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?

I think there are lots of things at play.

1. the NHS is not set up to give 100% responsive care to women in normal labour

1. staff do not always support that anyway (though thank goodness many do)

1. women/couples do not necessarily know what that means, and in some cases actively refuse to learn what that means, and what might be a best and worst case scenario for a normal labour = they go in completely unarmed, sometimes knowingly unarmed. I find that sad.

1. we are used to a consumer society, being treated well as a customer, but hospitals are outwith that system so it is naive to imagine that your caregiver will have your best interests at heart

1. normal labour has become fetishised, something that's only for a certain type of woman: I've been called a spiritual hippy dippy weirdo fgs just for being quite interested in it. That sort of stereotyping has been so damaging. (I am the least hippy, least spiritual person I know.)

1. midwives these days are talking of never having seen a normal labour, eg one without an epidural, let alone a breech birth. They are becoming deskilled - willingly?

oh god I could go on for ages

Can I add

1. In sharing their experiences with women who haven't yet given birth, and educating one another, women tread a thin line between advocating for/ being positive about natural labour and not making people who don't want one feel bad.

Long-time lurker on this board, but first post here, I don't really have a point to argue, not sure what I'm trying to say, or if it's even relevant, but here goes.
Giving birth to my DC1 was dehumanizing. I felt like a cow on some sort of production line. It wasn't just that I didn't get the birth experience I wanted, because I understand it doesn't always go to plan, but I remember lying there on the bed in my own piss and blood, and not feeling any sort of empathy/sympathy/care from the MW (female) or consultant (male). I was hooked up to all sorts of monitors and a drip which meant I couldn't move around, or get up to go to the toilet, even. My poor son was dragged out, his head all mashed, leaving my pelvic floor tattered (it took 2 hours and 3 male doctors to sew me up). Afterwards my MIL was told by another MW that I shouldn't have been made to vaginally deliver such a big baby.
In my subsequent pregnancies, I have had to argue with healthcare professionals who have all assured me that my body is capable of delivering big babies again... yes, I got one big baby out, but it left me incontinent, unable to walk for 6 weeks and pretty traumatised, if you don't mind me using that term. I feel, and I'm sorry if this is crass, but I feel like they view me as just a vagina, to which they can damage as much as they like as long as they get the baby out "naturally" (ie through the vagina). But my birthing experience was an absolute mockery of natural childbirth, an surely anyone looking at my notes should feel some empathy and think, we can't make her go through that again, how can we help her have a better, safer labour?
But my fears and concerns are brushed aside. I'm not the one with the medical training, no, but I am the one who has to live with the injuries, and I feel I should have those concerns taken seriously.
I don't really know where I'm going with this, and I don't think I'm presenting a clear arguement because my bitterness about DC1's birth probably still clouds my judgement. I think what I'm trying to say is, in my experience at least, my body has been an afterthought in the birthing process.
No one has taken into account the state my body (or mind) is left in after birth, the physical consequences I have to live with. I know my body and it's capabilities - a consultant who has seen me for all of 5 minutes doesn't, I'm sorry but he doesn't. I'm not disputing the fact he has the medical degrees and experience, and I don't. But he has patted me on the head and assured me that because of my Irish ancestry I was "built for making big babies", and that doesn't reek of understanding, personally I wonder if he would feel so assured and calm if he were in my position, I'm not so sure.
I want to have babies, I love being a mother, but I dread childbirth because the attitudes of the professions I personally have encountered are so dehumanizing.
Even when I talk to other women, there is a general feeling that one accepts the loss of dignity during pregnancy/childbirth as par for the course. "You won't care who's down the business end when it comes down to it". But I do care! I want a bit of dignity, I don't understand why I don't have that right.
I don't want to be examined by a male (there's a history there I don't want to go into) but been told I cannot be guaranteed a female . I have asked to have my lower half covered during scans etc, and been told "all your dignity goes out the window when you're a mum", to which I replied "actually, mine doesn't, I want to be covered up, please."
Uhhhh... I've lost my train of thought, hang on...
I would like some sort of unspoken acknowledgement from my carers that I am not just a vagina for pushing babies through to suffer the consequences after, but a whole person who has anxieties and concerns about the limits they are pushing me towards. I want enjoyable, positive birth experiences that enhance my feelings of being a woman and a mother, instead of lying on a table with no control over who is doing what to my body without an explanation. Does this make any sense???

Ah yes, that is a total minefield.
The thing is, if you DO want unmedicalised birth, you stand a low chance of getting it, statistically (I'm assuming a normal, straightforward labour btw). I know far more people who went in and their labour was basically interfered with against their wishes. I'm not talking about people who needed intervention: that's a different matter.
I also know people who've chosen the medicalised route and been really happy, or regretted it. But really not that many people (esp first time) who got an un-mucked-about-with labour. (Myself included - I had an intervention that was not explained to me, was probably not necessary, and with hindsight was probably to hasten labour because the mw's shift was finishing.)

(Sorry, that reply to BaggedandTagged)

Wrt to cost of educating women about childbirth - I think that this would save the NHS money!

If women learn more about natural birth then they are more likely to have a natural birth and not have uncessary interventions (which require a doctor = £ and sometimes lead to a C-section ££££).

This is not to say that I do not realise that in some cases interventions are required to save mother and baby's lives.

I can recommend hypnobirting.

When people talk about "natural birth" it is so so emotive - mine could have been more natural but it was by today's standards for a hospital birth pretty natural.

What I learnt in the hypnobirting course is that a lot of pain in childbirth comes from fear inhibiting the womb's contractions - so think cave woman in labour - sees a sabre tooth tiger = adrenalin - labour stops so that she can run away until it is safe to continue.

I feel that the course I did and the breathing and hynosis helped to reduce adrenalin/stress and made it reasonably painfree up to 10cm - whereby panic set it as I was in a bath with DH and no midwife...

I don't want this to be dismissive of others in pain - your pain was real - it may have been caused by an underlying medical condition/presentation of the baby - but maybe it could have been lessened by some information on natural birth and a more natural environment.

I always think of where cats and dogs go to give birth - all cuddled up in dim lights etc - and then I wonder at the delivery suite environment...

(NB DH was not in the bath with me. - and we were in the delivery suite - just that they wouldn't listen to me when I said I thought things were moving along v rapidly.... (3cm - 10cm in 2 hours first time labour).

So my main message would be let a woman listen to her own body and then LISTEN TO THE WOMAN!

AhickeyfromKenickie - yes you do make sense. (((Un MNy hugs))).

Have you looked at the birth trauma website link and accessed any counselling?

I understand from what I have read that you DO have a right to a C-section for subsequent births.

What you are describing falls into something I see so often with women on various different issues:

Nasty experience.

Thinking about/discussing being angry about nasty experience = unaccepatable.

So then you have 2 problems instead of 1 - not only has XYZ happened but apparently I should be A-OK with that "silly me" .

If you have a chance to have a water birth then go for it. I have had 1 and it was a wonderful spiritual experience. Highly recommend it.

Good thread thanks lucy :)

I had DS in hospital. The birth went fine and the midwives I had were fantastic. They really were. When I lost my cool a bit and started yelling about an epidural, they persuaded me to try pethidine, as it would take time to get an anaesthetist in. They were really supportive and encouraging and DS arrived fine although did have to be resuscitated so I didn't get skin-to-skin.

However, I do know mums who have had horrendous experiences at the same hospital. I think one problem is that the professionals will use emotional blackmail to make a mum do what they want 'If you don't do x your baby will die/you're not doing the best thing for your child' (read 'you're a crap mum') I think women should have a choice. they should be given advice, complete with information about the risks of taking/not taking the advice and then be allowed to choose. I do think then that it is the mother's responsibility to choose well given all the facts. But I guess this is a bit idealistic?

I do think that with the wealth of information out there, it isn't hard for mums to arm themselves with facts. I did. I was terrified of being induced. I asked here on MN and got such good information. I read the NICE guidelines on induction. When DS went over 14 days overdue I refused induction. I do think the senior staff could have respected my decision more instead of trying to bully and blackmail me into changing my mind. The normal midwives were very supportive of my decision, it was the senior midwife and the consultants who kept going on at me about it.

I'm currently 23 weeks pg with DC2 and hoping for a homebirth this time. Unfortunately DP believes that fecking study saying that homebirths are not as safe as hospitals. Argh. We had a looooong discussion about it all last night.

Agree with the emotionally blackmailing. Of course I want my baby delivered safely, what a riiculous thing for them to say. But I woul also like them to try and minimalise the amount of damage they do to me during delivery.
Thanks tabouleh. I wouldn't say I needed any counselling, I get on quite well by talking things through with DP when I need to, who is very understanding because he's seen me struggling to heal afterwards. With DC2 I had the loveliest MW and consultant who listened to me, and my concerns, I ended up having a wonderful labour under their care, and it was very theraputic to have that experience. But a lot of that has been undone by the professionals I have seen in this pregnancy, if that makes sense. I feel like with their attitude, I am preparing to go into battle rather than give birth!

emotional, not emotionally - sorry

"there is a general feeling that one accepts the loss of dignity during pregnancy/childbirth as par for the course. "You won't care who's down the business end when it comes down to it". But I do care! I want a bit of dignity, I don't understand why I don't have that right."

Absobloodylutely! It's not just those in the medical profession who have this attitude, I see it here on mumsnet almost daily. There seems to be an attitude that having a baby at the end is such a wonderful reward that mothers should surrender their dignity and just accept everything.

Sorry to hear your birth experience has been so bad.

I demanded a cesarean with my first child because I didn't want to be treated as less than human. I was 19 and absolutely terrified (pregnancy was part of an abusive relationship).

I wanted to know what would happen and have a say. I originally wanted a homebirth, which wasn't possible for pyhsical reasons, so I said I was going to have a cesarean.

They made me jump through some disgusting hoops, but I got it.

I should add that part of my reasoning was that I was so scared - of the medical profession in general and of giving birth itself [I was in denial about the pregnancy for a long time] - that I felt I wouldn't progress well. Animals won't/can't give birth where they do not feel safe. This was utterly dismissed and later thrown back at me with "well if you fail to progress you'll have a section anyway". Nothing anyone said gave me any confidence that things would be other than I feared - me not secondary in importance after the baby but entirely irrelevant.

I cannot STAND the "well [baby] got here safely so that's all that matters" bollocks. It is NOT all that matters, of course how the birth goes - and how the woman giving birth is treated - is going to have a massive impact on her, and her relationships, including with her baby.

I remember from when I had my third child, arriving for my section and hearing a nurse on the phone - "oh, she's down for a homebirth but she'll have to come in, we don't have the staff". Seeing labouring women TOLD to lie on their backs with their legs apart. There was one 'active birth' suite in the hospital and two water birth pools and that was considered pretty amazing. But 20 women gave birth the day I did.

The words 'Failure to Progress" should just be BANNED.
It is not a "failure". Dilation is not linear and it can be a very emotionally-linked process. "Progress" is a massively loaded word.

What fucks me off no end is that there is very little about managing an uncomplicated birth well (and that does include with use of epidural and cs) that isn't now far better understood. There's good research into it and some places work using the research and have excellent outcomes (say, 2% C-section instead of the WHO's 'try to keep it under 15%' that seems to have gone out of the window) and report very high (horrible phrase) 'maternal satisfaction' - which translates directly into improved postnatal health and mental health.

The trouble is that it needs people, and a certain kind of person at that, to work long hours; and birth centres, which have already been proven to not be cost-effective.

Interesting thread.

Yes definitely birth / pregnancy / breastfeeding (all these issues) are of feminist interest.

However, I will go against the grain here & say that as much as unneeded medicalisation of labour/birth is a negative thing, there is also something to be said about the availability of effective pain relief for women during labour (for those who want it).

If you read birth: a history by Tina Cassidy (it's been mentioned in this thread before) you'll find that women always, in every century, tried hard to fight pain during labour. Yes, for some women birthing can be a wonderful, even painless experience, but not for the vast majority. There is something positive & feminist, having to do with choice, with the wide availability of epidurals. Let's not forget that, and let's not minimise the significance of pain during labour...

I agree in principal Maria but the problem is that women are often not well-informed about the potential side effects or interventions that pain relief can increase the risk of.

Also agree with Aldrin that the 'baby is healthy and thats all that matters' is crap. Just among my group of friends I know 2 women who have been treated for PTSD following traumatic births.

I have seen campaigns in the past for 'one woman one midwife' systems, which I think are a fantastic idea in theory, but would probably be prohibitively expensive for the NHS. What do you think would mmake for real improvement?

It can equally be shocking & very difficult or even traumatic to not have access to effective pain relief when needed! There are many politics played out in maternity wards; not least, a 'war' between midwives & anaesthetists. Often midwives don't know how to properly handle epidurals & don't let anaesthetists to monitor women, with disastrous results. In my case, for example, my epidural was left to 'wear out' a bit towards the end. It was awful! It was not done properly & I went from feeling nothing to feeling everything (pushing, pain etc) within seconds. This led to forceps and all the disastrous results of an emergency theatre delivery.

An anaesthetist friend of mine said this could have easily been prevented by letting an anaesthetist in to monitor the epidural! I think women have the right to be informed about all sorts of things, not just about natural labour. About proper use of anaesthetics, too.

Something that is screaming out to me from reading your posts everyone who has contributed, is that women simply aren't told and aren't asked about really important aspects of their care during childbirth! Sounds like the use of forceps without consent is practically GBH! I think, in every other medical situation I get information and they bloody ask me consent, why is birth any different? Shocking!

Taking the main intervention to do with pain relief (and I completely agree that pain relief should be of massive concern!), there are epidurals and there are epidurals.
So-called 'walking epidurals' allow for more movement - even if just being able to kneel instead of recline- which allows for better descent of the baby; however they need more monitoring by staff. Stick a woman on her back, immobile, and she is less trouble, less work, and labour will likely follow a more predictable path involving intervention.

(It's worth remembering that epidural use varies around the country too - iirc London is much better off for provision of the lower-dose, mobile epidurals. I wonder if figures on epidurals that are collected there are not necessarily giving the same picture as out in the provinces. Don't know, though.)

"What do you think would make for real improvement?"

I think a lot of it comes down to education and self-empowerment by women. Many aspects of labour have upsides and downsides and the more informed you are, the better able you are to advocate for yourself when, eg, you're being told that despite you being fine and the baby being fine, they are going to intervene to "speed things up".

I like to think of myself as generally well educated, but before I got pregnant and started to read up, I had no idea that lying down was not an optimal way to labour for many reasons (yeah- maybe if i'd thought about gravity for 5 mins I would have twigged, but there you go ). I imagine that many women get to hospital still not knowing that.

Whilst I still think it's important to appreciate the limits of self-education - I am never going to be an Obstetrician- I do think understanding as much as possible about the course of labour and childbirth and feeling confident to reject "convenience" intervention is a good thing.

Sorry, UnePrune, but 'sticking a woman on her back & leaving her immobile etc' (with very strong epidural) is really not what happens these days in labour wards, it's really rare. There are also women who actually want to be lying on a bed during labour (I was one of them, I was so bloody tired).

So called 'mobile' epidurals which simply are lower doses of the medicine or different medicines (not sure) are used routinely. The much more strong epidurals which make a zombie (almost) of the labouring woman are used in theatre.

Correct me someone if I'm wrong, I'm not a doctor :)

Maria- I think the epidural depends on the hospital and "mobile" epidurals often still don't allow that much mobility- it means you can walk to the loo and back supported, not that you can get into a few yoga poses, sit on a birthing ball etc. In many cases, they'll also give you a drip which obviously impacts ability to move freely.

Epidurals have been invented with good reason and if women want them, they should get them BUT I also feel that women who dont want them shouldn't be patronised like they are some weird masochistic freaks.

BaggedandTagged. All that you say is true. Still, I think there's a lot of being patronised going on in both directions, ie women who opt for epidurals are made to feel as if they're not 'relaxed' enough, not 'strong' enough, not 'natural' enough etc. I was told once I had a bad birth experience (involving a lot of pain, leading to an epidural) because I'm too 'scientific' (whatever that means) .