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

@LampreyHoover

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 found this too - some people were sad for me. I was just relieved DS and I lived to be honest

We need a complete overhaul of maternity services in this country. I'd go as far as saying they're structurally misogynistic.

That is an accurate description of the NHS.

Don't get me started on NCT. Our teacher was trying to be balanced, and she did cover C Sections (one of us was having an ELCS). But her prejudices were seeping through the cracks despite her best efforts. A few choice examples: "And if a doctor as much as looks into your labour room, that will be enough to disrupt your hormones and for labour to stall!". Or, to me, after I relayed some advice from a consultant obstetrician about pelvic floors: "Consultants know nothing about women's bodies, only midwives do!". The advice from the consultant was subsequently corroborated by a specialist women's physio.

One of the girls in our class was so swayed by her - and by doing hypnobirthing classes with her separately - that she refused induction 24 hours after her waters broke. Thankfully she was lucky and her labour started soon thereafter. I know two other people (one a relative) who were not so lucky when they did the same - they and their babies ended up in hospital for ages with severe infections.

@TheWayTheLightFalls

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.

I had DS with the albany midwives. They were amazing and I was so sorry to learn they had closed.

Agree that all the ushing breast feeding and guilting mothers is a big issue - my milk dried up in 4 days with DD2 and it was a contributory factor in my PND

I’d add that I feel particularly horrified at the natural birth cult because of my family. My grandmother gave birth at home just after the war, in another country where there was no other choice. She was luckily assisted by a doctor as well as midwives. It was a complicated birth and my mother had to be pulled out (I think with forceps) leaving my grandmother with very severe birth injuries. Sex was always extremely painful for her, which didn’t help her relationship with my grandfather; she could never carry another baby, much as she wanted to, for medical reasons; and because of poor contraception provision there at that time had to have multiple abortions. She gave herself an incredibly hard time about that - she told me all this when I was in my twenties, because we were very close. I’m not sure if even my mother knows everything about it.

Her life would have been so different with modern medical assistance in a hospital. I honestly think she would have given her right arm for that chance. And to see people deliberately denying women this assistance, or indoctrinating them against taking them, is just heart breaking.

I deliberately chose a trust known to be happy with intervention and with high rates of c sections (partly because they treat many complicated pregnancies). I avoided the nearest trust that prides itself on low C section numbers. Just as well - I had a very difficult and complicated back to back labour. I dread to think what it would have been like without an epidural, and without the very vigilant medical team who spotted what was likely the beginning of a placental abruption.

I read on here several years ago a woman who wrote that it’s a woman’s duty to have a natural childbirth without pain medication. She likened it to men going to war. Apparently childbirth is our battlefield. I remember thinking how barbaric she sounded.

@EarlGreywithLemon

Don't get me started on NCT. Our teacher was trying to be balanced, and she did cover C Sections (one of us was having an ELCS). But her prejudices were seeping through the cracks despite her best efforts. A few choice examples: "And if a doctor as much as looks into your labour room, that will be enough to disrupt your hormones and for labour to stall!". Or, to me, after I relayed some advice from a consultant obstetrician about pelvic floors: "Consultants know nothing about women's bodies, only midwives do!". The advice from the consultant was subsequently corroborated by a specialist women's physio.

One of the girls in our class was so swayed by her - and by doing hypnobirthing classes with her separately - that she refused induction 24 hours after her waters broke. Thankfully she was lucky and her labour started soon thereafter. I know two other people (one a relative) who were not so lucky when they did the same - they and their babies ended up in hospital for ages with severe infections.

Sometimes when I am reading posts describing traumatic births, I am wondering how much of the trauma is self-inflicted due to absorbing the 'natural way is the only true way' ideology and treating any medical intervention as a personal failure. Women sometimes seem so unhappy about the need to use forceps, episiotomy or c-section because it prevents them from having 'full experience' of childbirth.

@Epli I agree. I know people who didn’t even have interventions, but maybe a more painful or longer labour, who think it’s their “fault”because they weren’t “as in control” as they should have been. So so sad to hear. And to hear said NCT teacher congratulating a girl who had a straightforward birth “because of hypnobirthing”. Damn, if only the four of us who had complications had done some of that! I’m sure that would have shifted my daughter from back to back in no time!

@SalsaLove read this and weep. It’s old, but still astonishing amp.theguardian.com/lifeandstyle/2009/jul/12/pregnancy-pain-natural-birth-yoga

I wasn't a fan of NCT when I did it 3 years ago. The leader (who was an NHS midwife) spent 2+ sessions discussing vaginal delivery and about 5 minutes on c sections. She had a few views that I thought were a bit dubious, she was keen to push the idea that no one needs to be induced, you can go over the dates and it'll probably be fine, emphasised everything that can go wrong with an induction. She was quite anti epidural too. It's not that she was completely wrong but the information she emphasised Vs what she minimised was a bit off imo. In the event only one of us had an unassisted delivery.

www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/

So apparently already in 2016 there have been talk about informing women of the risks of vaginal births, but I'm personally not too sure this is happening. Or maybe they are mentioned in passing as something not worth worrying about. I now know two women who had severe PND due to a traumatic birth and I truly think a major contributor for both of them was not considering the 'worst case' scenarios. They set out to have uncomplicated natural births and when that failed they felt they had failed as women. And for that I mainly blame the system for not managing their expectations properly.

When I did my research about elective c-sections I concluded that I'm much more comfortable with the risks involved in that than the risks involved in vaginal birth. Then I needed to meet with two consultants and both of them explain the risks to me, and the second one made it a point to emphasise the risks that were higher with c-section than vaginal birth, but funnily left out mentioning any of the risks that are higher with vaginal births. How many women aiming for a natural birth get the list of risks and complications explained to them thoroughly and made sure they understand all of it?

A lot of the accounts involved women who were requesting c-sections and being refused, or trying to tell the drs something wasn’t right or their pain was bad and being dismissed and disrespected. In a lot of the cases it was the attitude of ‘dr knows best, your voice is not valid, you will go along with our views and our system’ that caused the issues

@GinnyBee fascinating article here, that shows that most comparisons of the risks of vaginal births vs C sections are not even like for like:
www.theguardian.com/lifeandstyle/2022/feb/13/caesareans-or-vaginal-births-should-mothers-or-medics-have-the-final-say

From the article:
"Second, the risk of vaginal birth is often underestimated, so the comparison is skewed. This is because researchers do not always account for emergency caesareans as an outcome of attempted vaginal births. In fact, many older studies lump in the emergency C-section risk with the risk of all other caesareans, despite the fact that they are clearly more dangerous and almost always the result of a vaginal birth not going to plan. As Nice makes clear, ideally, studies would compare people planning a C-section with those planning a vaginal birth, but this information is rarely available."

My anecdotal case confirms what you say: I went in with eyes wide open, had a difficult birth, but I didn't find it traumatic. That said, I'm having an ELCS in June for baby 2. My trust is luckily very open about the long term consequences of a second forceps birth or third degree tear, if one were to happen - and having one already doubles your risk for the second birth. All women are offered a C Section option if they had a third degree tear the first time around, and the perineal midwife actually recommended it in my case.

I don't think it's helpful to make this about "natural birth" versus "c-sections".

I agree with the others saying the main issues are better funding, more midwives, continuity of care so that women feel supported and their wishes are respected.

Women should be able to choose a c-section, but also women shouldn't be pushed into interventions they don't want- or which aren't explained properly to them.

@EarlGreywithLemon Yes I struggled to find any good statistics about c-section risks that didn't lump them all together. Such data probably doesn't even exist. What I did find though was that the risk of complications during a vaginal birth for first time mothers without specific risk factors is 43.4%! Did anyone think it could be that high?

www.bmj.com/content/371/bmj.m3377

I don't think it's helpful to make this about "natural birth" versus "c-sections".

This was not my intention at all, I was trying to highlight the difference in attitudes about the two, which IMO is relevant to the discussion. If women are actively discouraged from choosing c-sections, or even refused when requesting one which was found to be a major issue in this report, it would logically follow that they are being steered towards having vaginal births.

I think it’s pretty disgraceful if women aren’t given clear information about c-section particularly if data lumps planned and emergency together! That needs to be addressed ASAP

The term 'natural' needs to be done away with IMO. There's fuck all natural about an induced labour.

The trust were obsessed with vaginal deliveries and would choose all levels of obstetrics intervention to avoid c-sections.

Those of you sneering and blaming women who wanted a low intervention delivery... I have no words.

What is important is that women get appropriate medical care in their pregnancies and in child birth. Vaginal delivery is the safest option for most women, less complications, quicker recovery, better outcomes for babies BUT we need to accurately identify those who require assistance either through an assisted delivery or a c section promptly.

I haven't read the full report just the newspaper summary but the upshot is they were not sufficiently providing the care and monitoring women need in pregnancy to identify those who would be safer having an elective c-section and in labour to ensure that it was progressing and interventions were not required.

This isn't about nct or natural birth, it's about failures in maternity care.

I hope so. The college of midwives, NCT and RCOG all had a “normal birth” campaign for years to get midwives to get women to push and to tell midwives to promote natural births all the way.
It’s shocking and it went on for decades.
Childbirth is risky, sometimes interventions are needed

@Theregoesmyhomebirth Absolutely so many of the stories seem to involve really brutal forceps deliveries where a c-section would have been appropriate, it seemed they wanted ‘vaginal birth at all costs’ rather than ‘natural’

And yes I am quite appalled some are somehow trying to turn it around on women’s expectations of birth- the report itself mentions the hospital wrongly blamed women for the outcomes! One of the main points is that women NEED to be listened to and their concerns taken seriously, it was the ‘the healthcare staff know best don’t question anything and we won’t listen to you anyway’ that caused a lot of the issues!

@gogohm

What is important is that women get appropriate medical care in their pregnancies and in child birth. Vaginal delivery is the safest option for most women, less complications, quicker recovery, better outcomes for babies BUT we need to accurately identify those who require assistance either through an assisted delivery or a c section promptly.

I haven't read the full report just the newspaper summary but the upshot is they were not sufficiently providing the care and monitoring women need in pregnancy to identify those who would be safer having an elective c-section and in labour to ensure that it was progressing and interventions were not required.

This isn't about nct or natural birth, it's about failures in maternity care.

Actually it is quite a lot about NCT and natural birth. RCOG has apologised in last few days for signing up to the NCT normal birth consensus statement, saying it may have contributed to women not getting interventions. RCM also signed up too and has since said sorry. These ideas were prevalent not only in Shropshire but elsewhere

It is interesting how long this has been going on. I had my first in 1971. The ante-natal classes were all breathe in and out and sing Jingle Bells and you won't feel a thing. The reality in hospital was pethidine and episiotomy.

@HilaryThorpe

It is interesting how long this has been going on. I had my first in 1971. The ante-natal classes were all breathe in and out and sing Jingle Bells and you won't feel a thing. The reality in hospital was pethidine and episiotomy.

Exactly my point. We know interventions (especially medications, epidural, limiting movement and instrumental delivery) all come with huge risks - and when this was pushed by a hospital people jump up and down to blame the birthing woman.