Sunday, 23 February 2014

If giving birth is safer than at any other time in history, why is the prospect scarier than ever?


Giving birth is a pretty nerve wracking thing; anyone thinking about going through it or looking back on the experience can testify to that. It seems to me that it is especially terrifying in the UK at the moment, which really shouldn't be the case. In terms of medical advances in monitoring high-risk pregnancies and special care for premature or high-risk infants, we should be comforted that, chances are, mother and baby will come out the other end ok.

But if you hang out with parents much, there is usually a rather grim edge to discussions about birth. More often than not, it's better to avoid the topic entirely.  Nearly all the mothers I know have had at least one negative birth experience. This does not necessarily mean that the outcome was negative or tragic. It means that they found the experience in some way distressing or traumatic. In a few cases, this can be very serious; the term "birth rape" is now becoming more widely used, referring to women being made to feel vulnerable and constrained, subjected to intrusive physical interventions by medical staff without their consent.

This is not the place to delve into the gory details of birth stories. I will simply say that both my birth experiences, although clinically straightforward, were not what I would have wanted. Long labours and stitches aside, on both occasions at various times I felt anxious, vulnerable, neglected and helpless.

And I guess I was warned that the glowing birth experience of my dreams was unlikely. In the hospital antenatal classes, the frank midwife told us that we would come in wailing in pain and the midwife would say "you are only this much dilated" (holds fingers to size of 5 pence piece), "go home". This did not suggest there was going to be much sympathy or care when we arrived at the hospital. And when trying to call the birth centre to book a tour, no one ever answered the phone - not very reassuring when this was the number you were supposed to call when in labour. Similarly, my NCT classes (yes, we did both!) presented a situation where we were unlikely to have much say. We were advised to stay at home as long as possible  - arrival in hospital would only start a series of events over which we would have little control be it inductions, IV antibiotics, ventouse, forceps, emergency c-sections...

Giving birth is the time when a woman is most vulnerable. It is the most primal, all encompassing physical experience, usually involving a lot of pain and anxiety. Yet in the UK, you can expect to be attended by complete strangers, who more often than not are overworked and under-resourced. It is not surprising that time and sympathy are in short supply. If you are lucky, your partner can stay with you but they can end up taking on the role of midwife, as yours is having to tend to several women at the same time.

Everyday the news tells us that midwives are leaving the profession in droves as cuts make their jobs impossible and dangerous. Women who want to care for women in their greatest time of need are working past their contracted hours with no breaks. This article in the Independent from a midwife leaving the NHS after 10 years is both depressing and heartbreaking.

It wasn't always like this. Our grandparents had kids younger and had more of them, with fewer of the pregnancy and birth complications associated with age and obesity that are commonplace today. Many more women had babies at home or in small maternity hospitals. In the 50s and 60s, women stayed in hospital for 1-2 weeks after a normal birth. Clearly most people these days would rather get home than hang about in a hospital but it is sad that where once we cared for women at this time of huge physical and emotional upheaval, now they are kicked out after 6 hours with a dry piece of bread and a bag of painkillers to make space for the next one. Home births are an option for some but not all, depending on your postcode and your level of risk, and many home births seem to end up in a stressful blue-lighted ambulance journey as the midwife unsurprisingly has to err on the side of caution.

I would say my own birth experiences have had a lasting impact on me and the current maternity situation does not give me confidence in having another child. I know I am not alone. The middle classes are choosing hypnobirthing, doulas, independent midwives and private hospitals. Where does that leave everyone else?

Wouldn't it be nice to have someone familiar to look after you? Wouldn't it be nice to feel calm and safe and cared for? This is what everyone deserves. And look, I know there are women dying in childbirth across the world, but surely we need to stop regressing...It deeply saddens me that it is the maternity services and A&E services that are being axed across the country, yes the two services that when you need them, you really need them now and you need them close by.

Is this a feminist issue? I would argue that women are suffering disproportionately from cuts to our health service and we need to fight that, in terms of protecting both female patients and female employees. It is sad that fear of birth is affecting some women's decisions about whether to have a child at all, let alone in what place or manner that birth might take place.


10 comments:

  1. Your post echoes a lot of my own feelings and I too am struggling to find an answer to the question.

    I'm now 10 weeks on from what I, and many others have agreed, describe as a very traumatic birth. I won't go into details. I was SO positive about birth before I had my son, I genuinely felt invincible. Unfortunately, I didn't quite have the support of a good midwife and I think that ultimately led to the catastrophic sequence of events that was my son's birth. It's something I will never recover from mentally (though hopefully physically I am doing).

    Since then, I am really disheartened and saddened to hear so many people who have each have very different births, but majority of them would term them as traumatic for one reason or another. I struggle to find people who have had what they feel was a fully positive birth. I often wonder what has gone so wrong in NHS midwifery services that mothers, and fathers too for that matter, feel this way?

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  2. I read your blog with such a heavy heart. My own birth experience was mixed. The first part a fantasticly empowering and calm experience with Hypnobirthing. The second part, a catalogue of escalating interventions. All of which I now see were unnecessary.

    So many women say 'it was ok in the end', which means 'my baby was fine and that's the important thing'. But I believe that's just not good enough. What about the endless numbers of women who are living with feelings of dissapointment, or guilt about what happened.

    I now teach hypnobirthing in an attempt to help some women to have a better experience, and hopefully feel more in control. But it is an uphill struggle with mums-to-be having low expectations, and midwives burdened with protocols and paperwork.

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  3. I have mixed feelings about your article. On the one had I completely agree with everything you have said, on the other I see yet another article telling women how painful labour is supposed to be. I was petrified of giving birth when I got pregnant due to all the horror stories women pass on to each other. You hardly ever hear of any 'good' birth stories. In order to get over my fear I hired an independent midwife and attended a Hypnobirthing course. I also read 'Childbirth without Fear'. I went from wanting a C-section to wanting a homebirth. When I went into labour at 2am on my due date I was so relaxed that I didn't even think I was in labour. I didn't even call my midwife out until the last minute. She arrived at 7:30am and my son was born at 8:20am in a birthing pool at home. I had gas & air to help me regulate my breathing as I couldn't breath deeply enough at the end stage and I can honestly say it was not a painful experience at all. That is the power of your natural endorphins. I even had a small second degree tear. There was no 'pushing'. I relaxed and let my body do what it naturally does. Now I agree that not everyone can afford an independent MW. In fact independent MW can no longer practice due to the recent EU ruling. (Another one there for taking choice away from women!). What I found the most useful aspect of my MW was the continuity of care. I believe it is this aspect that health providers need to focus on as well as educating women of the process of childbirth. Every book and every class (inc the NCT ones I attended) focus too much on the 'pain' relief aspect and not enough on how to avoid it altogether (because you really don't need it as long as adrenaline does not get into your system). To all the women out there, please don't assume labour is an awful experience. Research it for yourself and good luck x

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  4. Thanks for your input everyone. I agree that a positive mind set and relaxing therapies can really help - some great birth stories in Ina May Gaskin's Guide to Childbirth, pregnancy yoga and reflexology helped me to stay calm and focused during tough circumstances. Sadly they don't change the reality that most women face in NHS labour wards and birth centres.

    I guess I'm referring here to a political issue - for all the women who can organise home births, hire birthing pools or pay for hypnobirthing (usually about £200-250 per couple), there are many more women who are being very poorly treated in our current system. It is not OK that the only way to get a good birth is to pay for it. Our maternity services need to change so that everyone can get the birth they deserve.

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  5. I think women need to remember that it is their body and their baby. If u feel in control of what is happening, half the fear dissipates. Women need to know they can speak up for themselves and not just get swept away by hospital protocols and procedures.

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  6. A great and timely article; as you say Maternity services are being cut and not enough new midwives are being recruited; a travesty and definitely an issue that affects women both as patients and workers.

    I am currently pregnant with 2nd baby and have a newly diagnosed, but unrelated to pregnancy condition and battling doctors at my hospital for what I feel are totally unnecessary interventions and concerns about my baby and the birth (in the process of getting a second opinion). So I do agree with the commenter above, but it is difficult to argue against hospital protocols sometimes. And I only feel I have the confidence to do so 1)as a health professional myself and 2) as I already see a consultant at another hospital who is completely unconcerned with regards to my pregnancy and how I want to have the birth. It is often less informed women and those disengaged from the health care system, normally from poorer and less educated backgrounds who disproportionately and unfairly suffer the consequences.

    But on a positive note; it is possible to look outside the politics and nhs led maternity services and (try!) and get the birth experience that you want without having to sell all your worldly goods to pay for it. I am much more cash strapped this time around due to that other great feminist issue of childcare fees and not having the back up of maternity pay to rely on. So I got a book on pregnancy yoga from the library, have arranged to meet up with other imminent second timers through a FB group to discuss feelings around birth again, got a cranial osteopathy appointment through a charity so I didn't have to pay full wack for it (luck of living in London though) and have found the confidence to self refer myself to a home birth team even though my GP midwife was not keen on the idea through local forums and meeting up with other mums who have had home births - and hopefully a free inflatable water pool to borrow in the bargain! I know this might be more difficult to achieve if you live in a more isolated place but good community links can help you have a good birth even when the NHS does sometimes slightly let you down!

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  7. Thanks for your post, that's a really interesting perspective. I do think it is very hard to fight hospital protocols - even though I think of myself as well-informed and reasonably confident, I tend to do as I'm told - especially if "told" by assertive professionals when I am feeling vulnerable and confused that their way is the only way to safely bring my baby into the world.

    Hopefully we can help more women to be positive and assertive about the birth they want but also fight to save services so that women continue to have the option of home births, birth centres etc. Good luck with baby 2 - as always, a bit of help and support from people around you goes a long way :)

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  8. Oh I've found a kindred spirit. One of my sayings is "maternal health is a feminist issue". Women are being disproportianetly affected by cuts. Also a lot of the "birth industry" is run by men - magazines, tv production companies, advertising agencies.

    I had a potentially scary birth my son was born by c section at 27 weeks. The consultant team and midwifery team worked to make it calm, beautiful and memorable. I had a great birth. I didn't feel frightened because I felt empowered. My consultant who I had only met the previous day for the first time, put me in the centre of that experience, and made me feel like I was in control.

    As women though, we need to take ownership and empower other women, not just here, but across the world, to help them realise that childbirth is part of the feminist experience and deserves to be valued as such.

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  9. I totally agree. Essentially it doesn't matter what type of birth you have, it is whether you feel empowered throughout and then ready to cope with being a mother. I will be publishing BIRTH WEEK this month, hopefully with a good mix of positive angles along with what needs to change, so please keep a look out!

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  10. there needs to be a total change in the way pregnant women are prepared for birth and yes, we all need to be empowered and armed with the knowledge to make confident decisions in childbirth. If any pregnant woman is taught the process of what happens at each stage of labour and practises some relaxation techniques (such as hypno birthing) birth becomes understood as a natural experience and is not scary. The medicalisation of birth itself by the NHS and on television portrays it so wrongly, giving an impression of birth in general causing pain and trauma which will be eased by medical intervention such as epidural or Caesarian. Why are women always shown as lying down in a hospital bed when being static like that is not advisable during labour? Nothing could be further from the truth. I managed to understand this through a £10 book and £10 hypno birthing cd on Amazon so not much money actually needed!

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