Writing a book on the medical side of birth - will it be useful?

[DoctorMonty]

Hi MNetters... your reputation precedes you, I'm a bit nervous...!

As briefly as possible: I'm a labour ward doctor (obstetrician) and it seems to me that mums-to-be are well prepped by loads of books/NCT etc. about natural childbirth, how to avoid needing an epidural etc.

But...! Sometimes things don't go to plan, and that's where my job starts. But again and again, it seems like women - particularly with first babies - haven't been told much about the medical side of things, and then you're expected to take it on board within minutes!

Take for instance forceps deliveries. I totally get you'd want to avoid a forcep delivery - believe it or not, so do we as doctors. But there's not much good being told everything about it, the risks and benefits etc, in the few minutes before you end up having one! And sometimes time really isn't on our side. I still see regularly on birth plans "I don't want forceps unless necessary", which I can understand. But at the same time, we don't do it unless it is necessary...! Why is no one putting that information out there pre-birth?!

We had our daughter in 2015, my wife did amazingly, she had a hypnobirth in a pool . So I understand about not wanting to visualise negative things, wanting to picture the perfect birth and all of that... but some people like to know what Plan B is!

So, I'm 4000 words into a book that explains in plain English why we do certain medical things on labour ward and what the risks and benefits are. Some pregnant mums won't want to think about it - I get that. But presumably some would prefer to know as much as possible, so if something starts to go wrong they know what happens and feel more in control...?

Particularly if you're someone with a complication picked up in pregnancy, when a home birth in a pool is just not on the cards.

Anyway, I'd love to know your general opinion on this. Whether you're pregnant and would or wouldn't want such a book, whether it's something you wished you had, what you think should definitely be included... literally, anything. As I said, I've already started it, and if the idea has legs I'd love to enrol some expert help from here to critique it before it's published.

Finally, the format (at least for now) would be an eBook as they're so easy to get out there. I've got a paediatrician and an anaesthetist also writing sections about babies and pain relief/anaesthetics too.

Thanks so much for your time.

Book is a good idea.

Too much "fluffy" information out there which doesn't actually address the fact that pregnancy is a high risk time in a woman's life.

Birth plans are a waste time ... I never did mine & im glad I didn't as I was one of many women who needed life saving intervention.

Good lord here's a tip: don't patronise your audience by using terms like 'labour ward doctor' instead of obstetrician.

When having my son it drove me crazy that all insisted on referring to 'baby doctors' instead of paediatricians.

Other than that it might be an interesting read.

I get where you're coming from but I'm not sure that women would seek out or want to read an entire book on childbirth complications. Perhaps spending some time with midwives and seeing how they teach birth prep to women may be of use for you to see where the gap is and how you can fill any gap with your own expertise?

It is difficult within the constraints of the NHS to give women a realistic image of what labour may be like but women are told antenatally that forceps would only be used in an urgent or emergent situation. I believe that most women really don't want to know what forceps look or sound like, let alone what they'll be used for inside their bodies, and it's likely that they write 'only if necessary' on their birth plans to convey that they do consent in an emergency but also to have some sense of control and autonomy as they approach labour.

There is already a book about C-Sections which is actually rather good and prepares mums to be for both planned and unplanned lscs with tips for recovery too. It's by Leigh East.

I think you'll get a mixed response on this one.

I wish I'd known more. But the problem is, I was so sure I'd have the birth pictured in my head that I wouldn't have sought out something like your book. I also think more information on inductions would have been useful - I had no idea what I was in for.

I think it would be really useful. I just tended to use google and it scared me shitless half of the time. I had oc in my first pregnancy and wasn't given hardly any advice, just what meds to take. I did my own research and was met with loads of stories of negative outcomes. When I was being induced there wasn't much info either!
I think it needs to be factual, to the point and reader friendly
Good luck!!

I think it's a great idea.

With my first baby, I went for homebirth. I was very positive about it and so were my mw's. I ended up (after meconium in waters at home) in hospital. I had a terrible labour. Baby presented OP (first time I've ever heard that term) after epidural and forceps. I had a 3rd degree tear.

My preference for a book would be to have a whole big section on myth busting. As I went down the natural route I read up on 'natural' births and read frequently about how bad hospital can be for escalating intervention. I refused pethidine as I'd heard it was a terrible drug to have. Basically, once my preferred birth plan was long out of the window I was a bit lost as to what may happen.
I had many people in the delivery room when my dd was born. I didn't realise that wasn't that normal. I overheard 2 clinicians say something like
"I can't believe we just delivered an op baby in delivery and not in theatre" (I was out of it at the time and it was 12 years ago!).

It took me a lot of time to mentally and physically recover from that birth. Not because of the hospital per se, but because of the expectations and 'myths' I had in my head beforehand. I truly thought I'd failed to do it properly.

I just don't think people will seek out that information unfortunately. Even if they do they'll just think "it won't happen to me".

I was given the East book on c sections by my NCT class leader, as I was having a planned c-section due to Placenta Previa.

It was brilliant. Well written, clear, reassuring. I suggest you have a read as prep for writing your work.

Incredibly useful replies already, can't wait to read more, thank you.

Mungobungo - you're absolutely right, it won't be for everyone. Whilst there will be a short section on emergencies at the end, my hope is to present the rest of it as things a hospital might do to prevent problems, so it's reassuring rather than a list of things to worry about.

There were 10 women in my NCT group. Of that 10, 1 of us - me - had read voraciously and was aware of all the potential complications etc. The other 9 all stated they would prefer to remain in denial and cross that bridge when and if they came to it, so to be honest I think a large section of your potential market wouldn't be interested.

I think if it was well-written, not patronising and explained risks/benefits honestly and without bias or agenda, some women would like to read it. They're probably the same women who already read up on it all anyway though and you need to think about what extra you can provide that they couldn't get from googling and choosing reputable online sources.

I think it could be useful for women who know they are likely to face complications but who are not the read-up-on-everything types.

I would have loved that book.
Especially if it included information about how often eg forceps, ventouse, episiotomy etc are required, why doctors would use one method over another etc, what happens when interventions aren't used.

It'd be nice to have VBAC info too - most bits you read are very general, and I didn't really feel informed until I saw the consultant at 38 weeks (despite looking for RCOG guidelines etc) because I couldn't find info that applied to me. Ideally I'd have liked to read about it while TTC. Things like why no induction, what's a balloon catheter, pain relief options and odds.

Yes absolutely would have wanted to read something like that, and you're quite right NCT focuses far too much on the ideal of a natural birth.

I was induced and had very little idea of the process. Even when my waters broke after the pessary, I thought I would then be able to have a natural birth. I ended up being started on a drip at 1am as the doctors told me 95-97% of first time mothers would need a drip and I would only be delaying the inevitable if I refused. Was very hard to labour for hours without having had any sleep. I also wish I'd had advice about what you could eat/drink while on the drip. I had nothing until a consultant said I could eat haribo - would have packed some in my hospital bag.

I don't know if this covers your remit/expertise but it might be pertinent to include a section on midwife options etc or at least some information. I think most women hope for a natural birth and might be put off a solely medical book etc. Apologies if someone has already suggested this. Best of luck writing.

I think it's a good idea. But it might be really useful for women with earlier complications. I found that as soon as there was a problem, the pregnancy books had a sentence or two (saying that it was 'very rare', or happened to 1 in 300 women etc) then explained no further. Fortunately I had a good obstetrician and GP who explained things.

More so than in the case of birth emergencies, don't patronise this audience though. If you have had daily ecgs and check-ups for the last trimester, you know a few medical terms.

Conditions such as placenta praevia, oligohydramnios, high blood pressure, gestational diabetes, PUPP, etc etc. Also issues such as transverse or unstable lie. BUT I think you have to do it in a non-frightening way. I was terrified when told I had a low lying placenta because I read all the stories about bleeding out. It never happened but I could have done without the anxiety. A matter of fact discussion about the condition and treatment/precautions would be helpful.

Yes, sure that knowing in a lot of detail all the myriad of things that can go wrong with labour, perhaps complete with photographs of third degree tears and personal stories from women who've had a torrential PPH or a shoulder dystocia would hugely improve women's expectations and experience of childbirth.

Not.

Fear of childbirth and complicated childbirth is at record levels. Most women know about forceps, emergency c/s. Really they do.

I would welcome a book like this and would want it to take a clear look at options for 'normal' birth as well as when it goes wrong. E.g. the implications of eating for the risks involved in general anaesthetics vs keeping your energy up. I would want something in the style of Emily Oster's book Expecting Better.

Hmm, I think it might work better as a section in a book about labour and all the possible scenarios. Lots of women buy books about how to have the perfect labour, but I bet they don't buy books solely about how to have a medicalised birth!
Shame, because it would be good to have the information from an obstetrician.

Anyway, I'd have wanted cold hard facts and numbers: numbers of women who have problems with placenta in VBAC, number of women who have to have forceps, pros and cons etc. I'd have bought that!

Could you team up with someone else who's writing a book about a more holistic approach to birth?

Zumbumba, why is it the fault of the NCT that the medical staff doing your induction didn't give you a full run down of what to expect and how to help yourself - that's their job! How could you make an informed choice to accept treatment when you didn't fully know what it involved?

I didn't do NCT. I knew all about forceps and epidurals from doing me own reading. Didn't make it one but better when I needed them to help birth my daughter. I would have appreciated some help to get me off my arse in labour and less repeated encouragement to get hammered on pethidine. Might have managed to get her out without needing instruments if that'd been the case!

I agree with MrsNuckyThompson

Otherwise it sounds like a great idea. Some good suggestions here.

Will you include cesarean deliveries?

I had loads of questions regarding mine.

Induction info would be useful as you get told you'll be induced on X date but that's it, I had no idea what was going to happen and also that I could refuse to be induced and have monitoring instead for example. I didn't know it might not work, I didn't know it could take days to kick off.

And also what happens with failed inductions, failure to progress resulting csections be it semi elective* or emergency.

*after days of being induced and nothing was happening I asked for a section so had one the next day. I had no idea what to expect as even though it was planned in advance (about 24hrs notice) I was in hospital so couldn't really prepare iyswim

I have had 3 complicated deliveries.

2 emcs, the 2nd was a failed vbac. The first I had read extensively about interventions, I had a detailed birth plan centered around natural birth. In the end it didn't matter it all happened so quickly and I was so tired, out of it and in pain that I didn't have time to think about the reasons or what was happening.

The second I planned in detail, researched thoroughly vbac's and what I wanted. It didn't matter as I arrived in advanced labour and was too far gone to advocate for myself in between contractions. Quickly the staff went into medical birth mode I had to tell them more than once to read my one page birth plan in between back to back contractions. The lack of respect for my choice/needs went down a predictable route leading to another emcs.

The third a elcs with placenta percreta nothing I read could have prepared me for (and I read a lot, medical papers, personal stories etc...).

The thing that affected me in all three deliveries was not my reading around the subject. It was the staff. From the midwife who ignored my dd1's dipping heart rate on the trace. The midwife not reading my birth plan with dd2 and the obstetrician who wanted me on my back straight away after labouring to 10cm fine standing at home. To the superb midwife who supported my DH as they fought to save my life after dc3 was delivered and the two consultant obstetricians and theatre team who pulled me back from the jaws of death.

Educate the staff. Help them explain in human terms what is going on at the time from the midwife and obstetrician appointments, to the delivery and post-birth. Encourage them to see the person not the procedure, the mother and father who need compassion and humanity in the midst of a stressful experience. Help them to sit down and support parents after a traumatic birth, be transparent and talk about what happened in terms we can understand. Offer support services after birth, it can be months or even years afterwards that people need to ask questions and talk.

This is more important than any book.

Having said that leaflets would be welcome to give to mothers who are facing certain birth complications with factual information clearly presented, they could be given to them after discussion with their obstetrician to digest the information in their own time.

I didn't read anything but I think I should have. I had an epidural which kept falling out which gave me back pain for the next 15 years. I think I might have refused if I had read up on it beforehand. It also hadn't crossed my mind to use the bathroom before labor... .

I hadn't DC pre internet so everything I would have learnt wold have been from books or anti natal classes - I guess it's different now.

I think I would have liked a factual non-jargon and non-twee 'guide book'

Statistics are always good and case studies make things readable. I'd b happy to read a fairly graphic honest book. It obviously wouldn't suit everyone but I would have liked it.