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!

lou, I don't think anyone is suggesting IUGR is not a case where intervention is needed. The guy who wrote 'Childbirth Without Fear' says this at the very beginning of his book.

My point all along has been that intervention should be saved for incidences where it is completely necessary and required, which a complication like IUGR would justify.

This is completely different to 'if your waters haven't gone by ten o clock, we'll break them for you', or using intervention where there is no apparent complication which leads to a cascade of others.

well I have seen both sides of the coin

my first ds suffered iugr but due to the medical staff not wanting to intervene too soon my ds was born asleep

Second time around ds2 was fine but consultant recommended being induced at 37 weeks ..

yes it was early, yes it was forced quite hard , yes it ended in epidural and forceps yes it was a horrid day

did we make the right decision .. Absolutley

Any delivery that ends in a healthy mum and baby is a good delivery. The only bad deliveries are where you dont hear your child cry!!!

Lou, there was a poster a month or so ago who insisted on intervention - against the medical staff's wishes - because she trusted her body and was convinced that there was a problem. She was right, and the intervention probably saved the baby's life.

It's hard to make wise decisions about choices you are given when its your first time - if I don't go for an induction when first offered, will I have enough energy to get through the birth/what effect might having an epidural have on baby's keeness to breastfeed - and if so, which is more important to me - /is having an injection to speed up the placenta delivery a good idea for me, or can it actually cause retained placenta in some cases (like mine). I would always take the best advice offered. A friend's baby sadly died in childbirth and it has made me much more aware of the risks (undiagnosed breech baby). But it does seem that sometimes a chain of intervention is started that is more about speeding things up - probably more for the anxious parents than for the teams - but maybe not that necessary.

Another factor for me is the fact that the recommended interventions seem to change so much over time, and are more socially influenced (rather than medically influenced) than we sometimes realise.

Over 20 years ago, when I started having babies, women were routinely given episiotomies (because their vaginas were thought not to be up to the task), routinely shaved (so the midwife could see the vulva better whilst the women was flat on her back), routinely starved in labour (in case surgery proved necessary later on) and so on. These were all said to be vital to the safety of the baby and there was considerable pressure to consent. We now know differently.

So we have to ask the questions - are they suggesting an injection to speed up the delivery of the placenta so they can turn the room around quicker, because they are a bit busy on the ward today? Is this (painful) induction happening because a public holiday is looming and they think they might be a bit short staffed? Am I in pain and needing an eipdural because they have forgotten about me and left me flat on my back strapped to a monitor for hours? Do I need forceps because I should really have been upright for most of this labour, but nobody was available to encourage me?

This is why people are wary of such interventions - they are often socially driven and not medically based.

Got to say Charleymouse, whilst I understand most of the anti-intervention comments on here and perfectly understand everybody's right to choose the type of birth they have, I don't think bowel movements are a good analogy at all! The fact is that bowel movements generally are not excruciatingly, unbelievably, mind blowingly painful (thank GOD!), or possibly (just possibly, I know) life threatening for you or the ..... ummm, movement!

I DON'T think that intervention is a good thing in all cases, I really really don't! But I still DO think that there's a lot on here about a golden age when women's bodies supposedly knew what they had to do and got on with it, which just almost certainly didn't exist. Childbirth has always been a potentially dangerous and yes, scary event. Perhaps less so now with all the help of medical science. I do absolutely agree that at times it has gone far to far in the medical direction though.

Prettycandles - that's so great that your births got better and better but could it possibly be that at least some part of the reason that the third one was better was because it was your third? And you knew better what to expect, as did your body? Just a case study of one, but my mother for example had five children and said that although each one was amazingly painful, they did get easier.

Sorry to keep this debate going, hope people are not fed up with it by now.

boffinmum I was with you till you said

Do I need forceps because I should really have been upright for most of this labour, but nobody was available to encourage me

That sounds like you think its the womans fault that she needs help in the end

You dont get medals for doing it all yourself

They dont announce over the tannoy in the mat unit frasersmummy just gave birth with only gas and air

charleymouse

I dont know what the mothers mortality rate is in childbirth so you might be right about it being really low I honestly dont know

But I think this statistic says there is nothing routine about childbirth.

17 babies are either stillborn or die in the first few hours after birth in the uk EVERY DAY

That's interesting boffinmum, I totally get that. But if you go private, so theoretically there's fewer worries associated with timings/staffing/cost etc, presumably there is just as likely to be intervention? I guess in that case intervention is related to a different but equally skew-whiff set of priorities ... still comes down to money in large part though.

I'm still really really interested in whether there's a system of childbirth in the world which results in really great (or comparable) outcomes (and where women are really happy with the system) but is less medicalised than it is here? Or when people look back to before the medical profession got too involved and therefore things were better, what precise point that was in history (and how we know, as I guess there isn't much out there giving women's testimonials on childbirth in the past)? Does anyone know?

No, I didn't mean that, I just meant that if women get good 1:1 midwifery support they are less likely to end up needing things like forceps. I do feel passionate about the need for good midwives by your side.

LOL Re: tannoy

There's a word for it BetaDad - its called the Naturalistic fallacy. And it is a fallacy.

Some infant mortality rates:

180 United States 6.26 2009 est.
181 Guam 6.05 2009 est.
182 Cuba 5.82 2009 est.
183 Italy 5.51 2009 est.
184 Isle of Man 5.37 2009 est.
185 Taiwan 5.35 2009 est.
186 San Marino 5.34 2009 est.
187 Greece 5.16 2009 est.
188 Ireland 5.05 2009 est.
189 Canada 5.04 2009 est.
190 Wallis and Futuna 5.02 2009 est.
191 Monaco 5.00 2009 est.
192 New Zealand 4.92 2009 est.
193 United Kingdom 4.85 2009 est.
194 Gibraltar 4.83 2009 est.
195 Portugal 4.78 2009 est.
196 Australia 4.75 2009 est.
197 Jersey 4.73 2009 est.
198 Netherlands 4.73 2009 est.
199 Luxembourg 4.56 2009 est.
200 Guernsey 4.47 2009 est.
201 Belgium 4.44 2009 est.
202 Austria 4.42 2009 est.
203 Denmark 4.34 2009 est.
204 Korea, South 4.26 2009 est.
205 Liechtenstein 4.25 2009 est.
206 Slovenia 4.25 2009 est.
207 Israel 4.22 2009 est.
208 Spain 4.21 2009 est.
209 Switzerland 4.18 2009 est.
210 Germany 3.99 2009 est.
211 Czech Republic 3.79 2009 est.
212 Andorra 3.76 2009 est.
213 Malta 3.75 2009 est.
214 Norway 3.58 2009 est.
215 Anguilla 3.52 2009 est.
216 Finland 3.47 2009 est.
217 France 3.33 2009 est.
218 Iceland 3.23 2009 est.
219 Macau 3.22 2009 est.
220 Hong Kong 2.92 2009 est.
221 Japan 2.79 2009 est.
222 Sweden 2.75 2009 est.
223 Bermuda 2.46 2009 est.
224 Singapore 2.31 2009 est.

The thing I find interesting here is that the US has a highly medicalised and hospitalised system but higher infant mortality rates than Canada - is this because of social inequality and the lack of midwives?

The Isle of Man scores worse than the UK overall. Why is this?

Germany and France are doing better than us. Why?

Love stats. So many things to consider.

DH and I know personally of 6 stillbirths and neonatal deaths in our close circle of friends and family. Three of those have happened since we have been adults and aware of exactly what has gone on. In no case was the death due to the woman avoiding intervention and insisting that her body knew best. They were just dreadful things that happen and nothing could have been done to prevent them. So I think that the stillbirth statistic is misleading.

I am not at all lentil-weavery about birth. I have been in the chorus persuading a woman to reconsider freebirth on MN. I would never have a homebirth myself, although I can understand why it would be a good fit for some women. I almost had an elective C section for my second delivery. But I still think that we are struggling as a society to move on from an entrenched culture of intervention in birth as a matter of course, rather than something that is done on a very specific case by case basis.

I wouldn't knock any woman who had a delivery with intervention by choice, by the way. And I don't think that a birth with intervention is necessary a "bad birth" - I know of at least one induction (for very good medical reasons) with lots of monitoring (ditto) that was a very positive experience and where the mother had an upright labour where she felt completely in control.

mrs tittlemouse I wasnt suggesting for one minute that the stats were caused by women saying no to medical help. If it came across that way I am really sorry

I just meant that if we demonise medical intervention it could make the stats even worse

I personally think 17deaths a day is atrocious

I am intrigued that the states have a higher mortality rate than us despite being a lot more medical minded than us when it comes to childbirth

climbs off soapbox

Really interesting Boffinmum! As you say, it raises more questions than it answers in some ways. Infant mortality must be the best and most important measure I guess, and I suppose no-one ever measures 'mother's satisfaction' as well.

Unfortunately in the USA if you don't have good medical insurance then you might not get much antenatal care at all. Hospitals have signs at the entrances detailing the law that they cannot turn away a woman in labour. It might well have been the first time that they saw that woman.

frasersmum - sorry, I hope that you didn't think that it was a personal attack on you. I agree that it's important not to demonise intervention, but I think that we're working from the opposite end - that we've had intervention as standard for so long that it's seen as "normal" - hence the enthusiasm shown by those who have found something different. I may be a bit unusual in that I wanted a very natural birth, but my body wasn't capable of that, and then I fought for a C section, but wasn't allowed one and was forced into a botched instrumental birth. My second birth, I was lucky enough to delivery naturally. I can't pretend that it didn't colour my opinion that instrumental delivery is the work of the devil and should be reserved for cases of foetal distress where a swift exit is vital.

"Mother's satisfaction" I think is a bit misleading as a lot of us (me included) are not "dissatisfied" but actually traumatised (flashbacks/nightmares etc.) and in my case physically injured and unable to have sex (now cured thank goodness). The plan wasn't to exchange my marriage for my children.

The key to working out what is happening here might be to see pregnancy, childbirth and the postnatal period and any associated health problems (aka maternal morbidity) as part of a continuum. Currently they are tracked independently, so connections may not always be made between long gaps between ante-natal appointments and lack of continuity of care, for example, and creeping maternal panic and ill health, and their subsequent impact on labour.

There's a lot of literature on maternal morbidity, and some of the US work suggests it's time all this was linked up properly to get a better understanding of women's journeys through the childbearing experience.

One random example here

One thought that occurred to me - I happen to have private health insurance with maternity benefit, and the insurers are surprisingly pro home birth. This is not because they are woolly or lentil eating. It must be because they know that actuarially it costs them a lot less money in the end if low risk mothers are encouraged to deliver at home, as the medical outcomes are better. These companies are surely not daft! I wonder why the cash strapped NHS does not apply the same logic??

Sorry Mrstittlemouse, completely take your point and didn't mean to trivialise people's experience. Apologies if it sounded like that.

No problem. You are getting the fall out from me hearing "as long as you leave with a healthy baby that the only thing that matters" and "it's only one day" just once or twice too often!

I have access to complaints made by women about their birth experiences in a london hospital.

Interestingly, the majority fall on one side or the other of this argument. The mother either thinks they were rushed or pushed into unnecessary intervention or that not enough intervention was offered or provided.

Inevitably, the answer tends to be, the benefit of hindsight is a wonderful thing. Midwives in particular should try to respect and advocate for the patient's wishes where possible. But at the end of the day, the midwives and obstetricians have responsibility for doing whatever appears to them to be clinically necessary to ensure mum and baby remain safe and well. To some extent, they're damned if they do and damned if they don't.

I personally had a failed induction, a selection of pain relief and ended up with an ecs, none of which I had hoped or wished for. I was extremly upset by my experience and it took me a long time to get over it. My experience first time round makes me anti-intervention. But part of dealing with my experience was recognising that both me and my baby were safe and well.

For those who have what they consider to be unnecessary intervention, we may never know if this was truly unecessary as we cannot compare what would have happened without that intervention.

Hi to all the mums and interested parties on this thread,
I've been reading with interest all your views and experiences and thought I would put my thoughts into the melting pot! First off it does sadden me that so many have had poor experiences which seemingly could have been different. A lot of the points made above are valid, supporting both sides of the medical intervention argument (although I do struggle to accept the argument that Obstetricians are intervening unnecessarily to make their lives/schedules easier!).

Whilst Obstetrician?s and Midwives have different roles in caring for pregnant women and their families, both groups have gone into their respective vocations to try and do the best we can to ensure the best possible outcomes for pregnant women and their partners. At the most basic of levels this is ensuring that parents are guided through the pregnancy culminating in a healthy baby and a healthy mother. This is mirrored by the long-term trend in maternal and perinatal mortality rates in the UK. In 2003-2005 there were 295 Maternal deaths in pregnancy and childbirth (14 maternal deaths per 100,000 deliveries). To put this in perspective (2007 WHO report) in 2007 there were just over 500,000 worldwide maternal deaths with maternal mortality rates in developed countries running at 9 per 100000 maternities compared with rates of >1000 per 100,000 in less developed countries (in India alone 117,000 women died in pregnancy or childbirth in one year!). Pregnancy and childbirth as nature intended are unfortunately not without hazards. But many other endemic factors also affect these figures eg. maternal poverty/nutrition, general health as well as the quality of local maternity facilities (including the availability of obstetric interventions).

In the UK the maternal mortality rates for the last decade appear to have reached a plateau despite national efforts to reduce them further. Thankfully the focus has now also moved onto looking at near misses, the quality of care being provided to mothers is more of an agenda item.

In an ideal world the care we provide should and can be tailored to individual needs. In the real world unfortunately sometimes other factors prevent this (staffing levels, capacity issues, financial pressures from management/Gov.t, fear of litigation). As in all walks of life there are also good and bad Dr's and midwives. Furthermore we are not infallible and sometimes yes we do make mistakes. Equally sometimes, despite our best efforts, nature intervenes and the outcomes for a pregnancy are poor. Such tragic events contribute to professional experience and understandably this all can affect perception of risk and clinical judgement.
Expectant mums should be supported by their midwives and obstetricians to make informed decisions throughout their pregnancy. But there also needs to be an awareness that although we are reasonably effective in predicting/managing some of the most serious pregnancy complications sometimes we do not have the means to know in advance which interventions may not have been necessary (hindsight is a wonderful thing!). Often it comes down to a risk/benefit assessment and each parents assessment of the degree of intervention-related risk vs non-intervention related risk they are prepared to accept is different . The decision to intervene should be a joint one!

It is not always easy from the other side of the fence, some mother?s are very eloquent in expressing their fears/anxieties and wishes when it comes to childbirth whereas in other cases it can be difficult to determine. Sometimes parents are not sure quite what they want or simply have not had the options appropriately explained.
What I would advise all the expectant mums out there is that if your midwife / Obstetrician knows what your expectations are it is easier for us to try and ensure we can move to try and accommodate them. Furthermore if you feel unable to connect with your midwife or Dr then do consider switching to an alternative (your local Head of Midwifery is usually a good place to start, they know which team members(midwifery and medical) would be best suited to provide the type of support you need). This should n?t be too much of a problem antenatally, unfortunately the NHS Maternity services do not have this flexibility on the delivery suite when you go into labour. One-to-one care throughout pregnancy would remedy so many of the poor experiences our mums are exposed to during child-birth, if only the resources were always available to ensure this!

frasersmummy - so sorry for your loss. 17 stillbirths a day is an awful thought. But any birth after 25 weeks of pregnancy is classified as a stillbirth so not all of these babies would/could have been saved by intervention. Perhaps more/better antenatal care would have helped some of these babies.

Like MrsTittleMouse I don't subscribe to "as long as you leave with a healthy baby thats the only thing that matters". Some women are emotionally and/or physically damaged by their birth experience. Some have long term problems with everything from PND to incontinence. This isn't an anti-intervention rant. Just want to stress the importance again of appropriate, well timed intervention for the right reasons.

I do agree with sympathetic consultant that 1:1 care is the way forward. My vibe is that this is the only thing that can reduce infant and maternal mortality rates further. The current situation is haphazard at best and riddled with problems.

Sorry MustHaveaVeryShortMemory
That is not what i was implying!
This may have been the approach in the bygone years of my predecessors - before the 'old' medical establishment acknowledged the place for maternal empowerment & choice. However now more than ever before in this country the current priorities in maternity services include measures to try and improve the quality of maternal experiences in pregnancy and childbirth through the provision of the Choice agenda. I don't disagree that we still have a long way to go , but increasingly within the profession the desire is there.

Firm government announcements addressing quality related Maternity performance targets would move many NHS Trust Executives to re-allocate funds and staff to ensure such traditionally neglected aspects of the NHS core services such as Maternity were appropriately prioritised. Presently one of the main maternity related performance targets all Trusts have to meet is to ensure that 90% of women have been booked by 10 weeks!! There is a reluctance in Gov.t to quantify Maternity related 'Quality' measures because they are directly related to increased funding and staffing implications.

If anyone can tell me how i can get my consultant to give me my damn c/section i would be eternally grateful. I WANT intervention, they wont give it to me.

My MW says c/sect is the way to go
My Physio's (i have seen several) say c/sect is the way to go
even my doctor says C/sect is the way to go

My obstetric consultant, my back consultant and an anethestist says no that i should do it naturally. it will be better for me and my body apparently. I can have an epidural, hooray.

I have a prolapsed disc, spd and sacroliatic problems. I can barely lift myself from the sofa. I'm on morphine. i'm in constant pain. and have been deteriorating since week 8 (now 33 weeks).

Physically i do not feel able to birth my child naturally, i'm terrified of damaging myself during birth (despite the consultants reassurances that i wont) i dont think my body can do it. Mentally i'm a mess and am fearfull of what i will be like during and after birth if anymore pain is inflicted on my body.

I'm really scared and i really want intervention. this is my second baby.

nobody can agree on whats right for me, and nobody has known what to do with me throughout my pregnancy.

sorry for rant.