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 women weren't taught at every turn to defer to 'authority figures', not trust their instincts (or that their instincts are somehow shameful/embarrassing), not make a fuss - then perhaps it would be harder for medical professionals to be 'desensitised'.

If they are taught to prioritise the baby and that the mother is an irrelevance, and the mother is unable to say "I am a person", or words to that effect, then it's easy for them to ignore it, yes. Doesn't make it excusable.

I recently gave birth at Uch and i think had a very different experience from some women on here. I am writing to reassure people that not all birth stories are awful. I have a lot og sympathy for women who have had terrible birth experiences, n fact i read a lot of stories similar to these prior to giving birt and was subsequently terrified however it was not like that for me so i want to reassure any first time birthers.
I was induced because my waters broke and i did not go into labour within two days. I was on drip, the doctor recommended an epidural prior to going on the drip as he said the intensity of contractions in that situation can cause a lot of distress i gratefully accepted the epidural but not before i had had a long discussion with the anaesthetist who took the time to explain things very carefully to me. Towards the end of of a very short labour the baby's heart rate dropped so they took me into theatre and asked me to sign a consent form for forceps and epiostomy. My DH and i protested as i did not want forceps and they stopped and took the time to explein things to us and when i consented i felt fully aware of the reasons and everone in theatre was fantastically supportive. I did not feel dehumanised in any way and despite the interventions have fond memories of my birth.
I don't mean to negate anyones experiences but felt tat an alternate experience should be put forward.
Sorry for the long post.

I had a simple birth and was well-treated in general (and specifically, had a fantastic midwife, therein lies the key I think) but I'm still angry about what I've seen my friends go through.

Wow, I'm so sorry to hear that so many women have had traumatic birth experiences.

Although, I did occasionally find myself advocating for women whose babies I was delivering or just observing their births (I am a medical student) as I was the only one who read the birth plan and had time to spend with one woman. I don't know if this is the case for everyone but when I observed a birth or delivered a baby I sat with a woman from the moment she came into the hospital until the birth - even if her labour was rrrrreeeeaaaaaaalllllllllyyyyyyy long. This was often good as the midwife shift may change, but I was constantly there and always told the woman exactly what was going on - I could translate medical jargon. I have found all of the births that I have had the privilege to be part of a positive experience and have had very positive reviews from the ladies. Even one Dad who I caught as he fainted. I also always visit ladies on the post-labour ward and if I'm lucky, hold the new addition. My point being that if you get the opportunity to have a medical student it really can be positive.

When I qualify I intend to pursue a career in obstetrics and gynaecology so it is really useful to me to hear all of your opinions about your interactions with medical professionals as it will affect how I behave in the future.

Thank you MN.

The question the OP is asking is, "is childbirth a feminist issue?", if I am wrong to say I am not sure it is then I am definitely missing the point of the thread.

The point of feminism (as any other -ism), as I have always interpreted it, is that someone/thing has to be against women.

I did think this was meant to be a discussion and I thought I was discussing it with you. Surely, there is no point of a discussion without an opposing view otherwise there is no discussion, it is just a conversation relaying each other's experiences. Being a woman and having given birth (having had a hairy experience), I feel I am more than entitled to be on here.

I have put my view that it is not a feminist issue. However, this does not mean I don't think that everything the medical establishment does is correct or that maternity services are perfect (I think they are far from perfect and under-resourced).

The next part of the OPs question is how could it be improved. Well to me it is obvious from my own experience what needs to happen:

1. Midwives need to be trained better, ie, to a standard where they are capable of dealing with most emergency situations.

1. Research needs to be done to improve the drugs used on induction.

1. Postnatal follow-up needs to be consistent and last for longer and women need the opportunity to ask/be given counselling if this is what they need.

I hope this clarifies why I am on here.

1. There is no point in training midwives better (and bear in mind that most are trained to a very high degree but not allowed much responsibility) if there aren't enough of them to do a good job. Understaffing birth units to a sometimes dangerous degree discounts the needs of mothers and babies and does nothing for a half-way respectful birth experience.

1. The research is there on the drugs used for induction. Frankly, the drugs are "good enough" if you discount maternal satisfaction. They will get the uterus contracting more strongly, and they will do it quickly. What happens afterwards is generally the problem (very quick move to unbearable pain...cascade of intervention etc. Labour is often augmented because there is a pressure to get women through the system quickly. Both of these points seem to point to a general disrespect for the labouring mother.

1. Well quite, but if you know you've fucked it up, or had to fuck it up because of 1 and possibly 2 - you're not likely to welcome complaints with open arms.

It's a feminist issue because for centuries now, the view of labour and birth has been to utterly discount the knowledge of the women who worked with mothers, to systematically remove those women from caregiving by legislation, to essentially rewrite the book wrt equipment, expectation and often outcome (look at the US and their stats on neonatal and maternal mortality) and only to change things when women mobilise and demand change - and that's as recently as the 80s in this country.

Ali - I read the part of the OP which said:

"As a newbie feminist is it a feminist issue?" as being a kind of "ooh hope no-one minds if I post this here type of thing".

I'd be interested for your thoughts on this thread as it seems as if discussing things within a feminist context/umbrella seems to make people really uncomfortable as if somehow it means that the item being discussed is of no relevance to men or that individual men are against inidividual women.

Why do you think your issues (1,2,3) are not being currently addressed?

OP - if you are around - feel free to correct me/confirm what I thought.

And before anyone talks about more lives being saved, remember that the biggest leaps in saving lives have been made by hygiene and nutrition. Technology has been wonderful, cs is wonderful and vital, but don't be lulled into thinking that that's the whole story. Improved hygiene has saved countless lives (google Ignasz Semmelweisz) and the data collected in Britain on maternal nutrition improving childbirth outcomes over generations since c 1880 is compelling.

tabouleh, the issues are not being addressed because the NHS in general is underfunded which means, that they do have to prioritise where money goes, which in turn does mean maternity care will suffer because it is not deemed urgent. Probably, what they consider to be urgent are illnesses / conditions people die from regularly, like cancer and heart disease. Somehow, someone has to make these decisions and I am sure they are very hard to make.

Whether this is right or wrong can only be answered by any individual relative to their own experience on the NHS.

If you want to take the view that it is a feminist issue because it affects all women (well most) then I still draw the same conclusion because nowadays most birthing partners are men and by proxy they are also affected. When I asked the question before: where was your birthing partners? quite a few women came back and said their partners were treated with an equal lack of respect/care. Also, do you not think men are not affected by watching their partner's suffer / worrying about their unborn child? I know my DH was beside himself seeing me in so much pain during my labour and, initially with DS2 he was really keen for me to have a c-s so that he didn't have to watch me go through it again (luckily he is over it now).

For the above reasons, I do think nowadays it is too simplistic to say it is a feminist issue.

But a feminist issue is not an issue that affects, or is concerned with, women only.

Rape is generally considered to be a feminist issue but it certainly does not only affect or concern women.

Nobody is saying that birth is an exclusively feminist issue or an exclusively female issue (impossible when you consider that around half of births concern male babies).

Birth is also a social issue, a public health issue, often a poverty issue, a cultural issue, etc. etc.

Birth is considered a feminist issue because feminism is concerned with how women are treated within a patriarchal society IMO.

If most women were saying that they birthed as they wanted to, (within reason) in surroundings that were sympathetic, with people who respected and listened to them, with every effort being made to reduce unwanted intervention and physical and emotional trauma then perhaps birth wouldn't be considered a feminist issue.

As it is this is not the experience of many many women. It is IMO up to women to voice that and change that - I doubt anybody else is going to do it for us. Therefore birth is a feminist issue.

Improving birth experiences does not have to be expensive so this isn't just about funding.

Something else - I'm not sure that this relatively new thing about men as birthing partners is such a good thing.

I'm kind of in two minds about it.

Whilst I think that is is great for fathers to witness the birth of their child (if they want to) I think a women who has had experience of giving birth is better equipped to 'accompany' a labouring/birthing woman.

Saying that my DH was a real rock to my with DD1s birth when I started to panic and lose it a bit.

However I suspect that if for DD2 I could have had a homebirth with one to one care by a midwife who knew me I probably would have encouraged DH to leave us to it and just make his appearance at the moment of our baby's entrance into the world.

I needed him with me for my hospitalised births because I was pretty much left to my own devices by the maternity staff.

Sorry for lack of punctuation and typos!

Beachcomber, how do you know that most women don't birth as they want too? Most discussions in relation to childbirth on mumsnet are probably more likely to draw women who have had negative experiences than those who had good experiences. I have never seen any statistics nationwide or otherwise that women are generally dissatisfied and maybe this is something that we need to find out.

Improving resources is one way of making a woman more comfortable and for me it is what would have improved my experience. The sympathy and respect route I definitely agree with - however to me this is an issue of training. I do think there is an issue of spending money on research to improve the drugs because they make the whole thing excruciating.

"Birth is considered a feminist issue because feminism is concerned with how women are treated within a patriarchal society IMO."

I really don't feel like I live in a patriarchal society - I have all the rights I could want. I have freedom to: marry who I like, vote, work and also to birth as I want. TBH I feel the feminist has done a bloody good job so far.

Your implicatino is that the NHS is run by men. If it is not run by men then it is not a feminist issue. If it is then I concede and it is. However, I would be interested to know what the male/female ratio of staff is high up in the NHS (I ask this as from watching my sister's meteoric rise I suspect it is a rather female friendly employer).

Lastly, I would agree with what women are saying about men being there. If they don't want to be they definitely should not be made too. However, I was glad DH was there at my labour. As I am sure you are aware, he is completely bloodyminded and stubborn at times.

Ali, the vast majority of political power is held by men.

The vast majority of economic power is held by men.

That means you and I live in male dominated society AKA a patriarchy.

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.

Just because we don't hear a massive, obvious public outry about something does not mean that it is not happening.

In fact shedding light on issues which are not high up the agenda is very very powerful.

I've noticed that there are a lot more US resources/voices about childbirth - probably because what goes on over there is pretty fucking shocking.

ANYWAY - I am hoping we will get to hear more experiences of women and some more ideas of what can be done about it.

My idea up thread was connecting with your local Maternity Services Liaison Committee.

tabouleh, I'm really liking your posts tonight. I like this comment:

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.

My own experience was faultless. I don't have any complaints and felt respected, listened to and cared for throughout. My MW was fabulous. However, hardly anyone else I've spoken to in RL can say the same, and I wonder if my experience was so different because I was classed as high risk (twin pregnancy) and therefore definitely given preferential treatment. My sister had two dreadful deliveries but AFAIK, she's never been asked for her opinion or had it recorded so no official figures would show her disatisfaction.

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.

Or if there is, we do not merit seeing it.

(Actually I can't imagine how you'd get good data. It can take years to tease out feelings about a birth.)

"It can take years to tease out feelings about a birth" - Yes totally agree.

Unsurprisingly you see a lot less feminist activism from those with small DCs due to time constraints.

I just thought of a project for someone though - set up a blog with links to the NICE guidelines and seek testomonies which compare birth experiences with those guidelines.

Maybe the existing guidelines are not being followed or maybe we need the guidelines to change - or how about donating to provide women with access to doulas?

I've noticed that quite a lot of activism involves some ground roots work - a little ground swell of interest - you get something in the mainstream media - target starts to pay attention.

UK Feminista is all about helping feminists to take action.

So this thread is a starting point in any case - you know the more posts here - the more likely MNHQ are to adopt this as a campaign - in fact they are already pretty influential with the media.

Links to NICE guidelines:

Postnatal care.

C-sections

Antenatal nad postnatal mental health.

Induction of labour.

Antenatal care.

I think that a lot of maternity wards hold "birth afterthoughts" services where if you have issues you want to talk through you can - and I think they go through your notes.

I think I want to do this - if lots and lots oof people started doing this then that would send a message!

Ali, there is a huge body of research into birth dissatisfaction, because believe it or not, a lot of people are very concerned with trying to improve the experience and the service delivery around it. Midwifery journals, medical journals, conferences, documentaries and webpages, all dedicated to this issue. Just because you don't know about it doesn't mean it doesn't exist. I agree entirely with tabouleh, but frankly, the fact that you're asking this question implies that you do not, in fact, know that of which you post.

Here's something from an abstract, which is talking about the same elements we've been discussing here:
The first regression analysis identified five explanatory variables: involvement in the birth process (perceived control) and midwife support were associated with a positive experience; anxiety, pain, and having a first baby with a negative experience. Parity remained a significant predictor in the second regression analysis, but the others were replaced by augmentation of labor, cesarean section, instrumental vaginal delivery, and nitrous oxide (Entonox), which were all associated with a negative birth experience.

So midwife support and involvement in the birth process are the things that will help towards a positive birth experience. Interventions contribute to the negative.

When you consider that women struggle to be 'allowed' to be involved in their own labour, it looks pretty clearly like a feminist issue to me. I can't really even believe we're debating that. The central issue around maternity care is just that; whether women are treated as active agents capable of making informed decisions*, or whether they are treated as passive vessels through which a doctor delivers the baby.

*I hate the term "informed consent". It presupposes that when you're given the information, you'll necessarily consent - i.e., you're given the information necessary to extract consent, not the information necessary to make a decision.

"It's a feminist issue because for centuries now, the view of labour and birth has been to utterly discount the knowledge of the women who worked with mothers, to systematically remove those women from caregiving by legislation, to essentially rewrite the book wrt equipment, expectation and often outcome (look at the US and their stats on neonatal and maternal mortality) and only to change things when women mobilise and demand change - and that's as recently as the 80s in this country."

brilliant post UmePrune,

Tortoise, I know you're in Australia, and an Australian friend of mine gave me "a girlfriend's guide to childbirth" and I was at the comments in there.
"Don'T complain when they put you in a wheelchair; they have to for insurance purposes"
That could halt or disrupt the labour, let alone increase the pain, the idiots.

Then it emphasized throughout the book that as soon as you arrived at the hospital you had to be on your best behaviour not to "upset anyone" who might be treating you later because they might get their own back on you when you were in a compromised position.
ABsolutely shocking

It sealed the deal for me. I had two homebirths and was very happy. I can easily describe them as "beautiful births."
But it was all about being listened to and respected, above anything else.

The Girlfriend's Guide is an American book. We don't get put in wheelchairs in Australia. It's true in America, though, about the insurance thing.

I actually had a really wonderful hospital birth, but I was very, very fortunate to be able to do so, and also I fought tooth and nail in the leadup to be taken seriously. The GP who caught my daughter, afterwards, said to me that if I'd been another person she might have intervened more than she did.

I gave birth in a small, underfunded country hospital. Because it was so small, there was only one private obstetrician who practised there, and he wasn't resident, just on call. No resident anaesthetist. The rest of the service was provided by a group of four female GPs with an obstetric speciality, who rotated. I saw one of them for prenatal care, but couldn't rely on her being there for the birth. I saw all three of the others at least once before the birth, though. They were all country GPs, and three of them were middle-aged salt of the earth sort of women who were very woman-focused and very anti-intervention. The main hospital staff were midwives, all female. I only saw a doctor a couple of times during the labour, and I had a three day labour.

That hospital prided itself on its low C-section rate, which was around 10-15%. The leading private hospital in this state has a 60% C-section rate for primagravidas.

Anyway, the actual labour was very long (waters broke Thursday 4am, daughter born Monday 11am), and in a more medicalised environment I'd absolutely have ended up with a cascade of interventions. As it was, I was absolutely supported by sympathetic and interested women throughout. They let me talk about how I was feeling when I wavered about pain relief, and never told me what to do. Even the GP's recommendation, two days into active labour, that I have pethidine, was made as a suggestion with no coercion or emotional blackmail.

At the end of proceedings, it became obvious that the cord was wrapped very tightly around her neck, and she was in acute distress, and so the GP wanted to do a small episiotomy to allow a quick delivery. I didn't have a written birthplan, by choice, but she (GP) remembered that I'd not wanted any intervention at all. So she explained what was going on, and she explained why she wanted to do it, and she said she realised it wasn't my first choice but she thought it was best, and she absolutely made sure I was 100% on board with the whole thing. Likewise, my original desire to have the cord left intact until it stopped pulsing was lost, because my daughter needed resuscitation.

But when she was over at the resus table with my newly delivered daughter, and once the first flush of activity was over, she not only kept me informed about what was happening* but she apologised several times for the epi and the cord, and sympathised that things hadn't gone entirely to plan. She said it again a few hours later, as a follow-up, to check that I was alright with that.

At every step I was in control, I was listened to, I was treated as the person in the best place to make decisions. Like Sakura I was listened to, and I was respected. And it was definitely a feminist issue, because that was all about bodily autonomy and choice and respect.

*well, except no-one told me it was a girl. Funny story, another time.