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?

If I experience a similar chilbirthing situation to one experienced by someone of my grandmother's generation, that tells me some things have not progressed since her day, and something needs to change. Giving birth in stirrups and having episotomies is not uncommon at all in 2010. I genuinely don't understand how demanding a better birth, better care, more one-to-one time with MWs, is insulting to my grandmother's/mother's generation, or men either.

larry - I didn't say eeurgh, don't make stuff up thanks.

I haven't said any particular procedure is an affront to women but please take note of something I have actually said (as opposed to you making it up) that performing major procedures on a woman without her consent is a feminist issue. This is also, not relateable to testicular cancer as childbirth is not an illness and does not always need to be intervened with (as refers much of the discussion on the thread) I really don't see what you are gaining by telling us that this isn't a feminist issue.

When we say something is a feminist issue, we're not blaming you specifically so try not to take it so personally, we're drawing attention to something that specifically applies to women (and in this case it simply is an action by a male dominated profession)

MsRisotto,

Sorry, you said "thud" instead of "eeurgh". Same implication, though. You are equating it with barbarities such as female circumcision, as opposed to an umpleasant though sometimes necessary medical procedure. You also mentioned in an earlier post "should I ever have children". Clearly you are have a theoretical rather than a practical interest in childbirth. Fair enough, but maybe you should gain some knowledge of what you speak before wading in. You also clearly missed (I suspect deliberately) my last paragraph saying performing major procedures on ANYBODY without consent is illegal today.

Avril, I don't think that the general standard of maternity care is that bad and is similar to many specialties within our rather overstretched and poorly managed health service. I think I explained the genuinely patriarchal nature of the health service in my mother's generation (no female doctors, no informed consent, no pain relief except gas and air) relative to that of today (high proportion of female doctors, informed consent as a guiding principle, choice of pain relief, birth plan guiding the whole process). Why it is insulting to men is that is assumes that it assumes that how their partners and unborn children are treated during childbirth is neither here nor there to them. For most fathers this is one of the most scary and exciting days of their lives and they want THE VERY BEST for their partners and unborn children. To assume there is this cabal of men trying to cause women unnecessary suffering is ridiculous. They too have partners and children.

AHickey: "birth in stirrups not uncommon in 2010"...evidence please?

What I would love to see for everyone (and we paid for privately) is one to one midwife care, from the start of pregnancy through the perinatal period. However, whether it can be afforded versus all the other pressing needs of sick people, I really do not know.

What I think it comes down to (whether you want a natural drug-free birth or an epidural from the start) is that women often aren't treated as real, competent, adults in labour and birth. Their views and feelings aren't taken seriously (again, whether it's wanting an epidural or not wanting an intervention), procedures aren't explained and consent isn't sought. The birth process often becomes something done to you, rather than something you do.

I genuinely don't understand where the implication that this is somehow anti-men has come from???? Who has suggested that "how their partners and unborn children are treated during childbirth is neither here nor there" to expectant fathers? My DP is not a feminist (nor is he anti-feminist, iykwim), but of course he supports my wish to have a safe and positive birth experience, as I'm sure 99.9999% of all fathers do (I would say 100% but then I would be accussed of generalising ). He is not offended by any form of campaign for better maternity care.
My grandmother gave birth at home, and while I'm sure lots of things have improved since her time, I am genuinely envious of my mother's three 1970s labours, where she was encouraged to be active, had waterbirths, and got to stay in hospital for 5-7 days after. She also got a cup of tea after giving birth She wasn't strapped to the bed like I was, or kicked out 6 hours later.
The birth plan does not guide the whole process, it is a list of the mother's preferences. If the birth plan states "no episotomy", but the baby's head gets stuck, the OBs will not not perform one just because the piece of paper says "no". They're designed to make women feel as if they have some sort of control over an obviously unpredictable situation. I don't bother with one, personally, I don't see the point.
I gave birth to DS1 in stirrups. I guess though that my personal experience (and experiences of friends/MN friends) doesn't count. What makes you think this doesn't happen any more?

Avril - it is very difficult to comment on individual cases without all the facts however, in your case, if they did not ask for your consent then they have broken the law (I believe it is called battery) and also breached their duty of care to you.

I did not have my idea labour in any shape or form. There are some things I would have changed but these are things that I have learnt with the benefit of hindsight (for example, knowing when I need an epidural, being a bit more forceful about waiting for waters to burst naturally) and it has prepared me well for my second birth.

MsRisotto "Is it about the baby's life being more important than the rights of the mother?"

Put another way, would you prefer your baby to die and you to live or both of you to live, even if it is more uncomfortable for you? Surely, you are not suggesting that you would allow your baby to die so that you could have the birth you wanted. You would be devastated.

The medical profession would generally not allow a baby or mother to come to harm - if anything happened to the baby or the mother die it would be called negligence.

my mum says her 1968 hospital birth was awful. My Dad wasn't allowed in the labour room and when he came to visit as soon as he picked up the baby he was told to 'put that baby down!' by one of the midwives.

My mum says she had my sister at lunchtime but then didn't see the baby until the following day!

she decided to have the next two at home. I hope the birth experience has improved for fathers too.

My mum was asked if she wanted an epidural.

My dad said she didn't.

She didn't get one.

Oh, and only one woman on the whole of her ward tried to bf. They were told that bf was inferior because women didn't eat everything needed for full nutrition, whereas fm was made by men in laboratories and had everything a baby needed.

"Put another way, would you prefer your baby to die and you to live or both of you to live, even if it is more uncomfortable for you? Surely, you are not suggesting that you would allow your baby to die so that you could have the birth you wanted. You would be devastated."

Personally I'd prefer to be given the options, advised by medical staff, and be able to make decisions myself on what I feel is best for me and and my baby. Interventions fully explained, alternatives discussed and informed consent given.

"Personally I'd prefer to be given the options, advised by medical staff, and be able to make decisions myself on what I feel is best for me and and my baby. Interventions fully explained, alternatives discussed and informed consent given."

Are you not given these though during labour? I did my antenatal classes and knew what each intervention meant (I am sure most first time mothers do).

This is actually also the purpose of a birth plan and a partner. You right your plan, which is really more for you and your partner than the NHS, and your partner sticks up for you when he needs too.

Also, in certain cases they do have to assume that consent is given, ie, if it is a case of life or death of you and/or baby. If you don't say anything then they will automatically put the life of you and your baby first. I actually can't believe you are defending MsRisotto's view. I find it it a strange one. At 9 months the baby is not just a bundle of cells - it is a living being that you have spent 9 months building a relationship with (actually probably 8!) and does actually have rights.

Moonunit I agree that in an ideal world that is what should happen, but in practise think it is unworkable:

firstly, these decisions often have to be made in minutes - there is simply not enough time to explain all the options and wait for the parents to make a decision. Not to mention how you deal with a situation where parents decide to go against medical advice where there is a very real risk to mother or child.

secondly, even where there might, in theory, be time to explain all the options to an individual the consultant invariably is under pressure to be elsewhere, dealing with someone elses emergency.

What The Fuck larry don't you dare say I was equating it with FGM!!! I never even mentioned it! If you continue making stuff up about what i've said, there's simply no point in me responding to you is there? For gods sake!

I may not have had children yet but this is directly relevent to my own body. You can think about this from a very objective 'it'll never happen to me' perspective but I am not so fortunate. Someone on this very thread has said they had an episiotomy without knowing, that their husband consented for them so the fact that performing this stuff no people without their consent is illegal, it clearly isn't a law in much practice. I said 'thud' on discovering what an episiotomy is, because it is fucking horrendous and I can't believe that that could happen to me.

Ali (are you his wife or mum?) - of course I would be devastated but I bring that up because taken to the extreme and we have people who value the rights of unborn foetuses over the rights of the woman and some things said here are veering close to that sentiment.

what kind of decisions are you talking about nancyDrew?

I was primarily thinking about decisions to perform an episotomy as that is what much of this debate has been about. Although I think my argument would stand in relation to all interventions that are carried out in an "emergency" situation.

And I am shocked at the assertion that giving birth on stirrups is common. Apart from ahickey's experience I have never heard of anyone giving birth in stirrups except where it is a forceps delivery.

But surely an episotomy is rarely a life and death decision?

I am certain that a woman can refuse intervention - but often her permission is not asked.

Even a "if I think you are going to tear, can I make a cut instead?" - which is often the reasoning - would go a long way I think.

Maria2007 I really don't think thats ticking a woman on her back to labour is that unusual. FWIW, have given birth 3 times in the last five years and that's exactly how I laboured (not through choice). Oh, except for number two, when I was held down and my legs pushed into stirrups.

The majority of women who have ventouse or forceps give birth in stirrups. I found an article saying 44% of women at a particular hospital in London gave birth in stirrups. It's from 2007, so don't know if it's acceptable to reference it here, sorry, couldn't find anything a bit more recent.

www.thisislondon.co.uk/standard/article-23423256-13-london-hospitals-named-among-worst-for-childbirth.do

That was in 2007 btw.

But not in London, x post with hickey

I believe they are carried out either where there is a medical need to get the baby out sooner rather than later or the midwife believed that due to positioning a natural tear was going to be far more damaging to the mother, or a mixture of both.

I am not an expert but I imagine cases where the baby remains in the birth canal once distressed are life and death situations (for teh baby at least)

MsRisotto, I can parse English. Your implications were clear.

Why do you assume that I am fortunate that it will never happen to me? Producing and nurturing a new human life is an experience I will never have. That has upsides and downsides but certainly there is a part of me that would love to be able to experience it. Labour is a random and sometimes unpleasant experience, however well managed. Some women have told me they hardly noticed the episiotomy after the pain and exhaustion of 20/30 hours of labouring. You need to gain some perspective (and knowledge) on the subject. If you don't want to risk that kind of thing, don't have children.

I would really like to know the details of the people who had these procedures performed on them without consent. For instance, whether they were physically able to give informed consent at the time and whether they pursued legal redress afterwards. My own clearest memory is of listening to the anaesthetist and surgeon clearly explaining every detail and risk of the proposed C section to my (beyond exhausted) wife and me as I was watching George's (my son's) heart trace and just wishing that they would get on with it!

Ahickey, where on earth is Kenickie?! Your and your friends experiences sounds so different to anything I have heard from so many people who live anywhere near me. My feeling that this is anti men is the OP is putting it forward as a "feminist" issue. I would love to see better care in many areas of medecine including care of the old (who are treated appallingly by the NHS and prostate cancer. However, I would not call these "masculinist" issues.

Larry is DH although he is on his own on this one (he does take an extreme view in theory although much less in practice).

You talk about the woman who had the episiotomy and her husband consented on her behalf. Is that wrong if she was incapable of articulating what she wanted? Call me old fashioned but I would have thought that she would have discussed her birth plan with her DH.

In fact it is a question I would like to ask all those people who had bad experiences on here - what were your partners doing? How much did you discuss your birth plan with them? They must have thought that they were doing the right thing by you.

In relation to the rights of the baby (foetus seems the wrong word for a baby ready to be born) taking precedence over the rights of the woman: well the woman's rights always come first legally. I know a woman who, in her determination had a natural birth against all recommended advice and had a stillbirth. Do you think that she was right in this situation to go against the medical advice?

When it comes to less important matters like pain relief and whether she chooses to be induced, or natural vs c-section she is more than entitled to make those decisions as she sees fit, and as she wants. When it comes to important decisions, that will affect her and/or baby's health then I do think she has an overriding duty to look after the health of her baby and herself.

Ahickey,

Thanks for the link but it really misses my point. My mother and most of her generation LABOURED in stirrups. They pitched up to hospital and were then strapped to a bed, put in stirrups and told not to move. they might have had to remain like that for 24 hours or more.

That is completely different from a ventouse or forceps delivery when people need access for a (relatively) quick procedure.