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Talk about every stage of pregnancy, from early symptoms to preparing for birth.

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

143 replies

Frenchie8690 · 30/03/2022 10:47

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

OP posts:
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mathanxiety · 02/04/2022 20:14

@gogohm, yes, a lot of this was about sheer, gobsmacking incompetence.

DogsAndGin · 02/04/2022 20:20

If im lucky enough to get pregnant I will absolutely have an elective c sec. If people want to bully me for that decision, they can go right ahead and f themselves Grin

mathanxiety · 02/04/2022 20:21

@DGSR, acceptance of and adherence to ideas that have no basis in science (for example, 'the instant a male enters the labour room your labour will stall', 'perineal massage is effective and great', etc) is medical incompetence.

GreenOrangePear · 02/04/2022 20:57

@teezletangler

If you actually read the report - which i don't think a single journalist has actually done - a cult of "natural birth" was not one of the issues at this trust. There was certainly a culture of vaginal birth even where inappropriate, but not natural birth, which is something very different (birth without drugs).

The main issues seem to have been understaffing, bullying, poor management and toxic relationships between professions and between different areas of the maternity service, all of which contributed to poor outcomes.

The media seem to have run with "natural birth" because it makes a good headline.

I agree with you - the report doesn't sound to me like it promotes a cult of "natural childbirth" at all -.I dont think what most people mean when they talk about "natural childbirth" is getting the baby out vaginally at any cost with instruments and drugs (used inappropriately as described in report) to have low c-section rates.
GreenOrangePear · 02/04/2022 21:23

@mathanxiety my contractions stopped whenever anyone entered the room when I was in labour.
There is evidence that women feeling safe in labour makes a difference to progress.

EarlGreywithLemon · 02/04/2022 22:05

@GreenOrangePear so then surely it isn’t helpful to demonise obstetricians, so women are stressed when they see them in the labour room!

I for one don’t believe obstetricians are part of some conspiracy to foist interventions on me, or that they know nothing about women’s bodies (as per my NCT teacher). So when the (very very nice and competent) Registrar came in, I was perfectly relaxed and delighted that someone senior was keeping an eye. Poor man, he was so lovely, he’d have been horrified to know he was supposed to be the bogeyman!

GreenOrangePear · 02/04/2022 22:26

@EarlGreywithLemon I don't think it's helpful to demonise obstetricians - of course not. Definitely not what I was saying. I also met some very nice reasonable obstetricians although not during actual labour.

I know based on my experience of labour that I'd like the least number of people possible there in future because I think privacy made a difference to how labour progressed and how I felt...so I'd only want an obstetrician to come in during my future labour if there was a medical reason for their presence.

EarlGreywithLemon · 03/04/2022 05:43

@GreenOrangePear see, I didn’t feel that way at all. I liked having people around. So it’s not helpful (by the NCT or the like) to generalise.

GinnyBee · 03/04/2022 08:35

I suppose where the 'cult' comes in is how risks of vaginal deliveries are often minimised but risks of c-sections exaggerated. 'Cult of vaginal births' is probably more fitting than 'natural'.

Frenchie8690 · 04/04/2022 09:32

[quote EarlGreywithLemon]@GreenOrangePear see, I didn’t feel that way at all. I liked having people around. So it’s not helpful (by the NCT or the like) to generalise.[/quote]
Exactly. You couldn't put enough experts in the room for me! I totally understand some women love home births but totally not for me

OP posts:
inheritancetrack · 06/04/2022 19:05

[quote EarlGreywithLemon]@inheritancetrack I agree.

It’s anecdotal but I think the CTG saved my daughter and me. They spotted decelerations (fairly small ones) so took us to theatre. As I was being moved, the midwife spotted some blood. After DD was delivered I had a PPH. The registrar said she thought I’d been having a placental abruption. I discussed this at the debrief with the consultant, and it sounds like they were very vigilant and caught it early because of the decelerations. I’ll be forever grateful for that eagle eyed registrar and midwife, and for the CTG.[/quote]
A significant number of midwives and even doctors cannot read a CTG competently, yet they do not have to have annual updates and prove competency, and then spout this statistic that they don't improve outcomes. My placental abruption symptoms were ignored as there was no decent telephone triage and my baby was brain damaged. I don't see any recommendations to implement telephone triage. I used to use triage and know it is a powerful but simple tool. Constant abdominal pain is a red flag which was ignored. This report doesn't surprise me one little bit

mathanxiety · 07/04/2022 03:08

I have looked at the work of one prominent 'pain for a purpose' advocate, Judith Lothian, in connection to the need to minimise disturbance during labour, @GreenOrangePear.
www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/

It's in "The Journal of Perinatal Education (Advancing Normal Birth)"
The author is a nurse with a PhD.
She quotes research from 1987 and 1992, hardly cutting edge.
Newton N. The fetus ejection reflex revisited. Birth. 1987;14(2):106–108. [PubMed] [Google Scholar]
Newton N, Foshee D, Newton M. Experimental inhibition of labor through environmental disturbance. Obstetrics & Gynecology. 1966;27(3):371–377. [PubMed] [Google Scholar]
Odent M. The fetus ejection reflex. Birth. 1987;14(2):104–105. [PubMed] [Google Scholar]
Odent M. 1992. The nature of birth and breastfeeding. Westport, CT: Greenwood Publishing. [Google Scholar]

Here is an excerpt:
Women choose to give birth in hospitals because they believe it is “safer” than birth outside the hospital. In fact, laboring and giving birth in most hospitals create a set of physiologic responses that actually occur when we feel unsafe and unprotected. In the typical hospital environment, women are disturbed at every turn—with machines, intrusions, strangers, and a pervasive lack of privacy. The shadow of “things going terribly wrong at any moment” follows women from one contraction to another. Together, these fears contribute in powerful ways to the release of stress hormones, moving women into an attitude of physiologic fight or flight. On an intellectual level, a woman may believe that the hospital is a safe, protected environment, but her body reacts quite differently. No matter what her head says, her body gets the message loud and clear. Her body responds on a primal, intuitive level, kicking automatically into fight-or-flight mode and dramatically altering the process of labor and birth. In choosing modern medical “safety,” women are stressed physiologically, which makes labor and birth more difficult. The lack of attention to women's inherent need to not be disturbed in the typical hospital environment has set the stage for an almost 27% cesarean rate, the routine use of epidurals in labor, the high rates of augmentation of labor, and the high incidence of instrument deliveries in the United States...

...When the trappings of medical birth—monitors, intravenous needles, hospital beds, and epidurals—fade away, when women are quietly and patiently encouraged and supported in exquisite privacy by friends, family, and professionals who trust birth and trust each woman's inherent ability to give birth, when women stop being “disturbed” in labor, many more women will give birth normally and ecstatically.

This is garbage and the author's bias is very clear.

When monitors are not used or read properly the results can be horrific. When correct interventions are shunned because HCPs have allowed an ideology to guide their decisions, women and babies can and have experienced catastrophic outcomes.

Nobody is advocating women give birth in hospital rooms that are like Grand Central Station or that women be wheeled in and hooked up to machines and offered no explanation or support. But to pooh pooh monitors and pain relief and to shun intervention because it's not natural - no, just no.

My grandmother lost her mother and her baby sister in childbirth when she was two. It was a common occurrence back in 1901, when women gave birth at home attended by the district nurse and maybe a female attendant. Since then, we have developed the means of saving pregnant women's lives and babies' lives, and we have also recognised that women's and babies' lives are worth saving.

Meanwhile there are 'normal birth' advocates (what does that phrase even mean?) bleating about fairy tale scenarios where Good prevails and it all comes right in the end. Sadly, there are trusts which are still mired in the dark days of perinatal death of woman and babies, shrugging shoulders when things go wrong as a direct result of uncritical acceptance of the desirability of 'normal birth' above all else.

www.sciencedirect.com/science/article/pii/S1871519221001165
Here is a much better article on humanisation of birth.

It is worth noting that wards are not a thing in the vast majority of US hospitals, either antenatally or postnatally. Nobody has to put up with other women's loud, drunk, smelly, or otherwise offensive partners two feet away while in labour or trying to recover after delivery, establish breastfeeding, get up to use the loo, etc.

For the most part, women labour in a private room and recover in a private room, at most a double room. There are private showers and loos ensuite. Also, women who receive pre natal care will have their doctor or midwife attend the birth. The woman and the HCPs of any given practice get to know each other, and records are easily available when delivery is imminent.

How much would it cost to provide private rooms for all in maternity hospitals/wings?

EarlGreywithLemon · 07/04/2022 10:26

@mathanxiety thank you for posting; that makes such disturbing reading.

For those who say that the problem in hospitals is women's judgement and wishes being overlooked - this is what this woman is doing. She's telling women that, even if it's their considered choice to have their baby in a hospital, this isn't really what they want - they just don't know any better. And she's ignoring the latest research on epidurals to scare women who want one into turning it down.

Both my daughter and I might not be here if I'd had a 2.3l PPH at home. My grandmother, although attended by a doctor as well as a midwife, had horriffic birth injuries after having my mother at home - it literally affected her on every level for the rest of her life. I know someone who has double incontinence after having her baby at home. An EMCS can prevent that, but if it's an emergency and the baby has to be wrenched out, there's no time for a hospital transfer.

This makes me so so angry. Before modern medicine, women used to sew their winding sheets before giving birth, because mortality was so high. Is this what we want to come back to?

EarlGreywithLemon · 07/04/2022 11:01

Sorry for the double post, and it's only anecdotal, but: my labour picked up pace dramatically once I was on the labour ward, on an epidural, with monitoring. I relaxed, and went from less than 1cm to 10 in 4 hours. I had previously been at less than 1cm for 18 hours+. To tell me that I was actually stressed and had no idea is insane and offensive.

Also, maybe if hospitals and doctors weren't being demonised by this brigade, fewer women would feel stressed in them.

EarlGreywithLemon · 07/04/2022 11:02

@inheritancetrack I am so sorry for what happened to you - there is truly no excuse Flowers

GreenOrangePear · 07/04/2022 19:59

@mathanxiety

Thanks for the interesting articles.

I suppose the thing is that everyone feels differently - so what the quote from Judith Lothian describes is what I felt instinctively during labour (as in I had a strong desire to hide away completely alone away from the monitors and stay in the bathroom with the lights off...). I don't agree with everything she says but I don't believe idea of being disturbed during labour can change things is complete "garbage" either ... although I didn't stay in the bathroom.
Also I don't expect everyone to feel like me - different things feel safe to different women.

I think we agree the system ought to be centred around listening to women and what they want - and medical professionals explaining the risks/benefits of different choices based on each women's medical history. Interventions are necessary and life saving in some cases and since 1901 things have improved (although if you read up on the nineteenth century and up until the 1930s there's evidence of some doctors causing more harm than good).
Pain relief should be available to those that want it or need it.

I had an induction and I am convinced that part of the reason it went (relatively) smoothly is that I had a private room - my early contractions stopped dead every time anyone came in.
I think its shocking that some women are expected to labour on a shared ward with strangers around.

If hospitals were built with woman's needs in mind then I think they would have far more private rooms. I'm sure it would be expensive but I wouldn't be surprised if the cost/benefit might work out in the end. They obviously need to be properly staffed by professionals with a culture of supporting mothers and babies as well - very far from what's in the report.

mathanxiety · 09/04/2022 07:12

Also, maybe if hospitals and doctors weren't being demonised by this brigade, fewer women would feel stressed in them

Agree, @EarlGreywithLemon

PaddlingLikeADuck · 10/04/2022 08:14

I started my foundation degree with the NCT last year to become a breastfeeding counsellor and post natal worked. Morally I didn’t want anything to do with the antenatal classes.

As part of my training we had to do a module about birth and the lectures were very uncomfortable to listen to it. “Natural birth” was the end goal and the general message was if you have a wonderful birthing plan and refuse intervention then you’re going to have the most perfect birth. This agenda was pushed in the lectures and also in the antenatal classes that I observed.

C-sections weren’t even covered in the birth lectures and instead we were told to go into groups and talk about it, but the lecturer didn’t actually talk about it herself. It was made to feel like such a taboo and not even worthy of being discussed or taught about.

I’ve had two sections in the past and the lectures made me feel so ashamed that I ended up leaving the classroom in tears. It was awful.

I really disagree with the ethos of the NCT and I left after my first year and didn’t go back. People describe it as a cult and it really did feel like one.

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