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.

I think this sort of book would be incredibly useful BUT...

Context is everything. In order not to feed people's fears you will need to be extremely careful to give information about how common the various procedures are, and also how likely the problems they are seeking to prevent actually are.

E.g. Induction - when you say 'higher risk of placental failure after 40 weeks' pregnant women may hear - 'placenta is definitely going to fail in the next week get the baby out today before it dies!'

We are already good at jumping to the worst case scenarios!

I'd like to see it with a few stats on how common each risk actually is.

Just want to agree with ricepolo above...reading that your wife did amazingly with hypnobirthing etc immediately labels that as the holy grail and any mothers who require intervention as failures.

Mini informed consent is obviously very important, and most doctors go out of their way to explain risks/benefits to people as clearly as possible. In an emergency situation there isn't the time to discuss things in the same level of detail- this is recognised by the GMC- a different level of explanation is required for elective vs emergency procedures. My DD was born via a GA crash section- if we had spent 15mins talking about the pros and cons of it she would have died.

OP - I think a book would be very helpful. What would probably be more useful would be a medical presence in some part of the NCT classes or NHS antenatal classes. A brief discussion about the reasons for induction, indications for various procedures etc. Or some sensible discussion during that very long birth planning meeting with midwife in late pregnancy. The problem with books is that people with a very clear vision of desired natural birth probably wouldn't read it.

I'm a medic (not an obstetrician) and find myself concerned about some of the myths about natural birth that are out there.

See it's there again:"Information IS out there for those who want it."
Well, not when you don't know what you're looking for, it's not.

OP It sounds like the birth of your child played a part in you wanting to write this book. Is this correct? If so, did it change your understanding of birth and how? How is it like to be on the other side?

"Mini informed consent is obviously very important, and most doctors go out of their way to explain risks/benefits to people as clearly as possible. In an emergency situation there isn't the time to discuss things in the same level of detail"

The vast majority of procedures in childbirth are done in circumstances where there is time to discuss what happens and why.

particularly induction

There is absolutely no excuse for a woman starting the process of induction without a clear understanding of what it may entail or the statistical likelihood of it succeeding.

I think it's a national scandal that so many women opt for an induction without having fully talked it through with a medical professional before the induction starts.

If you're planning on including information about statistical likelihoods and outcomes information then I hope you're spending some time thinking about how to present that information in a way that will be accessible and meaningful to your intended readership.

You're maybe already aware of Gerd Gigerenzer's work on this, and also his findings on how medical professionals also often lack the skills to interpret risk accurately.

This is an interesting approach to communication. It's aimed at surgeons who need to talk to families about the likely outcomes of high-risk interventions, but is probably applicable to writing about other scenarios where we have to make choices based on the information our doctors give us.

Regarding the 'dumbing down' of informartion; I think this depends on your audience. A large section of mumsnetters seem to be well educated, high flying careers etc (I'm aware this a sweeping generalisation btw) and will find there is a fine line between 'plain english' and 'patronising'.
However, a lot of pregnant women are not educated, well read, articulate etc. It will be hard to pitch it to be accessible for these women without seeming patronising to others.

A colleague was involved in producing some patient/carer leaflets and was advised to pitch it to a reading age of 8 years old as that was the average for our area (which has pockets of deprivation but I wouldn't say is too bad an area).

So much useful stuff here. Thank you. And the differences of opinion are interesting and also useful.

A few points:
Apologies for getting the etiquette re. birth story wrong. You're all absolutely right, it's largely luck of the draw - "did amazingly" is my subjective opinion. Didn't mean to imply failure/holy grail/etc. Sorry.

I'm not here to undermine/slag off the NCT, or perpetuate any myths. We're in the same business - trying to help women to have positive birth experiences and birth their babies safely. Some women, either through antenatal classes or NCT, will have had good info on medical intervention, but as seems evident from plenty of comments on here, some haven't. I'm not really in a position to influence antenatal classes or NCT class delivery nationwide! Maybe one day I will be, but not yet. Trying to create a decent resource seems like a worthwhile first step.

Thanks for that last point bigredboat. There does seem to be a keen "don't patronise" element to the advice, and I'll take that on board. Someone suggested putting a comprehensive glossary at the back - great idea. Then readers won't feel patronised but can easily find out what they need.

Consent - a very tricky thing in obstetrics. minifingerz is right, for most stuff that takes place on labour ward there is at least some time to give options and discuss. But there are so many issues that affect this - how tired and stressed a woman is, what her baseline knowledge is, what degree of urgency is. An hour might sound like a long time, but getting round to theatre, getting a spinal in, potentially calling up extra members of staff - it all takes time. It might be an hour before we actually get round to doing a procedure, but that doesn't mean you've got an hour to think about it - generally it's "these are the risks, these are benefits, are there any questions - now decide please!". It might not always be an immediate, life-saving emergency, but the stress surrounding labour complications does impact what "informed consent" would look like in an ideal world. I absolutely do take time and make effort to explain things in detail at the time, but for some, they're not in position to take it all in because of the situation.

The baseline knowledge is what I'm aiming to affect here. I'm not going to use gory pictures or horror stories. What I want is for those women who value knowing beforehand to be able to be somewhat familiar with what is suggested, and therefore feel more in control.

The benefit of this book would be to gather all of that information in one place. In terms of the facts, it probably won't be too different to a good leaflet's worth of info on each topic - but as I started writing it I realised there are a lot of topics. And as pinguina16 pointed out, if you don't know what you're looking for, why would you? Why would you randomly google "fetal blood sampling", for instance? Yet some women might really value being somewhat familiar with it in case it becomes necessary.

Induction = Can of worms. Tempting to dive in but that's not why I'm here!

Oh, and a big thanks to those who work in PR/publishing for the tips. I will definitely look into approaching a proper publisher.

I really want this in eBook format as well as any other formats, because I want women for whose pregnancies are maybe taking a complicated turn to be able to get hold of it instantly rather than wait for delivery, and I want it to be very affordable. But I'm sure a publisher can sort this out.

I would have really welcomed a book like this. I would have probably been tentative during my first pregnancy and dipped in and out, but would have definitely read it fully during my second pregnancy. There are so many celebrity pregnancy books and those books where you read a chapter for each week of your pregnancy (that swear you'll stop feeling sick by week 12!) that something more factual would have been really interesting to me.

Also, I was one of those women who unfortunately had complications during labour, my DD's shoulder got stuck and she suffered a brachial plexus injury. I felt so guilty that I had damaged my beautiful daughter and this affected me for years after her birth. Had I been able to read about this from a medical point of view, I would have known that it wasn't actually my fault and would have enjoyed my time with my baby a heck of a lot more. You don't need the gory details, just facts and procedures that may happen in certain circumstances.

Good luck with your book and I would love to read it, even though my baby days are now over.

I was one of those in denial about a potentially tricky birth, so I wouldn't have read a book on "things that can go wrong" (as it might be seen).

But I would have loved a series of leaflets that could be given out either in advance, during or afterward that explains what happens during the most common interventions, particularly if they say why the obstetrician is likely to have recommended that course of action, the risks and what can be expected afterwards in terms of recovery for mother and baby.

You could do a bit of research by talking to the director of nursing or whoever does the post-birth de-briefs at your hospital, and see what the common themes are amongst mothers who have had some difficulty or trauma in their delivery. That might help you focus on the key things that women want to know (and currently don't) about what happens in the labour room

Did anyone here ever see the MIDIRS Informed Choice leaflets? Sadly I don't think they've been updated for a few years but they were exactly what everyone has said is needed. Balanced, evidence based, non-judgemental. On all aspects of birth.

BTW OP Going by your posts I'd say that you write really well

Another medic here (though I'm in palliative care so the complete opposite end of the spectrum!)
I would absolutely read this - one thing I didn't know was about prolonged rupture of membranes. My waters went, went into triage and I was sent home, but nobody told me about the risk of infection - fortunately I went back before the 24 hours , but if they'd slowed I might have been missed. Now, this is something that I should have been told, but if I'd read about it before I'd have been better informed about going back.

Other things I'd like to know
-vbac statistics (success rates with different circumstances)
-information about tears- how common, what happens, when do you need to go back to theatre etc.,recovery times, longterm outcomes.

Good luck!

I think it's a brilliant idea. I had trawled my way through countless baby magazines with my pregnancies and the internet forums at the time of my first were just up and coming.

Through two births with ventouse, forceps, episiotomies, a tear etc I had no real information up until the point of them being NECESSARY in which case I had no option and was beyond caring even though I was frightened. Even in pregnancy notes there is little information go on as to what you've been through. Even though you're told you can ask a Dr/Nurse/surgeon/midwife they all seem to disappear post birth and everyone is understandably very busy so can't sit (or stand rather) down for a chat any longer than a few minutes at the most, then it is only when they are due to see you anyway. You don't want to bother the drs too much as you know how in demand they are. For instance I had no idea how dangerous my high blood pressure was in late pregnancy with my first child. No idea at all, I was told vaguely that I "just need to be monitered for a while" in hospital. I really, really hated it and was only given "wooly" information. If I'd have known what the issues were plain and simple good and bad I would have felt less impatient that being in hospital was best - yes obviously I know being in hospital was best otherwise I wouldn't have been sent there- but I felt absolutely fine!

Sounds like a fantastic idea and exactly the kind of thing I wish I had had available. If you want a "guinea pig" reader I'd be happy to volunteer. I've just had a baby 3 weeks ago and it was quite a complicated pregnancy so it's all still very current for me.

I would have read it, but I was another who "over prepared"

Just a thought, might it be better marketed at women who have given birth and were unhappy with eg the cascade of intervention? Explaining why things happened as they did?

Well after your first post I was going to leave a short comment alone the lines of don't bother, you sound really fucking patronising. But I have now come round after your last post.

I would definitely have read such a book. I did hypnobirthing classes and very much believe in having a birth as intervention free as possible - but of course if your baby is transverse for example you can't breathe your way out of that, and I knew that. Although I did (and do) believe that relaxation techniques can help with dealing with surgery, although I've never had to test that belief. I tried to research the medical side of birth too but did find that very hard. Antenatal classes covered forceps etc but very much in a 'if it's suggested, you kind of have no other option, so be a dear and be good about it' way. Very much felt like pressure to consent should the situation arise rather than a proper education on the subject.

I would welcome in a book the reasons why interventions are used. 'Failure to progress' - what does that mean? What are the consequences? Also information about the negative side of interventions. All people ever seem to focus on is 'oh they both survived' like that makes everything ok. But what the chances of incontinence problems for example? Or long term pain?

Stats would be very helpful. And some kind of discussion of what medical research is actually being done. When is the last time anyone changed the shape of forceps? Does anyone do much research on birth methods? What is the research and how is it shaping recommended practice? Etc.

Regarding a specific medical subject - the placenta. It's often left out of birth information. Just mentioned that the placenta comes out after. But how long is the time frame between birth of baby and placenta. At what point is the non-appearance of the placenta a concern - 5mins? Half hour? Does cutting the cord accelerate that time? Etc etc. For me in my second birth the shit hit the fan over the placenta, not the easy, hypnobirthing water delivery of the baby. I still don't understand what happened, just that it was scary and there was blood everywhere and my placenta was the biggest they'd ever seen. I don't understand now what the risks were or why they did what they did. I was basically told - you might die, consent. In the aftermath, nobody told me about the link between a breastfeeding mother taking antibiotics and the baby developing oral thrush, for example.

Sorry. Essay. I'm pregnant again and am still (as ever) interested in the reasons behind transferral to labour ward from MLU, risks, interventions etc. Unlike other pps I have found it hard to find decent information.

I would have found this genuinely interesting although perhaps in shorter format than a book as my attention span was shot when I was pregnant.

Contrastingly, i would love to read it now, after a complicated delivery, to try and understand what happened and why.

I didn't nct classes recently with my daughter - her dp was at session 1and5 but the middle ones I was at covered all drugs, induction, sections and stats on everything. We looked at how, why and when these things would be used and the facilitator made the point repeatedly that you can't control everything, that knowing your options and the possible outcomes helps you process them if they are relevant to you.

There are some great books by midwives - I borrowed about four over the course and the section book mentioned above. i am all for information - I learned lots I didn't know on the course (despite lots of birth experiences). I think you might be surprised by what is out there already, I think the NCT would be unlikely to need you to consult when my experience saw them referencing NICE, RCMs and research (think they might do this too - not sure though). In the reunion my daughter went to two women had sweeps conducted by a male obs whilst in labour, they were told this was happening rather than asked and found if the most awful part of their difficult experiences. maybe your book could look at informed consent too - isn't it a bit typical of a male obs to start this without reading what is available and doing good research into women's experiences. Makes me feel a bit despairing that the NHS can't provide this all for mums and dads. That would be a campaign I would really be behind!

I would have appreciated having the statistics available, for example, success rate of a sweep, what % of women suffer complications from epidural, % of forceps problems v emergency section problems.

A big topic that many women may find useful from a book is induction as you get time to think about this so it's something people may be more likely to read about to try and make the best decision. I would have appreciated statistics-so what % of women have minor/major interventions with induction compared to spontaneous labour. What % have problems with going overdue. What options are there if want to decline induction and statistically what are the risks. I think many women know the risks and benefits but not in real terms so they may know that placenta can fail but with regular monitoring how likely is this???

I would have read it, I think, as I like to be prepared for when things don't go to plan. However, pre-birth, I had no idea which channel to direct my research down, there were so many potential scenarios.

Having now had an induction at 42 weeks, and a lot of emergency intervention, I would love to read your book now. As, because of the emergency situation, there was no time to discuss the risks etc, just a "we're going to do this, okay?", "okay". That's the way it had to be, no time for pain relief. But I'd like to understand now what happened and why.

I went to the NHS classes. The midwife taking it wasn't great, implying that labour wasn't that painful and there was no need for pain relief (she hadn't had children). The session on intervention and induction was not particularly thorough.

Definitely don't patronise. Use proper medical terminology.

Ps- definitely don't big-up your wife for doing amazingly with a hypnobirth, as that will potentially really upset the people that will end up having the type of birth you're writing about, likely a huge portion of your audience. Don't imply in any way that women who have been through a traumatic birth haven't "done amazingly", they have.

I think you might find that your target market is second/third... time mums. With my first I kept myself blinkered to anything that didn't focus on a perfect birth but after a horrific time I was much more clued up second time round and sought out information on every eventuality so I was up to speed whatever happened.

I think I would have devoured this book BUT then found research which provided a critique of your 'facts'. And this seems to be one of the problems with your idea. It simplifies things too much - there will always be a different, newer piece of research which interrogates the assumptions your 'facts' are based on (for that is how medical practice improves and develops). There will also be differing practices between hospitals and staff. In my own case (state-funded birth abroad), I found one consultant pretty much anti VBAC and another, prepared to run with my well-researched choice to go ahead (I swopped consultants to the one who would support me). Whatever you write will be partisan - presenting opinion' as simple truths, I think, will date your book quickly - and I'm not sure of the ethics of this.