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 considered training as a midwife because I felt so sorry for everyone concerned in the 'normal' section of the wards I was on.

If a midwife has four or five (or more), labouring women in their care at any one time then it's going to be almost impossible to build up an individual picture of each birth and labouring woman - how it's going, how she's feeling, what she needs (physically, emotionally, etc).

Most of the care of the women - pre and post birth - and their babies seemed to be left to 'support staff'. The actual midwives I interacted with were almost all lovely but that was not true of everyone and when you are feeling so vulnerable and sidelined it can be really crushing to be ignored or dictated to.

I had serial miscarriages and my treatment during those was pretty shocking too. I remember insisting on all the numbers and measurements and being shown the screen during their diagnostic ultrasounds. I asked questions constantly, it was the only way to be acknowledged as a human being.

Fine I was pregnant (or not), but I was still a human being.

I don't think attitudes to childbirth are woman-centric, I think they're more time-centric (if that's even a word??!!). You're on a clock to dilate so many CMs in such-and-such a time (I believe it's 1cm every hour?), and if your body doesn't run to schedule, then you have "failure to progress" written on your notes and immediate pressure to speed things along - drip, waters broken etc. Labour wards are a production line, there's no two ways about it. If you look on the Childbirth forum, it's full of women who desperate to go into labour naturally because their MWs are pressuring them to be induced. They're fearful of not progressing fast enough and having to have EMCSs. Essentially you're not looking forward to giving birth to your child, you're stressed and anxious and upset. Do stress hormones slow down labour?
Is this a Feminist issue? I still don't yet really understand what the word means... but if childbirth issues don't apply to women, who do they apply to? (Not being facetious or sarcastic, just genuinely wondering )
I wish we could see more one-to-one MW care. I had this in my second pregnancy, and it was so reassuring to see a familiar face during my labour, someone I had discussed my fears with over the course of 7-8 months and had come to like and trust. 'Course, that's the expensive option though...

How can you say nhs care around childbirth is woman centric amidst women on here who have told of having forceps delivery and episiotomies without their consent?? The damage that both those interventions do is massive and seeing as consent was given, it is more like abuse than an intervention. Those are NOT woman centric, baby centric yes but at the physical expense of the woman.

Where I live we see the hospital midwives in the next county until 20 wks. We then see community midwives in the county where we live until we go back to the hospital and the other lot of midwives to deliver. We then get sent back to our own county's community midwives post delivery.

Surely forcep deliveries and episiotomies are about saving not just the life of the baby but often the mother as well.

Best practise of course dictates that the mother ought to give consent but what about when she doesn't? Is it right that drs don't intervene when they can save a life beacuse the woman believes a certain type of birth is preferrable and attainable if only she tries a little harder?

Bearing in mind that the reasons woman often refuse such interventions are because they have been encouraged to believe that only woman who give birth naturally and without help are to be praised and considered sucessful is this not equally damaging?

Incidentally I am not saying it is right - have just reread my thread and realise it sounds like I am advocating treatment where it has been refused.

I just feel very uncomfortable about the idea that you have to conform to the all natural approach at a risk to your life.

Personally, I'm not arguing that no intervention = a 'natural' birth, i'm just concerned for the rights of the women giving birth because IMO they are being violated when procedures are being conducted on them without their consent!

Why is the whole consent issue around childbirth more difficult than any other procedure, like your abdominal surgery though? Is it about the baby's life being more important than the rights of the mother?

mrsrisotto I assume it is because eg. abdominal surgery usually follows a clearly predefined path: there are a couple of things that might occur and can be dealt with easily whereas with childbirth there are so many varients and potential outcomes.

When you combine that with the idea that there is clearly a school of thought that minimal intervention = good and intervention = failing and the fact that in any other surgery the patient would not be concious and so problems would be dealt with on the basis of (for example) how do we save this womans life? whilst in childbirth that has t be reconciled with giving the woman the birth that she wants....

'one woman one midwife' is pretty much what you get with a homebirth, and that is cheaper than the average hospital birth. It is affordable - it just needs a change in the system towards a less medicalised approach (and then for more women to buy into it)

think about how much more consulants get paid than midwives!

i think generally within the NHS patients are often treated less respectfully than they would be at a till in their local Tescos. Women in labour - because they are vulnerable, in pain, and often drugged, seem to be treated even worse.

I particularly agree with the poster who hates the 'so long as you get the baby' thing. It is so much bollocks and shows no regard for the wellfare of either mother or child. You wouldn't be that pleased with any other branch of medicine that took you in for a routine procedure and sent you out after probably avoidable major invasive surgery.

Additionally, and of course this is not an excuse, but drs and other HC professionals are far more stretched in a busy labour ward than on a day surgery ward.

I had a gynea procedure a couple of years back, consultant came and saw me had a chat, I was opperated on, consultant came back and had a chat. But said consultant had a list of say 10 patients that he was required to operate on that day he knew he could allocate x minutes to each one.

On a labour ward that is unrealistic (which is why we must have better funding for more staff). A consultant may be dealing with three or four emergencies and be stretched to absolute limits - they simply do not have time to engage in polite chit chat, run through every conceivable option/outcome. Sometimes time is of the essence and they have to make a decision there and then.

None of this is OK - but I think it is indicative of a general fault in the system (and that may be patriarchal) rather than the fact that all Drs are in some way anti women.

Thank you this thread is really helpful.

I found giving birth fine, because when the midwife when behind a curtain to discuss an emergency ceaserian "beacuse she's panicing and wont handle delivery" I popped my son out myself, and then shouted thats a curtain not a sound proof barrier - or words to that effect.

the midwife and the doctor appologised wholeheartedly and i explained that women in my family go from 1cm to 10 cm in about 2 hours so when i was screaming the head is comming despite a check 10 mins ago, i knew what i meant. I accepted their appolgy because they treated me like an adult and responded like medical professionals. all fine.

when i got to the ward however, the midwife in charge came running to my bed where i was bf and said " i've just seen your notes you're a late booker and a single mother. have you had any prenatal care?!you know you'll need a car seat to take this baby home? do you think you'll be able to borrow the money from someone?"

Literally like that without pausing for breath and in a very loud voice. I remember because i went from sublime joy with my son to outrage in a heartbeat. I answered, I have a car seat, which i payed for as part of the travel system i bought 4 months ago. Even tho i am a later booker, all of my tests are perfect and my midwife thought the Midwife led unit was perfect because I had it all under control.

She then left to get a social worker!

When my mum came to collect us (complete with carseat) i lost it and cried and cried. Thankfully she is a consultant so dragged the department head to me who couldn't appologise enough.

BUT the reason i am so thankful for this thread is that during my stay in hospital i never had my blood pressure taken, stiches checked or was shown freeding changing etc. not a problem for me but there's many a young woman out there who could have left in real danger. Nothing was done because the original midwife left a note to say nothing was to be done till i saw a social worker (which i never have)

I am furious that that precious first day with my son was marred by someones ignorance and sheer lazyness at not reading my notes. i had thought it perhaps a limited occurance but now i feel less alone.

We are women not animals in a barn. just because they do it every day does not mean we deserve to be treated on a production line.

excuse spelling, baby on my knee.

just re read that, didn't mean to be such are rant in bad grammar, hope it makes sense!

Avril I agree ultimately it comes down to funding and the unpredictable nature of labour and delivery menas that it is difficult to allocate funds and staff in the way in which I assume it happens in other departments.

I think there is probably an element of "as long as you get a baby" everything is ok in the thinking.

How this is dealt with as an issue is dependent on what your ultimate goal is. Mine is not that every woman should have the birth she wants at the expense of her own safety/health or that of her child. I know there are some woman who will vociferously argue that should be the aim.

I am not uncomfortable with the idea that the husband in the OP was able/allowed to consent to the episiotomy. Equally I am aware that some people are horrified by such a concept.

fionathefrog that is awful, what an awful and judgemental sounding midwife!
Did she just assume that because you were a single mother you would need to see a social worker?? I would have slapped her!

I think because I look young (i'm 25) and was on my own at this point she assumed I was completely alone.

I was on my own because I wanted to be, there was enough noise and disruption on the ward, without my family flapping about.

Normally i would have torn a strip off here but I had delivered only a few hours ago. I was so over run by emotion i didn't know what to do. I was so confused that she thought I hadn't had any pre natal care, my wee blue folder was as thick as anybodys and they said that the reason i was a late booker was because I was so healthy there no pregnancy symptoms, not so much as heartburn or a swollen foot - or a swollen belly come to that, not till 7 months.

She seemed to realish sticking her nose in and when there was nothing juicy to get into couldn't even be bothered to take my blood pressure.

Very insensitive way of speaking to somebody who is already emotionally drained!

MsRisotto,

Do you have children or any experience of labour? . My wife actually gave birth in 2009 and is due again in November. I was present throughout (until she had a G.A C section) so I at least have some clue as to what I am on about.

I notice you had to look up the word "episiotomy" and instantly decided that it was an afront to women (I think your actual comment was "eeurgh"). How about you look up orchidectomy and tell me whether that is an affront to men imposed by a matriarchal society or a legitimate treatment for testicular cancer? Unfortunately we are not in the star trek world where everything can be treated with a painless scanner. In the real world, treatments evolve based on experience and scientific evidence. I think episiotomies are used more and more rarely now as the evidence of natural tearing vs episiotomies is coming more to favour natural tearing. It was used to try to prevent natural tearing which, it was again believed, was more likely to lead to incontinence than a controlled cut. It might have been wrong but it was never anti-women.

From my experience in numerous antenatal visits, the labour ward and the neonatal ward, obstetrics is a specialty which tries its best to serve its patients. More and more of the specialists are now women.

Naturally, childbirth will always be a women's issue (or at least until such time as men give birth, or all babies are incubated in artificial wombs). However, to say it is a "feminist" issue in 2010, implying that there is some patriarchal anti woman agenda is an insult both to my mother's generation (see my previous post) and men, who actually, genuinely, take an interest in getting the best for their partners and unborn babies (who they will co-parent for the next 18 years).

Informed consent is a fundamental right of any treatment. Anyone who is not asked for informed consent has a right to sue the health provider. Any hospital who asked a husband for consent for a procedure unless it was believed the woman was incapable of giving it is risking a very expensive settlement (and rightly so).