Why do so few FTMs manage birth ‘naturally’?

[hopingforapeainapod]

Hi all, am 24 weeks with my first baby and have started online antenatal classes and have been quite scared by the stats they have shared with us. In my trust, 25% of first time mums are induced, 25+% end in c section, and around 25-35% end in instrumental births. Anecdotally, I have 4 friends who have given birth this year for the first time, and 3 have ended up in emergency c-sections, and 1 ended up with forceps and some quite nasty complications. Another one of my friends is now having an elective c-section because she has heard so many horror stories. All of this, plus all the maternity scandal and birth trauma stories in the news recently, has somewhat thrown my confidence and I now feel like giving birth vaginally without intervention is the exception rather than the norm. My mum also had complications with us (I was born via epistiomy and ventouse) and I’m quite petite, and I guess I am just doubting my ability here…!

Basic biology - as others have said - means human birth is much more complex and prone to problems compared to other mammals.

So many women used to die during or after childbirth.

On top of that, better nutrition and antenatal care means babies are bigger, raising the risk of them getting 'stuck'. Mothers are also typically a bit older and bit less fit/more sedentary in general - neither of which help. And better healthcare means some women who - 100 years ago - wouldn't have lived to adulthood because of medical conditions (e.g. diabetes) are now fit healthy adults but do need careful antenatal care and sometimes an ESC as a result.

@hopingforapeainapod I think for your birth plan I would just visualise holding your healthy baby in your arms and whatever method gets you there you accept as the end result is holding your lovely baby. I think there is no point in saying I’d prefer x but not y etc as you’ve no idea what’s going to happen. Could be easy, could be long, could be intervention followed by c section. I found friends who had detailed birth plans of wanting x and y and natural and no medication were more traumatised from the birth as all their plans went awry.

In fact, statistically (no. of deaths each year), getting in a car is more dangerous.

This is nonsense, sorry. Death rate in UK for mothers in childbirth is about 13 in 100000. In contrast, 749 people died in a car crash last year, in the whole year and a country of 66 million, so just over 1 death per 100000 for the whole year. Childbirth is far, far more dangerous.

On the other side, I'm as unfit as it comes, no excersize ever in my entire life pretty much, was bed bound from almost beginning to end of pregnancy in excruciating back pain, gained 4 stone, zero of it muscles, knees completely fucked to the point I can't even squat without pain let alone get back up, I was 27 when I gave birth - started getting contractions 6am, didn't dialate at all until 3pm, dilated from 5 to 8cm from 6pm until 8pm, and gave birth without any intervention, only gas and air, after pushing officially for 5 minutes. I did basically 2 pushes and baby came out. Bang on average birth weight, healthy happy baby with no complications at all.

Not to say you're wrong, but if you were right I should've had a terrible birth. I just pushed as hard as I possibly could, all doctors around me telling me it was too early, yet my body was saying otherwise - couple big pushes and I felt baby come out.

I didn't feel put out at all energy wise and found the pushing and contractions easy. They fucking hurt, yes - but I could've kept on for another hour if I had to. I mean I usually get out of breath just walking up the stairs. I couldn't run for a minute - but giving birth felt like it had no correlation to my fitness whatsoever, I was barely out of breath. It isn't quite an endurance sport in the same way as actual endurance sports.

On the other hand you have very fit and active people, smooth pregnancy and terrible scary birth. I don't think sedantary lifestyle has anything to do with it to be fair, humans have always been the animal that struggles most during birth because of our birth canal shape and the size of our heads. Birth is no harder now than it was 100 years ago when people were generally more active - in fact the doctors usually op for c sections when the baby is larger just incase there are complications, to cut out the dangerous middle man. Women have a much better chance at survival during birth these days and I'd think evidence points more towards intervention being a large part of that.

@hopingforapeainapod I did ask for an elective (maternal request) c section, exactly because of those statistics.

I knew that (for trauma related reasons) I didn't want an instrumental delivery and would have found dealing with a birth injury quite difficult. I also knew that there are situations in labour where you can't really say no to a forceps delivery (I mean you can, but you would be risking harm to your baby, so it's a bit of an offer you can't refuse).

The midwife and consultant were both happy with that and it was definitely the right decision for me.

I am petite and all my family had to have c sections my sister didn't dilate etc so for my first birth I was really scared it would go down that route. I had a 5 hour water birth at a midwife led unit not attached to a hospital. I felt ready I felt confident in my body because it felt like it was doing all the right things like bloody show etc I don't know that I can pin point it down to doing anything like being active/hynobirthing etc I could of done all those things and it not happened that way.

For me personally knowing my body I am more comfortable away from hospitals they make me nervous. I need to feel supported in the right ways and my body relaxes. I went on to have two more very quick homebirths 2nd being 2 hours 3rd being so quick the midwives didn't get here in time. No tearing or stitches needed in any of them. I've been very lucky it all could of easily been very different.

So it absolutely can happen without any issues but It's not in our control. All I did was give myself the best chances I could for my body.

@hopingforapeainapod I have had a C-section (not an elective one but carried out in pretty calm conditions) and a vaginal birth.

I healed well from the C-section and although the recovery wasn't a walk in the park I was up and about fairly quickly and my scar is very small and neat. It followed a failed induction where I had the full range of interventions, balloon catheter, waters broken, syntocinon drip and epidural, but failed to fully dilate.

Second time round I had to decide between an elective C-section and an attempt at a VBAC. I had a sweep at 40 weeks and went into labour the next day, had a lovely straightforward VBAC with a lightly dosed epidural but no other interventions at all.

The advantage of an ELCS is that it is probably the second best type of birth after a straightforward vaginal birth without any major interventions, but you can plan for it in advance so you know what you'll be getting. But I am still really glad I had a vaginal birth for my second because the overall experience was much nicer and the recovery easier. So there are definite pros and cons to an ELCS.

I read a hypnobirthing book by Siobhan Miller before my birth which really helped me. The main message of the book is that how you feel about your birth - whatever form it takes - is much more important to mum's wellbeing than the actual practicalities of how you give birth. It's about getting into a mindset where if C section is the right thing, you're ready to embrace that birth as the right thing for you and your baby
. The key is to remain informed, in control, be advocated for, and so on. I'd recommend it as previously I had wanted a very medicalised birth and it convinced me to let go of specific expectations and focus more on the experience and on staying receptive to new developments that might help my baby.

I ended up having a non-medicalised water birth and weirdly, I never would have had the courage to give birth in a pool in a midwife unit if I hadn't already have made my peace with all the different eventualities and how I might handle them. Knowing you have choices and making them as you go is key (for example, I felt confident pushing an induction back until the last possible day, and my midwives were receptive and supportive).

Sorry for the derail - but to answer your question, more interventions because more mums and babies are saved.

In the past even women who survived suffered appalling birth injuries. I think it was only in about 1940 that doctors were consistently successful in treating fistulae following childbirth. I just think we should be grateful that medical intervention is availalble.

I would actually recommend that all women who are giving birth and have not already had a C-section properly inform themselves about what one involves, and make sure their birth plan includes the C-section eventuality. It sounds stupid but I never really gave it much thought because I naively assumed I'd have a straightforward vaginal birth. I wish I had understood in advance the different stages of a C-section, what happens beforehand, during, afterwards, how long it takes, what the aftercare and recovery is like and so on. I gave birth outside the UK where it isn't standard practice for the mother and baby to have skin to skin when she is still on the operating table, and I had to wait an hour to hold my baby which I found really upsetting. I had no idea how long it was going to take and it felt really long. I wasn't prepared for the fact that my baby would be born within the first few minutes and then I would be lying there for another 40 minutes while the surgeon put me back together again.

Second time round I talked about my feelings with my doctor and we agreed that if I did need another C-section they would do their best for me to have immediate skin to skin on the operating table unless there was a medical reason not to. I'm sure that if I'd needed a second C-section it would have been disappointing, but ultimately less traumatising than the first because I'd have known what to expect and I'd already taken steps to ensure that it would go more how I wanted it to.

@ColinMyWifeBridgerton I completely agree that how you feel about your birth is much more important than how you actually give birth.

I also agree @MissScarletInTheBallroom that all mothers but especially first time mums should prepare for c section as an eventuality, and that is definitely something I should be doing as it has happened to so many of my friends.

I think I’m just particularly nervous about birth as a) I am a natural worrier and like to be in control, and birth is all about letting go and surrendering which I don’t find easy at all, and b) I’ve been very lucky so far in life that I’ve never really had to undergo anything particularly medical or painful - never had surgery, never had a tooth out, never even broken a bone - so I have no idea how I will cope with the pain or even being in a hospital environment really (which explains why I find c sections quite nerve wracking, I don’t think I’ve ever even had painkillers stronger than paracetamol!)

After the first time you've been stretched out so it's easier. I hear after the fourth one it's like a slip and slide and it just comes shooting out.

I’ll admit I’m terrified of giving birth (and I have to do it in December, which sounds very soon!)

I had a placement on a gynae unit as a student nurse and I remember vividly running a bed down the corridor with the obstetrician riding the trolley with the haemorrhaging woman, her entire fist was inside her to stem the bleeding long enough to keep her alive on the way to theatre. She survived only because she had access to modern medicine. She was a ‘low risk’ pregnancy by all accounts but she just bled and bled. There was nothing she could have done to stop it happening, and it was a huge shock to all involved as it wasn’t immediately post birth. She walked out of there a week later grateful and lucky to be alive.

C sections (unless needed, obviously) are more dangerous for mum and baby. A relative had her last baby at 46yrs old. It was an IVF pregnancy (higher risk), she developed Gestational Diabetes, and, of course, she was that much older. She assumed she’d behaving a C Section - but the consultant said a vaginal birth was best. I, myself, had a high risk pregnancy, saw a different consultant and was told the same. So, I wouldn’t go for an elective section if there was no problem. More than that, the recovery time is way longer.

OP, build your confidence back up. Read something like Active Birth by Janet Balaskas (sp?). Although none of us can predict possible problems that might develop, the best thing you can do is develop a positive ‘can do’ attitude. Things change frequently during labour and keeping physically and mentally strong is the way forward.

If it helps, I’m very petite too, my first baby was huge - and yet I gave birth vaginally with no epidural and no instruments. How? Partly luck, of course, but looking back, a big part of it was that I was young, determined and had utter faith in my own ability. If you stay positive that will also help you if you do need to reconsider any birth preferences as the decisions you make will be made from strength not panic.

You are not your friends and there’s nothing to say you can’t give birth vaginally, like hundreds of thousands of women in the U.K.,including first time mums.

OP, I think you’re absolutely right and you seem to have a sensible approach.

Medical intervention is a wonderful thing if needed and there is definitely no such thing as ‘failure’ in childbirth. Having an open mind and keeping on top of any anxiety will stand you in good stead.

All of this!

Look for a comprehensive antenatal class, be wary of any classes who seem to evade the topic of any interventions in their adverts. Of course we'd all love an intervention/medication free vaginal birth if we can cope with the pain but it's not reality. Interventions are medically necessary at times, if you're struggling medication can take the edge off etc. Just look into your trusts policies, for example I was told I needed a ventouse delivery, I avoided it thankfully but both me and baby were fine, I'd just hit their 2 hour pushing threshold. I didn't have an urge to push due to baby's position and had no instruction from my midwife. Once they said that baby was out 3 minutes later with no intervention.

Both my babies would have killed me if I hadn't had sections.

🤷‍♀️

I opted for an early epidural for no other reason than I saw no benefit of being in any pain or discomfort. A perfect day - lots of sleep, did my nails and watched Wimbledon!

A range of complicated reasons. Mothers getting older, fatter, more sedentary, more poorly nourished. Childbirth still being fairly poorly understood. Hospital being a poor environment for labouring women. Medics erring on the side of interventions and monitoring. None of us ever knowing what would have happened if a certain intervention hadn't been made.

Fwiw I'm petite and have had two unassisted vaginal births, straightforward with no birth injuries whatsoever, and both were positive experiences.

A lot of the "interventions" in pregnancy are actually not very important in the long run. You may be induced, so what - you can still have a vaginal birth. You might need forceps or ventouse, they dont automatically come with complications although sometimes the babies head may be a bit odd looking for a few days. You need to be prepared that you may have an episiotomy, a cut to help get the baby out, or a tear. A local anaesthetic will be used if it's an episiotomy. These are common and really not a major intervention. Perineal massage may help. https://www.cuh.nhs.uk/patient-information/antenatal-perineal-massage-explained/

Birth is much safer for mother and baby now.

@CaptainCabinets I understand what point you are trying to make about how interventions can be life-saving but horror stories like this also don’t necessarily help either!

@Parker231 did you have any other interventions after the epidural? I was quite open to having an epidural but there is a chapter on them in the book ‘Expecting Better’ which scared me somewhat as it says they are much more likely to lead to other interventions…

Me reading these replies in my third trimester 👁️👄👁️

It was actually childbed fever that was the #1 killer of women associated with childbirth, not the birth itself. The #1 killer of women was infectious diseases overall- cannot forget the impact of cholera, tuberculosis, scarlet fever, polio all in an era before vaccinations and antibiotics.

The high maternal death rates from childbirth were mostly due to unsanitary birthing conditions causing childbed fever- an infection of the womb leading to death by sepsis.

Induction increases the chance of csection and instrumental birth, so there will be an overlap.

The overall increase is imho due to insufficient staffing on maternity wards and poor care of labouring women. FTMs are at slightly higher risk of needing interventions, but that has always been the case and doesn’t fully explain the upward trend.