Ockendon review - the end of the cult of "natural" births?

[Frenchie8690]

Shocking findings from the report out today. Hopefully this will mark a sea change in how women are cared for during pregnancy
www.theguardian.com/society/2022/mar/30/baby-deaths-inquiry-shrewsbury-nhs-trust-condemned-for-repeated-failures?CMP=Share_AndroidApp_Other

Sadly I think as long as there are people peddling the myth that you can prepare (and spend) your way to a glorious, easy, natural vaginal birth, that cult isn't going anywhere. My NCT group are currently all discussing perineal massage on the advice of their doulas and how painful it is, but how it's so worth it to prevent tearing. I imagine the majority will end up with tearing anyway.

Following with interest. I've gone through 50 pages of this report and had to stop as it's made me feel sick (I am struggling with MH following recurrent miscarriages and various complications in the third trimester when I was expecting DS). What this report identifies is dreadful, but not surprising.

Is there a bigger thread on this? Surely this deserves to be highlighted, @MNHQ?

@PurplePansy05

Following with interest. I've gone through 50 pages of this report and had to stop as it's made me feel sick (I am struggling with MH following recurrent miscarriages and various complications in the third trimester when I was expecting DS). What this report identifies is dreadful, but not surprising.

Is there a bigger thread on this? Surely this deserves to be highlighted, @MNHQ?

Agree. This report should be as seismic as Francis, Shipman, Winterbourne, etc.

@LittleGwyneth

Sadly I think as long as there are people peddling the myth that you can prepare (and spend) your way to a glorious, easy, natural vaginal birth, that cult isn't going anywhere. My NCT group are currently all discussing perineal massage on the advice of their doulas and how painful it is, but how it's so worth it to prevent tearing. I imagine the majority will end up with tearing anyway.

This makes me really sad. I never joined the NCT because I had ideological issues with it so I missed a lot of this stuff and wasn't aware how widespread it was. I had two c sections for mine so mainly dealt with consultants. I think I was lucky

I bloody hope so.

Having to grit my teeth and smile at people, including family (Ann and Maureen, I’m looking at you) being bitchy about me being “too posh to push” was horrible.

The reality was I underwent a double life saving major abdominal surgery but I was too tired, sore and overwhelmed to give them a bollocking at the time.

No one cared that we nearly died, lots of people thought it was “the easy way out”. I struggle to connect to them as mothers tbh.

I think this depends on area, but I've just had my ELCS approved without any push back from anyone. I have no medical need for one, and when I mentioned to my midwife at my booking appointment all she said was that I have every right to choose it but may have to fight for it as it isn't easy to get. Well, when I finally met with my consultant I barely got a chance to even tell her why I was requesting one before she agreed to it. That was the week after NICE updated their guidelines about dropping all c-section targets.

But I've certainly noticed some attitude from other mums about my decision. Some have said they wished they knew it was an option and they would've had one too, but the majority seem to view their vaginal births as more 'proper' births than caesareans.

Will be starting Bump & Baby Club in two weeks, will see what the response from the group there is. I've heard they can be more positive about all choices than NCT so I'm kind of glad that the NCT group I was initially signed up to got cancelled due to low bookings.

That is shocking and horrifying to read. How has it been been allowed to go on for 20 YEARS without anyone taking action earlier.

Sadly, nothing is more natural than dying in childbirth or burying your infants.

@MadameDragon

Sadly, nothing is more natural than dying in childbirth or burying your infants.

Isn't the whole point that modern obstetrics makes this much much more unlikely?

It seems women were not listened to (I’ve not read the full actual report just the media articles) There was one example given where a woman in pain was dismissed and called ‘lazy’ by a doctor

Women requesting elective c-sections (including those with ‘medical need’ as well) were refused then went on to have horrible complicated vaginal births with bad outcomes.

Not just an obsession with natural birth as there seemed to be an obsession with forceps as well- anything to keep the c-section rates low even if that meant other types of intervention and births that were actually riskier than a Cesarean.

I really hope this improves informed choice and consent for women and actually listening to their voices. Those poor families.

@MadameDragon

Sadly, nothing is more natural than dying in childbirth or burying your infants.

Dying from a lot of illnesses and injuries is also quite natural. But thankfully with modern science we've managed to eradicate most of that. Not sure why childbirth has to be the exception.

I haven't read the report. I don't need to. Nearly dying on the operating table after two days of me bleeding and saying something wasn't right and being ignored is enough.

I was saved by an anaesthetist. Who only came in to put me on a drip (as my veins kept collapsing and they'd stabbed me over 20 times with no success). He diagnosed me and dragged me to theatre. Fucking midwives and doctors just said patronisingly 'is this your first child...?'

Don't even get me started on the NCT. If I'd known then what I know now I'd never have got involved in it. My teacher made me feel ashamed and that I'd failed because I had a life saving section.

Bump and Baby pushed breast feeding but not vaginal birth. They went into details about all the things that can happen during an attempted vaginal birth including the various stages of emergency c section. It was very good. Someone asked about candles etc.... in the room and the lady leading it was very clear that the priority was being able to get help to the mother if something went wrong so the room couldn't be cluttered. Personally, I thought it was excellent.

I think that might have been MadamDragon’s point- I avoided nct and other guff as had severe morning sickness and just did not fit in with the bubbly excitement-now know school mums of similar age and think I avoided something really unhealthy- it’s cult-like ideals about motherhood taken to the worst possible outcome I think.

I went to the NCT classes and they weren't pushing natural birth at all. They taught us about all kinds of different painkilling methods, but when push came to shove I couldn't use any of them because I had been severely let down by the system.

But that’s my point, it’s absurd to hold up natural childbirth as any kind of ideal.
We should be demanding evidence based patient centred care, not idealising something that is fairly likely to kill us or our children.

@Peppaismyrolemodel severe morning sickness set me off on the path for rejecting the cult too. I was totally disregarded by the midwives and nurses so the trust was lost. I thought they were all mad. Looking back now, I'm sort of glad because at least I set myself up properly for the birth I wanted (c sections). We need a complete overhaul of maternity services in this country. I'd go as far as saying they're structurally misogynistic. I hope this report marks a sea change in our approach.

You know what also makes it more unlikely?

Knowing your caregivers. Being able to build trusting relationships throughout pregnancy and the postnatal period. The actual support you need being there so that the hormonal balance that facilitates ‘straightforward’ birth is facilitated (note: not pain free or spiritual or any of those things but a physiological birth, not necessarily unmedicated). Or, the relationship with a consultant so that requesting an elective CS isn’t a massive stressful battle.

All of that is what most midwives start out wanting to achieve. Lots get lost along the way and burnt out by the ‘system’. Iatrogenic harm is real. But that isn’t to say that all intervention is bad. Some of it is very very necessary. But the way to support women to have physiological births with minimal injury afterwards is not to put them on a conveyor belt through pregnancy, make them feel like an unknown number and then when they are in labour to throw them in a bright room with strangers and tell them to ‘perform’. And then wonder why intervention is needed.

That’s not a criticism of this particular Trust but more of how women are expected to respond to the way the system often works and then people wonder why it goes wrong. The studies show that in a mixed risk caseload with known one to one caregivers the rate of instrumental and caesarean birth decreases, stillbirth rate goes down, risk of tearing reduces, there are so many things that improve when you have known midwives and doctors. And for women who require intervention the outcomes are better too. It is just so hard to fund care that works like this while giving staff a proper work life balance but the people who lose out is women having babies. You can’t just demand those outcomes but not put the investment in at the top end.

I'm glad this review took place and it's shocking what has happened.

We should be demanding evidence based patient centred care, not idealising something that is fairly likely to kill us or our children.

Natural birth is not "fairly likely" to kill us or our children. I am 100% supportive of evidence based care and of women being able to choose the birth that's right for them, but that goes both ways. I'm glad that nobody forced me to have c sections (or told me that natural birth was fairly likely to kill me!)

Bump and Baby pushed breast feeding but not vaginal birth.

Personally I'm not convinced pushing breastfeeding is a great idea either actually. Lots of women struggle with it and several friends ended up with PND because they felt they'd "failed" at breastfeeding. I don't think we should be idealising either natural birth or breastfeeding, but recognising that everyone has very different circumstances and what works for one won't work for all.

Maternity care has so many issues- woeful lack of staff, some women being bullied into having unnecessary interventions, on the other hand some being denied life saving intervention; then what seems like just a minority who are given the tools and input to make informed choices about their care (not their fault).

Regarding breastfeeding- evidently the way its handled now isn't working as we have exceptionally low rates after the first days following birth. It seems many women want to breastfeed but waffling on about how great it is without adequate support in place doesn't work, and in the crossfire formula feeding mums are made to feel bad. Yet it's never addressed, just blame the formula companies for advertising (which they haven't been able to do for years). It all needs an overhaul.

@glowingcandle

I'm glad this review took place and it's shocking what has happened.

We should be demanding evidence based patient centred care, not idealising something that is fairly likely to kill us or our children.

Natural birth is not "fairly likely" to kill us or our children. I am 100% supportive of evidence based care and of women being able to choose the birth that's right for them, but that goes both ways. I'm glad that nobody forced me to have c sections (or told me that natural birth was fairly likely to kill me!)

Bump and Baby pushed breast feeding but not vaginal birth.

Personally I'm not convinced pushing breastfeeding is a great idea either actually. Lots of women struggle with it and several friends ended up with PND because they felt they'd "failed" at breastfeeding. I don't think we should be idealising either natural birth or breastfeeding, but recognising that everyone has very different circumstances and what works for one won't work for all.

100% agree. I completely disagree that natural is always best and support women and mothers choice in all aspects of birth and baby raising. However breastfeeding and vaginal births are the biological norm and in general are the assumed starting point for those discussions. Natural birth isn’t dangerous for the majority of women and babies but it does need carefully monitoring and collaboration between HCPs and women to be successful and positive. I am a failed breast feeder but I appreciate the support for Bf and why it’s encouraged wherever possible.

I went to NCT and "natural birth" wasn't especially pushed and we talked a lot about various interventions and risks. I've also had a friend recently have a elective C-section by choice with no issues and another supported when she wanted to go well past due date without induction. I don't really like the phrase "cult of natural birth", don't think it's a helpful way to see it. I think the issue is about women being listened to, trusted and their wishes respected, and I think we all need to that for each other and not judge or push low or high intervention births as the "best way".

Sod natural births, women and children died regularly in childbirth for hundreds of years leaving families without a mother so I cannot see how it's so fantastic.
I just wanted a birth where my son didn't die, I wasn't permanently injured and I didn't want to be in pain for hours on end. Not much to ask in the days of science surely?

I think the issue is about women being listened to, trusted and their wishes respected, and I think we all need to that for each other and not judge or push low or high intervention births as the "best way".

Absolutely this. I feel really strongly that ALL women should be able to choose a planned c-section for their birth for any reason and that it should be straightforward and easy with no hoops to jump through.

But I also think its important that other women are supported in wanting less interventions- eg. Home birth always being an available service, looking at how intervention rates can be safely reduced in low-risk women- as someone mentioned above continuity of carer, optimal birth environment etc etc

One of the clear issues in the report is women not being listened to and just being put through a system based on numbers and targets and what somebody else thought was best for them. The law says women should be the decision-makers about their care, medics are there to advise in a non-bias way. Autonomy and informed choice is fundamental to good outcomes.

Clearly more funding and way more midwives is needed for a better system.

Everything @Iwouldlikesomecake said. Look up the Albany Practice in south London and what the midwives there achieved with continuity of care, before being shut down. Better for patients, better for midwives, better for outcomes and I suspect cheaper.

Fwiw I was pushed into a section in my last pregnancy and continue to resent my treatment - but every person I met in the hospital was horrified at the idea of a vaginal birth with twins and steered me off. And the hospital I gave birth at is actually very quick to recommend sections. In the horrifying cases highlighted by this report clearly it was pushing “natural” births which was the issue, but in general I’d say it’s a fundamental structural issue with maternity care in this country and what makes a (genuinely) good birth. It ain’t whale music and candles.