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?

Massive feminist issue. LIke the breastfeeding threads, I find these threads painful to read.

I had two homebirths.

Can I draw your attention to something that angered me recently

1. Amnesty International Criticized the shocking maternal death rate in the US, citing the fact that a major problem was that women were allowed no say in their care

www.alterpolitics.com/tag/states-rank-on-maternal-mortality-rates/

And they have the second worst newborn mortality rate in the world:

edition.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/

After the AMnesty report, rather than the US trying to alter their system, the WHO issued a report saying that the US C-section rate was suddenly OKay, and there wasn't a problem in the US after all (it was on the MN headlines)

A few days later, there was some US research witch-hunting midwives:

news.bbc.co.uk/2/hi/health/10465473.stm

I get very angry that midwives are witch-hunted all the time, whereas the medical establishment gets let off scott free.

ternal-mortality-rates/ Amnesty Report

/mothers.index/ newborn mortality rate

midwife witchhunt

Yes it's not about natural birth/epi/c-section. It's about basic respect and listening to the woman's wishes. I had a homebirth because I simply did not want to be in the situation of so many women on this thread. If I was guaranteed the control of my homebirth environment in hospital I would have gone there. BUt they are very episiotomy-happy in hospital.

The lack of funding for midwives and investment in the "birthing system" (for want of a better phrase) is certainly a feminist issue.

But I do believe that many of the issues described in this thread relate to the traditional ways in which Drs (both male and female) operate and a system that encourages a lack of communication from practitioners and a lack of questioning from the recipients.

Anectdotaly the worst treatment I received during any of my three labours was from a female consultant with a god complex who was too busy performing for her students to bother to explain that she was about to break my waters.

God, I just looked up episiotomy - thud.

Yes I had a bad experience with a female doctor. But I live in a country where I'm able to chop and change my doctors. I found a lovely gentle man who had a great respect for midwives and was happy to play second fiddle. He wasn't present at the births of my children, but was "on-call" in case there was a problem

Just skimmed the thread. I was thinking this sort of thing yesterday with regards to medical treatment during pregnancy.

I have had insomnia almost the whole way through my pregnancy. Am up between 3 and 6 most nights and am at breaking point.

I went to Neal's Yard who refused to sell me anything because they couldn't guarantee it was safe (but if I paid £20 to see their medical herbalist she might be able to help ), the pharmacy in Boots who refused to sell me anything, even Nytol, at which point I sobbed on the assistant for 10 minutes.

Eventually I went to the doctor yesterday. He gave me some sleeping tablets after consulting the on call obgyn registrar at the hospital. I had also asked him about Nytol and he said he couldn't say whether they were safe or not.

Now I know there are ethical issues wrt testing on pg woman, but it does seem to me that there is a complete blanket cop out over treatment of ailments during pregnancy (mainly ones caused by pregnancy). It seems rather than saying 'we don't know if these things are safe' someone should start saying 'well how can we find out if they are'. In my darkest moments I did think 'If a man had to go through this I bet they'd damn well try and find a way to make these things safe', though that might be a little unfair.

It just seems to me that illnesses during pregnancy are dismissed and we have to put up with it for the greater good, same with drugs during breastfeeding. Never mind the quality of life for the mother.

An example from a webchat with Dr Hilary Jones (lord I despise this man):

'sonia: My doctor prescribed me a low dosage Codeine for a bad back when I was 3 months pregnant. I have since taken it for other pains, as he said it was ok for my baby. I am now due in 2 weeks and my pharmacist said it was strange my doctor let me take it. Will my baby be addicted?

Dr Hilary: Codeine is a mild opiate based medication, but provided you only take it occasionally and in a low dose the risk to your baby is minimal.

Personally I never prescribe medication during pregnancy, ever, unless it's absolutely needed - especially since back ache in pregnancy is common and normal.'

So because back ache during pregnancy is common and normal we just have to put up and shut up

bumper, I wouldn't take medicine unless it was absolutely needed. But obviously women have should have the right to decide what's best for them, as long as they're presented with the facts.

But there are no facts available for most things, that's the point. Manufacturers give either a blanket ban or 'consult your doctor', you doctor says 'I'm not an expert, so I don't don't, but I wouldn't take them'. Sure you wouldn't now, but when you haven't slept properly in 8 months while growing a person inside you, you might reconsider. (That's the imaginary argument in my head to the dr not you!)

Personally, I don't think it is a feminist issue. When I had DS1 I knew I had the right to make any decision I wanted. I had my birth plan in place which said what I wanted. DH knew what I wanted to happen and did his best to try to make it happen for me.

I do believe that if one chooses to have a hospital birth you have to have faith that they are going to be trying to do the right thing by you. Of course, I am not saying there aren't cases of medical negligence where bad decisions are made by obstetricians and forced upon the mother, but generally it is not in their interest to do this.

I think if a woman wants to be taken seriously by the medical establishment she does have to educate herself not only on what her rights are but also on the relative risks of certain procedures.

There are problems and I do think there are aspects of childbirth that are archaic and money does need to be invested but the question is where the money comes from. It would have to be diverted from another source such as cancer care (I am guessing) and I imagine that the NHS sees this as much more important.

Bumper - the facts aren't available because of the ethical implications of testing medicines on pregnant woman. It is an impossible situation.

AvrilHeytch, I agree, research of this kind is massively important & there's far too little being done as far as I know.

For what it's worth, I also feel there's loads of unsubstantiated generalisations & misconceptions about the pros & cons of epidurals (and other pain relief). A lot of the 'cons' (argued by natural birth advocates) are simply untrue. I think there's a lot of ideology behind all these opinions (not that there's anything that doesn't involve ideology actually).

Yes the ideology behind my homebirths were "I'M shit-scared of hospitals!"

Sakura: fair enough :) My ideology behind using an epidural was 'I'm shit-scared of pain'.

But despite the personal decisions each of us makes, based on our fears & preferences, there's a background against which we live & form opinions, and this background is ideological & contains various different 'warring' systems of belief (which is why all this can be discussed from a feminist point of view).

I want to throw out something I've experienced as someone who has ended up needing highly medicalised births.

DD1 was v. late and after having sweeps and rupture of membranes from a mw (the sweep was the most violated I have ever felt) I was induced. DD1 got v. distressed and ended up being delivered by a crash section. She had an abnormal brain scan, her apgars were 1 and 2, her kidneys didn't work, she needed resussitating which resulted in a collapsed lung. Miraculously she has fully recovered and is fine now.

But when I was pg with dd2 I had an appointment with a male ob who tried to get me to go for a VBAC. I explained that I preferred section and was asked, 'but don't you want a real birth experience?' Er, I have a baby, how do you think she got here, the stork? So I explained about dd1 being so ill after birth and he said, 'Oh, it can't have been that bad, she was probably just a little bit distressed'.

I got a lot of pressure mainly from obs rather than mws to have a VBAC right up til the morning of my section. Luckily dd2 went breech and back-to-back so I didn't have to argue, but as a woman I felt my right to choose was being taken away and I was becoming a victim on an anti-section ideaology

I also had to give up bfeeding dd1 after she'd got used to tube feeding and I the kind of infective mastisis that lays you out cold. My mw said I didn't need to try again 'if you don't have the courage', so I spent first year of dd1's life convinced that if I'd been braver we'd have been able to bf. Again I think the mw's pro bf stance got in the way of treating me like a human being.

Then when ds was born (by section) dd2 was taken to hospital after collapsing with a mysteyr illness (they thought t was meningitis). I wouldn't leave the hospital until dh and dd2 were home because I couldn't cope with dd1 and ds on my own. I confided to a mw about how scared I was (I'd been in hospital for 2 week before ds was delivered and got to know her) and she looked down at me and said, 'I thought you were stronger than that', and walked away. On my notes it said, 'refused to leave, cannot cope.'

Don't know how much the last is anything to dowith medicalised birth or feminism, but maybe I wouldn't have had abreakdown had I got better care in the days following dd2's collapse.

Spiritmum, you make a good point (and I'm really sorry you had such bad experiences by the way).

I get hugely irritated by the casual mentions of words such as 'courage' 'strength' 'what's most natural' etc in the context of birth / bf. Builds up an image of women essentially being wimps if they opt out of 'natural childbirth' (or if they can't achieve it for whatever reason); the same goes for bf.

Much as I will probably be screeched at for making any comment (as a man), men are now encouraged to be "active" birth partners, so I think it is fair enough to take an interest.

I think, firstly, that some people have suffered appallingly. There are, I believe, approximately 600,000 live births every year and not every one will go well. There will, in a health service as large as ours, be some professionals who are much better than others in every regard. The corollary is that the worst will be very bad.

However, these days, I really do not think it is fair on the medical profession to make the claim that childbirth is a feminist issue. Firstly, let's rewind the clock to my mother's experiences in 1964-1966, when childbirth really WAS a feminist issue (she was one of the first NCT clients). She firstly had an ectopic pregnancy which burst. When she went into hospital, internally haemorrhaging, she was told she was a hysterical woman and to take two aspirin and go home. It was only when my father threatened to sue the hospital that the consultant was dragged from the golf course to operate on her. She was five minutes from death by exsanguination. Her two natural births were in stirrups, discouraged from moving at all, with an arrogant consultant looking in from time to time. Things really have got a LOT better.

I cannot speak for what happens in every instance but the whole idea of a birthplan, which is NHS procedure, is to put the woman in charge. Obstetricians are not meant to be involved in "normal" births at all, which are midwife led. The vast majority of midwives are women. I do think there is a degree of unfairness in the belief that any but the tiniest percentage of medical consultants are in it for anything other than helping people. No one goes into medicine for the money.

As to my wife's and my personal experience, though we had some issues with our son's birth, they have been more to do with competence and resource than attitude. She was made to wait 90 minutes for an epidural after she had an induced labour and amniotomy (obviously things became v painful v quickly) and the midwife present wasn't qualified to put in a drip when she was becoming dehydrated. She is now pregnant again and planning a VBAC (not my choice, but I will support her in what she wants). We saw the consultant last weeks who explained the risks. I was quite amazed that one is actually allowed an induced labour despite the fact that it puts the odds of uterine rupture up to 1/40 (we are not going for that option).

En passant, I am amazed that people expect testing of things like sedatives on pregnant higher primates. I am not an animal right's lunatic but I do think that kind of testing should be reserved for life saving drugs and not for pain relief. In addition, I believe thalidomide WAS animal tested. And there are plenty of drugs available in pregnancy, as my wife and I have found out through various ailments.

So, to sum up, although I would never belittle an individual's awful experience, I would say that attitudes to childbirth nationally are entirely woman centric in 2010.

Thank you, Maria.

The decline in maternity services that I saw between 2002 when I had dd1 and 2006 when ds was born was shocking. One thing they did was shut an entire ward of maternity beds which they replaced with a mw led birthing unit. When I had ds post-section women were being sent home with babies who could barely feed and who were borderline normal weight in order to make way for mums who were stuck up on the delivery unit. Yet this is one of the best maternity hospitals in the country, not least because of the MWBU.

I think maternity services ar ein danger of being so idealogically led that sight is being lost of the needs of individual women and babies.