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!

Consultant, if cs is comparatively expensive and labour intensive, and MLBU/HB is relatively cheap with better outcomes for low risk mums, why is there such an increase in the CS rate?? It's been baffling me.

Nutty, be strong and stand your ground. You are the one who has to walk away from this afterwards. Ask for a second opinion, but don't let anyone walk over you. You know what is best! In your position I would want a c-section too.

This debate may well appear in midwifery and obstetric training programmes:carry on.

Second the sympathetic consultant - no matter how much the health providers piss us off, they are in the vast majority of cases well intentioned. I do believe that.
I also believe they can have off days. In such a job as theirs, off days can result in life altering events for those they care for.
There needs to be more of them, who are less knackered, more motivated, and we as users must also realise they too must go home to their babies and families. Mutual respect, adaptability and sensitivity in the service. I have come to think that if we empower women to ask, and the health proffs to deliver, we'll do OK.

Currently everyone feels under fire and under threat, challenged negatively and distrusted, [user and provider] and that is never going to work.

AS a health provider, I must accept my opinion has to be given to a user/patient/mum/woman/family/and so on [it is my duty of care], and it may or may not be accepted. As a user, I have to accept that I can vocalise my choices, wants and needs - but on the day the 'team' may ride roughshot over them to keep me safe.
And we're going to have to put 10p on tax to do all this! I can't see any other way if we want the mega expensive high tech stuff incase we need it, along side the mega expensive real people to care for us in a meaningfull way wether we need intervention or not.

Boffinmum - you're such a boffin!!

I never know what to call 'us' [user sounds so clinical and in human, but patient is a no-no and woman discounts our lovely dp/dh!] and I never ever know what to call 'them'.

We need standardised terms for these people.

SmuttyNuttyTaff - There will be a tendency by many Obstetricians to refuse a CS for maternal request alone. However your case sounds very different. Electra is right the only way is to stand your ground most Consultants would feel uneasy agreeing to such a request as it does not fit the usual criteria for agreeing to undertake a CS.

So long as it is not the thought of the associated labour that is putting you off which could be managed for example with an epidural. Ask to speak to your Head of Miwifery too, if they are clear that you are not declining a vaginal delivery because you do not feel appropriately supported then it will be easier to win them over. She may also be able to recommend a more sympathetic Consultant for a second opinion. Do you have additional risk factors tht would make you a higher risk candidate for complications were you to have a CS? That may also be a factor.

However if you keep emphasizing the likely physical and mental effects attributed to the previous vaginal delivery and the next vaginal birth they should listen to you. It is likely your Consultant may ask for a second opinion from another Consultant before they agree, but so long as you make it clear that you have been appropriately counselled and you are aware of the potential risks associated with a CS they should eventually come round!

BoffinMum: That is the million dollar question!!
There are many contributory factors which include:

• High elective CS rate which then has a knock on effect in future pregnancies
• Relatively low VBAC uptake rates (typically ony 25-40%)
• More maternal requests for CS (a consequence of offering increased maternal choice!)
• Higher multiple pregnancy rates (more IVF preg.s)and therefore higher CS deliveries
• Comparatively less experienced junior Dr's on the delivery suite (hopefully being addressed with more consultants being physically present on the LW nowadays).
• Higher intervention rates, to a degree fuelled by fears of litigation.

-Better maternal nutrtion and consequently relatively bigger babies

There is also a trade off in terms of what the correct CS rate should be. Generally within the UK the lower your local CS rate the slightly higher the perinatal mortality rate and to an extent vice versa can also apply. however with high CS rates also come higher maternal morbidity rates (ie. higher complications of increased blood loss, infection, DVT/Pulmonary embolism)!

treedelivery : I whole heartedly agree with you

maxpower-'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.'

Is this so??

I wanted a natural birth at home.
Unfortunately DD was born a week too early.

I told the midwives that I did not want any intervention and no pain relief.

For a start they had me lying flat on my back with a monitor stuck to me. (did you know that these monitors can actually distress the baby?
Well I did and thats why i said No, but no they still made me do it anyway. Then they transfered me hospitals as mine didnt cater for premie babies - ecen though thats where my mom had me and my sis (premies also)
They also jabbed me with that stuff thats meant to make the baby's lungs develop. Not necessary as I was about to give birth!

So when I got to the next hospital they strapped me to the bed again!
I asked to be let off they said No.

Then all through my labour I was aked 'do you want any pain relief?' This happened about 7 times and each time they got a 'No'.
Why were they pushing me to have pain relief?I knew my body was capable.

And because I couldnt get off the bed - I tore and required stitches. Jabbed with a needle 6 times as she kept doing it wrong.

My baby was born 'grunting' and guess what they did...Left her on the bed, cut her cord and never gave her to me to hold. The MW walked out of the room and returned to put my DD in the cot - not in my arms! She told me my baby was grunting so the pead would need to take a look. The other MW who I was thankful for, as soon as the Head midwife went out the toom she gave me my baby ro hold for two mins.

I eventually got to feed my dd after 2 hrs! Though they never mediacally intervened when she was grunting??? Later on that night when I was on the ward dd's lips turned blue. So I went to get the MW as my buzzer clearly wasnt working. They called the babydoctor who sent dd straight down to NICU. where they gave her oxygen, an x-ray and believe it or not Fed her formula when they were meant to be calling me down to BF her.

Intervention in my labour was so not necessary although they failed to intervene quick enough when my baby was born.

i know what they are saying makes sense, i truly do (less recovery time, not having another thing to worry about recovering from etc). I just cant grasp how the heck i'm going to do it even with an epidural (how are they going to get it in there?? i cant even be stroked by a physio fgs), i have nightmares about being torn in two, being crippled, rejecting my baby because of the pain.

I'm all for going with the flow and seeing how things pan out but i have a huge niggling doubt that they are wrong on this one which is stupid really as they are the proffessionals and should know what they are talking about and really i should be reassured by that, its highly possible that the standard of care so far has knocked my confidence. I have been left while people try and decide what to do with me.

I wish there was more they could do to reassure me tbh.

also it may help if the people like the hydrotherapist didnt make comments like "you're joking, they're letting you do it naturally how do they expect you to manage that"

there seems to be split camps, its confusing and unsettling. My first birth was easy (i was extremely luck and i'm thanking my lucky stars) if i weren't in so much pain (and if i hadnt been for so long) i would happily have a VB.

(from a worn down/burnt out/fed up/demotivated/stressed midwife)

Would it be fair to say that the midwifery service is more or less flogged to its knees at the moment? That's my impression from this, my fourth, pregnancy.

Just to throw fuel on the fire. I regularly read the Dr Crippen NHS Blogspot. It is written by an NHS GP. He is always worth a read.

He is very much a sceptic of natural child birth. His post of 2 March 20009 is good one.

Dr Crippen

This is is his take on 'madwives' as he calls them:

"Midwives were the first nurse-specialists I encountered when I trained as a doctor. I developed an immediate antipathy as did most medical students. I hated the way they patronised the patients. I have never understood why, because a woman is trying to deliver a baby, it is assumed by midwives that she can be addressed by her first name. I hated the way women were made to feel guilty if they asked for pain-relief during labour. I hated the way that, if they did ask for pain relief, a pethidine injection was rammed into their thigh without so much as a by-your-leave and without discussion of the pros and cons. I hated the way that women who asked for epidurals were treated disdainfully. Time after time, I saw midwives delaying calling the anaesthetist for the epidural until it was too late. I hated the way that women who did not want to breast feed were treated as second class citizens and branded as failures. On the post-natal ward, there was a ?breast feeding room? but no bottle feeding room. I hated the way that, for all their practical skills, the midwives had little understanding of the science behind their practice."

Of course there are crappy midwives out there ABetaDad but for every midwife story, there's a crap consultant or registrar story. Not sure what your post proves?

How the dicken's can a doctor be a natural birth sceptic? Erm, sorry but women have been giving birth naturally WITHOUT doctors for thousands and thousands and thousands of years. Yes, there are problems occasionally but the majority have coped just fine.

I'm amazed at a doctor who is a natural birth sceptic. Talk about undermining a women's ability in her own body.

Dr Crippen is a twat and sums up everything that is wrong about the attitude of some (& hopefully the minority of) doctors.

I've read Dr Crippen's site. I think he's actually rather mysogynistic but dresses it up medically to make it look as though he isn't.

After going ritual physical humiliation, patronisation, and what felt like assault at the hands of a leading consultant obstetrician in a London teaching hospital on 12 November 1986 in the name of ante-natal care (see, I even remember the date, so traumatic was the experience) I find my opinion of hospital-based medics somewhat clouded.

In fact I had a flashback whilst I was having an unnecessarily violent internal at the hands of another consultant obstetrician in another hospital the other day.

Give me a decent midwife with her advanced practical skills any day.

just to come back to Boffinmum, I also have private health insurance, and they're a bit nonplussed by homebirth and the Dutch system generally, they won't pay the pool or the doula (ok I can understand a doula being seen as superfluous, but the pool seems a little harsh, given that I'm saving them around 3.000 Euros through not having it in hospital, and their representative on the phone said that frankly for them they liked a nice private elective Caesarian!

I haven't read all the posts,so sorry if i am copying someone else.

In reply to the op, i don't think its just mn where people are "anti intervention" i think its just what is (for want of a better word) fashionable, and for good reason. If your body is allowed to do what it wants to in childbirth, most of the time it that is correct. Mothers are wanting what is best for their baby and them, and in most cases neither "need" drugs to achieve this.

My mw talked me into going into the mw led birthing unit at addenbrooks, i was unsure, my first pregnancy, bit scared etc, but she left me with some information and we decided it looked like the best option. I think the reason these units are so popular is because they are meant to be more of a home away from home enviroment, which appeals to many.

Unfortunatly, due to an accident during pregnancy i was too anemic to go to the mw unit, and ended up having to have an emergency cs anyway.

I think that women do want to be more in control during labour and chilbirth and by going into one of these units, they feel this is more possible. We are all now led to believe it is best for our babies, which is what everyone wants isn't it?

musthave..

I am quite well aware of what constitutes a stillbirth thank you very much. I find the comment "that not all of them could/would make it" flippant and patronising.

I am not saying more intervention is the answer. I know some babies just wouldnt make it no matter what doctors/midwives could do.

I am just saying that the right intervention at the right time can save a baby's life... and save a family from a lifetime of heartache knowing there is always someone missing from their family. If medical intervention can save even one of those 17 children a day then its an achievement

Sympatheticconsultant is right hindsight is 20/20. With hindsight my consultant would have intervened sooner and my ds would be here but he didnt and he is not.

All I am saying is dont demonise medical births.. we dont want the number of stillbirths/neo-natal deaths to rise because mums feel medical births are wrong or makes them a failure

frasersmummy :
I'm sorry for the loss of your ds and hope that all your carers were able to support you through what must have been a very sad and difficult experience.
On behalf of the Dr's who are striving to make a difference and improve thing's for expectant parents thank you for your insight and your comments. We are all trying our best to help other parents avoid similar situations.

Nobody is demonising medical births. Not one person has done that. I sometimes think people can't read.

People are rejecting unnecessary interventions is all.

frasersmummy - not intended to be flippant or patronising. More aimed at someone who didn't know what a stillbirth was and may have imagined 17 low risk, term pregnancies ending in stillbirth everyday.

SympatheticConsultant We x posted, I hadn't seen your post when I wrote that. Just agreeing with MrsTittlemouse on a view I've heard expressed before.

sympathetic.. in defence of my consultant he based his decision on a scan that wasnt done correctly

I did get great support from him afterwards. It was obvious that he was very upset about what had happened and despite it not being his fault he kept saying I am the consultant I take full repsonsibility..I thought that was a very brave thing for him to say

He was very open and honest about a number of small pointers that in each in their own right didnt indicate a problem but put together probs should have. He changed procedures at the hospital so what happened to me couldnt happen again

You may be pleased to hear that his honesty, integrity and being available for chats re the pm etc left me in no doubt that I wanted him to deliver ds2

anyway back to the debate

ItsGrimUpNorth - In fairness the op did not say she felt mumsnet demonised medical births. More that she got an 'anti medical' vibe I guess. Other posters may have used those terms though, I dunno.
The op made an interesting point and certainly a stimulating one.

To add to the soup, I have personal reservations in regard to how we, the media, and the professions to some extent champion 'choice' and 'what we want'.
I read Junior and it really did focus on me really chasing the dream of 'what I want'
Sure, what I wanted was to have the perfect birth, probably pain free or low pain, prob not too long, prob with me floating on a calm serene cloud. Now what I got was a baby on board who didn't fit my pelvis and who couln't cope with shocking heart rate reactions. So in actual fact what I wanted meant nothing.
The constant barrage of 'dream chasing' pressure that I felt under left me feeling like I'd failed.

I'd failed, I knew what I wanted and I didn't get it, I made my choices and they were the wrong ones. A simple reaction.
I can easily see how people would look at the maternity services and say 'you didn't get me my choices, you failed me'
Years later I see this is not the reality, but I felt like that for a long time. My choices were limited by the shape of my pelvis and the mood my baby was in on labour day - that is not the fault of the service or of me.

I say this in regard to non specific, general mindset of the country, i.e. the media, at large. I realise that the awful experiences of many people here cannot be included in my own personal scenario. My heart truly goes out to all of you who have suffered from these life events, whatever their cause or circumstance. x

I think the unnecessary intervention which most people on mumsnet object to is routine induction for no other reason than the fact that you are overdue.

Contractions when you are induced are often more painful and 'full on' than contractions which start naturally and build more slowly as the body often has a chance to adapt to the pain and manage it more effectively. Therefore most (not all) women who are induced will choose stronger forms of pain relief than those who are not. Epidural is marvellous at pain management but it doesn't make it easy to push a baby out - cue ventouse/forceps/ECS.

If we had more monitoring (checking the placenta is still providing the baby with all the nutrients/baby still happy) of women who were overdue and less induction at the drop of a hat I am sure we would see a lower rate of ECS which can only be a good thing as they aren't a nice experience and cost money.

Not sure what Dr Crippen has to do with anything, he is a GP not an obstetrician! He sounds like an idiot....bottle feeding room indeed

Just want to add that I am not anti epidural at all.

treedelivery - a very sensible post.

In an ideal world, where nothing ever goes wrong, natural childbirth is obviously best.

Problem is that it is not an ideal world and it is not always possible to tell beforehand or even during proceedings whether a birth will go well or not.

I do think that some MN posters focus on the ideal world where the 'choice of the mother' and 'what she wants' is always paramount and can always be accomodated regardless of reality.

The problem arises when 'what I want' might kill the baby or the mother and at that point surely the modern medical world intervention is 'what we all want'.

I do wonder how many mothers would really want to go into a birth with absolutely no possibility of getting any advanced medical backup just in case. It seems to me that 'natural chidbirth' is a sort of cosy fiction that is pushed at women in the UK but in reality it is never really 'natural' because the advanced medical backup and the 'blue light dash' is always there if needed.

I just think there needs to be balance and honesty with mothers about what is a realistic set of practical choices given the circumstances of each particular birth and what is a fantasy wish list of ideal motherhood.