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.

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.

I agree with this completely from ricepolo. It really grated as I read it in your op.
I have two emcs. Both after long labours. My first baby was never engaged and getting distressed.

I did bloody amazingly and recovering from a long labour and c section was hard. All women giving birth do amazingly, whether they have a natural birth surrounded by flowers or a c section due to complications.

Surely the only successful outcome is healthy Mum and child?

I think a leaflet is a better idea, but I do think it's a great idea.

I would like to see included

How to properly care for your c section scar, how to wash it properly and dry it, and what to look out for with an infection, including who to see

The realism of how hard breastfeeding is and where to get help.

Get mark Harris to read it

It would have been nice, when I was in labour (for FOUR days), to have been taken seriously instead of being constantly sent home and told I was only 1cm dilated and that I was just a hysterical first time mum. I knew ds was stuck. I just knew. Had I been taken seriously I could have avoided four days of agonising humiliating pain. As it was by the time they realised I was right and not just over exaggerating it was EMCS time. Now I will never have a natural birth.

So something about prolonged labour and not dilating would be useful because no one ever told me that might happen.

I like the idea of your book and would consider buying it if I had another DC.

I would love to see more information about post natal healing/ recovery out there. Real explanations of how your body changes in the immediate period after birth - most women know that the uterus shrinks but what about the other changes? I had two sections and felt quite under informed about how I could expect my body to heal and recover from pregnancy and the operation itself.

Personally I am also really interested in the little postnatal "quirks" and what causes them. For example, I had really bad wind for several months after having my last baby - why? How exactly does a c-section wound repair itself and why were my abdominal muscles sorest several inches above the scar? Lots of questions like this that I wouldn't want to bother a medical professional with but was just really curious about.

Yes, I've clearly pissed people off with that... As well as my apology (see above!), I'd like to add something re. my "amazing" wife's performance...
She did indeed have a lovely natural pool birth. She then dumped half of her circulating blood volume onto the floor, fell unconscious, and had to be rushed to theatre. One manual removal of placenta and a few units of blood later, she was wheeled back round smiling weakly.

So, IMHO, she did amazingly. She came closer to dying than most women in labour, and when the floor was covered in blood and she was unresponsive, the only thing that kept me from having some kind of breakdown was the fact that I knew such things do happen, and what would be done about it, and that it would be OK.

So yes, as a late answer to pinguina16's question, I suppose my personal experience does have something to do with the motivation for this. If I wasn't a doctor, I feel like I'd have PTSD or something, and maybe I can help other people who aren't in my privileged position re. knowledge.

I would have loved this. All the bloody NCT told me was to avoid an epidural and question every single doctor on every tiny detail. . The teacher went on for hours and hours on breathing techniques and spent literally five minutes on caesareans. Really handy as 50% of the group needed an emcs.

Nct have a lot to answer for. They are not even medically qualified.

Nct have a lot to answer for. They are not even medically qualified.

I went to both NCT and NHS antenatal classes. The NHS classes were run by Midwives (medical training). The NCT classes were far far more medically educational than the NHS classes.

I would not expect this to be the case across the board but it was certainly true for me and I went to 2 sets of both classes.

As a labour ward midwife I think the NCT woefully unprepare women for childbirth. I've cared for women who have been told if you have a waterbirth you won't bleed.....then there's a normal amount of blood in the pool afterwards they start to panic thinking there's something wrong.

I've cared for women who have said to me "but you're so nice, the nct woman said all the midwives were horrible here"! Even if that were true, it's of no benefit to terrify a group of pregnant women who literally have no choice of another hospital (rural area).

I found NCT class a load of complete rubbish - the only benefit was meeting the others in the group.

The NCT class leader was also a doula and spent more time on mooing and massage than anything to do with the realities of labour or caring for a baby.

fenella I found both classes fairly useless as I'd read nearly every book that was ever published about birth, etc. and didn't really learn much new.

I think the group of friends was far more useful than the classes in both the NHS and the NCT!

PossumInAPearTree

FWIW, I'm an nct teacher, and like all the other NCT teachers I know I spend every moment of my classes trying to improve women's confidence in their care-givers. I am massively positive about the skills and kindness of midwives, and that's despite some of the stories I have heard over the years of really quite unkind, and sometimes incompetent care. I don't pass these stories on to women and I don't go around saying 'midwives are unkind and incompetent' on the strength of what I hear.

My classes cover:

• c-section
• fetal distress
• assisted delivery
• recovery from birth

and masses more. The women who attend my classes know what the ACTUAL birth outcomes are at their local hospital and what their likelihood is of achieving a straightforward birth in relation to this.

If it's of any interest, I often hear at reunions 'I wish I'd known about induction/how awful colic/how painful labour is' and I don't say "we covered that FULLY and at length in class, I gave you a handout to read, I sent you further information by email, how much more information did you need?' I use really good quality resources from the RCOG and the RCM as well as NCT information. I don't sugar coat anything. Women get clear, evidence based information, and I get regular feedback from women saying they felt the classes were absolutely balanced in their approach. But I still get some women who feel they didn't know enough, and I wonder if those are the women whose ears and minds are closed to the possibility that they might not get the birth they want prior to going into labour. Or perhaps there is no way that we can prepare women for how tough birth can be no matter what we do with them antenatally. All I'm saying is, just be aware that women not feeling prepared doesn't mean that anyone else was at fault.

In other words, if you don't swallow whole everything you hear about NCT classes, I won't swallow whole everything I hear about midwives....

Fabsmum do you have any medical qualifications and have you actually delivered babies or are you an enthusiastic amateur?

Our nct teacher was a trained antenatal teacher - it would be bizarre if she thought that qualified her to deliver babies?!?

There was a thread on here recently about retained placenta. About not being taken to theatre but someone putting their hand up and grabbing it out without pain relief above gas and air. It happens. It was a good thread and cast some light on what happened to me (I was like your wife, but wasn't taken to theatre).

Information on PPH would be useful.

But who wants to be taught childbirth by someone who has no or very limited experience? 😂 would you let someone who had never fixed a car tell you how to fix yours? No!

I did private antenatal classes run by NHS midwives who did the classes privately in their own time. They were brilliant.

I imagine I would have found birth much harder if I'd been taught by someone who only had theoretical knowledge. No way of knowing for sure tough.

Though*

I would like to see two things in such a work:

• a primer on statistics

Likely things are likely to happen. Not certain. But not do you need to look for complicated alternative viewpoints.

Decisions are made roughly by looking at [likelihood X Impact] . So a lot of highly unlikely things are tested for just because it makes a massive difference for the tiny fraction of people that come up positive. A bit like millions of people clipping their seatbelt every hour without imagining themselves upside down with the wheels spinning.

• real case studies explaining why medical decisions were made. I knew about a lot of things in isolation - but real medics make decisions considering how various factors inter-relate. So not just knowing the dry facts about a medical condition, but describing how someone was actually treated for it, and how they balanced the risks and benefits of each approach.

.

There was a thread on here recently about retained placenta. About not being taken to theatre but someone putting their hand up and grabbing it out without pain relief above gas and air.

Oh I think that was maybe my thread! [grin/grim]

Again, at the time there really wasn't time for a full explanation of what they were doing and why, and that's fine. Nor was it explained after, but again that's OK. In fact I think that was probably best for me, as I was in a bit of denial at what all had just happened; ignorance is bliss.

But it's something women, certainly me anyway, may want to understand after and so a section in your book would be good.

I'm not paid to deliver babies, or to teach other people how to deliver babies.

I'm a skilled facilitator and get good feedback not just from parents, but from parents on my courses who are trained health professionals - including doctors and midwives.

I always encourage parents to do both NHS and my NCT classes if they can bear it. I often get told that my classes are much less patronising, more fun, more detailed and more useful.

I've observed NHS classes - some were brilliant. Some midwives aren't just amazing midwives but are natural teachers who fill people with confidence. I've sadly seem some utterly lamentable ones too. Knowing how to deliver babies doesn't guarantee that you'll be good at running an antenatal class.

I think it would be super helpful to have medical information on how best to protect your pelvic floor during labour. The potential injuries you could sustain, as a women, of having a forceps or ventouse delivery. They give you chapter and verse on c-section complications, but neglect to tell you in the birth classes that about one in three women will actually sustain significant damage to their levator ani ligaments, or have them torn off the pubic bone completely. Women need to be informed of how their chances of this hopening to them increases, and be given options accordingly. My birth plan said no forceps, no ventouse. I quite like my pelvic floor intact. Unfortunately, I wasn't given enough information about how to labour properly, and my midwife intervened when she shouldn't have, and I've sustained damage anyway, which means I will be at risk for prolapse in later life.
OBGYNS and midwifes need to be a lot more concerned with protecting women's pelvic floors.

Many woman go into child birth not knowing what they or their bodies are going through. It may even be the first time they have ever been in severe pain or in hospital. Their main concern is that they will safely leave with a healthy baby. Their lack of knowledge either comes from embarrassment, uncertainty, fear and stress of what has to come or lack of information.

I think in preparation for labor, movement and birthing classes are a great source of information and simulation but by all means open that all births are different, woman's bodies are different and medical intervention is indeed acceptable and maybe instead of a birth plan have a way of presenting information that if this doesn't happen then we do this and this is why.... and this is what we are going to do next and this is how we do it.

Many people like myself have gone in ignorant. I had a planned c-section at 39 weeks as baby was breech. 3 days before the procedure, the waters broke and I found myself in hospital with an engaged baby and not a clue how to birth it! Mentally I was not ready for this as I was prepared for a c-section. Even this I had no information on what an epidural was and how it was administered or any information on how I was supposed to cope post op.

I finally managed a normal delivery without medical intervention or pain relief as no one told me that I couldn't have an epidural after a certain time...

I had a retained placenta and it was manually taken without my permission and without any prior warning whilst breast feeding my son. No one told me then that it would be better than being taken to theatre and given either a general anesthetic or epidural. No one told me that these things can happen and how they deal with them safely.

I am on baby no 2 and have spent so much time querying with my ob/gyn what happened in my last birth.

I think this would be an excellent opportunity to get some facts across and in fact educate us women about the benefits of the medicalised side of 'child birth'

OP I've had very medicalised and very un-medicalised births (and that one was twins and T2 was breech)

What I want to say is about the word 'choice' - lots of people think that means you can 'choose' a lovely unmedicalised birth. Of course you can't make that 'choice': Mother Nature/God/fate (delete as appropriate) does.

but

One does always have some kind of choice
somewhere along the line - however insignificant or irrelevant that may seem to a medical professional. I'd like you to highlight these choices that happen when the narrative has narrowed - perhaps to a C-section/forceps/induction. So for instance: what are the choices when you're having an emergency section? There are some to think about... what about if you have a GA?

Those small choices are all the more relevant and important the further one goes down a funnel of medical birth where things can seem very much out of your hands.

Also don't forget that most of us don't even think about the difference between an obstetrician and a paediatrician in the birth process. You need to include choices and info on NICU and all the complications that can happen for baby. A birthing mother sees little distinction in the heat of the moment.