The general feeling here seems to be anti-invervention and medical help. Why, when it has saved so many lives?

[greenwithyellowspots]

I am really interested in this question. I think that Mumsnet is really geat, I love it, but one thing I've noticed particularly on the childbirth thread is that on the whole people are anti-intervention or even that doctors etc are the enemy! With induction for example, but also generally, the consensus seems to be about letting women get on with it because 'their bodies know best.'

But in the past, and still today in many countries, it seems clear that women's bodies DON'T always know best - mortality in childbirth used to be/still is horribly high! It often seems as though the medical profession can't win when it comes to childbirth - if they intervene they are accused of being over zealous, but if they get it wrong, they are also to blame.

I'm sitting here pondering the fact that I'm likely to be induced soon-ish and am reasonably willingly putting myself in the hands of the medical profession. Is there not a danger or harking back to a golden age of childbirth that didn't exist? I hope this isn't a really inappropriate question but I'm generally interested in what people have to say about this, as I kind of feel like I'm missing the point somewhere!

I also don't understand the need of all the inductions given to women post term, a quick scan to check on the waters etc, shouldn't be cheaper than an induction?

not bloody Holland, that's for sure. I'm 36 weeks with second DC, they really really push homebirth here and it's hard to get an epidural, just not really socially acceptable. Had the full medicalised works with DS, but a good birth in the end, (in Belgium), this time and am going the Dutch way complete with birthing stool. They're too far the other way, absolute minimum intervention of any kind, reflected in their not terribly impressive perinatal mortality rates...

Gemzooks, I have 2 friends who gave birth in Holland and were a bit worried by the system there (mind you, we are Italian, it's overmedicalized here, we have the highest rate of c sections in Europe, sadly). Everything went well

Overdue lulumama! I already have a DD and was overdue with her and induced. Had the typical cascade, I suppose, every drug, and then forcep delivery. I just felt glad that she arrived OK, and that I had pain relief. And I am also pretty sure that there was no medical requirement for the induction - she was absolutely fine and even in the quite traumatic 30 hour 'labour' her heart rate etc never even really changed, the midwife says it was brilliant throughout. So ... hmmm, I don't know. I'm not stupid or a total sort of walkover but ... hmmm (much sighing and thinking about intervention going on!). I have to say I've found the posts here really interesting and reasonable and balanced, so now I feel as though I've been a bit unnecessarily provocative in my original comments! Which wasn't the intention. But I also thank the LORD for epidurals.

I'm actually a bit baffled why people would think that the medical establishment would want to intervene for "convenience". Why would it be in their interests to do that? Eg in terms of resources (staff, time, equipment) a midwife-led vaginal birth is far less costly than, say, a c-section.

Why would doctors be pushing women to have a c-section for any other reason than a) concern for safety of mother and/or baby, or b) to allow the mother the choice?

The latter is certainly what happened in my case with ds - I was induced for obstretic cholestasis, had 28 hour labour only to progress to 7 cm, then offered a c-section. I could have refused if I'd like, I was simply given the choice, I never felt it was being forced on me.

you are not really overdue until 42 + weeks though.. you can request expectant management if you prefer.. to ensure baby is happy in utero. also, definitely worth having a stretch and sweep or two at 41 + weeks, you will also know then if your cervix is not ripe, that induction may not be the best bet

there are always options and compromises to be had. and intervention when you and your baby need it.

Why don't they offer expectant management as a rule though Lulu? Isn't it cheaper than inducing?

Have to add the weirdest thing about my DD's birth was not the intervention per se but that doctors seemed to keep wandering in and just sort of doing something (like coming at me with a crochet hook, or telling me I had to stop pushing and go to theatre etc) and then sort of wandering out again. But DH says it wasn't AT ALL like that, I was just off my head on gas and air and various opiate derivatives! Not sure who to believe (he's definitely pro intervention!!!!). But that's a digression ..... sorry.

Oh, and also, I've got a Dutch friend and it's a great place but their attitude to childbirth (ie no pain relief) would encourage me to emigrate! GOOD LUCK Gemzooks.

Good question Franca. I should perhaps be more assertive re: the same thing, ie expectant management.

In Italy you are scanned every other day after due date to check if baby is still happy in there. I wonder why we end up with a scary rate of c sections here. Actually no, I don't wonder, I know

I agree with ABetaDad, on the whole

Labour and childbirth may be natural however, nature itself operates on a "natural selection" process where some make it alive and well, some don't.

We can now cheat nature to some degree due to the great developments in medicine. This possibly gives us a false sense of security that "our bodies know best", etc. Not always they don't. And if they don't, well, there's generally a medical safety net so we never need really worry that if our bodies can't/won't deliver then that's the end of the road.

Having been in labour for 24 hours myself followed by an EMCS, I have little doubt I would have been one of those who died in childbirth years ago as the baby could not/would not deliver vaginally.

Giving birth is like giving yourself a major operation, natural or not, IMO.

Also, I'm obviously completely not deciding what I think about anything now, but there is a tendency to suggest that natural = good, when that isn't necessarily the case. I'm not sure whether I'd equate it to a major operation really but I do think that some people are definitely better equipped for it than others (physically if not mentally!). My sister for example has had three children and she has been told that she would have died for each one (if you see what I mean) if it wasn't for the doctors. But it was the doctors who told her that. Maybe they were making it up!!

It sounds over-simplistic but ShowOfHands is right. If I had lived a hundred years ago then DD1 and I would have died because she was wedged so far up in my uterus that there was no chance that I could push her out. Even though I had worked really hard and tried different positions and upright active labour (that we know from research to increase the pelvis and help descent), nothing worked. So I was transferred to the consultant-led labour ward.

During DD2's birth though I did all the wonderful active natural labour things and DD2 was born naturally. It was a difficult delivery and I almost wasn't able to get her out - so I know that if I'd been "medicalised" - i.e. lying flat on my back hooked up to monitors - that it wouldn't have happened. The recovery from a natural delivery was much easier than the medicalised. And even though things didn't go well in the first delivery, I'm glad that at least I had the chance to try.

Did my body know best? Actually, I think that it did, as I found that I naturally wanted to go into the positions that best aid the descent of an awkwardly positioned baby. Would I give birth without a medical professional present in case things went wrong? No. Do I think that medical professionals do things for their own benefit rather than that of the mother? Yes, quite often. It takes more midwife power to stay with an anxious first time Mum and help her try different positions, and listen to her, than it takes to hook her up to a monitor and move onto the next woman.

I wouldn't be comfortable going past 41 weeks because the placenta can start to deteriorate and I'd rather have an intervention than an oxygen deprived baby.

But, I also wouldn't let anyone induce me again without telling my why I had gone past dates.

I am not anti-intervention at all - but I do think that all the facts should be laid on the table and the final decision should be left up to the mother. It's the "you MUST be induced" attitude that's annoying, rather than the "induction would be my recommended course, for these reasons, and the risks on each side are these."

Too often doctors give a black and white picture because they think for whatever reason you can't understand or weigh up the risks for yourself.

Also I think doctors in the UK particularly tend to have a very jaundiced view of birth because they are only called in when it starts to go wrong. The extremely nice doctor who stitched me up after my first (vaginal) birth told me in passing that he did not want his wife to give birth vaginally because he had seen too many sad outcomes and birth injuries. He said he simply couldn't bear the risks and would want her to have a c-section whether it was medically indicated or not. I thought that was so sad - and an example of someone NOT weighing up the risks in a rational way, even though that is his job.

I've had two c-sections (one elective) and one high risk pregnancy. I would probably have died during my first birth if I hadn't had intervention, and if that hadn't happened, I would very likely have had a stillborn baby after my second birth. Medical intervention where necessary is a lifesaver.

Yet I still think that keeping birth as un-medicalised as possible is the best option for most women, particularly first timers. Yes, birth carries risks, but intervention should be to manage those risks, not as standard practice. The induction rates and c-section rates - in fact, the whole cascade of intervention that happens in so many births, where a woman is pressurised into an induction, which leads to ARM and an epidural which leads to forceps/ventouse and and a large episiotomy and/or c-section - is unacceptable to me.

Have to agree. Without intervention both me and dd would not have survived as she was completely stuck after 24 hours and there was no way that she was going anywhere without being physically pulled out of me, admittedly resulting in massive blood loss, but better than neither of us surviving. I certainly don't regret any intervention. Must admit that with ds I was induced to stop size being a factor (although he was bigger anyway) but had a 4 hour birth with no medical intervention, although the midwives were always one step ahead to stop the disasterous labour I had with dd.

Also (Naomi Wolf makes this point in Misconceptions) many of the protocols surrounding birth are not put there to aid better outcomes, but to avoid litigation, no matter that they may have adverse consequences.

As an example - it's well-established that continuous monitoring of low-risk women doesn't aid outcomes and in fact often leads to unnecessary intervention. However the presence of a reassuring graph is good ammunition in the event of a law suit so the woman gets hooked up anyway - and then finds she can't move around/use the pool/labour effectively.

This is obviously more of a problem in the US than here, but still a consideration I'm sure.

you know, I was induced four times, differing reasons each time, and altho yes, I would have loved to have gone 'naturally', I know that me and my children would not be here without said intervention, so, IMVHO, YANBU.

altho

for some women, it works very well.

And Mrstittlemouse raises another good point, which is understaffed wards.

I haven't particularly noticed that attitude on MN but I do think that attitude is prevalent amongst mws to the point of not listening to what we, the patient, wants.

The mw led unit at my hospital are anti-intervention & openly criticise the doctors/consultants. They are proud that they have the lowest regional rate for epidurals. They actively counsel women away from pain relief unless it's g&a.

I certainly wish I gave birth to my first child somewhere else.

A problem in many developed countries is that pregnancy is seen as a medical problem rather than a natural condition. Hospitals can be quite stressful places and the stress can lead to complications.

There is no doult that good medical care saves lives. In very poor countries where there is no properly midwifery care, women die needlessly.

For example many hospitals are clinical in appearence, there are policies of putting a canula in the mother's arm whether she needs a drip or not, continuous monitoring, being told to lie on your back, lack of privay, not being allowed to eat and drink freely. These things do not make a mother relaxed. The more tense you are, the more pain you feel. The is a tendency to over intervene because of fear of being sued by patients.

I also think that epidurals are great in the right circumstances. If the pain is truely unbearable then why should anyone suffer? However if the pain is induced by the hospital enviromnent or being forced to labour in a bad position then that needs to be changed.

Midwives want to lead the way when a woman is giving birth.

Unfortunately they are not competent to intervene when things go wrong, which they often do. They also aren't able to administer epidurals.

When the shit hits the fan on a labour ward, they scatter and leave it to the doctors. There's nothing like the fear on the face of a midwife when it looks as though it might go wrong. The doctor, on the other hand, cannot pass the buck and has to remain calm.

Midwives have a different approach to doctors and different type of job. They have different set of skills to a doctor. The midwife has more of a caring role and is skilled in handling the normal delivery. They can also spot when things are going wrong.

Only 10% of births need full blown medical facilties. The problem is that many hospitals act as if all births are medical emergencies. This causes a cascade of intervention leads to many unnecessary medical proceedures.

I agree gwys.

But I am yet another one who had as medicalised a birth as it is possible to get - and am extremely grateful for it!

I feel there is a tendency not to want to hear about the tragic outcomes and, luckily, there aren't many these days.

But dI hear an interview on radio 4 the other day. 17 babies a day are stillborn, twice the number of people who are killed on our roads. iirc.

It is an unpleasant truth people are sometimes reluctant to acknowledge.