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.

@Soontobe60

Hello, I read this on Sara Wickham's Instagram page, she posted it on the 1st of June

I've tried to attach a screenshot I'm not sure if it will work because I haven't done it before, but if not and you wanted to investigate further that's where I read it

@Soontobe60

In answer to your other query, I would hope she was able to make an informed decision and do what she felt was right for her. You can opt to wait for natural labour to occur after waters breaking without opting for induction, but that does have possible risks of infection so that's something that a woman would need to decide for herself.

@Soontobe60

Hello, I've only just see now you copied me in to another comment. I'm glad you had a good experience with your midwives and felt supported in your decision.

To mousey I am so sorry to read about what happened. I hope you and your son are getting all the help you need and are well supported xx

I can see where the OP is coming from but I do think that birth is such a crapshoot that it is a little naïve to dismiss medical interventions on the basis of little more than an untested idea that if we have more "natural" labours somehow the outcomes for mother and baby will be better (also better how?)

I was similarly privileged to have the time, resources and wherewithal to read lots, plan my positive birth, hire a doula, kit out my living room for a lovely home birth, for similar motivations. I feared a cascade of interventions, I wanted a nice "experience" and I was frankly arrogant. I believed I knew better than the entire medical profession after attending a hypnobirthing course and reading some Gaskin, that birth was medicalised unnecessarily. On paper I looked low risk and so was supported in my decisions.

On the day, I was one of those 9 in 1000 where it goes horrendously wrong and we both had a 999 transfer due to a very rare complication no one saw coming and the obstetric team had only read about. We both ended up in ICU, both facing a risk of very severe, catastrophically disabling neurological damage. Somehow, miraculously, we are both fine, but I didn't see my son for two days until I regained consciousness and he had months of follow up appointments to screen for neurological damage. It was only because one of the obstetricians recognised this condition on the day that we are both still alive and well.

You can read as much Milli Hill, Gaskin and Odent as you like, but you never know with birth. You can never tell if you will end up with a positive experience, or you will end up in a life threatening situation. And the outcome is largely down to factors beyond your control. I put my baby and myself at risk because I thought I knew better than the doctors, and I wanted a nice, positive birth experience. They were the ones saved our lives though.

There is a trend to dismiss medicalisation in birth, and to an extent I can agree, but as others have said, do not underestimate having a healthy baby and mother at the end of it. For me and any further pregnancies, if that means having a cascade of interventions and a shitty stay in hospital for a few days, so be it.

I'm not entirely sure what the answer is. Others on this thread may think that if 199 women managed to avoid an induction that resulted in a very difficult birth, then we should accept the one birth that had a terrible outcome.

I don't think it's as simple as inducing vs not inducing. It's also about the pathway that follows induction of labour, and the likely outcomes after labour is induced.

Once you piece it together, the percentage of induced labours that end in ventouse/forceps delivery or EMCS for first-time mums is really high. (I'll try to find some stats, but this figure isn't usually published directly.) However, that's not presented in a clear way to women when they are asked to consent to induction. Instead it's implied that their labour will progress in the same way as if they had gone into labour spontaneously, which isn't really true.

I think if presented with the statistics that (say) there was a 75% chance of a forceps delivery or EMCS after induction, lots of women would choose to have the caesarean then and there rather than after hours of exhausting labour and a failed forceps delivery. (Note - 75% isn't the actual figure - I'm looking for stats now)

I fully agree Dragon.

I remember in my VBAC meeting, it was absolutely geared towards persuading me to have a VBAC - every stat she gave me was to persuade me against a pre-planned c-section (which from re-reading my notes was far more appropriate), yet she didn't mention any stats with similar stats that didn't - ie. it was a snow job, I wasn't fully informed at all. It generally all felt very production line, rather than looking at the woman in front of them and actually thinking what would be best in her case.

In general there seems to be this wanting to divide childbirth into good vaginal deliveries and bad cesareans when talking to women antenatally and the real picture is far more nuanced than that with a lot of people having poor experiences of vaginal births that no one seems to want to talk about

I've had both the most medicalised birth and the most unmedicalised. I've had twins and a singleton. They re teens now and I used to frequent many many pregnancy and baby forums. I've seen women post all of the views expressed here many times over.

We do nerd to stop pitching 'natural' v 'medicalised' here. I really feel we are fighting the wrong battle. The truth is that maternity care is severely lacking in many ways. And though it doesn't directly influence outcomes and can be sidelined, the attitude and respect for women and their views/capacity to have valid views on their own care is woeful in the extreme. The fact that we still haven't worked out a way for a woman to have proper continuity of care is a scandal. Most women understand that a medicalised birth is sometimes necessary, of course they do.

This is something we can all agree is needed desperately, not least because it is clearly helpful to avoid unnecessary interventions.

I won't go into my own complicated story but I can tell you the scariest bits were when I didn't know what was happening.

Tbh I considered myself no more qualified to decide what was medically necessary or advisable during my births than I would when having an operation etc. I wasn't even particularly keen on making a birth plan, because I wanted to let the medical professionals do whatever they thought was best. I'm not sure how I would have known whether I was being given the best advice or not tbh.

I was induced both times due to being overdue and having increasing hypertension. Both births were pretty difficult, first one was back-to-back delivery. I certainly wouldn't have wanted to be anywhere but in hospital. The idea of home birth gave me the heebie jeebies tbh.

Here's a very clear summary of the findings of the Cochrane Review into induction of labour:

www.cochrane.org/CD004945/PREG_induction-labour-women-normal-pregnancies-or-beyond-37-weeks

@Coreblimy

I'm not against necessary medical intervention, I'm sorry I haven't made that clear. Ultimately what we all want is for everyone to be safe and in an ideal world for women to look back on their experience as being positive.

I would like an NHS where women can make informed decisions, ideally where we are assigned a midwife who is with us from the start until the labour, so that there is continuity of care.

A few ladies on this thread have mentioned that there is a trend for non medicalised birth, I don't know about their areas but where I am the majority of women are induced (imy trust on their birth statistics) and homebirths are virtually non existent. Hypnobirthing itself is something that is meant be used in all types of birth and it is meant to be used as a way of giving women a sense of control and decision making. Unless a woman is in an emergency situation, there is always a choice and I think getting the opportunity to make that choice might not change the outcome of the kind of birth she has, but it could change how she feels about it.

I do find it upsetting that for a lot of women it does appear that they are being given inductions unnecessarily. Even if you look at what is recommended it changes from trust to trust so there isn't even continuity within the NHS. It's all well and good saying that we should ultimately always listen to the medical professionals, but even medical professionals don't all agree because of some of the advice being given is opinion based not fact based.

I had a typical induction that was long, uncomfortable and ended in an EMCS. If I go overdue if I get pregnant again I'll go for an elective CS and cut the fucking middleman out. Like other posters have pointed out, since they so highly end up in EMCS I don't see the fucking point. I had a 'good' induction because after 16 hours on the drip labour stalled and I was absolutely done in. I know other women that battled on resulting in very tough births.

Was there much research to compare the different methods and environments for these inductions as that could make a lot of difference potentially in the experiences for the women. This side of induction doesn't seem to be focused on so much.

Funny how it’s always those who haven’t had one, who don’t see the need for medicalised birth..... having a nice, natural delivery is sheer luck and nothing whatsoever to do with ‘preparation’. Can you honestly say that after hours/days of pain and lack of sleep, you would go against medical advice just because bloody Milli Hilli told you not to......?

I agree with the posters saying that post natal care is horrific but birth itself is just a lottery. I will be turning up next time with no expectations whatsoever. I certainly won’t be hoping for some twinkly light, intervention free ‘experience’ for myself. Childbirth is barbaric; you’ve just got to get through it. I say that as a committed feminist. I just don’t think the ‘experience’ seeking, all natural crew are doing a positive thing for women.

I do understand what you're getting at Perpetually. I don't think it makes sense to plan your perfect birth and expect it to pan out that way. My approach to it was o be totally open to all suggestions, and I had some great MWs along the way.

But when I talk about improving the "experience" of induction, I'm slightly euphemistically meaning "not being alone and scared and in mind-crushing amounts of fucking agony with only a begrudgingly-given paracetamol for comfort".

I never understood the fuss about creating a nice calm atmosphere for birth. I thought that was for weirdy crystal-gazers. But then I experienced first hand how panic and adrenalin mess you up and work against you in labour. So for my second birth I hypnobirthed like fuck. And even though I did need some intervention and ended up in theatre, I was much calmer and felt in control and that helped it all go smoother.

I'm not against medicalised births at all. And childbirth will always be hard, no matter which way you do it. But I totally disagree that it is necessarily barbaric. Men would never put up with this crap.

@CovidCorvid

* 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.

Just catching up not read all.

The hell? Oh fgs.. One size does not fit all. I want proper looking into differences in gestation for women from different backgrounds. Ways to monitor or somehow wait and see rather than what happens at the mo.

The outcomes from induction in terms of time labouring, intervention, emergency, CS and the resulting impact on the woman are rubbish aren't they?

I didn't mean for my post to sound quite so dismissive of all birth planning. I will make sure I am aware of all options, as I did before.

Like previous posters, I am exasperated by the lack of middle ground which seems to be available. You either throw yourself completely at the mercy of the medical experts/be a good girl and do as you're told. Or you go full hippy, natural and reject any intervention. I have looked at doulas and find it very hard to find anyone impartial/not signed up to some kind of dogma.

I didn't realise until after my birth just how infantifilised I had been. I was told I had 'lost a lot of blood'. It took reading my own notes to see I had a PPH and a transfusion was being debated. And don't get me started on the 6 week check which didn't happen..... nobody has checked my episiotomy scar to this day! The after effects of my birth were so downplayed and under-medicalised, it took me a long time to realise just how ill I had been.

The problem with this topic is I think

There is no crystal ball. There is only retrospect.
The consequences when things go wrong can be as bad as they get.
There is so much misinformation, withheld information. Strongly held opinions which the people who have them can be really zealous about.
From women I know, the support for women after traumatic birth is non existent.
The approach to pain seems peculiar. For some it's almost a point of pride to have no pain relief. Many women struggle to get any.

And then there's the fact that women who have had bad experiences naturally focus on what in their opinion went wrong. And discussion feels very personal, incredibly personal. That's natural of course but it often means that any threads about childbirth descend into intractable positions and a lot of upset.

Meanwhile the service is still failing large numbers of women and more babies are dying than should be.

We need to bring our experiences of course. But focus on the service we get. The unnecessary deaths of mothers and/ or babies. In more than one hospital. That the level of women who have terrible experiences/ are traumatised/ have PTSD due to their experiences are unacceptable.

That whatever the ideas about giving birth 'properly', the point is to get the baby out safely and in my opinion with the least pain/ damage/ fear for the woman possible. Unless she really wants the pain etc.

All the stuff about giving birth without pain relief etc being very empowering. Yes I'm sure it is. However. The idea that women are somehow better for that is awful.

It's in the press all the time (too posh to push is that still a thing?) and on here when a woman is having an elective. There's loads of posters saying it costs resources, recovery is awful, the baby will miss out on vaginal bacteria etc. And even when it's pointed out that elective means planned and is usually for a medical reason... Still they go on.

The whole tone is women arguing with women. When it should be women pushing for better care.

Like previous posters, I am exasperated by the lack of middle ground which seems to be available. You either throw yourself completely at the mercy of the medical experts/be a good girl and do as you're told. Or you go full hippy, natural and reject any intervention.

Yeah, I think you're bang on right there.

@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 a shit time with interventions I didn't want and don't think I really needed.

BUT I was so traumatised and then left with a tiny human to care for I didn't have the energy to fight for recognition or change.

I'm still raging about it but by the time I was up to making a fuss it all seemed too late.

Perpetually I agree.

I think the idea of a birth plan is to give women who are going to give birth whatever happens, a sense of control.

I didn't have one. If I did it would have just said all the drugs please.

The breathing and music and whatnot. Is surely only the sort of thing a subsection of women are into.

And the info is biased.

Essentially I got.
Breathe etc.
Water birth? (If they have a pool).
Any pain relief past gas and air is a disaster.
Not going to mention sections.
Not going to mention what the aftermath is really like. The possible injuries. To not to hesitate seeing a doc etc.

How many births are that way?

My group out of 10 there were a couple of planned CS and about 4 emergencies.

Forewarned is forearmed. Why are women being treated like children with this?

@RaeRaeMama “ It's all well and good saying that we should ultimately always listen to the medical professionals,”

Literally nobody said this.

You heard about some deeply upsetting births on this thread - and PP have said clearly that NOBODY knows, because nobody can rewind time - what would have happened if things had been done differently. Every woman does the absolute best she can by her own body, her own birth. Everybody here wants more support for women, not to be steamrollered either by medical birth process or the “natural” crew.

I’m sorry your NHS trust didn’t make you feel listened to but clearly different NHS trusts do things differently (mine did), women and births are different. I see you have an issue with induction specifically - despite by your own account, not having had one. I just don’t understand what you are trying to achieve on this thread. Maybe there are too many inductions, I don’t know. It’s a balancing act because there are no “facts” out there waiting to be discovered, each birth is new.

A wise poster on a different thread on birth resolved the birth prep/it’s all luck debate something like this: “reading up and knowing your options can give you a better birth experience. But despite that, sometimes in birth things happen that are beyond your control.” It was very good. I will try to find it.

@RaeRaeMama just to pick up on Hypnobirthing itself is something that is meant be used in all types of birth

Hypnobirthing was no use to me. How dare you proscribe what works for anyone else? Can’t you see how that comes across!?

Ironically I had a fully medicalised birth but at my own request, elective c section. However I’d still argue that I had to lie through my teeth to get it. The fact is, most women don’t get a choice and aren’t made aware of the options.
I’d probably have had a vaginal birth except I know that the anaesthetist would probably have been “busy” when I needed her so I’d have had to plough through with only light pain relief. Because who cares if women are in pain eh? They’ll cope.
No way in hell was I going to risk it so I choose to go full medicalised. It was fantastic. It should be a choice for everyone. Not that I’m saying that it’s the right choice for everyone. But every women should be able to choose how they give birth and what pain relief they want without being fobbed off by what is still fundamentally a patriarchal institution.

Still birth rates in the UK have not decreased significantly since the 1980's, nor has the rate of inductions changed significantly, however, the rate of cesareans has increased.

What would be good is to really understand where the risks are and to act on those.

There is a huge amount of research on this topic, despite people assuming there is not. There is one particular paper that concludes that cesarean rates above 15% do not improve outcomes for mothers or babies. Not all intervention is positive. But.. there is much that can be done to improve birth and much of that involved watchful waiting, undisturbed physiological births and a deeper understanding of the biomechanics of birth. Often the research looks at something that midwives know not to be the right question.. like a research paper i read which compared the outcomes for women who took an all 4s position during early labour to those who didn't. Those who work in the field know that if labour is progressing and mother and baby are comfortable, there is no need to dictate position and that instinctive positions are best, if things slow down or become intensely painful, there are biomechanics informed positions and movements that can help baby move and mother to release muscle tension and increase the diameter of the pelvis in different directions. Sometimes several of these interventions are necessary as the baby progresses through the pelvis. Despite lots of research on this, most women in the UK still give birth lying down and with their knees apart so the birth attendants can see the baby coming when in fact, biomechanically, on all fours or kneeling with the femur rotated inwards (kness closer together, heels out, makes more space at the base of the pelvis for the baby to pass through.

And when things get stuck, don't progress, become intense, we have things that can help, epidurals and cesareans, these are hugely important tools that we should use and should not with hold from women who need and want them.

but we must realise that as soon as we intervene, we disrupt the natural hormones in the body, artificially administered syntocinon cannot pass the blood brain barrier and there fore does not trigger the release of pain relieving endorphins and the hormones required for the milk ejection reflex so induction can indeed make labour more painful and can affect breastfeeding.

The question about. how many women and babies do we harm by induction or failure to intervene in long labours resulting in babies are born stressed to exhausted or medicated mothers where the perimaternal and perinatal reflexes and hormones are interrupted, to save the life of one still born baby.. that is not the right question, partly because we have not reduced the numbers of still births since the 1980's but it is how do we effectively and efficiently identifies those mothers and babies for whom those interventions are useful.

The evidence to support some of the increases in interventions is poor and the research to understand the negative impacts of interventions like artificial syntocinon is also poor. We need to get better at understanding the questions to ask and to really understand how we make birth better for mothers and babies.

Soap box!!