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 agree biskybat

The right intervention at the right time

We could really really do with more sonographers in this country. We are strapped for them, there are none at all to recruit it seems. It's hard training and requires a high skill level and high degree of responsibility for not much pence. The physics terified the life out of me when I looked into midwife-sonographer role development.

I am inclined to agree with biskybat and would be interested in our consultants opinion. It is a great step that NICE have stipulated post dates pregnancies can be managed with scanning and monitoring. But we need the services to back it up. Daycare units and scanning departments with open appointments that can be accessed same day. Not easy! Again, 10p on the tax right there!

Hello again. I didn't expect such a response when I posted the original question but have found this debate fascinating. My heart too goes out to anybody who has lost a baby or had a terrible experience, due to or in spite of intervention.

I think my terminology may not have been right in the original post re: anti intervention etc but I certainly agree that I don't think medical births are demonised as such (although sometimes I think the medical profession is, a bit).

As I read this thread, confusingly I find myself agreeing with most people even when they seem to be on different sides! One of the things about Mumsnet is that I get the impression (again, just an impression, not sure of the truth) that it is populated by really articulate, educated and dare I say it middle-class Mums (and Dads!). People who on the whole are pretty well informed and not likely always to bow down to supposedly superior medical knowledge? So views here are not necessarily representative of the whole population, for good or bad? Not exactly sure why this seems relevant though I admit ....

Anyway, for what it's worth I am delaying induction, and I might not have done so if I had not read this!

I am anti normal labour being routinely medicalised. I think the single greatest argument against the medicalisation of low risk labours is the fact that low risk women who have homebirths have (as a group) much better outcomes on a whole host of measures: lower rates of operative birth, higher rates of breastfeeding, lower rates of postnatal depression, lower rates of PPH and perineal damage... and of course the evidence on perinatal outcomes is also very favourable to homebirth, with similar rates of mortality and lower rates of morbidity.

I mean - doesn't that make you think? What is it that happens to women and to their labours in a hospital environment that leads to increased poor health outcomes for women? They're supposed to make you better in hospital, not expose you to harm.

Re: Dr Crippen. He's a pratt. What does he know about normal birth? Anyone who's worked in a maternity unit knows that medical students get a hard time from midwives, but that's par for the course. Student doctors pitch up on the labour ward hoping to witness a birth, but they don't want to sit through a labour - just be in there to watch the birth itself. How helpful is it to a labouring woman to have some adolescent public schoolboy suddenly appear in the room with his eyes glued to their fanny as they try to push their baby out?

BTW - is anyone here aware of any research on rates of cs for primaparous women undergoing induction at term? I've read somewhere that the cs rate for first time mums being induced is 50% in some hospitals. I find that deeply shocking.

"treedelivery - a very sensible post.

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

I don't think that's what treedelivery was saying at all

Birth without intervention is healthiest, unless a labour becomes dysfuntional and then interventions may result in a better outcome for the mum and the baby.

"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."

So how do you explain the good outcomes for low risk mothers labouring at home? In the 'real world' over 2000 low risk women in the UK have their babies at home, without immediate access to doctors and operating theatres. Those women have as good or often better outcomes than low risk women labouring in hospitals.

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.

"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."

Well - probably none. But then who is arguing for that? Arguing that women's emotional needs in childbirth should be acknowledged and (if at all possible) makes complete sense in medical as well as social terms. Women who have care in labour which
is sensitive to their social and emotional needs have better clinical outcomes.

"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."

Sorry - I think you have a bizarre idea of what natural childbirth is. You seem to think it's some sort of religion or philosophy which women subscribe to blindly when it's nothing of the sort. Natural childbirth is simply a way of describing normal, physiological birth.

Wanted to add on a wider note, that I feel very strongly that doctors and midwives do their very best in difficult circumstances. I don't think any doctor or midwife deliberately exposes women to risk or to what they genuinely believe is unnecessary intervention. However, I do think the system of maternity care, institutional practice and culture, and the environments that women are expected to labour and birth in make healthy, normal physiological birth very difficult for women and midwives to achieve.

Whoops - should read "Well - probably none. But then who is arguing for that? Arguing that women's emotional needs in childbirth should be acknowledged and (if at all possible) accomodated makes complete sense in medical as well as social terms. Women who have care in labour which
is sensitive to their social and emotional needs have better clinical outcomes.

Surely the default position should be that birth will happen naturally with as little intervention as possible. And in most cases it could and does. The cases where intervention is required, that is available and all well and good.

The problem comes when intervention is seen as the norm. And no births are expected to be trouble-free and natural. What could be be easy (well as easy as delivery ever is) and straightforward becomes complex and over-medicalised with all the attendant complications. And it's a vicious circle - induction for example may lead to other difficulties which can only be fixed by intervention and so and so on.

Nowt wrong with intervention where required. But everything wrong with it in the wrong place. To use a cliche - if it ain't broke don't fix it.

Oh it's all been said Of course.

"The problem comes when intervention is seen as the norm. And no births are expected to be trouble-free and natural"

And that's what's happened in many places - lots and lots of unnecessary damage being done to women and babies in the name of safety and of science.

We should all be incredibly grateful to the likes of Wendy Savage, Sheila Kitzinger, the NCT, AIMS, Michel Odent and the legions of 'madwives' who've stood up for natural birth (and been pilloried for it by the likes of Dr Crippen), because if it wasn't for them, and for ordinary mums defending their right to autonomy in birth we'd all still be giving birth flat on our backs with our legs in stirrups....... [phew - comes over all militant for a moment ]

Oh gosh - I'm remembering my own mum's story of giving birth to my brother in the 1960's. She'd slipped a disc in her back, and was made to give birth to a 9lbs 6oz baby lying flat on a narrow table. When she cried out the midwife slapped her round the face and told her off for frightening my dad who (unusually) had been allowed into the room..... Thank god things have changed since then......

Standanddeliver - you know that the qoutes in your post are not mine don't you? Wasn't sure as my name was at the top of your post iyswim? The qoutes are ABetaDads.

Stand - my mum was woken at 6am by the midwife turning the lights on, pulling her covers back and told 'get that bastard off my ward'. That bastard was little me. 1975, not that long ago. It's come such along way the service. It has far to go!

greenwithyellow

do what is right for you and yur baby

if you do decide to wait make sure you have regular checks

good luck with the birth

will be praying for a safe outcome for you

standanddeliver

"You seem to think it's some sort of religion or philosophy which women subscribe to blindly when it's nothing of the sort."

I obviously don't think that but it does come across from some people on MN and elsewhere as if it is a religion. I do get the sense that sometimes some women feel under presure to go the 'natural' route. That seems unfair when the natural route very clearly is the wrong route for a sizeable minority of women who absolutely need medical intervention.

I am guessing from (standandddeliver)you are involved in this issue in a very direct way as either a midwife or natural birth advocate?

Why would anyone not be a natural birth advocate, ABetaDad? Who on earth advocates unnatural birth? No one. Not one consultant, midwife, mother.

It's already been said so I'm not advancing things very far but pregnancy and childbirth are not an illness! It can make you ill, yes, it can go wrong, yes, and we are lucky to have treatment and intervention available.

The whole mindset which you put forward in your OP "birth is an extraordinarily dangerous process that can go terribly wrong" is flawed. Birth is not extraordinarily dangerous.

As for your comments on extended BFing and cloth nappies, frankly, what a load of tosh. I'm not suffering from an urbanised horror and lentil weaving urge to get back to nature, I followed scientific guidelines laid down by inter alia, the WHO.

Treedeliver - sorry I didn't make that clear. I was pointing out that aBetadad seemed to have misinterpreted what you said earlier! What a terrible story about your mum. I wonder if that's where your vocation came from - to do the right thing as a midwife (you are a midwife aren't you?).

"I do get the sense that sometimes some women feel under presure to go the 'natural' route."

Maybe that's because midwives and doctors are health professionals, so that they feel obligated to promote the mode of delivery that is healthiest for mum and baby. For most women this will be a natural birth (I am using natural interchangeably with normal - by both I mean a birth which is physiologically normal, ie, not augmented or assisted by instruments). And actually once women themselves are armed with a lot of information about the birth process and the risks of various interventions (as well as the benefits) they themselves often feel very strongly about having a natural birth - ie, the pressure comes from within.

"That seems unfair when the natural route very clearly is the wrong route for a sizeable minority of women who absolutely need medical intervention."

No - you are distorting the argument. Doctors, midwives and other people involved in the delivery of maternity care don't deliberately encourage women who need medical intervention to go without it. Or at least not in my experience.

greenwith. IMO there is a lot to be said about avoiding unnecessary intervention. This is because it has been proven that intervention itself can cause more intervention and damage too.

Basically in western hospitals you have a conflict between those that want to create an environment where women can labour 'naturally' (without intervention but near facilities in case of emergency) and those who want to reduce their risk statistics as much as possible. The latter philosophy leads to a huge amount of intervention to avoid risk and therefore legal action.

We in the west want a guaranteed healthy live baby at the end of every pregnancy. But nature isn't like that. Western hospital medicine aims to take as much doubt and risk out of the whole equation. It means that a huge number of normal healthy pregnancies end up getting the treatment of far riskier pregnancies through interventions.

This will never change, western medictine is hostile to taking risks, natural childbirth takes risks. That's just the way it is. But it can be a far less damaging experience if healthy labour is left alone with the professionals on hand if you need them.

abetadad I do disagree with you to some extent - I think there are SOME women who long for a little imaginary ideal etc, but not all of us do. i had DS in hospital, as I wanted to be close to medical help should the need arise. i did refuse induction, but had daily monitoring. If the monitoring had shown a problem, I would have agreed to being induced. (I also use cloth nappies, again not for the reasons you suggest, but because I prefer them to dispos)

COnsensus does seem to be against unecessary intervention.

Just thought i would post an update in case anyone is interested.

MW has been and gone i must say i feel a whole lot calmer now. We worked out where my fear's lay regarding natural birth & labour, basically pre and post epidural, how will i manage to labour without being active (i was very active during 1st labour), how will i deal with the extra pain etc. Basically i'm to go straight in to hospital when i start contracting/ waters break etc and have an immediate epidural rather than the usual stay at home as long as possible and wait it out. While this is not ideal it ensures i will not pass out or die form the extra pain or become exhausted. Post baby i will just have to wait and see but shes confident that i wont be in as much agony/ more damaged than i think i will be. I now dont feel so desperate for a section now the logistics seem to have been explained.

and for all you MW's out there can i just say my MW's of which i have 2 who alternate (and doctors too) have been outstanding, actually listening, hugging me when i have cried inconsoleably, providing reassurance and support where needed, chasing & making refferals, ensuring that i'm aware that i can call them anytime even if its just to cry on the phone. When this is all over they will be reciveing flowers and gifts from my direction.

unfortunately the consultants i have seen dont seem to have taken the time to listen or talk through things properly and alay my fears (my back consultant hasnt even seen me, just my MRI!). I understand that they are obviously very busy people and thats fine i dont want to bash them (tis not my intention) but surely they can spare more than the quick 5 minuites that i recieved to talk me through this. or is that just me being greedy?

Smutty, I'm really glad your MW has been able to offer you some reassurance.

This probably isn't something you want to get into now, but after your baby has been born and you are feeling up to it I would consider getting in touch with PALS to give them some feedback on how the consultant's lack of interest has made you feel.

Have you written your birth plan yet? Would you be able to afford a doula to be present with you at the birth, to remind you and the MW delivering of the birth plan and advocate for you? Or is there a female friend or relative you could trust to do this? Having my mum at DS's birth was the best decision I ever made.

You might be interested in a few quotations from a book I have, called The Motherhood Book. It is a parenting manual from the 1920's.

Regarding pain relief:

"Whether a mother should have a drug during childbirth depends entirely on herself and her own reactions to pain. ...[the doctor]...will probably tell her the comforting news that no mother who is giving birth to a child is asked to bear more pain than she is able, although, for the sake of the baby, the anaesthetic is withheld as long as possible."

Regarding labour and birth:

"During the first stage it is not necessary to take to bed, and the mother should move about indoors and occupy herself as much as possible with reading or knitting." She may have "a light meal...if she feels inclined."

Once she reaches the second stage:

"The mother from now on must be in bed, lying on her left side with the knees drawn up...Considerable comfort may be derived if the nurse rubs or presses firmly the small of the back during a pain...The patient should be instructed to stop bearing down during the pain, and asked to cry out or pant while the head of the baby is being delivered."

That was our greatgrandmothers' generation. Our mums ended up flat on their backs with their feet in stirrups, fasting, and having drugs administered without permission or explanation. Now we've come back full circle.

several people have talked about a cycle of intervention. my prenatal teacher talked like this and it convinced me not to get an epidural. i was induced at 42 weeks and 1 day, as i had zero amniotic fluid, and not a hint of a braxton hick. if left to it's natural devices my body would not have gone into labour, and my baby would have died. the induction worked temporarily, but not enough to dilate me to 10 cm before my bleeding got so heavy that they took me in for emergency section. what i'm trying to explain is that the cycle is often caused my the body's lack of ability, which ends in the intervention, rather than the intervention causing the cycle. And yet, I 100% agree with the OP, stop making people feel bad for giving birth through intervention MNers, you know what you are!

I really really do not get this thing about MNers 'making people feel bad about giving birth through intervention' though. It honestly seems like a myth to me!!

I've read plenty of posts where people say they are against unecessary intervention, which is a good thing!

And certainly you'll find posts where people describe how they felt empowered by giving birth naturally - but that's not the same as being critical of people who don't.

I really think sometimes it's really difficult for women to say 'Yes, I had a natural birth and I feel really great about it and really empowered', just in case it offends someone else whose birth wasn't natural.

We need to keep this in perspective. Most pregnancies and births are straightforward, and don't medically require induction, epidurals or other major interventions. Some pregnancies and births do require intervention. It's the stuff which isn't based in medical need which is the issue.

No! There are lots of threads where people express concern that they haven't given birth 'properly' because of a cs or whatever, and generally others are very supportive and assure the women that of course they have. It's not a flipping competition!

Any woman in her right mind embraces medical help when it's needed (eg in the situation you describe with a post-mature baby). It's just when people are interefered with for the purposes of staffing rotas, ignorance, or hospital convenience that they resent it.

I have never seen a post in 8 years slating people who have a c section or other intervention.

Indeed I have oprbably posted on hundreds of threads by Mums saying they felt like that to say of course you shouldn't feel like that, you cared and nurtured that baby before during and after birth and the exact mode of delvery is immeaterial.

All people really want is the ability to have some control over thir own birthing. Quite often that fails to fit a specific cost / convenience led hospital protocol and they are labelled anti0intervention or somesuch but they usually have read all the reseearch.

After all, if people opting for VBAC, HB etc weren't wanting to be informed tere wouldn't be so much discussion on research on here, or available from groups like AIMs.

I'd have no truck whatsoever with a mohter who refused to go into hospital when in danger or tried to freebirth, but i've never met one either.

Boffin's post makes me want to ask the question why do some people feel concerned about the way their birth happened??

Somebody somewhere must be applying pressure to do it naturally .. is it ante natal classes or friends and family or doctors or a combination of all 3

Like I said there are no medals for giving birth with no medical help.