Induction

[RaeRaeMama]

Why is nobody talking about how medicalised the NHS has made birth?

I didn't know the shit storm I was walking into when I got pregnant with my first. I think a lot of the treatment of women is absolutely disgusting and I cannot understand why we are all letting it continue.

@Bordois

Its not such much that birth is medicalised its the way that you are told that this is whats going to happen.

For me, I was told that I would be induced at 40 weeks, because that's what they did for mothers over 40. At no point was it presented as an option, just thats what was going to happen.

I agree with this, absolutely. I had higher than normal uterine artery pi at 20 weeks (which has since normalised) and I keep being told that they won’t ‘let’ me go beyond 40 weeks. Now, that may well be the medically sound approach and induction at 40+1 might be what I choose. But

1. the language of ‘not letting’ me go overdue is terrible. They should explain what the benefits and risks are of inducing or not inducing and give me an opinion on what they consider to be the safest option. I should then decide. That would be more accurate in terms of what they can actually do, and, more importantly, it would make me feel safer, more informed, and more empowered, all of which are shown to improve outcomes.
2. I am absolutely certain that the 12 week scan dated the pregnancy 5 days later than it should have, so 40 weeks by their count would be 39+2 in mine. I would at least like the option of talking through going with my dates rather than theirs. As it is, I feel I’m being treated as though I don’t have the right or the ability to understand or make decisions (with support from medical professionals) about my own body and my own labour. It does not sit well with me. At all.

@KM38 I've had the exact opposite experience - been told that I dis not need an epidural and if the anaesthesist had to come in every time a woman was put on the drip the nhs would collapse under the budgetary pressure or something. Strong hint that I was a wimp. (I'm not a wimp. It hurt like hell. And if they gave drugs that cause this kind of pain to men you bet your socks they wouldn't have to beg for pain relief.)

I had a positive birth because I spent my pregnancy researching and reading so that I could make informed decisions throughout about mine and my child's health

Do you think those of us with shitty births just weren't educated enough? That we didn't do our due diligence? Fucking unreal.

Some of us need medicalised births. We should be trying to improve the processes around that to make it more positive, rather than demonising it.

This thread is making my birth PTSD go off hard so I'm muting it.

I have had a lot of surgery in my life. I trust doctors generally, I like them. My parents are doctors. I spent s lot of time in children's hosp.

I've had more general anaesthetics than you can throw a stick at and plenty of invasive scar leaving cutting up.

I heal well and am used to recovering from surgery.

I was induced. Waters went about 3 hours later. Started passing meconium. Got told to lie on my left side for the monitor even though I KNEW that I shouldn't do that as it felt just wrong. Started vomiting with each.. contraction? Cervix was tight shut. My body was not ready. My baby was not ready. Who cares how overdue. It was not yet time.

Anyway vomit vomit. Meconium. They took me to birthing room thingy.

By this point I was really struggling. I thought/ assumed contractions would feel like really awful period cramps. This felt like a knife in my gut with this kind of awful twisting feeling. I knew it was wrong, you know? I've had a lot of pain in my life but this was .. different. Vomiting and just... Not right.

The midwife said what's the matter with you? Why are you being sick? I've never seen anyone behave like this before. She looked... Like she didn't know what to do tbh.

I had been offered no pain relief at any point.

Anyway then a doc came in and looked at the monitor (foetal distress) looked at me (distressed) and said we need to do an emergency section. And I thought. Great. Thank God. Back with what I know. Kind anaesthetists. Etc.

Couldn't get epidural in so I had a block and fuck me. It was just so good.

Baby out. Rushed her off. Cleaned her up. Skin to skin in recovery room. All good.

[quote RaeRaeMama]@KM38

Yes there does need to be a degree of responsibility with the women themselves. But I feel like, particularly with first time mums, they trust that they will always be given the best advice and I don't think they always are. I don't see how they can when the care isn't individual[/quote]
@RaeRaeMama The same could be said in any medical situation though, not just childbirth. I think it’s just as dangerous going into childbirth and not listening to the opinion of the professionals.
I have one DS - born during lockdown. I had an induction on medical advice. I knew I would be labouring alone for at least part of it due to covid restrictions so I ensured that I had researched as much as I could and knew what I was happy to accept and in what circumstances. I knew the higher risks associated with induction and ensured that I researched all possible interventions.

I still need to get that off my chest sometimes.

Second was planned section and was easy as pie.

'But I do also believe that women need to research and know their options and stand up for themselves'

You see I hate this.

Which other situation where hosp is involved it's up to the patient to do the research and speak up?

Some mothers are very young
Some mothers trust the NHS ante natal classes
A large number of adults in the UK have a reading age of 8 (I think it was, can find stats)
Etc etc

No.

It should not be up to labouring women who are by definition vulnerable to do this.

And loads of partners are shit.

Thanks Rae. No it wasn't that. I was induced in a room on the maternity ward and they don't allow men there at night (for the safety and privacy of the other women). I knew that as soon as I was in established labour, I would be moved to the delivery suite where I would be allowed a) my birth partner and b) proper pain relief i.e. gas and air as opposed to just paracetamol. What no-one ever explained to me was induction isn't like a normal labour, and you can be having strong frequent painful contractions, but not dilated enough to be in established labour. So I was scared and in pain and alone in a room. (And unfortunately with a midwife who didnt give a shit.)

Anyway - there's me all panicky and full of adrenalin, cascade of intervention etc. Honestly, if I was going through it all again I'd insist on sitting in the car in the car park with my husband. I'd have been better off.

Sorry long post, not expecting anyone to read it all. I'm a really calm placid person, but this still really upsets me when I think about it 9 years and a second happy birth later ...

I really do need to fill out that consultation, don't I!

[quote RaeRaeMama]@CovidCorvid

I would argue that the interventions cause more harm than good

I read yesterday that in the past 16 years induction and interventions have increased but still birth rates have not fallen [/quote]
There is evidence that when saving babies lives bundles have been implemented the still birth rate has been cut in those trusts by 25%. here

Saving babies lives bundles are still not fully rolled out nationally and a lot of hospitals have only adopted some of the bundles snd not all yet…working towards the others.

In the West Midlands which has led SBL they looked at historical still birth cases and the cause for those and they reckoned that if SBL bundles had been fully implemented during the time period they examined they could potentially have cut the still birth rate by 50%. West Mids have had the best results since implementing SBL and I think their current rates are around 50% lower than pre SBL.

[quote Hoping4second]@KM38 I've had the exact opposite experience - been told that I dis not need an epidural and if the anaesthesist had to come in every time a woman was put on the drip the nhs would collapse under the budgetary pressure or something. Strong hint that I was a wimp. (I'm not a wimp. It hurt like hell. And if they gave drugs that cause this kind of pain to men you bet your socks they wouldn't have to beg for pain relief.)[/quote]
@Hoping4second I’m sorry you had that experience! Nobody should be refused any kind of pain relief that they need. It absolutely should be every woman’s right to have their pain managed the way they choose.
It was my hope that I would be able to have a labour with as little pain relief as possible and I am very thankful that I was able to have that despite being induced and having a longish labour (39hours).

I think so much of this must come down to staffing. I had home births (and where I live only 2% of births were at home which I assume includes unplanned home births so not at all usual). I felt very lucky to have the undivided attention of 2 midwives throughout my labour monitoring me. I knew if things started to look risky I'd need to go into hospital (which was fine) and I felt cared for through out. I trusted everyone. I'd have been happy to have had my baby with any medical intervention required (and drugs would have been a bonus!) but for women with low risk, who live near a hospital etc a home based birth can be great. That said the midwives left very quickly after and I think better support in the week or two after would be great. The birth is just the start!

@BlueBrush

Thanks Rae. No it wasn't that. I was induced in a room on the maternity ward and they don't allow men there at night (for the safety and privacy of the other women). I knew that as soon as I was in established labour, I would be moved to the delivery suite where I would be allowed a) my birth partner and b) proper pain relief i.e. gas and air as opposed to just paracetamol. What no-one ever explained to me was induction isn't like a normal labour, and you can be having strong frequent painful contractions, but not dilated enough to be in established labour. So I was scared and in pain and alone in a room. (And unfortunately with a midwife who didnt give a shit.)

Anyway - there's me all panicky and full of adrenalin, cascade of intervention etc. Honestly, if I was going through it all again I'd insist on sitting in the car in the car park with my husband. I'd have been better off.

Sorry long post, not expecting anyone to read it all. I'm a really calm placid person, but this still really upsets me when I think about it 9 years and a second happy birth later ...

I really do need to fill out that consultation, don't I!

Similar to me.

I agree induction really needs to be looked at.

One size does not fit all. Term is on average different in different parts of the world. I'm sure I read that women of Asian background are left too long, and those who are full on North European of the very pale variety are done too soon.

I mean that's shit.

If I knew then what I know now I would have insisted on waiting... Or would I? The your baby could die if you don't is a pretty massive push...

@NiceGerbil

'But I do also believe that women need to research and know their options and stand up for themselves'

You see I hate this.

Which other situation where hosp is involved it's up to the patient to do the research and speak up?

Some mothers are very young
Some mothers trust the NHS ante natal classes
A large number of adults in the UK have a reading age of 8 (I think it was, can find stats)
Etc etc

No.

It should not be up to labouring women who are by definition vulnerable to do this.

And loads of partners are shit.

I agree with this. It should be health care professionals presenting unbiased options to women with full statistical explanations where possible. If a woman then wants to choose something which goes “against” the policies, etc the midwife should be an advocate for the woman and stand up for her if necessary. I’m aware that sadly that may not often/always happen.

I still need to get that off my chest sometimes.

@NiceGerbil I see you a lot on FWR and you're always full of wisdom, but just for this I'd like to pour a for you and the other women on this thread and just wallow in a moment of shared crapness.

And yes I did loads of research too. They just weren't very honest with me.

I had two so-called 'elective' sections (a term I particularly hate because neither was actually optional). I knew my births would be radicalised, and I am incredibly grateful that I had two safe deliveries.

What I found hard was the complete unwillingness of anyone, other than the consultant, to talk about c sections. The midwife refused point-blank in the ante natal sessions. I felt like nothing was particularly upfront. So, what exactly are the risks of a ventouse? Or what are the pros and cons of pethidine? So much time was spent on 'breathing' and how DH could support me, but I was left to research myself. I'm lucky in that I have the capacity to do that - but does everyone?

For me, the bigger issues with maternity care are related to the postnatal experience. Pain relief offered was poor and infrequent. My DH is medical and could advocate for me, but the most vulnerable don't have this. This is not the case for other surgeries - why can they manage pain relief?

Plus there is a shocking lack of understanding about BAME amongst many midwives. It is just not acceptable that black women are at such a huge risk of maternal death.

You sound a bit naïve, op. You've had one experience that you were fortunate enough to be able to afford to hire an independent midwife for, and you've read a few books.

The decision to recommend a medicalised birth is absolutely not taken lightly. Every guideline is evidence based and absolutely has a reason for recommendation. Most midwives will attempt to keep women on as normal a path as possible.

I understand your desire to promote normal birth but I actually think the way you're coming across is a little dangerous and derogatory.

Iam yes of course it's staffing.

Birthing is in this weird middle ground between medical and not.

Giving birth is huge though. It's a massive thing for the woman to do. She may need help. She may not.

But there's no crystal ball.

What other stuff that is hospital-y though

Are the patients (can't think of a better word!) expected to read up on it themselves so they can know what to do and
Tell the people looking after them how to look after them properly
When else is informed consent so often out the window?
Are there any other abdominal procedures with the same level of severity as a section where you are expected to go home the next day. And be responsible for a newborn?!
Why is pain relief often so hard to get?
And why do they let hard sell people into the ward to flog stuff to women who are tired/exhausted/elated/in pain?
In my case. On morphine!! Hard sell to someone on morphine? I mean come on.
The partners are there 24/7 to provide care... That's why. How is that ok?!

Anyway. I just want things better for women and less pushing of this or that and guilt.

I have 2 friends who feel they failed! Because VB didn't go as planned. I mean FGS.

@YourSexNotGenderIsOnFire

My water's broke but labour never fully established, so I had to be induced. It all ended with an EMCS because my baby's heart rate was dropping. He had the cord wrapped around his neck. It was very medical but we're both alive and grateful for the NHS.

I don't really understand the point of your post. If anything I think we ought to be examining the pressures placed on women (including by various hypnobirthers) to have a non-medicalised birth when this is often not the appropriate route. They sell you on these ideas of using a birthing pool which is actually only suitable for a small proportion of women.

This happened to me as well. I didn't dilate very much. I wonder if the harder contractions caused the distress or if I could have progressed more naturally if in a position where gravity helped.

The lying down position was rubbish and I was too uncomfortable to walk around. I thought a sitting position straddling a chair in the opposite way to which you sit would have been more helpful. Or being to put your weight on something, while leaning forwards.

Sadly, the maternity section didn't seem to be geared up for many options for women giving birth.

BlueBrush thank you

I think it's a little off to suggest that those arguing against medicalisation are suggesting that those with a need for interventions shouldn't have them.

But there is a lot of evidence that too many interventions cause a lot of damage and maternity care is full of unnecessary interventions.

I think to some extent it's about a certain culture of birth that easily grows in a hospital environment. It tends to treat birth as disease and doctors often want to DO SOMETHING when birth is often about waiting. And about convenience in a medicalised setting - timing, moving around, monitoring. Safetyism has also had an impact.

I always find it interesting to se the difference between human medical practitioners and vets and farmers - the latter seem to be much more clear-eyed about the fact that they are dealing with a biological system. So an environment where the mother feels safe and calm, or moving around, etc, are really important factors, and interventions are known to have real potential downsides. Many of these elements are largely discounted in hospitals where the body seems to be viewed as a machine.

As for why this isn't reformed - I think a few reasons. One is that big systems like modern medical systems hate to change and have a huge amount of inertia, and they hate to lose control. They are risk adverse. The aggressive approach of a lot of modern medicine isn't very compatible with maternity care. Good maternity care takes a lot of time and is expensive as a result.

And there are pretty mixd messages from women, too. On the one hand complaints that interventions aren't medically warranted and lead to too many sections and poor outcomes. On the other complaints that it should be up to mums to choose sections and interventions no matter whether they are medically indicated.

'What I found hard was the complete unwillingness of anyone, other than the consultant, to talk about c sections. The midwife refused point-blank in the ante natal sessions. I felt like nothing was particularly upfront. So, what exactly are the risks of a ventouse? Or what are the pros and cons of pethidine? So much time was spent on 'breathing' and how DH could support me, but I was left to research myself. I'm lucky in that I have the capacity to do that - but does everyone?'

Yes. This exact thing.

I asked about CS and pain relief in my NCT class and my NHS one. (PFB ).

They looked unhappy and refused to talk about it.

They DID talk about the cascade of intervention a lot. The message was. As soon as you get any pain relief essentially you're on the road to ruin. So don't.

???

Women in that room were going to end up there, how does that make them feel?

I also raised on my NCT breast feeding session. Do you have any advice if it's painful, you get mastitis, or you just struggle. She said. That's so unlikely there's no point. I said, all of my close friends have had various issues. She said. Well that's extremely unusual.

And that was that.

Why not be honest? Give some useful info?

It's all about shielding women from the bad stuff isn't it. Why? Women are being treated like children imo.

No I didn't, because I used my savings and hired a private midwife so I had more control over what happened. But I was very pressured for my baby being "late"

Well, that's because the risk of still birth goes up after a certain point. Doctors and midwifes want to act in your best interest but you don't have to take their advice, it's just that most people do......

There is a book called how to give birth like a feminist?! Surely a book called how to give birth safely would be more useful? Whatever next......

Can't agree with all of that smokedduck.

I think it's not so cut and dried.

Induction needs to be looked at properly. Totally reviewed. Women are being induced too early and that is an awful experience.

OTOH. My experience of midwifery on the NHS is it is very much Pro natural birth and almost against letting the docs near you. To the point that women get the idea they've failed if they need even pain relief.

' On the one hand complaints that interventions aren't medically warranted and lead to too many sections and poor outcomes. On the other complaints that it should be up to mums to choose sections and interventions no matter whether they are medically indicated.'

It's not about too many sections

It's about instrumental deliveries that can and do cause massive injures to women, and can and do harm babies.

CS is a different ball game.

Medical experts base their decisions on research, why would they do anything else? I don't for a minute believe that their aim would ever be to oppress women! This is a really wired thread!

@Talkwhilstyouwalk

No I didn't, because I used my savings and hired a private midwife so I had more control over what happened. But I was very pressured for my baby being "late"

Well, that's because the risk of still birth goes up after a certain point. Doctors and midwifes want to act in your best interest but you don't have to take their advice, it's just that most people do......

There is a book called how to give birth like a feminist?! Surely a book called how to give birth safely would be more useful? Whatever next......

Have you even read the thread? Suggest you do so.