Labour

I don’t want children. I’m not particularly fond of them, have very little patience and a low tolerance of high-pitched noises. I’m also under no illusions about how much childbirth will fucking hurt. However, luckily for the repopulation of the planet, some women do want children. Some of them are my friends. And listening to their stories about pregnancy and childbirth, it seems there’s a trend in antenatal classes to downplay the pain and convince women to go down the natural childbirth route.

When my friends got into the labour suite therefore, and discovered for themselves how much it absolutely hurt, they were begging for drugs – only to be told, in a number of cases, that they were too far gone and they could only have gas and air. That was a new one on me. I’d had no idea there was a point beyond which intervention wasn’t allowed. You’d have thought midwives would point this out during labour, instead of standing over the sweating, shrieking woman, coaxing her away from pain relief. Is pethidine being rationed?

So I’m not exactly surprised to read in the Guardian today that there is a rise in the number of women asking for caesareans for second or third births, after experiencing birth trauma with an earlier baby. This article seems to lay the blame at increased medicalisation and intervention, much the Naomi Woolf route. I have two thought about this.

First: I can well believe that being surrounded by people in white coats prodding at you with things that beep and metal things that are cold and sharp, when you’re in the middle of giving birth, could be horrible. I’m sure there are doctors out there who forget the mother and concentrate on the baby. But I also wonder whether the natural childbirth lobby has raised women’s expectations to an unnatural degree. Very few women will experience labour as a wonderful time filled with rose oil and Mozart. There could be complications, it could last days, it will hurt. If you give birth in a hospital, there will be machines and bright lights because it is a place of modern technology, all there to make sure both mother and baby are safe. Are women adequately prepared for this reality?

My second thought is also related to the natural childbirth lobby. If women have had a first labour using no pain relief, is anyone really surprised that some of them are a bit traumatised afterwards? We wouldn’t have a tooth pulled without anaesthetic these days, it seems bizarre to think we would attempt to push a bowling ball out of our vaginas without something to dull the pain. Here, of course, I need to pause and acknowledge that I am not someone who will ever imagine experiencing an amazing connection with the bowling bowl I am pushing out of my vagina; I will never be sat in an antenatal class being told that pushing a bowling bowl out of my vagina will be the most incredible experience of my life. So I will never feel a crushing sense of disappointment and failure when pushing a bowling bowl out of my vagina feels like pushing a bowling bowl out of my vagina, and not an incredible connectedness to my baby and the glow of motherhood. But I can imagine that some people would. In fact, I know some people would – remember Kate Winslet? (That’s a link to the Daily Mail; disable your Tea and Kittens blocker before clicking.)

Dr Tracey Johnstone, consultant in foetal maternal medicine at Birmingham Women’s hospital, says “a lot of women are less tolerant of pain now”. I think we’re all less tolerant of pain now. That’s what comes of living in the modern world. When did the idea come back that pain in childbirth was good? Women gve birth naturally 100 years ago because they had no choice; they also died a lot because of things like puerperal fever. That’s ‘natural’ too. Dr Johnstone goes on to say: “they should realise that childbirth is painful”. I think you may need to have a chat with the antenatal classes in your area, Tracey. Because from what I can gather, a lot of them have been taken over by people with agendas.

We’re supposed to be all about choice these days. Yet in childbirth, women don’t seem to be given the full range of options. They have pressure to resist pain relief – some NHS trusts have targets to reduce the number of epidurals. Hmm, maybe pethidine is being rationed – and live up to a golden image that may be impossible for them to achieve. What’s wrong with giving women the truth about the pain, the interventions on offer and the risks and consequences of them all, and letting them decide for themselves? In a neutral fashion, without anyone telling them what’s ‘right’ and ‘natural’? Set up realistic expectations for women, and I bet you anything there’ll be fewer traumatised births.

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3 responses to “Labour

  1. Amy November 16, 2010 at 11:30 am

    Apparently epidurals for first time labours aren’t generally encouraged, according to my midwife, because you can’t feel as well to push and first time mothers ‘don’t know what they should be doing when it comes to pushing’, which leads to greater likelihood of interventions, e.g. forceps/ventouse/episiotomies/c-section etc. I’m not sure I agree – for me, on both occasions the second stage of labour and the ‘push’ stage has been more of an uphill struggle than the ‘urge’ they talk of. Both of my babies have emerged just as the consultant has popped into the room to talk about interventions, the little drama queens!

    In my experience, you don’t really get much information beyond the technical unless you seek it out yourself. I’m not sure if that’s the right place for the responsibility to lie? With my first labour, it was an emergency induction – I was given a photocopied A4 leaflet on inductions and given half an hour to digest the information in the delivery unit. Given the situation, not the best frame of mind to absorb detail…

    As it happened, I had a reasonably good idea of what was involved, the risks and process – but that was thanks to an amazing yoga teacher whose classes included half an hour each session talking about things labour-related, the different stages, inductions, pain-relief, caesarians etc and from the point of view of people who’ve been through it, rather than the cold medical detail.

    While clearly it’s sensible to make an informed decision based on risk of action/inaction, you can ask questions of the medical staff – like “why do you need to do that?”, “what are the risks if you don’t do it?” “What happens if we wait half an hour before doing it?” etc – and questioning medical professionals is not something that would have crossed my mind previously.

    In the throes of labour you’re not best placed to communicate, and that’s when a good birth partner comes into their own, in terms of representing your best interests and giving you some control over proceedings. For instance, in my first labour, the midwife kept trying to make me lie on my back – it’s the easiest position for them to examine you in, isn’t it? However, in a back-to-back labour (baby’s spine against yours, instead of other way around), it’s also the most excruciating position to be in. And you can be examined in other positions, it’s just less convenient. Huge gratitude to my husband for arguing that out with the midwife when I was in no state to… I think that having him there briefed and fighting my corner, plus a prior knowledge of what was going on (albeit theoretical), made it a less traumatic experience than it otherwise would have been.

    With my second labour, when they sent me home at 10.30pm (2cm dilated) I said to my husband I bet I’d miss the window for pain relief – and sure enough when I arrived back at 12.30am (oh how surprised they were that I was fully dilated) it was too late… with the benefit of hindsight I should have argued that my first labour had a very fast first stage and insisted I stay put… Sometimes you know your body better than they do.

  2. rachel bagelmouse November 16, 2010 at 11:52 am

    “Sometimes you know your body better than they do.”

    Interesting you should say that – you’re not the first person I (we) know to have been dismissed in early stages of labour only to say ‘erm, no’, and for the initial medical decision to have been wrong.

    I think your experience shows that each woman is different, and each birth is different, and each woman should be allowed to make her own decisions based on her own expectations / situation / prior knowledge, after being given all the information in a neutral way – in advance. It’s no good heaping on new information in the delivery room. On epidurals, for example, my mum had one and I was born fairly quickly, and without extra intervention, even though I was breach. Does that mean all epidurals are good? No. Does it mean epidurals are bad? No.

    The main intervention that seems to be needed here is common sense – stop bombarding pregnant women with different opinions and let them get on with it…

  3. Amy November 17, 2010 at 4:34 pm

    Following on from this, Department of Health survey out today says:

    “Only around two-thirds of women surveyed were offered antenatal classes while only 42% of those who knew about them thought there were enough classes in the course (42%) and that they covered the topics women wanted (45%).”

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