Mothers are being abused during childbirth. We need our own #MeToo

[stumbledin]

I dont necessarily agree with the idea that this is the same as #MeToo but definitely at the extreme end of how the entrenched paternalism with health services too often leads to women being ignored and not listend to. And there examples of how many standard procedures are based on the needs of a male body not a female one. (another reason why pretending gender identity is the same as biological sex is not only nonsense but could lead to inappropriate treatment).

interesting that the author is part of Index on Censorship.

Caution: some women may find this difficulat reading www.theguardian.com/commentisfree/2018/dec/28/mothers-abused-childbirth-metoo-movement-women-give-birth

Indeed. We have it very wrong.
I was doing school run the day after I had my ds.

It seems that there is a god complex going on.

Lots of excuses like we don't have time we are trying to save lives. Well a sweep isn't an urgent life saver. if youve got time to get implements you've got time to say what you are doing. There is no excuse to talk to husbands instead of the woman. Telling women that the pain relief has kicked in, woman will know that won't need to be told. Denying women CS especially when it is clearly in a woman best interest. Not giving anaesthetic when stitching.

From what I see there is not the wil of all the HCP to make things better. I think it goes further than just giving birth but all women's services. I remember a nurse wanted to examine me internally to see if I could withstand a procedure without anaesthetic (before being referred) when it is patient choice on how the procedure is performed. I did not consent and got to choose but it's clear I would've been bullied into something I didn't choose.

We need a campaign because it's clear the change isn't coming from within.

The PP who identified themself as a midwife expressed horror at all of these testimonies, but then went on to say that they haven’t got time for consent. Well, that’s ok then - it’s all in your best interests, you silly women. Too bad if it doesn’t turn out well for you.
The scariest part of these stories is when midwives don’t believe women who say they are in labour/in pain/about to give birth in the next 60 seconds. What’s with the not believing people business? I am staggered by this.

Completely agree with the pain relief issue.

I was offered the same pain relief after my third section that DH was offered while waiting for an ingrown toenail to be removed.

The PP who identified themself as a midwife expressed horror at all of these testimonies, but then went on to say that they haven’t got time for consent. Well, that’s ok then - it’s all in your best interests, you silly women. Too bad if it doesn’t turn out well for you.

God no, that's not what I meant at all! I'm sorry if it came across like that. What I said was "rightly or wrongly - a decision is made to save the life of a woman or baby, and every second counts so we don't use the time to explain things or get proper consent". Our current approach is obviously wrong, as this thread illustrates. Realistically, though, if we went through all the risks and benefits of e.g. a ventouse while the baby's heartrate is at 80bpm, there's a greater chance of the baby ending up in NICU or with long-standing brain damage. So whether we proceed without consent, or we stop and get consent, we risk doing damage. That doesn't mean it's ok for us to make the decision to risk damage to the mother instead of to the child. The solution, to me, seems to be to talk about it before it becomes time sensitive.
As mothers, do you feel like it's more appropriate to talk about possible emergencies in an antenatal class / appointment, or would that have made you more frightened of labour? (Not a rhetorical question; we're overhauling a few aspects of midwifery care at our hospital and perhaps an extra appointment to talk about these things would be something we could add in.)

Rita - yes - my first c-section was done by two, young Canadian women (and the traditional comedy anaesthetist) - they communicated before about what I wanted, what might happen, what would happen, I went to recovery for an hour whilst DP looked after the baby, and a recovery nurse (with an english accent - I don't know if it was on purpose, but it was lovely having a voice from home sat next to me as feeling came back), they checked me after, and I healed beautifully, everything where it should be (all a bit tight for a couple of weeks, but then back to complete normal).

My second EMCS in the UK, I didn't meet any of the operating staff before hand, none of them introduced themselves (despite me being fully mobile this time - having held off on epidural in favour of a quick spinal block for the surgery). The anaesthetist and some other dude spoke about their holiday plans throughout - it was like I wasn't even there. The only person who actually spoke to me was a nurse.

I healed fine (didn't feel as tight at all), but I can still feel bits pulling inside me (5 years later), I have a numb section of stomach, and massive overhang - due, I think, to a different style of stitching - I felt multiple layers dissolve the first time as I healed, but the second time everything just seemed to be left wobbling around (hard to describe).

And like everyone here, beyond the midwife removing my external stitches a couple of days later, no-one checked up on anything at all around my csection. Absolutely insane standard of care.

Realistically, though, if we went through all the risks and benefits of e.g. a ventouse while the baby's heartrate is at 80bpm, there's a greater chance of the baby ending up in NICU or with long-standing brain damage. So whether we proceed without consent, or we stop and get consent, we risk doing damage.

My baby's heartrate dropped when I was being induced in Canada - the maternity nurse immediately pressed the call button, put me on oxygen, and started to talk to me about what might happen next whilst doing everything. I refused a head clip and when the doctors came in we started immediately talking about emcs, whilst doing everything (we'd already had initial chats during induction etc. so everyone was aware of my wishes)

In the UK, the midwife just tried to bully me into being quiet on the bed (apart from the aforementioned good one), contrary to your emergency situation, an awful lot of time was spent with various medics, in various stages of dress (the dude who put a cannula in my hand - because it was oh so important even if not used and even though it was then replaced in the operating theatre anyway had his coat on hand had to put his carkeys down first) waffling on trying to get me to change my mind about various things I'd been very clear on - no sweeps, no induction, if anything's wrong, or it's taking too long, straight to cs (it was taking too long. I wasn't dilating, I was knackered, baby was starting to tire too).

It was a fucking shambles frankly.

I had an awful time a few years ago having my first. Developed pnd which was partly a reaction to having stayed in postnatal ward for 5 days. It was truly horrific. Hardly any staff, it was 30'c outside and warmer inside with no fans, no air con, we were made to keep our curtains open for air flow (was none) so no privacy whilst having big difficulty bf. Had to leave babies in a room on their own to go and eat (so I didn't) and looking back my mental health was in a bad way and no-one noticed. I could go on and on about that stay. However really happily, my second visit to the same hospital 3 years later they had made some real improvements and I had a positive time overall. They allowed partners to stay now which helped me enormously, and I wouldn't mind guessing that it helps them because the partners can do a lot of the care that the staff would otherwise have to do (and can't because there aren't enough of them).

Apart from a very few life or death in seconds scenarios, consent can be obtained - what’s needed is discussion beforehand so that women are aware of the intervention routes. Why isn’t the choice of intervention vs section discussed beforehand?

There’s a disgraceful lack of communication. My friend had a baby recently and has been left with permanent damage from hours of pushing, an episiotomy and forceps. She found out afterwards that they KNEW the baby was poorly positioned and the chances of natural birth were almost zero. But no one told her ahead of time. No one discussed what would likely happen. No one gave her the option of a section. Instead she had to endure days of pain, increased risk to the baby and permanent physical damage (they broke her pelvis and coccyx.)

But they didn’t accept that she was in pain after either - they didn’t pick up the two breaks for weeks, during which time she was unable to walk or sit, belittled and told she was making a fuss by staff, refused investigation by her GP until four months had passed as ‘things can be sore.’ She finally got an x ray after 16 weeks.

I know women who e been sewed up too tight ‘for their husbands.’ Women who’ve been left maimed for life, incontinent, traumatised, and women who frankly never want another HCP near them again.

It’s an absolute disgrace.

Wow! I can totally relate to this. I hadn't really considered how the whole 'at least you got a healthy baby' mentality is so ingrained I've even been saying it to myself about my own poor experience with DD's birth!

There is a mum on Woman’s Hour right now talking about the death of her son from sepsis. She has said she was dismissed as neurotic and a ‘first-time mum’ and not taken seriously when she kept saying he wasn’t right.

I bet no health professional has ever dismissed a ‘first-time dad’ as being neurotic.

I know hypnobirthing gets a bad rep on here but the course I took wasn’t anti-medical at all.

It had a lot of physiology in the course, explaining the process of a straightforward vaginal birth.

I think it’s true that it’s nigh on impossible to really understand / consent to interventions if you don’t understand the straightforward birth you are being compared against.

And yes to HCPs not informing people in a timely manner - I still remember overhearing Midwives discussing that baby wasn’t in an optimal position and they would give me X amount of time before calling the ward.

I had been labouring for 12 hours at that point WHY THE FUCK HADNT THEY TOLD ME

And I’m sure if that had needed to transfer me it would have then been rush rush drama drama ‘no time for consent’

Bollocks. We see you.

What I'm going to say is going to be very unpopular with any midwives reading this but I don't care - women are being traumatised and put in danger so I think honesty here is really important:

A lot of midwives have a HUGE chip on their shoulder about doctors not knowing anything because they aren't usually in the room unless it's an emergency, and they think they know it all because they've delivered X amount of babies. They make decisions that they aren't qualified to make and allow emergency situations to go way too far before calling in the doctor. I've seen them standing there arguing with the consultant over the best course of action during a medical emergency whilst a woman is in labour. This happens a lot. The sheer stupidity and arrogance astounds me - an obs and gynae consultant has spent at least 6 years at medical school, followed by 2 years of hands on internship in a hospital, followed by a minimum of 2 years as a JHO/SHO in a hospital, followed by a minimum of 4 further years as a registrar who is essentially running the ward ALL OF WHICH has been focused on OBS and gynaecology, and all of these phases of career require you to pass very complex and difficult practical and theoretical medical exams (which have a low pass rate because they are so tough) in order to progress to the next stage. Midwives these days don't even have to have a basic nursing degree - you are now allowed to do a midwife course off the back of an irrelevant bachelor's degree. The fact that a midwife would presume that their medical knowledge is any way comparable to the consultants, let alone better, is absolutely ridiculous and is downright dangerous. It's irresponsible for a medical professional to put their arrogance ahead of the safety of women and babies during birth. Childbirth is not fun and games - it's only due to the advancements of modern medicine and the knowledge and experience of the doctors that it has become a safer experience. Prior to all this many women died a slow and painful death during childbirth, as did the babies.

I'm sorry if this offends anyone and I'm not tarring all midwives with the same brush - I know some of them are brilliant at their jobs and know when to step aside and let the doctors jump in, but unfortunately in my experience they seem to be the minority. I would like to see a shake up in the way that medical care is provided during birth, and for midwives to be held accountable when they've endangered patients by allowing an emergency situation to get worse because they were too arrogant and irresponsible to call the doctor in. I can't see it happening anytime soon though

Oh, and I gave up breastfeeding too easily. After 4 days in hospital where I was there and trying! All the help I got was “nipple to nose”.

It took a dr to tell me to get some bloody milk into the baby and snuck me a bottle from the secret supply. I was discharged straight away when the midwifes saw. At 2am. With no milk at home. They wouldn’t give one small bottle to tide us over till the shops opened.

If someone had looked at my breadth they might have seen I had breast cancer. But no, it was my fault for not persevering. Didn’t get diagnosed for 9 months! When I showed the oncologists photos of me (breasts akimbo) on the post Labour ward-she could see enough marks that would have caused her concern.

PregnantSea
I agree.
Also agree with pps that it's very easy to minimise your own experience. Whenever anyone asks me about my birth experience I feel at pains to tell them how it was pretty good and how grateful I am for my relatively calm emcs but I barely ever talk about my experience of post natal care, the thought of which brings me out in a cold sweat! It's just not seen as being that important I think but it definitely contributed to my PND.

@PregnantSea - the flip side of what you are saying - from my experience as a nurse and when in labour myself - is that the doctors don't see the uneventful births - they only get called in when something isn't going smoothly, problems are arising, and their intervention is needed - and this can lead to an impression amongst them that birth never goes smoothly, and always requires intervention. This can make them more keen to intervene when it isn't necessary and, when left to herself and the care of the midwives, the woman could have given birth with no intervention, or fewer or less major interventions.

Both sets of professionals need to respect the skill set and knowledge of the others - midwives know far more than doctors about managing uneventful, straightforward births, and doctors know more about dealing with problems. Both need - for want of a better word - the humility to know their own limitations, and when to defer to the other group. And sometimes midwives NEED to advocate for the woman - which can look like arguing with the doctor - if the doctor is proposing an unnecessary intervention.

And of course you are right that, at the heart of it all, should be the welfare of the woman and the baby - their needs must come first, and no professional should be putting their professional pride above that.

@SDTGisAnEvilWolefGenius Firstly I just want to say thanks for replying to me in such a calm and balanced way - I hadn't read all of the other comments on here before I jumped in and it seems you are being somewhat unfairly attacked from all sides. I probably wouldn't have pushed my point so strongly if I'd read all of that first.

And of course midwives have an important place in the process of delivering a baby, and I do respect that. However I don't agree with your point about arguing with the doctor when they are planning "unnecessary intervention". I'm sorry but for all the reasons I explained previously, how on earth can you claim to know when a doctor is proposing something that is unnecessary? You are basically saying here that you know better than the doctor .You simply don't have the medical knowledge to make that call against a consultant, that's just logic. Saying that you do is kind of proving my point.

I’m not a midwife - sorry if I gave that impression, @PregnantSea. . I did 8 weeks of obstetrics as part of my general training, and was trying to see both sides of the issue. Doctors are highly trained, but are more likely to see problematic births and can be predisposed towards more proactive intervention, whilst midwives - who are also highly trained - see the vast majority of uncomplicated births and are more likely to believe that a birth with no intervention or minimal intervention is not only possible but preferable.

The problem with intervention is that one intervention can lead to another and another, and end in a highly medicalised birth which is not right for the woman, when a bit more patience could have led to a less medicalised birth, a better experience for the woman and an equally safe outcome for the baby.

I am an example of when the hands-off approach of the midwives led to a better experience for me without any negative results for my baby.

With ds1, my waters went, and from that point until the birth was 37.75 hours. I was in first stage labour for 36 hours, u Dee the care and monitoring of the midwives - which is longer than many hospitals will let women go following rupture of membranes. I was monitored for any sign of infection, and was allowed to go through labour at my body’s pace. When I did start to push, that went slowly too, and I wasn’t making enough progress, so I was moved, by the senior midwife, from an ordinary labour room to the higher risk room (where more intervention could be carried out if necessary), but stayed under the care of the midwives. Eventually, when ds1 was crowning, the midwife suggested an episiotomy, and I agreed - and that enabled me to deliver him with no more intervention.

If the doctors had been involved, I am sure I would have been given drugs to speed up my labour, which would have made contractions much more painful, so I might well have been offered an epidural, so I’d have been less able to move around and be active in labour, which would have slowed things down more. I might well have ended up needing internal monitoring, so I’d have been unable to get off the bed. I wouldn’t have been allowed to go on pushing for 90+ minutes - at best, I’d have ended up with a forceps or ventouse delivery, maybe even a Caesarian.

The midwives’ patience not only enabled me to give birth with minimal intervention, it also enabled me to have home births for ds2 and ds3 - if I’d ended up having a CS with ds1, I would have had to have a hospital delivery for subsequent babies - probably sections again.

Doctors are highly trained professionals, but so are midwives, and as I said, both professions should respect the skills, experience and knowledge of the other. We are - or should be - past the days of the nursing staff being seen as inferior to the doctors, and just there to be their handmaidens. Doctors can be wrong too, and when the midwives are arguing with the medical staff, they may well be right!

As mothers, do you feel like it's more appropriate to talk about possible emergencies in an antenatal class / appointment, or would that have made you more frightened of labour? (Not a rhetorical question; we're overhauling a few aspects of midwifery care at our hospital and perhaps an extra appointment to talk about these things would be something we could add in.)

Absolutely. At my ante-natal class we had an average age of 36, someone with a pre-existing heart condition, someone with already high blood pressure (which turned into pre-e) and a couple of other things. We asked about interventions and were told we couldn't discuss them, that positive thinking would see us through. We ended up with 3 c-sections including my horrific c-section which I didn't give informed consent for (by the time they shoved the consent form into my hands I couldn't read or remember my date of birth) and 3 forceps deliveries one of which in particular resulted in massive blood loss and a lot of stitches to repair the damage as a large back to back baby was yanked out. There were 7 of us.

I detest the argument about not wanting to ‘scare women’ with actual facts to prepare them for labour, so very patronising and infantilising.

I really do agree that better education beforehand helps so so much with being able to give informed consent if a decision needs to be made quickly. My 1st birth taught me that. I only read the leaflets and booklets provided to me by the midwives, I lapped up the mantra that ‘birth plans go out the window, don’t bother’ I genuinely thought I had to go along with whatever the medical staff wanted, that I was ‘allowed’ or ‘not allowed’ to do things, it didn’t even occur to me that my consent was legally needed for anything. I ended up with a really traumatic experience as a result of this. My second birth, I researched and knew my rights, my options, the different choices available if certain things happened. It was much easier to communicate (even via my birth partner) what I wanted and to actually know and understand what I was consenting to.

I think from this angle it’s less ‘scary’ to worried pregnant women to say ‘oh this could possibly happen, you’ll be offered forceps you may wish to choose a c-section instead bla bla’ showing them that you don’t have to hand over total control.

SDTGisAnEvilWolefGenius

I am an example of when the hands-off approach of the midwives led to a better experience for me without any negative results for my baby.

and I'm an example of how that approach can put a baby in NICU and a mother under the care of the adult mental health team still almost 4 years later.

With ds1, my waters went, and from that point until the birth was 37.75 hours.

With my dc1, my waters went and from that point until the arrival was 81 hours because they didn't want to intervene. Ended up with failed forceps following a couple of hours pushing and an emergency section which tore my uterus.

So how do you balance it. I endured 75 hours of agony (first contraction hurt as much as the last) for nothing. My child suffered in utero and in NICU and at no point was I asked what I wanted. My husband nearly lost a wife, my son didn't have a mother for the first six months and nearly 4 years later (and another child) we are still dealing with the repercussions of his arrival.

My birth was also described as an emergency situation, but I could have easily given informed consent to either have Keilands forceps tried first or whether to go straight to a c-section if I’d properly been informed. It bothers me that somebody else that made that decision for me, about my own body. I have to live with the consequences of something I would never have agreed to.

Lots of areas of medicine will have issues with consent in emergency situations, however I find in childbirth it’s then just extended out into other situations (including emergencies) where consent and decision input could easily be obtained. And even everyday non-urgent procedures like vaginal examinations etc seem to constantly happen without consent

I do wonder whether it would ruin an aspect of job satisfaction for a lot of medical staff if they are suddenly on equal footing to the women in their care and are expected to gain consent and respect them as equals.

I'm an example of someone who was pressured into a venteuse delivery completely unnecessarily by a pushy doctor who the midwives could see was making my birth difficult. In fact pressurised is generous; I never actually consented. My labour slowed down every time he came in the room. He wanted to medicalise it from the start. I was on my third delivery and I knew there was nothing wrong with my baby. It honestly felt like they just wanted the room. In the end my dh had to intervene to prevent a cs. The fact that he was able to prevent it proves it wasn't necessary and it wasn't a true emergency. The key in all of this is "listen to the mother!" Whether it's over intervention or under intervention it is failure to listen to the mother that makes it potentially abusive.

I had a full debrief following a complaint. It turned out they had a picture of how they expected my labour to go (literally what the monitoring should have looked like) and mine wasn't tracking the picture. I was pressurised into the monitoring in the first place and it too was slowing down my progress because i couldn't walk around. There's quite a lot of evidence I've read which suggests that monitoring causes you to not be able to move around which slows down labour which increases the need for pain relief which slows down labour which increases the likelihood of an epidural which further slows down labour and makes a cs much more likely as a "solution" to a long labour. It was the doctor who needed the monitoring in the first place and therefore they created the situation they saved.

Gosh yes the not listening. I was told that because I was managing with just a Tens machine I couldn't be that advanced in labor and certainly didn't need any kind of pain relief.