Awful birth ‘options’ meeting

[Padronpeppersplease]

I’ve just had my 28 week birth options meeting with a midwife and wondering if anyone else has had a similarly pushy experience. She asked me about whether I intended to breast or bottle feed and also what I’m planning for the birth. I said I was 99% sure I wanted to exclusively bottle feed and then also that I was considering an elective c section. I’d heard previously that the NHS try and push both breastfeeding & natural births but I was not prepared for how pushy this midwife was! She said to me that bottle feeding was ‘way worse for baby’ and that ‘a c section was a million times harder on my body’ than a natural birth would be. According to her as my body is built for birth I don’t need to worry about the pain of natural labour and tears during labour aren’t anywhere near as bad as the potential complications of a c section, she also said that opting for a c section would limit the number of children I could have. Despite all this I’m still leaning towards a c section, I’m under no impression that it’s easy recovery & without risks but I honestly feel now like I’m doing something totally outlandish by opting for it.

I’m really sorry to hear that. You are right childbirth is unpredictable and dangerous. But a c section adds on the recovery of major abdominal surgery to that mix.

A vaginal birth has risks of organising damage too. A caesarean section generally has higher risk, however the absolute risks for both are very low.
For example risk of birth resulting in hysterectomy:
CS 150 IN 100000
VD 80 IN 100000

This is why adequate birth counseling matters.

Worth pointing out that emergency section, with the accompanying negatives, is one of the risks of attempting VB.

With the size of my bazoomers I couldn't even see my baby when breastfeeding 😂

And my mental health was made better by formula feeding. Preparing and washing and even feeding the bottles doesn’t always have to be done by me, my DH does it just as often. It’s easy.

Everyone is different.

I think it’s great you had such a positive experience form c sections. But this isn’t the case for everyone. Honestly I have had exactly the opposite as you - all fiends who have gone natural had great experiences and with c sections it was traumatic, difficult recovery, longer time in hospital, infections, blood transfusions, complications from surgery etc. In fact my bestie almost died from a planned c so your account while great for you isn’t accurate across the board.

Yoir post is a really good example of everyone is very different and each birth is very different. Neither are without their serious complications ans potential issues.

Sorry, but I really don’t feel like I can romanticise either of my c sections - emergency and planned (not by choice but needed because of medical issues). And I know my bestie still struggles with the difficulty of it all. I suffer from real and life threatening issues from my c section. So let’s be real about all experiences.

And I could write an essay on the stupidity of pushing breastfeeding - especially on a mother of a baby who was resolutely refusing to do it - after three years of infertility and two failed ivf attempts. If I’d had a bf crusader for my community midwife instead of an experienced sensible me my mental health would have been destroyed.

Step 1 in how to damage a new mother’s wellbeing: guilt trip her into trying g to breastfeed.

OP, my DS1 refused to bf, and was a healthy 7 year old when I was pregnant with DS2. I wrote ‘ the baby will decide’ in response to the feeding question. A mw I hadn’t seen before snorted ‘ what is that supposed to mean?’ I said, ‘exactly what it says - because not one single mw in Liverpool Womens could get a full term healthy baby to latch and feed last time’. She said no more after that.

I got into a routine quite early on and DH used to do the late feed so I could go to bed early. I got lots more sleep than my bf friends. I enjoyed my mat leaves both times. I have absolutely no regrets at bottle feeding. They are now 24 and 16 - both of them walking adverts for Cow& Gate.

@Padronpeppersplease I'm sorry you were left feeling so pushed - that's not right.

The person who knows best how to weigh up the risks and benefits for your own circumstances is... you.

You know the factors relevant to whether breastfeeding is feasible for you (eg some women can do it after surgery and in some people's cases it isn't possible) and you know how that might affect your mental wellbeing. Formula feeding is a medically safe alternative to breastfeeding, and as an adult who's informed about the pros and cons of all the options, you're capable of making your own decision.

Both vaginal delivery and elective c-section have pros and cons. My elective section was really straightforward and I was up and about pain-free within a few hours (once the feeling came back to my legs) with a quick recovery. Conversely, I know people who've had horrible recovery periods. I had a very traumatic vaginal delivery before that (pre-viability labour, pain was the worst I'd ever experienced), so I was absolutely not doing that again! Meanwhile one of my friends has had medication-free home births with no complications. You are the person best placed to weigh up those pros and cons for your own situation and make your own informed choice.

Don't feel pressured into making choices that aren't right for you because of other people's views. Get all the information you need and make the best possible choice you can.

You can ask for another appointment with someone else or to meet with a consultant to discuss your options more.

Great post.

You got the midwife hard sell. If you had seen a female obstetrician it would probably been a different tone. There is research that more female obstetricians opt for elective c section.

I had an elective c section and it was the best thing I could have done for me personally. I was pretty much back to normal after a week, signed off to drive after two. If it’s what you want, and you know the risks of both options, then it’s your choice and don’t let anyone talk you out of it. I had a meeting where they tried to understand my reasons for choosing one, but they weren’t pushing me one way or another.

I had an elective c-section having read the available research and disaggregating, as far as possible, entirely elective c- section data from emergency or medical reason data. There is a lot of misinformation about the comparative risks of natural birth vs entirely elective, planned c-section.

In any event, the best course of action is the one that is felt to be right by the mother. A distressed, frightened, unhappy mother who feels her voice is being trampled (either way) is the worst context for a baby.

When requesting my c-section I immediately asked for an appointment with the consultant and to have it formally signed off on my notes so there was no back-pedal afterwards. The consultant told me that my request was unusual but completely logical, as the preferred 'hierarchy' of 'good births' goes:

1. Uncomplicated natural birth;
2. Elective c-section;
3. Complicated/assisted natural birth

and you never know whether you'll get 1 or 3! Therefore plumping for the certainty of 2. is a completely reasonable choice.

It's also no more expensive for the NHS once the cost of treating consequential complications from a natural birth is factored in so don't be quilted there, either.

I did choose to breastfeed (and produced absolutely tonnes of milk after the c- section), but again, happy mother is an incredibly important goal, and an important benefit to the baby in itself!

Good luck, OP, whatever you decide.

nor did I appreciate being asked when I said I thought it seemed much more intensive what else I would be doing with my time

What was her tone? I think it's not unreasonable to encourage new mothers to spend as much time as they can with their babies. Maybe she was asking about your home set up. Is this your first child? With support a mother should be able to prioritise breastfeeding.
If you frame it as breastfeeding being the conventional way to feed a baby and that breastmilk is normal and formula is a substitute it makes you look at the first few months of a baby's life differently.

It sounds like she wanted to ensure you have made fully informed decisions.

You are not being selfish, OP. The midwife's attitude sounds very unprofessional and I disagree with posters who say she is right on both fronts. Some people take a long time to recover from a vaginal birth and some take a long time to recover from a c-section. Everyone's experience of pregnancy, labour and recovery is very individual. I say this a lot on these types of posts, but you also need to consider what type of birth your mother and grandmother had, as it can be an indicator of things to be aware of for your own situation. e.g. big babies run in my family (no one has ever had a baby under 10lb), so I knew it was highly likely that I would have a big baby, and I did. I also knew both my mother and grandmother had severe hemorrhages during birth, which nearly killed them both, so there was a higher possibility than average I would experience this. Both of these things influenced my decision to have a hospital rather than home birth. (It ended up being an emergency, but that's neither here nor there.)

I had a c-section and was home within a couple of days, caring for the baby, taking out the garbage, doing normal things straight away. I won't say it was easy - for the first week, my body felt like it had been hit by a truck - but it didn't keep me in bed in agony or unable to function. My scar is neat, healed well, I had no infections and baby and I recovered well at home.

I exclusively bottle-fed, by choice. Baby and I had and still do have a wonderful bond, he grew healthily and met all his milestones etc.

Some workers in the NHS can be bloody agressive when trying to force their personal point of view on others, instead of simply explaining your options and possible outcomes so that you can make an informed choice. At the end of the day, do what is best for you. Oh, and if possible, ensure you have a strong advoate with you for the birth.

erm, excuse me, the 'Mother' is still a living breathing human being existing separately to 'Baby'. and a baby without a healthy happy mother isn't going to do very well either, so you can take your sanctimonious idiocy with you on the way to the door.

Aren't women only assigned an obstetrician if they have additional care needs?
And is it not the case that obstetricians see a skewed view of labour and childbirth (because of caring for higher risk mothers) which impacts their decision making?

Same, tbh.

Obviously, it's a shame you felt it was handled badly OP, but the midwife wasn't wrong to at least gently push towards the more natural options.

DON'T let someone else push you into something you don't want, you are just a number to them and they are encouraged to keep costs down. You are a human being and only you live in your body, only you who will have to deal with the reality of it all.

Everyone I know who has had vaginal births has ongoing issues all the way through their lives. I have no ill effects from my sections at all, they are the best choices I've ever made. You do what is best for you. Sections and bottle feeding kept me sane.

I mean all that is true about c-section, its literally their job to educate and inform people of that risk.

'If you ask your midwife or doctor for a caesarean when there are not medical reasons, they'll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.' - NHS website

People state that its your body and choice but there is pretty much no other time in life you would be allowed to easily and willfully just opt for medically unnecessary surgery on the NHS. The NHS actually does not have to provide anyone with any unnecessary treatments (they actually just removed a whole bunch of surgical options from then NHS).

Lower risk options should always be discussed and offered first such as ongoing support or treatment for anxiety and any OBGYN is legally allowed to refuse unnecessary treatment although they should offer to transfer you to another.

They are just upholding their duty of care.

Bottle vs. Breast... they where really bullying with this when I had my oldest (it use to be some awful tick box thing) even though I physically couldn't and it was awful but completely fine with my younger two so I hoped they moved on from the draconian attitudes (although it was a different hospital).

Bottle feeding is completely valid option and they have no say and it effects nothing really.

OP I find it deeply concerning that experiences like this are still happening in the NHS. Your meeting doesn't sound anything like informed consent.

I 100% endorse what @Phineyj said about the need for a standardised leaflet. This can't be left up to individual midwives, as the quality of their knowledge is evidently highly variable, and we know from various reports that some still subscribe to cruel, unevidenced and dangerous ideas about "normal birth".

I'd wager that that many of the people on this thread who are blithely declaring vaginal birth to be better as matter of "scientific fact", or that this woman was "just doing her job", are involved in maternity care. It's terrifying to be honest. Thanks to those of you who've attempted to share actual, decent quality evidence on the subject.

I myself have experienced a failure of informed consent during a pregnancy, when the risks associated with a course of action were concealed from me because the medic obviously felt that one particular option was correct. I've endured the consequences for many years.

In my line of work (research) the outcomes are far less life-changing, but we have to secure informed consent and take it extremely seriously, on ethical grounds. If I mislead a subject - knowingly or otherwise - there would be significant consequences for me, and rightly so. In medicine there seems to be a different convention and I'm not sure why we're all putting up with that. Maybe it's time to stop writing reports and start issuing sanctions.

Neither were my choice but after a five day failed induction where I was physically and mentally broken, the c section I ended up with (and it's subsequent recovery) were a walk in the park.

I wasn't able to breastfeed (section/PCOS) although I was desperate to. After a week of constant latch yet producing nothing and a semi starving newborn, we threw in the towel. All my friends breastfed exclusively. My child is the healthiest out of the group. I don't understand the demonisation of formula, I was under so much pressure (before and after birth) to breastfeed that it definitely had a negative impact.

Obviously this is my personal experience and totally anecdotal and I cannot speak for all.

As a GP, every week I see at least 2 babies who are struggling with formula - reflux, lactose intolerance, constipation, diarrhoea, vomiting, colic etc. We have to try a succession of expensive complicated formulas , different bottles and so on. And it can take weeks to find a formula that suits. It blows my mind that people without medical contraindications don’t even try to breast feed, given that breast milk is the perfect food for the baby, and it’s free.
OP your midwife would be negligent not to promote breast feeding. It doesn’t work for everyone but I can’t imagine not at least trying it.

Everyone I know who has had vaginal births has ongoing issues all the way through their lives.

But do you accept that not all women who have vaginal births have ongoing issues? I certainly don't.

Nah, it's not. Clearly CS isn't a million times harder on the body than natural birth. The midwife had a professional duty, set out in Montgomery v Lanarkshire, and this doesn't fulfil it. It's failing to uphold the duty of care.

The idea that a woman doesn't need to worry about pain relief is a total assumption. It would be one thing if the midwife had, say, advised that OP consider and research unmedicated options. Think more about pros and cons. But simply not to worry about it, this is poor advice.

How the NHS choose to deal with other matters is irrelevant. There are professional obligations which have not been met.

Hi OP,

I had a similar experience with a midwife when I requested an elective C Section. She didn’t even ask me or explore the reasons why, just started to tell me how i need to ‘at least’ try in such a patronising way.

I had been feeling quite stifled during my pregnancy and struggling to advocate for myself, despite being a Dr and working in that hospital (which the midwife hadn’t realised). I was acting the complete opposite to how I normally do. Anyway, her comments made me so angry, as I know it is my right to choose and I had very good reasons for requesting it. I got so angry that it helped me to get my butt into gear and advocate for myself. Honestly as soon as she realised that I had a valid opinion she immediately booked me to see a consultant and not one person even questioned my decision after that, in fact most told me that it was a wise decision and it shouldn’t affect any pregnancies in the future. They didn’t bat an eyelid.

I often wonder what would have happened if I hadn’t asserted any power / knowledge in that moment. People have a right to hear the pros and cons and then make their own informed decision, not to be made to feel like they are silly for requesting something else.