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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I totally agree with Athene. All the women in my NCT antenatal class went into it with unrealistic expectations: "breathe through the pain", "it's not really pain", etc. I take the point about not frightening women, but you've got to give them all the information, otherwise you are treating them like children.

C-sections weren't really covered at all, only mentioned right at the end when our teacher said "and if all else fails, you'll have to have a c-section". It was quite similar at my tour of the hospital. We were only shown the maternity ward and delivery room - why weren't we also shown the operating theatre and told "and a quarter of you will end up in here"?

It was interesting doing the NCT refresher class second time around. The same teacher who had taught us that epidurals were terrible things to be avoided at all costs had to hold her tongue when we said how much we wanted one in our second labours!

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argh I know I am repeating lots of what has been said already but really ARGH! at this article!
women have a bad time in childbirth, so this is the fault of antenatal classes giving them false expectations?
this is just a classic cart before the horse scenario.
if women have a bad time in childbirth, we should be focussing on what helps them have a better time in childbirth:
not being in a medicalised environment
fewer unecessary/over cautious interventions
proper support, one to one, through labour from the same person

all of this is not exactly rocket science.
but no, let's not do that, let's just tell women not to be so silly and stop expecting a decent experience.

yes, I have read her pruni.
she is interesting but sometimes a bit
if I were giving birth this week (and thank the lord I am not ) my biggest concern would be the infection risk in hospital, which can be pretty bloody nasty for newborns.
but no-one really engages with that. home is the dangerous place to give birth, apparently

poppysocks "I truly believed that if I stayed strong enough, mentally, I could do it". Yep that was me too. It was going to ba a 'good' pain And I really beleived it right up until the contractions really kicked in. Dh still teases me about it to this day.

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But, harpsi, some women want to be in a medicalised environment. I think the mum-to-be should have enough information to choose what she wants. And if the NHS can not respect pregnant women enough to tell the the truth -- the WHOLE truth - and nothing but the truth, how can they expect second time mums to trust them?

When I toured the hospital for my first birth, they announced to us that they couldn't answer and medical questions because there were no midwives available to give the tour. And I thought to myself "Thanks mate, why have you wasted my time bringing me here then?"

Personally, I think a consultant should have a spot on that tour where he/she tells you about the ficilities and procedure for a crash section should that happen.

yes of course some women want to be in a medicalised environment. in which case, they shoul dbe told that being ina medicaled environment makes it more likely you will find it harder to cope with the pain.
that your baby will have to be helped to be born using forceps/ventouse. and iut is more likely you will have an episiotony/stitches
that it is more likely you will end up with a C-section.
that if you have a C section, that is more dangerous for you and the baby, in terms of death rates.
that it if you have a caesarean, this could have an impact on your ability to breastfeed.
that having section reduces your ability to conceive and increases the rate of stillbirth
that if you have a section, this makes it likely that you will have another section next time
all of these are just increased risks and not certainties.
but women should be aware of them
do you think women are properly informed?

I went to very few classes due to local circs (NCT booked up, NHS didn't start till I was 37 weeks due to staff sickness). Instead I read quite a bit about labour - and I think I was pretty well informed - possibly better informed than had I gone to all the classes. One thing I wasn't prepared for was how tiring pre-labour could be, so affect my thinking red:pain relief. I think this where better resource midwifery care would help - or having a doula!

When I have discussed my labour I've been truthful, but I am very keen not to scare anyone!

My antenatals prepare you well.

I actually felt really well-prepared for birth, and this was in my mind due to having an amazing community midwifery team. the team consisted of just 5 midwives, all of whom I'd met before going into labour.

one of the key aspects that helped was their openmindness. By that I mean neither the "just move around, breathe through the pain" model, nor the medical model was promoted, and as such I cherry-picked from each. I was encouraged to leave the decision on where I wanted to labour until I was in labour. turned out that this was at home, but I was still able, and encouraged, to have gas and air (which I did have) and pethedine (which I didn't).

I also clearly remember being warned that as 1/4 women end up having a c-section, this was something I should plan and prepare for. Seeing the same midwives meant we could discuss options at an appointment, I'd go away and think about it, and come back with questions.

I was shocked to find out that the great continuity of care available to me was not available to women in the next borough, all of whom have there anti-natal appointments in the hospital, normally with a different midwife each time.

.... they should Harpsi....

.... but they should be told it in such a way that it doesn't make them feel like failures and that it's their fault if they subsequently have a CS and (for example) have trouble breastfeeding.

It's very difficult. I don't know what the best way is to do this, but you could see how all that information could lead to guilt and a sense of failure, if presented at the wrong time or insensitively, as it sometimes is.

The amount of research I have had to do, and people I have had to discuss things with to get my VBA2C this time round is phenomenal because no-one I actually saw in my care schedule wanted to discuss it.

I feel I am probably going to be the most clued-up woman in labour in my hospital when I give birth but I still cannot prepare myself for the pain, how on earth do you do that?

yes of course Kathy, it is my job! I think about it all the time.
but I think it is a huge mistake to think there is somehow a simple solution
e.g. all women need to be in hospital/at home
women just need to be told the Truth (whatever that is)
women just need to be better prepared
women just need to follow their instincts
women just need to have proper pain relief

childbirth really isn't like that - the risks and factors are complex and often difficult to balance. there really isn't some simple solution.

Yes you're right - there won't be a one-size-fits-all solution.

antenatal classes have to work within the system, whilst trying to empower a woman and partner to have the best possible experience of childbirth it is frustrating and pretty much impossible

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just a quick post as in the middle of stuff, but i agree with harpsi and pruners

had interesting meeting yesterday re an audit of maternity services ...

friend who is an ante natal teacher said something really interesting:

talking about induction, a women said to her after the classes.. why did you not talk about induction, i was induced and not prepared...well, induction was covered, teh women had not heard it , as she did not think she would be on of those women!!

we hear what we want to hear

also, childbirth is one of those experiences that until you have been through it, you cannot conceive of it as no other pain or experience is quite like it.. and women have different expereinces with each birth

it is incumbent on all of us, as women, as doulas, as teachers, as midwives , as doctors as obstetricians, as mothers ourselves to support each other

it is not the fault of one particular element that women so often feel they have failed or the system has failed them

those who feel passionately about this can get involved as user reps in the maternity services and help to drive change for the better

it is a complex issue

VS, just breathe through it !

i would implore women to read , to educate themselves , to watch birth videos , to find a birthing philosphy, as it were, that fits well with them, and go for it

VS, I don't think you can prepare for the pain.

With ds1 I had 2 days of painful contractions to get to 3cm then an epidural, so a not traumatic but exhausting and very odd birth in a way - felt I didn't know what 'it was like'. I then expected an equally hard time with ds2, had very very very manageable contractions, thought I'd be only a few cm, pootled to hospital on the bus only to be pronounced 9cm and suddenly bowled over by the most incredibly intense contractions that I literally couldn't move - so ended up on my back again (and there was meconium in the waters etc etc). I hadn't thought I was really in labour so felt I had no time to get into an in-labour mindset.

One thing that did help, and kept coming into my mind, was my ante-natal class with ds1. The (independent) MW was married to a Breton and passed round pictures of the very wild and stormy seas off the Breton coast. She said: those are the contractions. Go with them. I found that a very realistic and useful, almost exhilarating, image to 'work' with in the limited way in which I could.

And it really helped to release all inhibitions and scream my head off. I remember thinking 'I can manage without this scream, but what the hell, it is going to help me cope and get my baby out.' - AAAAAAAAHHHHHHHHH!!!

The problems of antenatal classes is they'll always be full of a diverse bunch of people. :0

Some will be incredibly well informed,some not, all will hold different fixed pre-conceptions.

Medicalised birth may be the only option for some due to high risk pregnancies so pushing home birth or mw led unit is not going to make them feel great as it's effectively saying you're letting yourself in for a section.

I attended 2 antenatal classes (glutton for punishment) - 1 hospital and 1 private NCT. The hospital one was great. It included in the last session a discussion of interventions and a mock up of a csec with members of class getting different roles to show how many people were involved so if it should happen you wouldn't get freaked out by the number of people suddenly descending on you and the procedure.

We also had a fun one on pain control in which it turned out that one of the dads to be had had pethidine and another G&A and they both described their effects. Nothing was pushed, the idea was to inform. So advantages and disadvantages gone through as well as some breathing exercises.

I knew pre-conception that I would have a high risk pregnancy due to underlying condition. I knew I would be induced early if bump had not appeared and this laid me at risk of cascade of interventions and csec and I prepared accordingly. However, if someone had told me what harpsi posted on risks of csec it would just have made me panic, not helped at all. Everyone can only take so much info and it depends on the individual.

I completely agree with OrmIrian and others - I was in no way at all prepared for the pain when I had my first baby and ended up having pethidine and the whole thing was a nightmare. Second and third times around I was much better prepared.

But I can think of several times since then when I've been expressly told by pregnant friends and acquaintances: "Don't tell me any horror stories". I am not sure that pregnant first-timers really want to be told in detail exactly what lies ahead.