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.

I had one induction because my labour was 'too slow' and they needed the room. Horrendous cascade of interventions birth. SIL worked labour ward and said they use inductions to manage patient numbers. I developed a risky condition with my second and was told I would be induced. I asked to see their policy for this condition and when they finally gave it to me it said women should be told the risk of child and maternal death was higher with inductions than from the condition. No induction, perfect labour and we were fine. With my third I was told I would be induced at 40 weeks exactly as I was over 40. It was the element of being told and the fact they were telling me I had to do something that increased my risk that was so shocking.

Obviously some interventions are necessary but many are not.

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

I think you’re being quite simplistic about this, OP. I did all of those things, did a lot of research, hypnobirthing, NCT, Gaskin, the whole bundle (and I grew up with a mum who taught seminars on this stuff and was a natural birth advocate and NCT leader, so I was well versed in it all).

In my own DD’s birth, the midwives failed horrendously both at the non-medicalised bit, and then the medicalised stuff. I had an extremely traumatic emergency instrumental birth after a precipitate labour, cord compression and the cord wrapped round the baby’s neck several times so tightly that there was no way I could have delivered normally.

The medical obstetric team (all women) were far better than either the “natural” or the “medical” obstetric midwives, several of whom bordered on negligence or incompetence. I would have been much better off had the birth been more - and more safely - medicalised, rather than the opposite. I would also have been a lot better off if I had seen a doctor earlier, who would have been alerted to what was going on (hypertonic labour which should have been slowed down).

Yes we should be sceptical about overmedicalised birth; but equally, some of the fantasies and practices around “natural” childbirth are also dangerously misleading, and midwives are not qualified to the standards that doctors are (and there is plenty of bad practice and ignorance among midwives). Some of the things I heard both midwives and the hypnobirthing practitioners and doulas advocating were dubious in the extreme and certainly not evidence-based. Some of it, sadly, was old wives’ tales and a bit of woo dressed up to sound good.

Safe, good maternity care should combine both the best and most up to date medicine and excellent woman-centred care. It shouldn’t be one or the other.

One of the things that would make a huge difference to the progress of many births, for example, would be a scan in early labour to check for malpositioning, potential cord accidents and so on. When I asked the emergency consultant why this didn’t happen, the answer was only the expense of having a sonographer on site 24-hours. (This is considered too expensive, but tellingly a multimillion-pound midwife-led water birthing unit which almost never got used was considered just fine….because it fitted with the idea of non-medicalised birth. Only, as soon as you needed anything more than gas and air or had any medical need at all you got transferred right out of there again).

If I ever had another baby I would be asking for an elective CS, my experience with the (female) midwives was that bad. My experience with the (female) doctors was great. I didn’t see a male HCP anywhere in the maternity hospital the whole time I was there, and I gather that’s not uncommon for obstetrics. So it’s not any more just a “female knowledge vs male medical establishment” issue.

'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'

This is the sort of attitude that bothers me. A lot.

The poster is on a different page but if you're still reading I'd love to know what your thinking is around making that comment.

Many women have shit births for a variety of reasons
Many women cannot read up for various reasons, or even think to do so
You must be aware that things change, go wrong with births. Sometimes mothers die. Babies die. Both.

Your view is this sort of thing is essentially the fault of the mother. That's what you said.

Why do you have that view?

You must be aware that women who have had all sorts of terrible outcomes are on MN. A poster earlier on told of the situation with her son.

You realise you're saying it's their fault?

I would like to understand why you have that view and also why you choose to express it when you know women who have had tragic outcomes will read it.

@Talkwhilstyouwalk read some of Milli Hills books or even better Sara Wickham’s book on induction. The research on birthing outcomes is rarely clear cut. Wickhams book is very good at explaining this and talking through the studies which have informed policy/guidance in the U.K.

Op I am so glad you started this thread. Read any of the birth club threads, people are being induced left right and centre quite often because they’ve been told by their doctors that their baby’s safety would be compromised if they don’t agree and this is often before anyone gets close to being overdue.

My understanding is that if baby’s safety is at risk or baby is ill they perform a c-section very quickly. They don’t wait days for an induction process that potentially puts a baby through the more intense contractions of an augmented labour.

Women are also not being properly informed by medical staff that once they get on the induction train they can’t get off. So many people seem to be told that they’ll start with the pessary and that’ll be enough, so they assume they won’t need the drip but that so often isn’t the case. Or they want to go home and then get told they can’t or they want more paint relief and that is withheld, or they are told they can’t progress to having their waters broken because their isn’t enough staff.

There needs to be more discussion about the experiences of women in these scenarios, about what they can expect and about what the risks of induction actually are for mother and baby.

I think induction is a massive issue.

I may be biased!

But that's what I think.

I should add (as it wasn’t clear in my post) that I also had an induction that was botched by the midwife administering it! But ultimately the birth was more complex than that in that the induction was badly done and caused the hypertonic labour, but the cord compression was not necessarily related.

I agree totally that induction needs far better use and management.

@irresistibleoverwhelm

That sounds dreadful, I'm sorry you and your baby went through that

The comment you highlighted, just to be clear, I meant for me personally if I hadn't have researched and read everything I could I would have likely stayed put with the team and the trust I was under, the way things were for me I think it would have gotten quite unpleasant. Even under my p midwife I still experienced a lot of pressure from the hospital when I went over my due date and this ruined the end of my pregnancy. I'm not saying that all a woman needs to do is read and her birth will be fine.

@NiceGerbil

I absolutely do NOT think that (I have actually said as much in a much earlier comment)

This whole post was because I felt I was fortunate, I was lucky but I don't think I should have had to use my savings to help me feel supported. This was my first pregnancy and I was frightened. Women should be getting the support and the correct care from the NHS. I'm not rich, I don't have lots of spare cash, I worked to save that money over years as a security net and I spent all of it just so I could feel safer. I sometimes think what could have happened to me if I hadn't have been able to save. I am lucky.

In regards to the comment you highlighted, I've explained in my comment below to another poster, I was referring to my personal situation. I don't expected every birth to go wonderfully just because you read a book. I'm saying, if I hadn't of read some books then I probably would have just trusted whatever the doctor or midwife told me and I don't think things would have gone well for me.

Im still fairly new to Mumsnet and I naively thought that surely other women feel the same way I do, that we should be getting more support and it's not right that so many women are being unnecessarily induced, but perhaps not because I feel as though a lot of commenters have just made lot of assumptions about me and been on the attack. I probably didn't explain myself well at all, I feel very passionately about this. Every time another woman talks about their poor experience I feel so upset on their behalf, that things should be better for them. They deserve it.

@PinkPlantCase

Thank you!

Sara Wickham's book is amazing, I wish everyone woman considering induction could know about it because it tells you everything you need to know so that you can make informed choices. It's one of the best books I've ever read and really helped me later in my pregnancy during a difficult time.

I feel like everyone seems to be getting inductions too, I follow a few pregnancy pages and every other post someone is going for an induction. My trust area has been releasing the birth statistics from November to present day recently (they have said they are playing catch up) and it has shocked me the amount of women having inductions.

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

The new draft Nice guidelines have done this amd they’re proposing to bring the standard induction date forward…I think to 40+7, it’s 40+10 at the minute.

I get the sense, OP, that you're talking mainly about induction and assisted vaginal births.

It may be worth remembering that some of us elected for a c-section and actually had a bit of a fight on our hands to opt for the most medicalised birth one can have!

I only mention it because it was absolutely the right option for me and I would do the same again in a heartbeat. Just another point of view.

@RaeRaeMama yes I remember it coming up during NCT... out of 8 of us I think only two had non-assisted vaginal births and one of those was slightly premature, so only the one had a go in the MLU in the end! Actually maybe two, one lady I can't remember her story. But we definitely had three c sections (beech, pre-eclampsia, v big baby) and two inductions for SGA/IUGR.
I really do understand where you're coming from, I felt quite rushed into going for induction when they realised DD was SGA and had had a few RFM episodes and when we were in on monitoring she was absolutely fine each time (had meconium/distress during labour due to hypertonic (?) reaction to the drip, and infection) but I think in that small subset any one of the 'medicalised' ones could have gone very wrong had they waited to see.

I'd love to think I can have an MLU birth if we have another but I would still think long and hard about going against medical advice after doing due diligence, just because they see far more births than I ever will.

@RaeRaeMama I am sorry you feel attacked. To be fair, I think the way you went at this made a fair few of us feel attacked. Literally every woman I know would say that birth needs to be woman-centred but as with anything important in life, people have different views how to go about that principle. No woman should be bullied either to have a more medicalised birth than she wants, or to have less medical care than she wants.

I had one induction because my labour was 'too slow' and they needed the room. Horrendous cascade of interventions birth. SIL worked labour ward and said they use inductions to manage patient numbers.

My baby is 17 now but this rang painful bells for me. I was asked to come in for a check about 36 hours after my waters broke, spent about an hour pacing the floor of the gynae wards trying to establish contractions. Was then told I was being sent down to the Labour Ward as gynae was getting full and the Labour Ward was lovely and empty. It was only when I got there, settled in a room and my husband sent off to the 24 hour garage to get himself a coffee, that they told me that I had to be in labour to be on the Labour Ward, so a drip was going in. Then only once the cannula was in my arm that they explained that meant no water birth, no toilet trips, no moving from the bed. I came out the other end with a healthy baby but spent weeks crying and months having flashbacks.

I am sympathetic to the fact you feel attacked op and do understand where you're coming from.

However this statement really stood out for me:
, if I hadn't of read some books then I probably would have just trusted whatever the doctor or midwife told me and I don't think things would have gone well for me.

Because I did that. I hired an expensive hypnobirth practitioner who told me stories about women whose waters had gone for days and days and they still had a healthy baby and natural birth. People told me medicalised horror stories and lovely water birth ones.
It all culminated in me making the decision to delay induction. I only waited 48 hours, but that was 48 hours that changed my life and my baby's life forever.

Yes induction is painful. Yes it may not always be necessary. But the view it's overused caused me to wait and the cost to my baby is too high. I've got severe depression, been suicidal, have extreme guilt because I believed those stories. If stories like mine were being told maybe I'd have acted differently. I knew it was a risk but didn't realise how quickly it can go wrong or how many actual lives ruined that tiny statistic is. I knew most people go into natural labour anyway within 48 hours. I knew most babies don't get infections.

But I was one of the unlucky ones.
And you were lucky, op.
That's kind of how birth works, yet an earlier induction and listening to the medical staff would mean my baby wouldn't have cerebral palsy. When something as permanent as that happens to you you realise how temporary giving birth is.
I have to deal with the fact I prioritised a natural birth over my baby for the rest of my life.

I did say I wasn't going to post again, but I think it's important stories like mine are put there.

Because without them it's not really an informed choice.

And I wish I'd heard one. My whole life would be complete and not destroyed.

That's it really.

I'm so sorry, Mousey. And I'm sorry that my own post sounds crass and unthinking next to yours. I would have framed and worded it very differently if I'd read yours first.

I wouldn’t want a non-medicalised cancer treatment or a non-medicalised operation. I don’t think it’s the medicalisation that’s bad. Also Hasn’t there been a lot of trouble recently (is it in Shrewsbury?) of midwifes prioritising their belief in ‘natural’ births over the safety of mother and child?

For me the most important thing is that women who are pregnant are given enough information to make truly informed decisions about their labour and birth and that they can make meaningful choices about how it happens within the unique constraints of their labour.

I would have made the same post if I had had a healthy baby.
But I learned the hard way why the NHS is risk adverse and think more stories like mine need to be told. If my post makes one woman double think her choice and it stops a situation like mine it's worth it.

@MouseyTheVampireSlayer

I am sympathetic to the fact you feel attacked op and do understand where you're coming from.

However this statement really stood out for me:
, if I hadn't of read some books then I probably would have just trusted whatever the doctor or midwife told me and I don't think things would have gone well for me.

Because I did that. I hired an expensive hypnobirth practitioner who told me stories about women whose waters had gone for days and days and they still had a healthy baby and natural birth. People told me medicalised horror stories and lovely water birth ones.
It all culminated in me making the decision to delay induction. I only waited 48 hours, but that was 48 hours that changed my life and my baby's life forever.

Yes induction is painful. Yes it may not always be necessary. But the view it's overused caused me to wait and the cost to my baby is too high. I've got severe depression, been suicidal, have extreme guilt because I believed those stories. If stories like mine were being told maybe I'd have acted differently. I knew it was a risk but didn't realise how quickly it can go wrong or how many actual lives ruined that tiny statistic is. I knew most people go into natural labour anyway within 48 hours. I knew most babies don't get infections.

But I was one of the unlucky ones.
And you were lucky, op.
That's kind of how birth works, yet an earlier induction and listening to the medical staff would mean my baby wouldn't have cerebral palsy. When something as permanent as that happens to you you realise how temporary giving birth is.
I have to deal with the fact I prioritised a natural birth over my baby for the rest of my life.

I did say I wasn't going to post again, but I think it's important stories like mine are put there.

Because without them it's not really an informed choice.

And I wish I'd heard one. My whole life would be complete and not destroyed.

That's it really.

@MouseyTheVampireSlayer I’m so sorry for what you’re going through. All any of us can do if what we believe is right at the time OP. I can’t even begin to imagine how I would feel in your situation Can I just say a huge THANK YOU though for sharing your story. I know it must be difficult for you but I really believe stories like yours need to be heard loud and clear. In order for women to make informed decisions they need to hear about all possible outcomes. I think all these threads demonising induction and intervention are quite dangerous sometimes actually. When I was advised to be induced all I could find online was horror stories of horrendous inductions and natural birthing sites telling me I had every right to refuse and my baby would come when it’s ready. I’m very thankful that I went with induction and had a very positive outcome.

Thanks. Life is very hard at the moment. Obviously it will always be but it's particularly raw at the moment.

Just for clarity, by the way, no red button was pushed for me and I gave birth vaginally.
The stroke could have happened in the hours we waited, or in the hours I was having the induction (there was an emergency elsewhere so the staff disappeared for a few hours)
I had antibiotics as well on a drip so despite their best efforts it happened. There isn't really much you can do other than hope an infection doesn't hurt your baby, once it's set in motion, not much can be done.
I was naive about that and thought a red button situation would save him.
It's very sad to think about how those misconceptions contributed to an unnecessary disability.

@MoonlightApple I think the problem is that many women aren’t given enough information to make informed choices about induction. Or they are given lots of information about the ‘first choice’ eg. A pessary induction or a ballon catheter but much less information about what needs to happen next if labour doesn’t become established. Or they aren’t given that info until after the first intervention has happened.

Equally there are different approaches to birth in general, as you say some people want a more medical approach, it makes them feel safer and they think it’s best for their family. Other people see birth as a natural process (both the good and the bad) that doesn’t need to be medicalised.

I don’t know how doctors and midwives find the balance but I guess they somehow need to become more patient led rather than using universal pathways, there need to be more opportunities for women to tailor their care. Whether that’s for a woman to decide she wants an elec. c section or a home birth.

In all fairness my trust do this very well, they have a dedicated home birth team where you have the same midwife the whole way through and I’ve found their views have very much aligned with mine but I’ve still be well informed of potentially risks of choices whilst always still being given the option to have ‘a home birth outside of guidance’ if the result of any particular test would mean that a hb would no longer be recommended. There has been no pressure, I could still decide on the day that I want to give birth in a birth centre or in delivery suite.

Anyway it’s the people that have no strong view on birth either way that I worry about. I imagine that’s where the most unnecessary interventions happen if women aren’t fully informed about what their choices are aside from what a hospital ‘has always done’ are and what the knock on impacts could be. Eg. The benefits of mobile during labour.

@KM38 I’ve actually found the opposite on here though about people’s approach to induction, there was a thread a week or two ago by a lady who was over 42 weeks but was refusing induction, she was overwhelming told by other posters that her baby would probably die as a result of her actions and was called stupid and selfish etc.

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

I did that and once of mine And me would’ve died if it hadn’t been for medical intervention.

Thankfully no long term damage, but that statement there is so crass.

mousey I'm so glad you came back and posted again. Stories like yours are really important. All the best to you and your son. X

Pink Plant.
One midwife told me I'd feel horrible if something happened.
That haunts me everyday.