Maternity care

[lucyintheskywithdinos]

My first thread here, been lurking for ages though.

I have been thinking about the way the medical professions treat women, particularly in regard to pregnancy and birth. This was sparked by one woman's comment at the natural birth support group I help out at. Her exact words were that she felt 'as though I wasn't human, I was thinking for God's sake, will someone just explain what you're doing down there'. While she was thinking this 'they' had actually performed an episiostomy with her husband's consent and delivered her baby by forceps.

I have expereinced a similar thing myself, DD1 was rushed away for recussitation my DP went with her, noone thought to tell me what was going on. I thought she'd died.

It seems to be quite a common thing amongst women I've supported (I'm a BFC), is it common in general? As a newbie feminist is it a feminist issue? And what can be done about it within hospitals?

What a great birth story tortoise.

I think your DD's birth perfectly illustrates what is being said here. You had a difficult time of it but everything was done to keep the experience a positive one for you.

Seems to me that every women has the right to childbirth being as positive an experience as it possibly can be.

When I think back to the birth of my first child I came very close to the 'cascade of intervention' because hospital policy was to induce anyone whose waters had been broken for more than twelve hours FFS. Of course I didn't know any better with DD1 and accepted the induction. I do remember asking if I had a choice and was told that my baby was at risk for infection due to my broken waters. Hospital policy was of course routine epidural for an induction. I consider myself 'lucky' that my epidural didn't work and I was able to feel and push actively - I would have had a forceps delivery otherwise.

For DD2 exactly the same thing happened - my waters broke 5 weeks before my due date. This time I was better informed (having planned a home birth) and I just plain refused the induction after 12 hours thing.

However what was crap was that from the moment I refused something I was treated differently by the staff. I went on to have my baby basically on my own without pushing/pain relief or any intervention.

One thing that hit me afterwards was that due to not having any pain relief (didn't want or need it) I could feel everything - I could feel that my baby was coming by herself, I got NO urge to push and just sort of lay back and kind of breathed her out. If I had accepted the epidural they wanted me to have (which I guess was meant to replace the lack of midwife - she was looking after 4 other women at the same time) then I might have pushed. If I had pushed I reckon DD would have come even faster than she did and I probably would have torn myself.

Also I remember asking the midwife to stop telling me to push as I didn't need to - she just looked at me like I was deranged and carried on her cheer leading impression.

I wish I had refused the early induction with DD1 - I'm pretty sure that if we had been given more time she would have come in a very similar to DD2 (my mum and my sister have very similar births too - no pushing).

Yes, my hospital was the only one in the state that would have "allowed" me to go longer than 24 hours after waters broke before inducing, and most of the private ones have a 12 hour policy.

Home birth is being systematically de-legalised here in Australia, which makes me very angry and very sad, because that's what I wanted in the first place.

And my birth experience was just astounding, it was really fun, and really powerful, and really important - I mean, a total defining experience for me. I am angry that so many women aren't allowed to experience that.

Actually when I say breathed her out it was more mooed her out like a cow!

I think I made quite a lot of noise in a very primal kinda way - was bloody painful too of course.

I remember apologising to the midwife afterwards actually about the noise I made. Later on I wondered why I did that - I had a natural birth and took up about half an hour tops of the midwife's time over the course of 12 hours - I didn't cost the hospital much (especially as I refused all their interventions) so I reckon a bit of noise in the last 3 minutes was fair enough really!

Optimists:

"Ali you said "how do you know that most women don't birth as they want too?"
Well there may be some brilliant conclusive evidence out there but for me an important part of feminism is listening to women, really listening to their direct testimony"

UnePrune:

"I think the fact that most of us have to rely on anecdotes from friends and friends of friends, and/or websites like this, to see the bigger picture about poor treatment during birth tells us that there is not much data out there"

www.cqc.org.uk/_db/_documents/Maternity_services_survey_report.pdf

Above links to a survey of 45,000 women in February 2007 undertaken by the Care Quality Commission, the body that monitors the implementation and outcome of NHS Policy. There was a 59% response rate. Every statistical survey has flaws but 45,000 scientifically surveyed tends to beat anecdote. It is far from all rosy but among the results was:

"89% of women rated the overall care received
during labour and birth as ?excellent?, ?very
good? or ?good? and 82% said they were
always spoken to in a way they could
understand during this time"

There are numerous other results and charts, not all of them so positive (27% of women gave birth in stirrups, which surprised me).

However, on issues of both care and attitude, the majority (and nearly always well over 70%) of women were satisfied.

Clearly, it would be lovely to see every woman satisfied but the only (objective) test of whether maternity is underfunded relative to other areas is to compare this survey with similar ones on other areas of medicine.

There you go again, Larry, trying to define the parameters of the conversation and making sweeping statements about objectivity as if you're the only one in a position to decide.

We're not really talking about whether maternity is underfunded, except as a possible contributing factor to an endemic problem. We're fairly clear that the issues surrounding maternity care are multifactorial. My satisfaction with my birth experience had nothing to do with funding; in fact, it was a much more positive experience than it would have been had I gone with a swish private hospital. Almost everyone here is talking about elements of maternity care which have nothing to do with funding. The only person to have focused on funding in the last page or two of posts is your wife.

Tortoise,

"There I go again"? What? A man having an opinion? Where is the sweeping statement?

I challenged people saying there was no objective evidence out there, providing a link to...guess what....objective evidence.

"Objective" has a meaning in English and in Science. It is not for me, you or anyone else to "decide". The whole science of statistics aims (if it is done with good intentions) to produce objective evidence, under the English definition of the word.

Of course that may be a "mansplanation" and, as such, automatically not worthy of consideration.

larry you will not convince me that it is not important, here in the Feminist section, to discuss childbirth and to be concerned about the experiences which women are having.

Just think about it: many many women are not as well informed as some here on MN and may not realise that they had eg a cascade of intervention.

Also a lot of the women who have been severely traumatised by birth ans suffering from PTSD would have avoided that survey like it was the plague - for fear of bringing back disturbing feelings.

I can't see why you want to put the energy in here to trying to disprove what the prevailing mood is here on the thread. It must be that you are just enjoying the debating.

I am interested in solutions: what can be done about it.

The opposite position should be indifference - not attack!

Tabouleh,

You may have noticed that I left the thread for a day or two as I had nothing to add, despite some fairly vitriolic attacks on me. I read it and decided to actually try and find out some facts, rather than putting forward a view based on experience and anecdote.

I thought (and still think) that a number of people may find the link that I posted of interest.

As my wife said, surely a discussion should allow different views.

Why do you think I should be indifferent? I have a view, it is just different to yours. My actual view is that I would love to see maternity services improved, although I accept that there are budgetary constraints and that there is no excuse not to treat anyone with respect and dignity. However, I feel that this would be best achieved by everyone working together through research and better resource allocation, not seeing things through the lens of "feminism" and assuming it is the result of a patriarchal society.

I am sorry that I disagree with you and the cabal of people who run this section. And, having spoken my piece, I will disappear again.

vitriolic attacks on you?! lol.

And the quality of your care is influenced by your ethnicity, education and marital status (here).

Avril,

I cannot win here. If I am on the thread, people question why. If I leave it, you say it is a shame.

I have no medical background but a degree many years ago in a hard science (physics) so I am good at numbers and stats. I took (and am taking) an active interest in my wife's pregnancy(s) and birth(s) (one to come), in order to be helpful and for us to be able to make informed choices.

But why are you accusing me of willful ignorance when I have done my utmost to acquaint myself with facts. Individual anecdotes are never a good way to make sound decisions if you can find anything more objective. On the other hand, that does not mean individuals have not been treated horrendously and are not deserving of sympathy and support.

Larry only just over half the women responded to the survey - what about the others? I don't have time to look at the report right now but I will. I will be interested in caesarian section rate and intervention in general.

As I have said before I don't think this is a funding issue really. Medicalised births are by their very nature expensive. I refused all sorts of intervention at one of my hospital births - I didn't need money spent on me, I needed respect, support and the feeling that I was being listened to and cared about even if the midwife was busy and looking after other women too.

I have a friend who is a midwife - she chose to have an elective caesarian because she has seen so many women give birth and not be listened to ending in cascades of intervention, forceps and cut up fanjos. (This is in France, not the UK where things may be better)

And another thing - I think a lot of women accept their birth experience for what it is and just get on with getting over it. Lots of women do not know about the cascade of intervention for example - many will accept the second or three degree damage to their perineums because they think that there was no other way.

BTW by declaring that your report 'beats anecdote' are you suggesting that we (women in general) just shut up with our sharing of birth stories and experiences? That is certainly what it sounds like.

I have no problem with you commenting as a man on this issue. I do however have a problem with the tone of authority you are taking over an experience that you have never had. I tend to find that men get on better in feminist discussions when they are willing to listen a bit more and try to understand things from the female perspective - otherwise it does just look like they are acting dominantly - behaviour guaranteed to piss off a feminist.

It's interesting that in the report Larry linked to, the numbers are quite different for postnatal care compared to care during labour and birth:

^of those respondents who stayed in hospital
after the birth, 42% said they were not always given the information or explanations they needed and 37% felt they had not always been treated with kindness and understanding^

Possibly postnatal care is much worse. But I also think people's expectations of what constitutes "good care" during birth are different to what they would expect at other times.

My experience was the opposite from the op's. My GP was brilliant, calm, patiently explaining everything, making sure I understood the significance of the various test options.

The mid-wives on the other hand were completely hopeless. One told me I had gestational diabetes without doing a test - which I pointed out - and then it was negative. She told me I was breech and needed a section when I wasn't. And they told me nothing during birth which happened after 43 hours struggling (although to be fair I was pretty tired by then).

I wondered if it's that I've always worked with men, spend my whole time communicating with men and find some women generally quite hard work. So maybe it was as much my expectations as it was them.

Well, as I said earlier, being asked by a male ob asking why I didn't want to have a 'real birth experience' because I'd had a crash section with dd1 and wanted to avoid teh same for dd2 by having a planned one was probably just a tad patriarchal. As much as I am interested in the views of men they don't give birth, and this guy had no idea what he was talking about.

Beachcomber, all the women obs I know (well, three of them, friends of friends mostly) opted for sections because they'd seen enough to conclude it was the safest option, for the baby and for themselves. (really needed to be told that when pg with dd1 and had no chance of an elective.)

Larry, I'm still upset by your comments that I shouldn't be here because I don't have children. I don't know if you realised the effect that post would have on me but I think you were a horrible SOB for saying that.

Ok Larry try to listen for a second.

Birth as an experience for the woman is not scientific - it is natural and primal and female and basic and mystifying. It can be wonderful, empowering and exhilarating.

It can be orgasmic - does your report cover that?

Science and surveys and reports are weak ways to study the life experience of giving birth. Discussion and exchange amongst women in a free and safe space are always going to much truer and richer.

Beachcomber,

We can have a discussion about survey bias and how it is dealt with. Clearly, as someone mentioned, new mothers do not always find the time to respond to a survey. Personally I suspect (and I have nothing to back this up) that those really upset and annoyed by their birth would want to respond the most. However, some would contend the opposite. I am not sure we can draw any inference one way or the other from the response rate (any statisticians care to comment?).

France is very different. My brother lives in Paris and has a 3 year old. The "normal" birth involves an immediate epidural and they think us anglo saxons are rather mad for doing otherwise. I won't comment either way on that besides saying that all I know is that it is very different.

I am not suggesting anyone "shut up". Sharing of anecdotes and being supportive is important. However, it is when people draw sweeping general conclusions from anecdotal evidence that I take issue.

I hope I do not take a "tone" of authority. I do tend to state facts as facts and views as views. If my style offends, I apologise.

Oh and something else - healthy and useful discussion does not have to be adversarial.

A discussion does not need an opposing view in order for it to be rich and useful - particularly discussions about subjects which stir up lots of emotion and vulnerability.

This strikes me as a very limiting way to engage actually - especially on a gendered subject like childbirth experience.

MsRisotto,

Should not have been personal. I did not think before I wrote. I do apologise for becoming personal. It was a reaction to your condescending and preachy posts. However, not good enough. I should have just shut up and ignored them. It was unnecessary and I am really sorry that I caused you upset.

People have said and implied some pretty horrible personal things about me. However, I do see it as just an internet debate and never dwell on them. I would actually hate to cause personal upset and I have always been too quick to open my mouth and (sometimes) regretted it afterwards. On the upside, I am also quick to apologise when I have gone too far. Just think of me as an insensitive male "twat".