Birth choices..

[143b]

Hi all

Me and my husband are currently thinking of starting the family in the next year, and being the control freak I am, I have been researching all about pregnancy, childbirth etc.

I have heard enough horror stories from friends of terrible tears, incontinence, injuries to babies etc to make me rather terrified of the perspective of the childbirth.. Also, I have had loads of problems with sex for years due to constant water infections following intercourse, and the idea of damaging this even further, being incontineny and having no sex life at all for months does sound quite frightening tbh.

After reading through NICE guidelines, NHS statistics and other people's experiences here, I do get an impression that ELCS is safer option for both mother and the child, and gives you some form of control over your body. But by the sound of it, it is a tough battle with NHS to get an ELCS approved with no apparent medical reasons.

At the moment I am thinking the best option for me would be hypnobirthing course and hiring a doula for the actual birth, who would help me concentrate on the techniques I learned. This , I hope, would reduce the chance of medical intervention and losing control over my body and what is done to it, which I think I am most terrified of..

My question is, can I refuse any sort of intervention like forceps or ventouse, by stating clearly that in case there is any needed I prefer the doctors to proceeds straight with the CS? I know a lady who had horrendous labour, hours of pushing before she was taken to theatre and prepared for the CS, but doctors decided to try forceps first, which resulted in feceal incontinence for months..

Also, if I am overdue, can I refuse induction, both pessary and ocitocin drip and ask for the CS instead?

Many thanks for your comments and sharing experience - they are much appreciated!!

yes in answer to your question you can refuse intervention

a doula would be a very useful advocate for you to have at the birth for this reason

another thing is that people are very quick to tell you lots of dreadful things about labour and birth but you are less likely to hear great stories of which there are many

i had two terrific births and my second was particulalrly fabulous

ELCS is not safer; quite the opposite, actually. But it is unquestionably indicated in when the anticipated medical risks of VB are greater than those of a section.

Yes, you can refuse an intervention. But there is a difference between a low forceps/ventouse lift out, and a high forceps. It didn't come to it on the day, but I had discussed this with my HCPs before labour and they had no problem with my preferred 'straight to CS' rather than high forceps.

Sometimes it's too late to do a CD but low forceps/ventouse is still needed. If they're talking high forceps then the baby should still be high enough for an EMCS, but there is a point of no return.

You can refuse induction but whether they will proceed to a CS without signs of fetal distres depends on the doctor involved. You can refuse any intervention.

This is all best discussed with your MW. I understand your reservations - DS was born in a particularly medicalised culture where assisted births are practically the norm - but the best you can do is prepare, optimise your chance for a natural birth and then hope. There is an element of unpredictability but well-informed is well-armed and you will sound less ignorant taking to HCPs of you demonstrate an understanding about which types of intervention are called for under what circumstances c

Such a shame that your friends and family are sharing awful birth stories and you're not getting a balance of lovely ones. There is a homebirth thread going on at the moment that's worth a read. Whether or not you'd consider a homebirth isn't the point, it's all about lovely births :)

However, guidelines do say that women who make the informed decision to have a CS should be entitled to one so yes, you should have that choice. Like many choices you may need to fight for it. CS has risks to mothers and babies. It has risks for future pregnancies. It's major abdominal surgery. Babies are more prone to a variety of problems including breathing problems and prematurity (the latter with planned CS in advance of labour). However, vaginal birth can of course lead to problems too.

If you choose a vaginal birth and get a good one (which with the right support and information you've got a really good chance of getting) then you're getting the optimal outcome for both you and your baby from a morbidity point of view. If you prefer the known risks of CS to the unknown outcomes of VB then that is a choice that should be supported by the NHS.

Incidentally, you also don't need to be induced (or have a CS) for being post dates, but that's a whole other kettle of fish...

birthrights.org.uk is your friend, by the way, if you need support with your choice.

Ladies - thank you so much for your responses!!! I will keep on researching and by any means will speak to the MW whrn the time comes to make sure I am making the very informed decision.

I will read the home birth thread as well - definitely need some positive stories. It's just it is so hard to find "clean" statistics on all births options, without mixing in emcs and vs as well as number of first time straight forward births with no tearing or trauma to both mother and a child.

I found on nhs website that one in 8 births ends up in either forceps or ventouse, which sounds pretty high to me, especially considering out of these 1 in 8 the majority are first time mothers..

Yeah, but there are ways to reduce the risks of instrumental births too. If you decide to consider VB rather than going straight to CS then there's plenty of things you can do to reduce the risk if you're happy to look into it. Obviously it's a risk reduction, but by knowing the most likely reasons that people have instrumental deliveries you decide whether to make choices to reduce that risk.

Organiccarotcake, yes, I think I would prefer to do everything to have a natural, unmedicalised birth providing my body allows me to have one in the outset (I e no induction etc).

Do you have any links to info re minimising the risks of interventions by any chance?

You can refuse intervention

But

Make sure you understand high vs low forceps and the interplay with c section

There comes a moment when a baby is too low for a normal c section
The only way out is a T cut that including a vertical incision across your stomach. It's risky and many doctors haven't done many which doesn't help

And there is also a point beyond which a safe c section may not be possible - trying it can mean serious damage to bladder, vagina, cervix, uterus

If your baby was stuck at this point with heart rate dropping would you still refuse all intervention?
I shudder when I think of forceps and would do almost everything to avoid them but I do know that they can save lives

What you hope for is that you would not end up in that position but conversely that if you do there is a doctor with plenty of experience using them. Apparently the latter are sorely lacking because of course none of us want forceps so they are generally avoided.

My obgyn said that I seriously mean no foreceps ever, no matter what, I should have a c section. He was very blunt about it. I did ask him to be blunt btw - medical family and all that.
You will never know what happens in labour to you and the baby and you don't know if there will be a theatre, obgyn and anaesthetist available at exactly the right time - perhaps there was and then another woman needs a crash c section due to catastrophic bleeding?

In the end we had no choice with DD and now I am having to think it through again with dc2. To vbac or not to vbac

And you will be fine. Talk to people. Read some great birth stories - natural and c section ones.

The question of refusing intervention as a patients' right is an interesting one that I hope we all only ever experience in theory. In 99% of cases it is just a clear cut case of respecting our preferences. And then it becomes a matter of life and death. I would not want to put my doctor in that situation. But that requires trust to say here are my wishes and here are the circumstances when you do what you need to do. And I trust you not t abuse that clause.
We can refuse blood transfusions. We can refuse antibiotics but do we have the moral right to make these decisions for our children? I know a girl whose twin died as a toddler as the parents refused to administer any medication that was tested on animals.

143b - loads of stuff - where to start?

I really like Midwife Thinking's blog. midwifethinking.com/ There's lots of useful info there and she references properly.

Blondecat is right that in extremis it's very hard to say no to interventions, although yes you absolutely have the right to do so (your body and it would be assault if you said no). But most choices aren't in extremis.

For example, you can choose to avoid, say, continuous foetal monitoring which is more likely to lead to EMCS without increased benefits to mum or baby. Or, you might choose to avoid epidurals which can increase your risk of IB or CS, and to do that you might choose to avoid induction (because induction can be far more painful than spontaneous labour) unless it was absolutely definately needed (in which case Michel Odent argues that the risks of induction hormones are high enough to consider going straight to CS).

The Birthplace Study (big, recent UK study) concluded that for low risk mothers of second or subsquent babies, planned homebirth was as safe as planned hospital birth when comparing baby deaths, and had a much lower risk of maternal and baby morbidity, CS and IB. For first time mothers there was a 3x greater risk of baby death - but from a veeeery tiny number to another veeeeery tiny number - and all the other factors applied, ie lower risk of morbidity to both and no difference in risk of mortality to mother. This is a good study to check out, as it shows that the best way to avoid what you're worried about is to stay away from hospital, if you're comfortable with that.

The thing is,nothing in life is certain. We are used to living in a super low risk environment. We do want certainty and control but that's pretty touch in childbirth. We can just try to make the best decisions we can, whatever they are, and you are going to have the very best chance of doing that by doing your research now.

Check out the AIMS books, they're brilliant, evidence based and really informative. www.aims.org.uk

Blondcat, I completely agree with you and understand that there are situations when forceps are the only option left to get the baby out safely and I have no problems with that.

My concern is that it sounds like nhs health professionals often prefer to use forceps when there is still an option for emcs in order to reduce the CS rates in their hospital, or induce women where things are clearly not going right..

My friend just had a baby in another country (privately). She wanted a VB, but was more than a week overdue with no indication of labour whatsoever. Her doctor attempted induction, and she had strong contractions for 5 hours with no dilation. Then, her doctor said that they can either proceed with more ocitocin and hope for the best, or go for CS. He said that in his experience the progress doesn't look good and iher chances for a straight forward birth are not that high. She chose to have a CS, which meant she was still not too exhausted to look after the baby straight away and the baby was delivered safely, with no distress.

I wonder if such scenario would be available on the nhs? From what I've heard nhs does not really care about how mother feels during the process and often doctors are happy to keep on inducing you and see what happens, on the off chance that the baby is born vaginally and they have avoided another CS ti add to their rates..

Well, every Dr is different and it's not possible to say that each would do X or Y. Induction is a funny thing. Sometimes it works brilliantly and women can have really positive births. More often than not it's much harder than spontaneous labour, and more likely to lead to interventions. I'm very worried about the number of inductions for "post dates" that we have here and most of them are completely unnecessary and the side effects are considerable to both mothers and babies.

There are very many wonderful Drs and MWs in the NHS who care deeply for the mother's experience and health but the limitations will be things like resources at the time. You could certainly push for a CS in that circumstance but you'd not be automatically entitled to one.

143b, I think the more you read, the better you will feel about this. I've been looking into childbirth since we were trying to conceive last year. I think it's easy to see the misogyny in how the NHS treats labouring mothers, that there is a focus on reducing CS rates which could be seen as inappropriate or even ghoulish, that it can be difficult from time to time to obtain the right pain relief for your individual needs because your ability to gauge your own pain limits is undermined or unrecognised. Phrases like 'cascade of intervention' further darken the whole issue. But actually, I don't think the NHS is some big evil machine, trampling all over the needs of women. I think the primary focus is very much on the safety of the mother and the baby.

I say this as someone who is going to be induced in 28 hours from now. Induced labour was the very last thing that I wanted. But, I have to follow the best advice available at the current time. This means that I have 15% chance of having labour end in instrumental delivery, which I never wanted to happen, and a 22% chance of induction attempts failing, leading to an emergency c-section. I haven't been to university and I am not a trained medical professional. Google can only reveal so much information to me. My utmost priority has to be the safety of my unborn child, and that means going with the educated advice of the professionals.

Organiccarotcake - thank you so much for the links and the valuable information! I have not seen these websites before - will definitely reasearch them!

Purrpurr - I hope everything goes well with you! It means you will meet your baby very soon!!

"there is a focus on reducing CS rates which could be seen as inappropriate or even ghoulish"

If simple things like ensuring one to one care in labour, improving access to fetal blood sampling in the case of fetal distress, and increasing consultant input in complicated births, all have the effect of reducing the rates of emergency c/s (they do), then it's quite right that hospitals should be focusing on doing these things.

It's not wrong to want to reduce the emergency c/s rate, which almost all health professionals involved in birth believe to be too high.

143b - if you want the best chance for a straightforward birth with minimal intervention, then find a free-standing birth centre, or opt for a homebirth with a case-loading team of midwives (ie a team of midwives where you see the same person throughout the pregnancy, birth and postnatal period). The statistics are very striking - women are MASSIVELY less likely to end up having multiple interventions with this type of care.

That said, can I also add - the vast majority of people who have a tear during birth, a ventouse or forceps delivery ARE ABSOLUTELY FINE afterwards. It's not usually a massive deal.

Gosh sounds like your friends have had some unusually difficult births. Most births really are straight forward. Hard work but straight forward.
Yes you can make choices but I'd recommend looking at the benefits of any of the procedures ect. Google Positive birth movement as they have free groups which support and discuss birth in a positive light. The idea is by telling positive birth stories you can remove some of the fear associated with it.

I had a really good birth. I was supported by my partner and my mum. The contractions were powerful and while at home I spent time in the shower on kneeling down in the bath with the shower running over my back. Massage helped too.

My waters had broke at home and I had a bit of a lie down.

We then drove to hospital. The midwife was calm and hands off and let me and my birth team get on with it. I had some gas and air which was useful. The midwife gave me some advice when it came to pushing as I wasn't sure what to do. I gave birth on my side but had spent most of the labor on a birth ball or all fours or kneeling.

I had some stitches. It didn't hurt having the stitches I had thought it would but they give you gas and air and an local so it didn't hurt. My DS was 10 pounds 2 so a large baby.

Yes sex can het put on the back burner for a bit and it took us both a while to readjust and get our groove back.

Getting a doula is a great idea, so are hypno birthing class or any antenatal classes so NCT, or Daisy birthing, or yoga ect.

143b if you don't want to interrupt your sex life don't have kids. At all.

You'll likely go off at least some aspect of sex for at least some of your pregnancy (e.g. I'm much more sensitive about not liking the taste when kissing poor OH if he has a cold atm) and a baby, however it is delivered, will take time, energy and love that you used to have to lavish only on your partner.

For us we've decided it is temporary and well worth it. But I'm guessing it might not be for everyone.

On the birth stuff - plenty of good, and varied advice above.

I had three difficult births - two colossally long labours, a shoulder dystocia with an 11lb baby and a forceps delivery with a 9b 6oz first baby. Still found each one the most amazing (albeit painful in the extreme) experience and the best days of my life.

When it comes to birth, long, painful and complicated is NOT always or even usually synonymous with 'terrible' and 'traumatic'.

Good care, not being scared, and having a well baby is the key!