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…!

This is exactly what I mean.

These messages and the horror stories that accompany them — that birth is dangerous, most likely to end badly etc etc are SO unhelpful to someone who is already pregnant.

Fear contributes to pain, so the more you can try to ignore them and focus on what your body is capable of the better.

FWIW, what helped me was imagining how strong and capable my body was. I knew that if I needed intervention I would happily take it, but I wanted also to try to control any fear or panic.

I’m just annoyed that I only really mastered this by my third and final baby!

I was luckily first baby 3 hour labour just gas and air and second 1 hour 40 just gas and air. I say lucky because I was terrified of having a c-section. I know a lot of women elect to have one, but that was my one recurring nightmare before my whole pregnancy. Give me labour over toothache any day! But I was unusual out of my friendship group. Most mums had c-sections or assisted delivery.

You need to think of birth as an exam. Study first it.
Know what all the terminology is.
Know the pros and cons of different options.
Pre make your choices about what you want under various situations.
You can have control if you plan it all out. But you'll need to do a lot of reading (not online!)

Eg what if you go to 40+10
What if induction fails
What if you get pre eclampsia
What if your waters break and labour doesnt start
What if there's meconium in the waters
What if the heartbeat drops
What do you want if you want more pain relief

Most of all understand the concept of the cascade of interventions

So are we to just pretend it doesn’t happen, and then nobody is prepared for it when it does? 🤔

Why on earth would you want women to NOT be informed on the risks and potential complications of childbirth so they can make informed choices on their care? That’s very strange to me.

I’m pregnant and I would much rather be fully informed on what can go wrong so I can make choices. We are all different, aren’t we 🙂

’Fear contributes to pain’ 😂😂😂😂 what a load of bollocks, a painful stimulus contributes to pain. I’m not frightened of stubbing my toe, but it still fucking hurts when I do! I know that if I walk barefoot, I might stub my toe, but I choose to do it because I know I might. I have chosen to have a baby, I know what might go wrong and that it’s likely to bloody hurt, but I feel empowered to make choices that are right for me and my baby.

Sorry if you are upset to read ‘horror stories’, but unfortunately they are just reality.

@CaptainCabinets of course not, that’s not what I said! And if you have read any of my other comments I’ve advocated all along that women should be informed and should understand the risks and be open minded so they can make decisions. But there’s a difference between explaining risk (eg PPH) and graphic horror stories

I didn’t have any fear or panic but opted for an epidural to avoid any pain or discomfort. I had decided on an epidural from the start of my pregnancy.

It’s just real life, not a ‘horror story’. PPH is unfortunately common, but some women might not understand what that actually means. ‘You might have a big bleed after birth’ could mean different things to different women. What some women may think is a ‘big bleed’ might be what other women think is equivalent to a heavy period.

I only described the reality of a severe PPH.

Fear does make the pain worse in childbirth. It’s nothing like stubbing your toe.

I also remember the ‘my body was designed for this’ mantra.

it isn’t.

came home from maternity ward to watch a report on the ‘One Show’ about early humans. The fact that humans walk upright has made childbirth very difficult and human evolution is largely stalled because bigger heads are impossible while hip size is limited.

it is a useful mantra for childbirth though. I’d also add another less catchy one- there has never been a better time in history to be giving birth.

Those stats from your hospital trust aren’t completely clear - are they saying it’s 25% induction, 25% C-Section, and 25-35% instrumental births - so only 15-25% ‘natural/ unassisted’? Or are the 25% induction included in the c-section or instrumental stats?

It’s hard to say why the figures are like that. For example, epidurals are said to raise the chance of needing ventouse/ forceps, but are women asking for epidurals because they’re in a lot of pain because the baby is in an awkward position, so would have needed forceps even without an epidural? Correlation but not causation.

The things I found useful where:

Accepting that childbirth was out of my control as I could not control what my body did. I could do things that should help (like moving about in labour rather than staying still), but ultimately I could not control it. I think this is quite hard for people to accept.

Educating myself on all possibilities. We went to NCT classes, which I later realised were very comprehensive and covered all aspects from totally natural birth to emergency section. The teacher talked us through the different pain relief options and their impact, ventouse and forceps, and we also acted out a c-section to show us how many people would be in the room and what they’d be doing. Sounds silly, but when they lost my DD’s heartbeat during labour and the midwife hit the emergency button, I wasn’t freaked out by the room being full of people. DD was fine, it was an issue with the monitoring equipment.

As a result, my birth plan set out various options (I’d try gas and air but if that wasn’t enough I’d try pethidene and so on) and I felt I understood the implications of each option. Looking back, that really helped. I ended up with an epidural and forceps, but felt that I’d been in control as much as I could.

good advice
I think a birth plan is a useful substitute for a midwife who has got to know you through your pregnancy- when you are in labour, how is the mw to guess whether you are an 'I want an epidural as soon as possible please' type of woman or an 'if I want pain relief I'll ask for it so don't keep bothering me about it' type of woman? a 'skin to skin immediately don't even wipe the baby' or a 'please wash and dress the baby and then hand it to me'???

As said above, it does help to understand potential problems, but it’s the way you think about them. Think about them in an objective, analytical, controlled way. Eg in my 2nd labour I was pushing and pushing and nothing was happening. The midwife assumed I was tired or not pushing properly, but when I asked her to check, she found the baby had turned and was ‘back to back’.

Knowing this, helped me understand why it was more painful and I then thought about and discussed what that might mean. I chose to push harder and not have an episiotomy or instruments. The midwife checked progress - progress was happening so all was good - so on I went. The whole time I was focussing on being ‘detached’ and in problem-solving mode. I felt I knew what was happening; I knew the possible options - and so I felt calmer and in control. Although the ‘back to back’ was totally unexpected, I’d read about it and felt informed to make proper decisions. It was also less scary because I was mentally prepared and knew what was happening.

I had a c section because after 24 hrs of labour there was no way the baby was coming out. I'm small and he was a big baby. So I think we would have both died if a c section wasn't available.

@EllieQ sorry I didn’t explain it very clearly - basically in my area around 25% of first time mums have c sections (both elective and emergency) and around 25-30% have vaginal instrumental births, which basically means only 45-50% of first time mums have unassisted vaginal births. Induction stats are separate, although of course induction does increase risk of c section and instrumental births significantly (think they said that if you have an induction the chance of you having a c section jumps to around 40-45%…)

it’s interesting you said that your NCT classes covered all types of birth - I had heard from a friend (admittedly in a different area of the country) that her NCT leader had very much skipped over c-sections and instrumental births, so that’s great you felt more prepared!

I agree with your correlation not causation point about epidurals.

In the UK and various other English speaking countries (which are more likely to be the source of information about childbirth in English) epidurals are not used as standard and women who are having straightforward "easy" labours tend to be encouraged to just manage with gas and air or a TENS machine or warm water. This means there appears to be a correlation between having an epidural and having a difficult labour.

But if epidurals were the cause of a difficult labour, I would expect to see a much higher rate of C-sections and instrumental deliveries in countries such as France where epidural use is extremely common. But there isn't.

@hopingforapeainapod even if you do have a section, you'll be given paracetamol as standard. Not all trusts give out liquid morphine willy nilly!!

I found it really useful to read birth stories when I was 39 weeks with my first because it gave me lots of scenarios to process, both the good and the bad. As another poster said, PPH is not a scare story, it's a common complication but one to be aware of.

I had my first (and only) baby in 2023, my trust seemed very keen for inductions and booked me in for one at 40+2 just because then I'd be overdue.. I wasn't going to attend that appointment and told them so, but as it happens by waters broke at 38+3 but I never got any contractions and was group b strep positive. So against advice I waited 12 hours hoping labour would start naturally but it didn't so I was induced with the drip, I had contractions and 3-4 of them every 10 mins but after 6 hours of this I hadn't dilated past 2cm so I had an epidural which was in place about 3 hours later, baby born vaginally with no interventions 3 hours later despite me having the risk factors for interventions ie drip, epidural and I was pretty much on my back

All I'd heard during labour was how difficult the induction drip was and how I'd need an epidural, and I couldn't eat as it was really likely in end up in theatre, but down to luck I had a really quick pushing phase whereby I just felt my body doing it I couldn't control it and had a very smooth recovery only internal grazes

I didn't do NCT but did hypnobirthing and the videos my trust emailed me and read some other books I found it useful to read up on everything so I had a better understanding what could happen, and I did write a birth plan that mostly went out of the window but I still felt better having one

Best of luck!

I'll admit I haven't read the whole thread (been out tonight and had a few cheeky wines) anyway, I had my first aged 27 and from the first contraction at 6am and then a natural water birth with no drugs or intervention to giving birth 7 hours later I can confirm that not all first, or any natural births are always "horrible or horrific" I was one of the lucky ones. I had a textbook pregnancy and labour, don't get me wrong, I'm not saying it didn't hurt, it did - a fucking lot! But I did it and had no follow up issues or complications. Just have an open mind and follow what your body is telling you. Good luck xx

Funnily enough I had a colleague whose wife had her one and only section (unplanned) on her 7th child. When it goes wrong it goes wrong.

My most problematic birth was my 3rd.

Your body needs to produce oxytocin to start and continue labour. Oxytocin will slow down if you are scared, worried, upset, not comfortable. So not a load of bollocks. And if you're scared, worried, upset, your muscle will tense, which won't help.

Hi there it's a labour ward midwife. I suspect French and Italian women have easier time in labour because they don't eat for 2 in pregnancy. As a population they also seems to be slimmer. A smallish baby will rotate from back to back position. A larger baby often stays there once the woman chooses an epidural. As a labour ward midwife I have seen many overweight and obese women having spontaneous vaginal births against odds if they just bloody-mindedly put up with the pain. So I do believe epidurals are responsible, to a degree. Another feature of randomised controlled studies is that they mostly studied low-risk women in spontaneous labour 3-5 cm dilated by the time they got an epidural. This is not your typical labour ward population in an average labour ward. Another issue - epidurals in randomised controlled studied were often designed just to take the edge off the labour pain, not to eliminate it completely. I have nothing against epidurals for a difficult or obstructed labour, they are a miracle of modern medicine in those circumstances. However it's perhaps unreasonable to expect "natural labour with all the drugs that's out there " (real life comment)

Well I guess I got lucky then because I had an easy and quick labour which was completely "natural" apart from the epidural I had a couple of hours before the end. 10/10 would recommend!

Severe PPH really isn’t that common though. It’s less than 2% of births. And if it does happen, there’s nothing the mother could do to ‘prepare’ for it. It will be dealt with by the professionals who are caring for her.

There’s a big difference between understanding childbirth and preparing to advocate for yourself and being told about (relatively rare) complications that you can’t control anyway.

There is so much fear and guilt surrounding birth and motherhood these days. It’s understandable that women who have experienced a traumatic birth want to speak about it, but it often does nothing to help educate pregnant women.