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.

That last bit you've bolded is interesting Shag.

Thank you

I believe places which have well organised homebirth services find about 10% want one. I don't know how the split is between primips and multips - I suspect it's higher for multips. I think when the service is organised on a "we'll start at home and see how things go" the numbers are higher.

I think what is deskilling midwives is not having the opportunity to use their skills. Any midwife who is mainly doing antenatal and postnatal checks and the odd homebirth every month or so is going to be more rusty than one delivering 3 babies a day.

Indeed. In my area (Shropshire) MWs work on each area in rotation - 6 months or so on the CLU/delivery suite at the hospital, 6 months or so in one of the MLUs, 6 months or so on Community.

One to one care wouldn't be appropriate for everyone either though.

One to one care would undoubtedly help a lot of women and solve a lot of problems. It is simply unacceptable that there are midwife shortages to the extent talked about upthread and that some maternity units are closing their doors as regularly as they are. Barnet effectively closing once every three days is nothing short of utterly scandalous.

However the problem I see in campaigning for it, is it then becomes THE solution politically rather than also supporting good quality research. Everything becomes focussed on it being the way to solve all problems rather than still looking at women as individuals in need of individual care. Certainly I fear that, it would still pressure women in certain circumstances - ie to have a VBAC or to not have pain relief - if ideological beliefs are allowed to remain the dominate force over evidence and women's individual feelings.

Please do not forget that just because you have one to one care it will mean the person caring for you, is going to listen to you, respect your views or not try to impose their own beliefs and agenda on you.

I would support one to one care campaign, but ONLY if this is recognised and that better scientific understanding both of issue and how women feel and respond in different ways is ALSO made a priority.

If evidence based medicine and an acceptance of individual needs - that sometimes might not fit into the bracket of 'preferred practice' - are ignored, you will STILL have massive problems for women.

I think we took a wrong turn when we started ignoring the hormonal physiology of mammalian birth when deciding how we were going to organise maternity care for women.

The biggest barrier to encouraging midwives to learn how to support normal physiological birth is their working in a highly risk averse environment where practice is primarily driven by protocol and a fear of litigation, and where epidural is seen as the only humane and sensible response to a challenging labour.

THis ^ is spot on.

It occurred to me the other week that natural drug-free birthing conjures up images and words like 'physiological'....whereas we should be thinking of these sorts of births as the norm. Bit like talking about bf as the norm, default option. I would like to see a sea-change in attitudes to childbirth and pain etc. How often do we read, see, talk to people in abject fear of birth? (this included me 2 months ago ) - it's almost a cultural acceptance. Whilst we all go around brandishing this fear, the dependancy of low-risk women on CLUs and hospitals will continue.

I would like to see more emphasis placed on proper preventative work e.g. more research on what is the optimum diet, what you can do to get the baby into the optimum position for a couple of starters. And much more emphasis on nurturing the pregnant woman instead of a catalogue of you mustn't do this, or that.

Heck this thread moves quickly!

Anyway I agree vinegar with:

" I think we took the wrong direction when we started concentrating on the place of birth rather than the quality of care"

Yes absolutely. I also feel for those women who have to deliver in CLUs for valid medical reasons - it often seems they get forgotten in the sea of lobbying. They often end up with a raw deal both in terms of midwifery staffing, and in terms of making their environment more pleasant to deliver and labour in (private postnatal rooms, flat screen TV etc) ."

Interestingly in between giving birth to my 1st dc and 2dc a MLU opened up at the hospital. The MWs I saw in the community said that as a result their experience of doing Hbs had DECEEASED as women were going for MLU rather than hb so the rate of hb had dropped. This worries me as I think the key to hb is experienced Mw. Thou interestingly with my 2nd birth I had 6mws in total (long labour) and ALL also did shifts at the clu and MLU.

Another point is I had decided to not have a hb with my second dc but in the weeks running up to my EDD I heard some really scarry stories about poor staffing and the resulting care at the hospital. This swayed my decision for another hb. So vinegar I also wanted the full medical team on hand at my birth like you did. But I also wanted the BASICS being done correctly, for ex. Having babies heart rate checked, being able to labour in private. These are NOT being done in my local hospital. What we need to do is replicate the benefits of hb in a setting with the medical emergency staff on hand if needs be.

But as I said up thread I suspect this would cost £££££ and there aint any in the pot

PS sorry for typos, receiving from norovirus!

Recovering

Well this has been a useful and thought provoking thread but I'm out. Just not interested in having discussions that involve immature eye rolling at me, sorry, especially following on from ascribing random opinions to me and making ridiculous generalisations about me and my colleagues. I think it's rude and unnecessary.

I shall stick to discussing inane crap and fruit shoots I think.

Sorry vinegar I realise I'm repeating my point about improving care at all settings and that you agree with this!

I hope that was not directed at me vinegar as I really only have respect for you and your profession, honest!!!!

I'm personally all for the odd fruitshoot :)

No, it was at shag. Having re read the post I think it was a sarcastic raised eyebrow rather than an eyeroll but my point still stands. Imvho we should be able to have discussions on a slightly more mature footing.

My DS won't touch fruitshoots, more's the pity!

Eh? This is hardly a bunfight. No need for anyone to flounce off.

Obviously if you have more important or exciting things to do fair enough but getting the humpf about a bit of disagreement with one poster and putting down your bat and ball is a bit wimpy.

I was just getting interested!

LeBFG, I think where fear comes from is really really misunderstood and not really known.

I think this is something that needs research rather than to make assumptions about.

The most common one I see, is that it comes from TV.
The next is from women sharing birth horror stories with each other.
Both annoy me, as I can not relate to this.

I first started saying I didn't want children when I was about 10 or 11. There was no reason for it. None at all. No one around me told me horror stories or spoke in a way I consider to be negative. I didn't watch stuff on tv that left me with this fear. It just sort of 'happened'.

And actually when they have looked at this in studies for primary tokophobia, the very basis picture they seem to have is that it often comes from childhood; usually at a similar age. They think it might come from a trigger - maybe the way a mother talks about birth or seeing something but they don't know and there doesn't seem to always be something there.

In my experience I genuinely can't pin point something 'bad'. The only thing is the fact my Mum had me by EMCS, but she's never really talked about it much other than to say I was in distress, late and needed to come out. Nothing scary or particularly emotive; she's always been pretty neutral in what she said.

I think my point is, that I do believe that, perhaps a good deal of fear is quite deep and goes back far further than we might initially give credit for.

Unless we understand where its coming from, how can you start to change it?

I had crap, neglectful care in labour. In a major London teaching hospital. I'm sure the midwife was perfectly competent, but there was only one of her, with seven women in active labour, so she just wasn't there most of the time. Hence I sustained a birth injury. It's sheer good luck that it was a normal delivery; had there been any problems, no-one would have noticed.

Fear of litigation may affect some consultants but sadly not hospital managers who can't be bothered to employ enough midwives. Compensation doesn't come out of their budgets.

Don't spoil my fun, I'm enjoying my first ever obviously not very effective flounce!

Tbh though I think I have exhausted my opinions on the subject (the ones that I can type one handed on a phone coherently anyway). Everyone else keep going if you're having fun!

PS I can bunfight with the best of 'em, I'm just bowing out politely before I get riled and regret it

No don't flounce off vinegar. Although we have different perspectives from each other and would personally weigh the risks differently, we have had quite a lot of agreement about issues.

I see this as being a vital debate about the provision and quality of maternity services and as edam implies we can't leave it to the hands of hospital managers.

Yes I was thinking about this while changing a nappy just now clearly I do not have anything more important or exciting to do! and one-to-one care is a starting point. You can have the best, most competent advocate with you (either birth companion of any ilk or family member) but if there's no-one to advocate to then that's probably worse.

I chose to have my babies at home mainly because of the one-to-one care. I'm also very close to two maternity units. I have come into contact as a patient with 3 ob registrars, 5 GPs, 5 sonographers and about 30 midwives. The only one who was negligent in any way was a community midwife. She is only practising in the community. Part of the issue with her is that she is rarely observed and so goes unchallenged. She is unreasonable, unhelpful and lazy (she routinely goes missing apparently ) and yet complaining about her does nothing. Those issues of poor practitioners need fixing too.

Look Vinegar, I'll stop eye rolling and being snarky if you'll admit, on consideration, that the article you linked to in your OP was far from balanced, and was in fact poorly written and researched.

No need to flounce.

You need to toughen up. I've been on mumsnet for a long time, and and am a raddled, battle hardened old bint.

But I'm sorry I called you vinegar tits.

Interestingly in between giving birth to my 1st dc and 2dc a MLU opened up at the hospital. The MWs I saw in the community said that as a result their experience of doing Hbs had DECEEASED as women were going for MLU rather than hb so the rate of hb had dropped. This worries me as I think the key to hb is experienced Mw. Thou interestingly with my 2nd birth I had 6mws in total (long labour) and ALL also did shifts at the clu and MLU.

I find that very interesting - So some women are opting for a HB because they really don't want a hospital birth, and there is no 'middle ground' if you like. The fact that it's a full-on hospital obviously doesn't appeal to many women.

shag apology accepted. Seriously, I don't think you do your cause any favours by being so combatative though. The idea of the obstetricians as patriarchal anti-women baddies is so outdated it's laughable. For starters, the overwhelming majority of doctors training in O&G now are female, which males a huge difference. Honestly we are all in this together to provide the best outcomes for women and their babies

I don't think the article is amazing. I think it's more balanced than many I have read. At least it actually mentions evidence! Most are just ill educated "my friend X had Y and my sister A had B" or unilaterally pro one agenda. But yes, I am embarrassed not to have mentioned the glaring intention to treat issue, which I definitely noticed (and in fact mentioned elsewhere online where I was discussing it....).

I enjoy a good online barney, honest. I may be a MN newbie but I'm a member of several fora, none of which are in the least fluffy. I just run out of patience after a whole with the dull stereotypes, especially when 80% of what we are all saying is in agreement.

Vinegar - honestly I don't see obs as 'anti woman' or as 'baddies'. I'm in awe of the work you do. You are very very lucky to be able to go to bed at night knowing that your work is probably the single biggest contributor to some women's life long happiness and well being.

though just to stop it getting a bit too peace and love round here I have to confess that I have been patronised and bullied by a couple of utter cunts in my personal dealings with obstetricians (yes, 'Mr Cesarean' with your tiny hands and your oily bedside manner, I'm talking about you..).

I thought her article started off OK but then degenerated when she started on about forceps and epidurals - but I have already said enough about that.

At the end though I found myself thinking that she was a bit crazy - she would take a known biased source i.e. the ACOG who don't have the faintest idea about home birth in the UK and let that inform her decision that in preference to good quality UK research? Since she wasn't contemplating homebirth why do their opinions matter?

It's up to her, but she could have been asking herself so many better questions about the actual care she will receive. Questions like: 'how often does my maternity unit close to new admissions?' What will I do if that happens? Will I get one to one care or will I be sharing with 6 other women? If I want an epidural, will I get it? What are the postnatal standards like, or should I go for immediate discharge?

In the process instead of setting up a straw man about home births and a bit of a dig about the NCT she could have done women a real favour in highlighting the standard of maternity care in this country.