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.

It's utterly appalling that people are expected to consent to treatments which haven't been properly explained.

Very good idea. As long as you state this is not for women who'd rather not know, I can't see a problem.
I keep reading "do your research", "I did my research" etc but if you've no idea what to look for it's difficult.

And no, none of my friends knew about forceps. "Isn't it just another natural delivery?"

I would have read your book, I'm not one to bury my head in the sand and would have liked a professionals view on assisted deliveries, c sections etc just in case that would have been needed.

As it happens I was fortunate enough to have a straightforward birth but if I had another I would read it as a refresher.

It's a good idea so long as it isn't mansplaining birth.

I would have read it. Especially if it had information on induction. The leaflet I was given was pretty good however it heavily implied that once the gel was in it would likely take at least 24 hours for anything to get going. It did not state that once labour stated around 12 hours after the gel was inserted the contractions would come so fast and be so intense that I'd barely be able to breathe in between them. I wish I'd known what to expect.

I also think that antenatally midwives should be discussing these things more. I know for a fact that had I needed any further interventions once I was in labour any consent I gave would have been far from informed. I was in so much pain and so delirious with it that I could barely hear the anaesthetist explaining the epidural (which I never got anyway) to me.

I think maybe some doctors and midwives think that the more they tell you about induction the more likely you are to withhold consent or request an ELCS instead...

Hi op, I think this is an interesting idea, and I would have read it if it were presented in the right way (factual, not patronising, but still 'light' and understanding of a woman's concerns and fears)

I work in marketing and pr and have launched several factual books that have gone on to be widely sold in supermarkets etc.
You say you are planning an ebook because it's so 'easy to get out there' - I wholeheartedly disagree. Yes it's easy to press publish, but what's the point if no one knows it's there? There are millions of Ebooks out there that have only been 'discovered' by a few readers. This book won't be for everyone, but ideally you at least want pregnant women to know that it exists so that they can make the choice to read it. You need help with marketing so that the book can have a chance to do what you want it to do.

Go and have a look in the baby book section, find books that are similar to yours (i.e., factual, expert led) and look at who published them. Try to find three different publishers and approach them - it's really not as difficult and scary as you might think, send them the 4000 words you have so far (you do not have to complete the book first) and if they think it's a goer they will help you with length, tone, routes to market etc and your book may reach the women who need it!

Best of luck

I remember reading books that I felt focused on the medical side, but they were American, so not so relevant in the UK. I found it hard to be fully informed, and I wanted to be. Most of my questions during my anti natal visits were brushed aside and I was told I didn't need to worry about that. I like to be in control of my own health, so this response didn't go down well. I would have read the book you're writing alongside Ina May Gaskil and the others. I think it would benefit you, as a doctor, to read up on natural childbirth so that you are aware of what women are aiming for in some cases.
For what it's worth, I had 3 births, one in hospital and two at home. By my 3rd, my husband and I did almost everything by ourselves, and the midwivessel only stepped in to supervise at the very last minute. It was an incredibly powering experience, and I think it's a shame that many of the doctors involved in birth are male, and only see the other side, when things are going wrong. If you could see more of the births that are not assisted, you'd know more about where women are coming from when they write thei 'natural' birth plans !

Too many variables. Possibly too much information (not in the ewwww sense but as overload). I agree with a PP who suggested a leaflet. Or, the non fiction equivalent of a novella perhaps.

Some parents may think about the perfect birth, some worry about all that can go wrong. Unless medics advise otherwise during birth/pregnancy, an open mind is the "happy" medium. Other medics might suggest your book to patients of course. Do you intend to self publish?

I think maybe some doctors and midwives think that the more they tell you about induction the more likely you are to withhold consent or request an ELCS instead...

I suspect you're right about this. It was only afterwards when I was discussing with the midwives on the ward that they all basically said inductions tend to be more intense because your body hasnt been given a chance to prepare itself. Yep thanks for that information yesterday

Don't say anything about how 'amazingly' your wife (or any other woman) did. Far as I'm concerned, the type of birth you get is largely a crapshoot, so praising someone who happened to have an easier birth than someone else at best annoys other women and at worst increases their feelings of failure.

To be honest I'm not sure what this idea will achieve.

It'll either dumb down everything and annoy those of us who, shock horror, can cope with proper medical terminology (I'm still bitter about the MW's comment last week that i could fill out my own notes but 'might not understand some of the words'....-think I'll cope, thanks), or it won't be any different to a medics' guide to birth.

So much pregnancy information is insulting in its simplicity (I wish Emma and her blessed diary would go disappear somewhere...): please make sure you don't fall into this category.

I don't know if it's unusual but my NCT classes covered the complications and medical interventions. I also had a couple of pregnancy books that had chapters on labour choices and interventions. I felt like I knew enough to make decisions at the time of labour. I wouldn't have read a whole book specifically on it.

I think it would be really useful. I'm a gp trainee and had an elcs during medical school due to breech presentation as a primip. It is only just now as I am finishing an o&g (and paediatrics) placement that I fully understand the risks and benefits of cs vs breech birth and also the implications of having a cs with your first. Despite my background I don't feel I was adequately counselled on these things and wasn't sure where to look for reliable info.

Think it would be a useful book for gp trainees actually

I'd read it. So far I've found very little information on why things are suddenly recommended in labour and I'm trying to understand what happened in my first labour and what could have been done differently. I vividly remember the 'consent' given after 30+ hours of labour.

I think this is a great idea! Especially if coming from a less polemical angle than something like Amy Tuteur's book (actually I agree with a lot of what she says, and find her obstetrical experience interesting: but facts tend to get 'used' to make a particular point about how bad home birth is rather than being presented neutrally).

Would be especially useful to have some concrete statistics. e.g. when I was ten days overdue with first baby, and had a Bishop's score of basically zero (this after three failed sweeps), I was sent up to the labour ward from the birth centre to see an obstetrician, because I seemed likely to be running out of time. She told me that if I tried induction I had a 60% chance of ending up with a c-section anyway. I thought this was quite amazingly high, and would be a useful fact to prepare women with. i.e. no matter how little you want /imagine a c-section, if you're a first-time mother and go overdue without effacing/dilating etc, a vaginal birth is probably not going to happen. I had naively imagined that induction was pretty much always effective. I'm sure there must be many more stats like that.

Something concerning me now are the stats for VBACs. Went to a VBAC workshop with a midwife at the hospital where we were, I suppose, being lightly persuaded to try one. Statistics (e.g. of neonatal complications, maternal hemorrhage) were presented in two columns: VBAC or c-section. Unsurprisingly, VBAC looked a lot better. But this seemed itself misleading because the c-section statistics aggregated the 'worst' outcome of a failed vaginal birth (emergency c-section) with the outcome of elective sections. Presumably it isn't the c-section that causes some of the 'bad' neonatal outcomes in emergencies but the process that led up to it and the accompanying fetal distress?

I am not a scientist but I feel frustrated by the muddying and (often patronising) way in which this kind of information is presented to women, as if we aren't intelligent enough to see fine-grained differences, or to ask questions about cause and effect. So I would love a book that was honest about all these things, maybe splicing presentation of data/ information with some (non-cheesy!) real-life obstetric histories!

Actually would be kind of cool to have a book with a strong case study element -- think this often works brilliantly in medical writing (e.g. Henry Marsh, Atul Gayuwande, Stephen Grosz) but understand this might not be your inclination... Anyway, keep us posted!

By the way, I work in publishing and I totally agree with Curls.

Find out your publishers. Approach them with your angle. In my experience most publishers are on the look out for something new.

A lot of info can be found in the Writers and Artists yearbook by A&C Black. However a lot of it will cover fiction etc there will be relevant info there.

DoctorBeat - as a medical professional aren't you shocked that women are expected to consent to things they don't understand?

I thought informed consent was a basic principle in the NHS.

You say you are planning an ebook because it's so 'easy to get out there' - I wholeheartedly disagree. Yes it's easy to press publish, but what's the point if no one knows it's there?

Totally agree. It's very easy to self-publish; it's very hard to market and promote and sell your own book!

DoctorBeat Thank you for saying that. It truly makes me feel less stupid for not having known half the things I now feel I should have known.
I thought pregnancy books and classes written and run by people who know about birth was enough. Little did I understand that promoting evidence based information could sometimes mean (conveniently?) ignoring facts (rates for tearing and induction for example) that don't serve one's agenda.
I was ignorant and naive.

My local hospital runs totally free parent education classes. Everything you described parents (mums) needing to know was talked through, discussed, described and explained at length. The classes are fantastic and run by a midwife who over the classes covers everything from "hypnobirth in the pool" to "emergency section" "forceps" "induction" and "transferring from the midwife led unit is not a failure"

The information IS out there for those who want it. I did. I got it and had my baby 4 weeks ago (hypnobirthed on a birth ball after an induction for pre eclampsia)

In stead of selling a book, why not encourage women to make the most of the services that are on offer?

I think it is a good idea. I got very tired of being treated like an idiot when I was pregnant (I had 4 pregnancies). I ended up reading medical journals for information.
Would like to reiterate what other posters have said: not an ebook, it needs to be on the shelves next to the fluffy idiot pregnancy books. And don't say your wife did 'amazingly', she was lucky.
Also, watch your writing style; ! seems patronising, and personally I don't like to be called a mum-to-be. Just be factual and clear.

Great idea
Don't dumb down too much just add a glossary
All these birth plans are nonsense if baby gets stuck. This needs addressing.
Use evidences based medicine rather than your opinion
Don't dress it up - childbirth is a bloody business why pretend it isn't
Good luck!!

Please don't peddle the myth that everyone attending NCT classes is sold the idea of some kind of amazing experience, that all these women then fully expect that amazing experience will happen no matter what, that they are then all deeply shocked and disappointed that the reality isn't like that...yes there may be some times where this is the case but that is mostly bollocks. The majority of classes, NCT or not, talk about both straightforward birth, and births where some medical assistance is needed. The majority of women know that some preparation for birth will most likely be helpful but that there will be some things that are out of their control. The majority of women will read around pregnancy and birth outside of any classes they do.

Medical professionals should be taking the time to talk to parents and explain what is happening, why, and what parents' options are AT THE TIME regardless of any preparation parents have done.