Guest post: “When we hear about birth we often hear two very distinct stories”

[MumsnetGuestPosts]

If you’ve had a difficult birth in the past, or are preparing to give birth at the moment, you may want to read this post with someone you feel able to talk to about any feelings that arise.

When we hear about birth we often hear two very distinct stories – that it’s either terrible, or wonderful. People talk about birth ‘horror stories’ that leave women and their families suffering, or they talk about the beautiful empowering experience of birth. When we talk in such dichotomies, there’s little room for those in the middle whose experience is often a little bit terrible and a little bit wonderful (and sometimes a little bit exciting and a little bit terrifying and at times even pretty boring). This can leave many people feeling unable to talk openly about their experiences – and whether birth is terrible, wonderful, or somewhere in the middle, we know that it can leave a huge impact on us. It’s the entryway into our parenting experience, and if we come out feeling that it hasn’t gone the way we had hoped, it can mean the start of that journey is complicated.

A year ago, I set up an organisation called Make Birth Better with my colleague psychiatrist Dr Rebecca Moore. We’d noticed this black and white way of talking about birth and wanted to provide a platform to showcase the wide variety of stories and experiences that exist around birth – from both parents, healthcare and birth professionals. We also noticed how few birth stories exist from people who, research shows, might face additional stigma from maternity services such as Black and Minority Ethnic women, same sex couples, trans individuals, non gender conforming people, those with physical or learning disabilities, women living with disadvantages. It’s only by showing how varied birth can be that we can start to speak about every kind of birth story.

Over the past year, we’ve met with women, partners and professionals to ask them what they felt could make birth better. While often antenatal education and stories about birth focus on the women or birthing person’s responsibility to educate and empower themselves, we heard stories about how ineffective preparation can feel when you enter a system which is, in itself, traumatised. Overstretched and overstressed maternity services can feel like they are reactive, rather than proactive, with midwives often dealing with more than one person in labour simultaneously, without time for a loo break let alone to learn about a person’s birth plans.

We’ve started to create a new story around birth. One which includes not only the woman or birthing person and her partner, but also the staff who will travel that journey with a family. And if we’re to include staff, we also need to include the systems that exist around them – the teams which support them, the organisations which treat them with either kindness or blame. If we begin to see birth not as a solo affair but a collaboration between all of these different layers of the system, then we can create a new narrative. That includes all of us too, of course. So that we not only share the different and varied birth experiences that we have (being mindful of any parts that could be emotive), but we ask to hear others’ experiences too. Then we can hear about births that are neither horror stories or fairytales, neither black or white, but full of colour.

If you’re reading this currently preparing for birth, do take a look at the online resources at //www.makebirthbetter.org and take a look at the Positive Birth Movement, Association for Improvements in Maternity Services & Birthrights. If you’re reading this and you think you might have some symptoms of trauma following your birth, do take a look at those resources too as well as the Birth Trauma Association who have an active peer support group on Facebook.

Emma’s new book ‘Why Birth Trauma Matters’ (Pinter & Martin) is published on 11 July.

EDITED BY MNHQ Emma will now be coming back on Thursday at midday

[SweetMelodies]

I think the quality of care and amount of dignity/respect is just as important as how the birth looks on paper-

A woman could have an emergency CS but be well cared for by friendly staff, treated with upmost respect and dignity throughout and come out of it feeling mainly positive and not traumatised. Alternatively a woman could have a straightforward ‘natural’ birth with no scares or complications but feel traumatised by being treated cruelly, having no privacy or dignity and feeling disrespected.

[Blahblahblahnanana]

SinkGirl that’s at a new build hospital though, and there’s still 8 women in rooms with little privacy.

[RowanMumsnet]

@SinkGirl

Tears are more common now because episiotomy is not done routinely. Episiotomy was previously done in the majority of births - by 1979, up to 80% of all births in the US involved an episiotomy, so more than that will have involved stitches. It started being used more commonly in the 1920s
gizmodo.com/a-brief-history-of-vaginal-cutting-during-childbirth-1710537581

Higher rates of epidural also leads to increased intervention and therefore episiotomy and tearing.

I recently went to a presentation about a new clinical trial looking at the prevention of third and fourth degree tears (and specifically anal sphincter injuries), and this particular trial recommended episiotomy in cases where women looked likely to have very bad tearing - which was controversial among some HCPs taking part, apparently. I thought it was interesting that we could be seeing the rehabilitation of the episiotomy (albeit in really specific circumstances)

[SweetMelodies]

I remember reading Mary Cronks (midwife) account of working in hospitals when routine episiotomy existed.. apparently she would witness midwives cutting women AFTER the baby’s head had been born as drs would go round checking every woman had given one. This is not so distant past as well, shocking.

If they do begin to make episiotomy more commonplace to avoid tearing then I think there would need to be more discussion with women about it during pregnancy so they could properly consent in childbirth.

[AnnaMagnani]

I don’t know anyone in my mothers generation or any of my peers who has had any problems giving birth

Really? Because I'm sure my mother's oft repeated story of the horror of my birth and her then prolonged PND is absolutely related to the reason I decided not to have children. I know loads of women my age with stories like this - one who asked her mum what having children was like and was told 'it's like death, darling, death'.

[Blahblahblahnanana]

Episiotomies are still carried out when there’s a clinical need, they just not routinely given to all women.

13.15 Do not carry out a routine episiotomy during spontaneous vaginal birth.

1.13.21 Perform an episiotomy if there is a clinical need, such as instrumental birth or suspected fetal compromise.

www.nice.org.uk/guidance/cg190/chapter/Recommendations

All the OASI care bundle is doing is ensuring the same standard of care is given to all women by:

• speaking with the woman about her risk and Obstetric Anal Sphincter Injury (OASI) and communicating with her during the birth to enable a slow controlled birth of the baby.
  
• performing an episiotomy (a cut in the perineum to assist birth and prevent tears) when required.
  
• using the hands to enable perineal protection at the time of birth
  
• and a thorough examination after birth to detect tears, not all of which will be immediately obvious.
  

There’s nothing really new being proposed, although some midwives will use a warm compress or practice a hands off the perineum approach.

[Oblomov19]

What's the point of this? Is someone paying you? How is this going to get any better, other than billions invested in better post natal care, more midwives, more staff etc?

Now the thread has turned into trans?

Both my emcs were ok. Some problems but middle of the road as such = not warranting discussion.

Feels like you're trying to make an issue, out of nothing.

Or certainly addressing the wrong core issues.

[PicsInRed]

"Birthing person". 😂🤔🤣

Message totally and utterly lost.

Hey Mumsnet, are we renaming "March for Men" to "March for Prostating Persons"?

Or is it just women's life changing/threatening issues that get bogged down with this semantic nonsense?

[SinkGirl]

SinkGirl that’s at a new build hospital though, and there’s still 8 women in rooms with little privacy.

Bays are needed in some clinical situations where patients need closer monitoring. So while rooms are ideal in terms of privacy there may be situations where it’s not the safest option.

The PP said that private rooms would never happen on the NHS - I was just pointing out that it can happen.

As I said episiotomies are not done routinely now but they are still done where there’s a clinical need.

[AnneLovesGilbert]

Birthing person ridiculousness aside, I’m unclear on what this is trying to achieve.

Is it campaigning to change maternity care and postnatal wards? If so, how?

Is it just seeking to reframe how we discuss birthing experiences? Are you suggesting the women you’ve had “okay” births wish to discuss them but feel unable to do so if it doesn’t for the traumatic/empowering narrative you describe?

On the latter, that’s not my experience with friends, family or my own birth. Most people will say bits were good and bits were bad and if mum and baby come out of it in one piece then it was okay. A lot of people find the idea that if your baby is okay then nothing else matters dismissive and u helpful. I had 5 MCs before my baby was born and of course I’m over the bloody moon she’s safely here and alive. Recovering from a EMCS and GA wasn’t much fun and when I had an infection in my scar a couple of weeks after was having a light moan to a friend who said “oh well, at least she’s okay and you know it was worth it for a healthy baby”. Of course it was worth it! But I was in a lot of pain and bending over to feed her or change her nappy was agonising and I was tired and had just had major surgery so you know, entitled to a little moan about it - but apparently I wasn’t.

[Blahblahblahnanana]

@SinkGirl high risk women who need more monitoring on P/N wards generally have their own rooms once moved from the LW to the PN ward, the well women are generally placed in shared bedded wards. This is generally what happens at the trusts I’ve worked at.

[SarahAndQuack]

What's the point of this? Is someone paying you? How is this going to get any better, other than billions invested in better post natal care, more midwives, more staff etc?

But surely, people need to research how to make things better too? Ok, yes, the NHS needs more money, but isn't it also important to figure out how to use the money there is?

[treelamp]

I think the PPs asking what this is trying to achieve have a point.

DD's birth wasn't great but I don't really think talking about it now would be that useful to me. For me, what would have made a huge difference is a better experience immediately after birth on the postnatal ward. More midwives with more time to provide support (on day 5 I was still in hospital and literally sobbed all day long and nobody even seemed to notice let alone ask if I was ok). More staff to help with basic tasks like getting food when I couldn't walk to the lunch trolley without fainting. Private rooms so I didn't have to struggle with breastfeeding right next to a man talking loudly on his phone. More support with breastfeeding full stop, rather than just being handed a bunch of leaflets about how great it is and how many benefits it has (presumably so you can feel even more guilty and useless when you can't work out how to do it). Cleaner showers, toilets etc (which were also being used by the men on the postnatal ward even though they weren't supposed to).

I suppose I'm not saying this is a bad idea as such, but when resources are scarce it's not the area I would choose to prioritise first.

[medusawashere]

I read "birthing person" and felt so angry I actually cannot respond to the post itself.

Women give birth. Only females give birth. Say "women and birthing people" if you have to. That's inclusive enough.

Seriously, what needs to happen to force people to see how scary and misogynistic this movement is?

[FadedRed]

Up to the late 1990’s the majority of midwives were trained nurses first, three years SRN/RGN training followed by 12/18 months SCM/RM (Certified Midwife/Registered Midwife). There were very few direct-entry midwifery courses available inthe UK. Then the universities took over from the Schools of Nursing/Midwifery and the the three year degree courses in nursing or midwifery changed the employment landscape. This, I think but have never seen it said anywhere in similar discussions, is one of the reasons why the post natal care (especially of those post C section or complicated delivery and/or pre-existing health problems, has deteriorated. Some, not all, women who are pregnant or post-natal need nursing, but very few staff have sufficient nursing training or experience to care for them.

[notangelinajolie]

Unfortunately, I stopped reading after birthing person.

[Pretendbookworm]

I stopped reading after birthing person. What a world we live in that even when someone becomes a trans man, their rights, as a man, and their identity, can genderwash everyone else despite being a tiny part of the population?

If you as a trans man decide to have a baby and be pregnant, then you are not really being a man. You are inbetween, which is completely fine, but that very unusual circumstance should not then equal us all being erased.

[CondeNasty]

I agree with others about how inappropriate the language of birthing persons is. I feel that a big part of the issue with birth is how poorly womens health care is treated in general. Take the word woman away so we become birthing persons, gestators or uterus havers and the like and it conveniently helps to disguise the disgraceful way we are treated. It is deeply dehumanising and misogynistic. Use Women and Birthing Persons if you must.

From my birth I have come to the conclusion that maternal choice is a myth. They'll hide behind it but it is their way only and will frighten you into it if necessary. Post natal care is appalling and you are largely on your own. I would have been far better off at home and comfortable than in hospital. Combine that with the empowering warrior woman narrative and you have the perfect recipe for PND and generally feeling shit about the whole thing.

[Lifeover]

@Soola - I suspect the differences relate to several factors but most notably many of the women who experience birth trauma nowadays would actually have died in previous generations so would not have had the chance to speak out. Also, there was a lot more stigma attached to mental health issues in previous generations so people would not have been as willing to speak up.

I myself suffered PTSD from my horrendous birth experience and aftermath and have found the birth trauma association life saving (quite literally). I've come across many people though trying to minimise the trauma some women (and their partners) experience during birth. I think if you have had a middle of the road or easy birth you cant imagine the pain and terror that can be felt, for such a wide variety of reasons as we are constantly sold this "women have been doing this for millions of years" spiel that should actually read "women have been doing this for millions of years and have been dying and left with horrific life changing injuries doing so through out that time".

I agree about the terminology though - I can understand the reasons behind it, but I think the majority of women giving birth (and by definition it has to be someone of the female sex who is giving birth) is extremely demeaning, Once again the woman giving birth is reduced to no more than a vessal through which a baby is born, it depersonalises them. Someone giving birth has to accept they are a woman, they must surely even identify as one, even in part in order to give birth. It s a shame this point is detracting from such an important issue, but it is even more important that the mother is not depersonalised and reduced down to the "birthing person", in many ways this sums up the exact issue giving rise to so much trauma in relation to births

[SinkGirl]

@Blahblahblahnanana things will change if there’s a move from majority bays to majority private rooms. Unfortunately when every patient is in a private room, it’s more time consuming and difficult to monitor them all. The needs of the patients are being prioritised by doing this, but there will be patients who will be better off in a bay for at least part of their stay, and there will be patients who’ll be better off in private rooms (the majority).

For example, when my son goes into paeds, the majority are private rooms. But if he’s really ill and needs constant monitoring, he goes into HDU which is three bays in one room so staff can watch their monitors etc all the time.

In the new site, the vast majority of women will have a private room postnatally. The bays will only be used when clinically necessary or when there is nowhere else to put them, which hopefully shouldn’t be often. I think it’s a good balance. There’s been a lot of patient involvement in the design process, and I think it’s going to work well.

[ALongHardWinter]

'Birthing Person'? Really? WOMEN give birth. FFS Mumsnet,I expected better of you.

[Blahblahblahnanana]

@Blahblahblahnanana I work in the profession. From my perspective it’s more difficult to get round the bays than it is to go to private rooms. The bays are cramped noisy places, there’s the woman’s bed, baby’s cot and often the woman’s partner to navigate even before you can get to the woman. The woman could also be on an IV drip ect so even less space is available, they are awful cramped spaces even in the newly built hospitals. As well as being cramped the bays are also noisy and not the best place for women to rest or to try and establish breastfeeding which is one of the reasons why the woman may need to stay in hospital. Unlike other clinical wards there’s no clinical reason why women need to be in a bay P/N it’s generally the well women who are in bays as the environment is very different to other clinical wards.

[Blahblahblahnanana]

Haha! I’ve tagged myself 😂

The ^ is in response to @SinkGirl

[fairydustandpixies]

Oh for goodness sake!! Really?? A 'birthing person'?!

Whatever happened to being a 'woman in labour'??!!

Oh, silly me, I forgot! We can't say 'woman, female, girl, male, man, boy...' anymore. Probably can't say 'labour' either, that's no doubt offensive to someone.

Is it permitted to say we're human?? Or is that not allowed either?!

Those government forms are going to get longer and longer...!!

[fairydustandpixies]

Oh and as a 'birthing person', I had one in hospital (we don't talk about the first stage incompetencies!), very difficult 3hr 2nd stage, forceps, episiotomy, no pain relief), then one at home, no pain relief (traumatic which apparently would have been a CSec if monitored in hospital as he was back to back and face up), also took 3hrs 2nd stage and ambulance was about to be called but I 'birthed' before they came.

'Birthing person'....🙄🙄