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.

@doodleschnoodle

pmc.ncbi.nlm.nih.gov/articles/PMC3620716/#:~:text=In%20comparison%20with%20vaginal%20birth,longer%20length%20of%20hospital%20stay.

Here's an article that isn't from a newspaper with states that go against your view.

I guess it's complicated when there's conflicting evidence though.

Here's the study if anyone is interested;

www.cmaj.ca/content/193/18/E634

She was out of line. The safest births statistically are natural births first with no interventions ( great if you can guarantee it which is vanishingly unlikely in mother who wanted a different delivery and has lost trust / has an antagonistic relationship with midwifery profession) then elective caesareans second above interventionist vaginal birth above emergency C- section . But these are generalities and so much depends on individual factors.

A first time mother is quite unlikely to have an absolutely no intervention birth in hospital. Then if you factor in maternal age and health etc you can estimate the likelihood of a straightforward vaginal birth more accurately. In my case I knew I would be having an epidural and no drugs that could affect my mental capacity. My baby was also inexplicably measuring small. Small babies don’t cope well with birth. I didn’t fight for an elective section. I ended up with an emergency section and a distressed baby who had cord round neck and aspirated meconium. Very rocky start for baby.

Someone disagreeing with you or providing alternative opinions is not necessarily judging you. It’s childish to think the midwife should just nod along with everything you want.

Well the problem is that unless we start recording maternal request sections separately (as in the Ottawa study), you'll never get an accurate picture because you're lumping in low risk maternal request sections with high risks pregnancies where outcomes are much more likely to be negative and there's a medical reason for the section. It stands to reason that babies who need to be born via section for health reasons are often more likely to then suffer health problems after, ditto with mothers.

The real question is whether maternal request c sections for low risk pregnancies (like OP is talking about) are more likely to result in adverse effects for mum and baby than vaginal births. And the limited data we have suggests that no, that's no the case, but it's difficult because of the way data is recorded elsewhere.

There is no difference in bonding between those breast fed and those not. The OP has decided to bottle feed and her decision should be respected.

I ended up with an emergency section and a distressed baby who had cord round neck and aspirated meconium.

Cord round the neck happens in approximately 1 in 4 babies and is not in itself a problem. Unfortunately it’s this sort of scaremongering that puts women off trying for a natural birth as they have visions of their baby being potentially strangled, which is actually very rare due to the way the placenta moves.

The medicalisation of giving birth over the decades has saved millions of mothers’ and babies’ lives which is fantastic. I do, however, think we are in danger of tipping the balance into over-medicalisation. Adam Kay has a lot to answer for.

Personally, I wouldn’t consider a section without medical need. I also struggle to understand why you wouldn’t want your baby to have at least a little bit of colostrum/breastmilk in the first few days. Having said that, it sounds like the midwife was very judgemental and needs to change tact if she wants you to reconsider.

I breastfed for nine months as I just assumed in blissful ignorance that I’d get it sorted in the end. But I can honestly say it hurt like hell for first couple of weeks and I only managed due to the excellent special care nurses since my baby and I were in for 12 days due to his rocky start. Friends who were in and out with vaginal births back then and even now found that there was no support whatsoever to help you with breastfeeding other than constant exhortations to do it.

I honestly wouldn’t worry yourself -fed is fed - do what works and tell anyone else to
mind their own business. I don’t believe it makes any significant difference long term and we don’t live in an ideal world.

I have two DC’s who were totally formula fed so I can see the results that they thrived and are happy and healthy. You aren’t a better mother by breast feeding.

Does she though? It sounds like the OP has made her decision and was pretty clear about it. A midwife's role in that scenario is to respect that choice, not a) argue and b) use hyperbolic language like "a million times harder". At most the midwife could have said "are you sure about your choice because there is evidence that X". That's not what happened here though.

It matters because it's this type of domineering, i-know-best approach that ultimately ends in not listening to women, and the maternity scandals all over the news these days.

@TheTreeLightsAreFuckingMeOffNow theres a lot of data and the issue is not everything is measured. So for example I suffer with prolapse and urinary incontinence following a vaginal delivery. When I spoke to the consultant - she told me that anecdotally, c sections carry less risk of making it worse. But they don’t measure quality of life for women and pissing like a mouse, only whether or not you shit yourself. And there’s clearly ALOT of grey between simply fecal incontinence and problematic symptoms.

I did a lot of research before my own section, including a chat with a good friend who is an obstetrician (and actually assisted with my section) which I don’t intend to repeat for the benefit of this thread. But the upshot was a planned section for a low risk woman (ie not a section owing to existing co-morbidities) has better outcomes - because the variables are easier controlled, than a vaginal birth.

I imagine that a factor in the midwife’s responses is that you sound as if you don’t trust your body to do it’s thing, and/or are sounding either disengaged or anxious about a vaginal birth and breastfeeding, and she was trying to figure out what was driving your preferences, and whether you were well-informed.

This kind of proves the point though and what the study I linked was trying to separate. There's no differentiation of electives for health reasons and maternal request sections.

So in your example, your baby required steroids and was born at 37 weeks, presumably as baby needed to come out then for health reasons. That's already a very different risk profile to my maternal request elective with number two, born at 39 weeks, didn't require steroids, had no health risks.

Those are two very different kinds of
planned section, but lumping them together means that the statistics may not be accurate for either.

I’m not a better mother.

im simply saying amazing is not the right word.

Statistically better isn’t the same as better! Sorry it makes me cross and I won’t get into a rant about frequentist vs Bayesian as it’s not helpful. You don’t know where you’ll be in the statics so advice can only be given in a general sense.

It’s fine to make your choices that are right for you. The problem is that with these things is that mums that make different choices have to come out swinging because everyone just piles on. Which just entrenches both side.

A first time mother is quite unlikely to have an absolutely no intervention birth in hospital.

That’s quite a statement to make. Have you got a source or statistics?

I’m not surprised she treated you a bit off on the c section point - it is a bit of a weird decision. I’d rather tear something that’s pretty much made to tear (and have done, twice) than have a huge great hole cut into my abdomen by choice. This is not the sort of decision that a midwife ought to be able to sign off, assuming you’re not a private patient in which case go ahead!

snap decision to bottle feed also seems ill informed at first glance for a first time parent - so clearly it’s her responsibility to educate you, but she can’t stop you bottle feeding.

Well, she's not wrong

Read Emily Oster if you have time. She is not pro / against anything - she just assesses the facts. Quite the eye opener.

https://www.thetimes.co.uk/article/blooming-the-truth-about-pregnancy-isnt-so-rosy-mz79qq8lx

About 90 per cent of women who give birth vaginally experience tearing with their first baby. A large UK study found that third-degree tears are experienced by 7 per cent, which amounts to tens of thousands of women each year. It’s almost too painful to write this, but third-degree tears are defined as “anal sphincter injury”, a rip through to the muscle of the anus — and unsurprisingly “there are not many evidence-based approaches to prevention”, Oster says. Medical professionals often abandon women with post-birth trauma with little follow-up, implying that they just need to be stoical.
“My guess is, that is the most silent piece of this,” Oster says. In the case of even more severe “fourth-degree” tears women should discuss caesarean section for a subsequent birth, she says, because “the trauma can be so significant”. But often women are not asked, and so keep quiet. “A lot of women may need a year of recovery and never feel like they get back to feeling the same, but unless we are able to surface this issue people are just suffering and don’t know how to get help,” she says. “A large share of even uncomplicated births leave women peeing on themselves. For a long time there’s been this resigned sense of: ‘Oh well, everyone does, it’s a regular thing.’ That’s a crazy thing to say when there is this entire array of treatments out there.”

It’s only weird in the UK.

I disagree, having done both. Obviously something like bonding is quite hard to measure in a research study, but to me it seems likely that breastfeeding feeding is better for bonding because there is a physiological relationship between mother and baby, which you don’t get with bottle feeding. There is obviously also the fact that the mother is doing all the feeds which is better for bonding.

I completely agree that no one should put pressure on anyone to breastfeed if they don’t want to, but I think we should be able to own the downsides of our choices as well as the upsides. You can acknowledge that breastfeeding is ‘better’ in some respects and still decide it’s not better for you in your specific circumstances.