Women Unprepared for Childbirth

[AtheneNoctua]

Interesting article on our perceptions of childbirth and how they affect how we feel about the experience when our (false) expectations are not met.

Women Unprepared for Childbirth

"But those involved in providing ante-natal sessions, while listening to these, need to make sure that women are aware of how things may go and help them construct realistic expectations," says Joanne Lally, who led the research.

I completely agree with this. My antenatal class, while it did cover pain relief, did not really communicate a true picture on what kind of pain to expect. Never mind intervention like forceps or worse yet a caesarean. Why not? Don't women have a right to go into labour fully informed of all the likely outcomes.

I wonder if not talking about caesareans and promoting natural childbirth contributes to a woman's sense of failure when she ends up in an unplanned caesarean or otherwise medicalised delivery. And furthermore does this contribute to the onset of PND?

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ah, just placed this article in 'In the News'

I happened to have a very good antenatal course, run by the Belgium equivalent of the NCT - the Brussels Childbirth Trust. I remember being told about what to expect if you want an epidural,and what to expect if you have a c-section.

I went into childbirth thinking I'd have an epidural if necessary.Of course by the time I needed one, it was too late!

I think most woman have my attitude.

That is true. I had no conception of the pain involved. And when it started to really hurt (as it does) I was totally overwhelmed and didn't cope at all. I ended up with pethedine and an episiotomy which I had been adamant I didn't want. I let the midwife do whatever she had to to get the baby born.

Second and third times I was ready and coped much better. The midwives were there as assistants to me, not as the ones in charge of my labour.

Not knowing about the pain isn't going to stop it hurting, but it will help a mother prepare. I don't think you can blame mothers. How are they supposed to know if no-one tells them.

I don't think anyone is blaming women for anything. I think the article is saying that antenatal care should give a more realistic expectation of what lies ahead so that you are not shocked and depressed when that isn't what you get.

They should tell you what kind of pain lies ahead so you can prepare yourself and make some informed decisions.

But, pruners, I think you make interesting point. Perhaps this lack of information also applies to those who want natural home births -- which of course is fine for those who want it.

I just think all the options should be presented so a mother to be can make some informed deccisions on her birth plan.

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i was unprepared for all of it. Was 19, mind.
Had no idea what all the different stages were and no concept of what the pain would be like.
DD shot out 20mins after i arrived at hosp though!

So, tell the mum-to-be all of those things. Tell her the pros and cons of all forms of pain relief, all forms of delivery, and all forms of intervention. Tell her that IF she has a section, x, y, and Z will happen.

And then let the mum-midwife-consultant make some decisions together.

But don't leave her in the dark because you think she isn't capable of thinking for herself. How horribly insulting. My brain didn't seize up when I got pregnant. I made the decisions second time round when I realised I'd been led down a path of false expectations with my first baby.

Athene - the thing is, you can't tell women if they don't want to know. And some women don't want to know, or they think they know more then they actually do. The imformation is there, if you hunt for it. In fact, I have far more access to information about childbirth then my mother did thirty years ago.

Belgo, but it isn't there. I sat in an antenatal class where she told us the gad and air would take the edge off the pain and told us how she had two kids pain medicine free. It painted a picture of unrealistic expectations. I actually had an epidural which turned into a crash section (the section was in no way caused by the epidural). So I personally didn't experience a whole lot of pain. But, I do know some of the other mums were rather pissed off about not being told what it was really going to be like.

In my antenatal class it built a real distrust of the midwives and the NHS in general. Most of us went on to have second children and we listened a whole lot less and did lot more of telling them what we wanted.

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Athene - I think there is a very fine line between giving women realistic expectations and terrifying them out of their wits.

I personally found it helped to talk to many women who have given birth,a dn go on two antenatal courses.

And of course I was very very lucky to have had two relatively straightforward births. Even so, that epidural is looking very tempting for next time...

I have only read OP, but tbh, I was fairly aware of what lay in store, and I knew it would be painful, but even so nothing prepared me for the pain of it really.

Even when I had dd2 and had already done it once, with a long labour (32 hrs) and dd1's arm up round her head so had to push that out too, I had not forgotten the pain of it, but was still caught out by it. I remember when the contractions kicked up a notch with dd2 thinking, F**K perhaps I had forgotten how painful it really was.

Can anything really prepare you for it??

Having now read more, I think there should be more talk of what can go wrong, crash sections etc.
I had a "natural" birth, with gas and air, and while they did take the edge off the pain, the big ones cut straight thru it. I had dd2 the same way so it wasn't a problem, but my sister had to be rushed to the hosp (we were in birthing centre) and have a forceps delivery when her dd would not be pushed out.

I totally agree with you Athene. When I was asked in front of the whole of my ante-natal class how I would know that I was in labour and said because I'd be in pain I was told very definitely I was wrong. The pain would be all in my head. Ergo, if I couldn't manage the pain, that was a weakness in my mental strength.

I truly believed that if I stayed strong enough, mentally, I could do it. Oh how wrong I was and I felt SUCH a failure.

I think we have to be careful not to scare women witless but we also need them to know that it's ok to accept help. As the article says, you wouldn't go to have a tooth taken out and refuse anaesthetic.

I agree BoM - can anything really prepare you for it?

For me the crux of it is in this quote, "Much evidence suggests, however, that women who are well supported by midwives and partners throughout their labour and made to feel at ease are the ones who manage their pain the most effectively and require the fewest drugs." I always maintain that so much about giving birth is what is going on in your head and having a supportive midwife is so importnat. . But with shortages, midwives dealing with more than one öabouring woman at a time etc, how can this doula-like, supportive role be effectively fulfilled by the NHS?

reading this thread, it does sound like some antenatal courses are giving very misleading information about the pain during childbirth.

The other point is that it really does vary - I got through labour on no pain relief (other than TENS) and managed, as did my sister and mother - different people react differently to different pregnancies. I think my antenatal class was quite realistic - we were told to try a range of pain relief up to pethidine and an epidural. I certtinaly didn't rule out pain relief, just ended up with a fast labour.

Actually yes, first time around I did not want to hear about interventions, cs etc. and sought out ante-natal info accordingly i.e. info that emphasised the natural aspect of everything. It's a tricky one. Would more graphic info have helped me or put the fear of God into me? I just don't know. I needed to believe in my ability to birth my baby I guess.

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I think the problem is that though there is loads of info out there it is so polarised and politicised that neither side can be relied upon to give a fair picture.

NHS antenatal courses do not always explain the pros and cons of intervention and often don't put much stress on things like keeping active and not lying down. On the other hand, I have heard many stories of people being either misled by NCT classes (eg - one of my friends was under the impression that a syntometrine injection will always make you sick, another that they physically strap you down so you can't move an inch during an epidural) or ending up feeling like aa failure among NCT acquaintances because they'd had a CS.

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I'm sorry but this is pure nonsense.
seriously, do women really go into labour thinking "this is going to be a total walk in the park??"
quite the opposite - women come along to antenatal classes feeling - often - very very scared about the pain of labour after hearing a million horror stories and watching woimen screaming in fearful agony on Casualty etc.
the focus is not on poohpoohing the pain of labour, but trying to reduce women's fear and panic and boost their confidence in their inherent ability to cope and identifying the range of tools and skills to help them cope.
every woman's experience of labour and the pain of labour is different, so you can't really prepare women for what will happen.
I honestly don't think that telling women oh yes it is going to be excruciating, you won't be able to manage, just have an epidural is (a) truthful (b) helpful (c) helping women "prepare" for labour in an y meningful sense.
sone women do manage labour without pain relief. this isn't "setting unrealistic expectations" - it is true and perhaps helpful for women to know there are alternatives

"We sometimes seem to forget that while childbirth is natural, women in the past regularly died as a result of it, and we should be a bit more positive about the advances medicine has brought us."

hmm yes but people didn't die of the pain
most women who died in childbirth died from loss of blood and/or child bed fever.

Unfortunately, Pruners, I too was so uninterested in what could go wrong first time round, my crash cs (after planning a lovely homebirth) came as quite a shock to put it mildly. Last time I was more benign about outcomes, but I managed a vbac albeit with an epidural which I now maintain could have been avoided with a more hands-on midwife - it really wasn't her fault though, she spoke German, I spoke English, it was a difficult situation. This time I'm taking my own English-speaking midwife with me