctor wants, nor may it even be in the patients 'best interests' at times - but having a good relationship between the patient and doctor trumps that - doors need to be always left open rather than slammed shut by the doctors actions.

It comes down to free consent rather than coercion and bullying ultimately. I don't think all medics know where the boundary lies.

Beyond that I don't think I can really comment as I don't feel my personal experience in this really helps this debate much beyond that.

I've read some, but not all of this thread (dealing with an ill DD), so apologies if this has been mentioned elsewhere.

I'm interested to know which outcomes are measured in these type of studies and how they are measured. Clearly it's not just about mortality, it's also about morbidity. But what is measured, how is it measured, and when is it measured? A data collection point 1, 3, even 6 months after giving birth may not be long enough to capture the true picture of what is going on for that individual.

In my case (1st timer, MLU transferring to CLU, epidural, medium bleed, 2nd degree tear), the full extent of the damage (cystocele, rectocele, enterocele, uterine prolapse, displaced coccyx, severe trauma to pelvic bones, detached puborecalis) and the toll on my health (PTSD, double incontinence, pain, infection, mobility problems) has only become apparent as the months, and indeed years, have gone by. The labour unit where I gave birth is, as far as I can deduce, not aware of any of this, as nothing has yet to come to light when I was discharged from the CM service. None of this will show up in their data, internal audits, whatever, and my birth which was a catastrophe for me, I assume, is categorised as having a pretty good outcome.

I can't imagine that this just applies to me - birth injuries often take some time to reveal themselves.

Cardomomginger - details of what the study was looking at here:
You'll have to watch the whole film to understand it.

The study talked about in the OP only looked at these aspects of maternal morbidity: unplanned c/s, forceps, third degree tears, and admission to HDU.

"my birth which was a catastrophe for me, I assume, is categorised as having a pretty good outcome."

The study doesn't refer to 'good outcomes' in relation to maternal outcomes - only to rates of intervention.

Thanks shagmund.
I guess my point is a general point concerning outcomes, as well as a question about this particular bit of research. Will have a look at the link.

Good questions cardamom.

If later outcomes could be related back to the birth, we might hear a bit less of this 'the only thing which matters is a healthy baby', (with its implication 'what are you making a fuss about?'), and have equal attention paid to the mother's health.

It's not only longer term problems for the mum that were not included but also the baby.
I asked the authors at the press conference presenting the findings about milder cases of cerebral palsy caused by birth trauma which quite feasibly might not be diagnosed until after six months of age. Was told those would be mild and so were dismissed as not mattering, in terms of the study.
There were also a collection of other infant morbidities which were not included in the aggregate infant outcome measure but I forget what those are now.

MedicalEd - have you watched the film I linked Cardamom to?

'In terms of the study' is a key phrase here. It doesn't mean it wasn't important in itself, just that they have to draw a line somewhere, otherwise they would still probably be collecting and analysing data now.