Thursday, 28 February 2013

Stop Googling Your Birth Options, And Hop Up On The Bed, Dear

Here's something every pregnant woman might like to know: during labour, you will be given a routine vaginal exam every four hours, and this will be used to check your cervical dilation, and to chart your progress. Your midwife might mention this at your antenatal appointments, but here's what she probably won't tell you - the exams are optional, you can refuse them, and unless there seems to be a problem or you actually want to know how dilated you are, it's probably better that you do, since this invasion of your privacy can actually bring you out of your Labourland trance, making your 'mammalian self' feel threatened and slowing or halting the very progress they are trying to check.

Learning about the various procedures, such as 'V.E's', that are likely to take place during your labour and birth can help you to make truly informed decisions about whether to accept or refuse them. It can allow you to think about the kind of labour you really want, and empower you to know your rights and take control of the experience, giving you a feeling of ownership and satisfaction, regardless of the way you ultimately birth your baby. There is a wealth of information available now to pregnant women, in particular thanks to the internet, and at the touch of a button you can inform yourself, and discuss your plans and concerns with other women who have 'been there, done that'.

Brilliant, right? What's not to like about this? Surely those concerned with the care of birthing women must be thrilled that some of them are actually taking an interest in what happens to them, and - often literally - getting off their backs and taking an active role in their labours? You would hope so, and yet Terri Coates, a practicing midwife, lecturer in Midwifery, and clinical editor to Call the Midwife, doesn't seem to be in favour of it in this interview from Tuesday's Mail:

"A lot of young women in the 1950s didn’t even know where babies came from. They were happy to have someone lead them and were more deferential. Now women are far more savvy, have apps on their phones, mum-and-baby books, better education. They know what they want and how to get it. Managing their expectations is like walking a tightrope. They expect the perfect birth, the kind they see in magazine pictures. Some feel that if they have anything but a drug-free birth, they’ve failed. But if they end up with a healthy baby, they’ve done extremely well."

So - the modern and informed woman is making life difficult for the professionals who have to 'manage her expectations'. Terri Coates seems to suggest that our access to information is encouraging us to set our sights too high, and she trots out the patronising and tired old idea that we should all be happy with a healthy baby. This attitude completely dismisses the mother's birth experience, and is often most painful to those of us who experience birth trauma, making us feel that we should stop complaining and be grateful that everyone simply survived.

As Elizabeth Prochaska, founder of Birthrights, the new UK organisation dedicated to promoting human rights in childbirth, puts it:

"What's worrying is an increasing tendency for healthcare practitioners to view the mother as simply a vessel for the production of her foetus, and to say “as long as you get a healthy baby and a live mother out of it that's all that matters". But it's not all that matters. Look at the cost to the healthcare system of women with serious disorders post-childbirth...The rise of post-traumatic stress disorder and post-natal depression are problems, too."

Women who have been traumatised are finding their voice, as in this recent article, in which several women, including Toni Harman from One World Birth, speak about the terrible treatment they suffered during labour and birth, including being shouted at, having their wishes ignored or belittled, and feeling as if they were being raped. 

However, commenting on their stories, Dr Gedis Grudzinskas, a former professor of obstetrics and gynaecology at St Barts Hospital, London, seems unmoved. It seems he agrees with Terri Coates - we women are getting our hopes up too high:

"There's a world of diminishing resources but increasing expectations from mothers-to-be. Labour is an all-consuming process, and discussion can be very difficult because you might only have one-and-a-half minutes between contractions. So there may be a perception of doctors and midwives being too assertive - therefore bullying - but they have the patients' best interests at heart."

Our hopes are too high - we expect silly things like a decent shot at the birth we really want, and if that turns out not to be possible, for professionals to talk to us and touch our bodies kindly and with respect.

Grudzinskas also echoes Terri Coates yearning for the good old days, when women - apparently - just did what they were told without question, and the dangerous technology of the internet was not at their disposal:

"In the old days, women referred to doctors as experts. Now, many women think they're well-read because they've done research on the internet. But much of that information isn't correct."

Birth guru Sheila Kitzinger takes on this attitude in her excellent new book, Birth and Sex:

"An obstetrician once snapped at me that he couldn't stand 'back seat drivers'. He meant women who had ideas about what they wanted in childbirth."

And, with the usual twinkle in her eye, she tells this story:

"One obstetrician in a major teaching hospital where one in four women had a Caesarean was pleased that there is 'increasing maternal input into childbirth'. It is not clear what he means by this. Women have always had a lot of 'maternal input'. Doctors could not produce babies without them."

Women - with the help of the internet and all of the information and communication that it brings, are taking back childbirth. Slowly, ever so slowly, the balance of power is shifting, and it is this that is causing some professionals to feel uneasy and long for a time when women would defer to their expertise, not ask so many questions, and comply.

If a woman declines vaginal exams in labour, this is likely to make things a lot easier and more enjoyable for her, but have the opposite effect for her carers. They will have to rely on other methods (and skills that they may not have) to make their assessments. They will not be able to chart her dilation on a partogram. If they can't do this, they won't be able to fully assess her 'progress' or lack of it, and follow their usual procedures and protocols according to the clock. They might even have to behave like the midwifes 'in the old days' as Dr Grudzinskas would put it, and, putting down their clipboards, turn their eyes to the woman as the most powerful and knowing figure in the room.

Water birth, pronounced risky by some doctors, has a similar effect of restoring power to the woman at the expense of those who attend her. As Marsden Wagner, director of Maternal and Child Health for the World Health Organisation for fifteen years, puts it in Water Birth Unplugged:

"Water birth like home birth is controversial. Why? Because the obstetricians are out of control. It's that simple. The water helps the woman, but it sure doesn't help the birth attendant. It's the opposite of the lithotomy position (on the back with feet in stirrups), which helps the birth attendant, but doesn't help the woman. With water birth, the birth attendant has many dilemmas, do I roll up my sleeves, do I get in the pool, do I take my clothes off, what do I do here? You can't really attend a water birth and keep your sophisticated control and dignity."

If you are faced with a choice about procedures and interventions in childbirth - ask yourself - who is this most likely to benefit, reassure, or make comfortable - me, or my carers? We must not be deterred from learning as much as we can about our rights and our options in childbirth, no matter how much it may inconvenience midwives or doctors. We do not have to comply with their suggestions, unless we wish to. We are allowed to be powerful in childbirth. Whatsmore, birth is not simply a means to an end - our birth experience matters, and is of primary importance, not just to us, but to our babies, our families, and the whole human race. 






Saturday, 16 February 2013

My Search for Birth Freedom in a Climate of Fear and Mistrust

Every generation likes to think they're free, and often only the clarity of hindsight reveals just how restricted they actually were. My mother, for example, thought, like many women in the 1970's, that it was the very pinnacle of freedom to have her labour induced, to be able to choose on which day of the week her baby came, and to be in a hospital which offered 'state-of-the-art' care for her and her baby. Looking back on it now, she can see just how far from freedom she truly was: shaved, enema'd and pethidined, with no formal talk of consent, and later, ushered sternly back to bed by Matron as she wandered the hospital corridors, drug-hazy and looking for the baby they had taken from her.

Nearly forty years later, that baby - me - is pregnant for the third time, and wondering - am I free? Do I have full freedom of choice to have the birth I really want and need? Can I feel assured that anything that is 'done to me' in the name of medical science will be absolutely necessary and helpful? And are there restrictions that none of us are even able to see, and that will only become apparent when the baby inside me is fully grown and making their choices against a new and different backdrop?

Already I have met resistance to my plans to birth at home. At my first appointment with the midwife, the flag was automatically raised because my last baby was born weighing ten pounds four. This is me just after I birthed her. You can see just from my face what a life or death struggle it was:


She was born in the water after a second stage that lasted about ten minutes, without a whiff of gas and air, without a single vaginal exam, without any instructions on when or how to push, without a hand laid on me except in love, and without a stitch.

But because she was 'so big', 'they' want me to do things differently this time. They want me to have consultant led care, a hospital birth, and an induction at 38 weeks. (That's a whole month before either of my other babies have been born - I'm a ten month mama!)

The size of my baby might have been a 'flag' for them, but let me tell you, I have 'flags' too, and I know how to wave them. They might not trust my body - but I don't really trust them - there are things that make ME lose faith in THEIR abilities. I don't want to list in detail all of my reasons here - I never want this blog to single people out or publicly criticise individuals - but let's just say that a few incidents and some inside information has led me to feel a lack of confidence in my local maternity unit, and a strong suspicion that they don't trust birth and don't have much faith or understanding of it as a completely natural process.

This local feeling would seem to reflect a national and international picture. In her latest book, 'Birth and Sex', Sheila Kitzinger describes a climate in which 'choice' is a buzz-word that is meaningless when applied to women's actual realities: "The rhetoric of 'choice' ignores the pressure exerted on women to have a particular birth place - hospital - and kind of care - obstetric management, and the power of the medical system, so that discussions about choice often amount to emotional blackmail."

Worse still, it seems that even those midwives who wish to support real choices have their hands tied. Kitzinger writes, "Midwives who support women in their own free choices are more at risk of being reported to the Nursing and Midwifery Council and losing their registration."

The prosecution and persecution of midwives who refuse to, as Kitzinger puts it, "guide women to 'correct' choices", is epitomised currently by the case of Becky Reed, held in the highest regard by leading members of her profession, a member of the legendary Albany midwives, and up before the NMC on the 11th March. Her campaigners state, "For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy. If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices."

They might well have written, 'make it EVEN MORE difficult' for it seems like this is already very much the case. As a trainee midwife recently said to me, "I'm already learning that it's best to keep any strong views or opinions to myself, otherwise I'll risk not getting the job at the end of training.", and a qualified midwife confirmed, "At the end of the day, it's a job and you have to feed your family. If you make too many waves you put yourself at risk."

In this climate of fear and mistrust, how can any of us be truly free? 

For me, too many flags and a search for true freedom have led me, as I did in my second pregnancy, to book an Independent Midwife. I just don't want to give birth in a system that has no trust in me or my body, that sees birth as medical not emotional or spiritual, and that is so intent on following protocol that it can't see the woman behind the clipboard.

We had our first visit from Tara on Valentine's Day, and she brought red paper and silver string for my daughters to make heart decorations. And this summed up her visit. It was all about hearts. She wanted to get to the heart of my previous birth experiences, she wanted to understand the fears and hopes in my heart for this new baby and birth, she wanted to share the joy in the hearts of my whole family, and she wanted to connect with me, the birthing woman, at heart level. Instead of being left, as I was by the NHS, with worries and fears about my possible malfunctions, Tara stayed for six hours, and left us all with a feeling of great excitement about the months ahead and the wonderful birth experience we will all share.





I've exercised my freedom, I've raided my savings, and I've made my free choice - to have a midwife at my birth who I already know, who truly believes in the wonder of my body and who understands how to behave in order to make birth a beautiful and empowering experience for me and my family. But it's lucky I didn't wait any longer to get pregnant, because from September 2013, Independent Midwives are likely to be unable to practice as they currently do, due to an EU Directive that requires all health care practitioners to have indemnity. If nothing is done to save IM's, it seems likely that the free choice I just made to opt out of the NHS system for birth will no longer be one that is available to pregnant women in the UK.

I'll be writing more about Tara, Independent Midwifery and the campaign to save it, as my pregnancy progresses. In the meantime, please sign this petition to help their campaign:
Finding a workable and affordable solution for Independent Self Employed Midwives
We need to take action now to help preserve, improve and extend freedom of choice for all birthing women. Every woman should have the right to be attended by a midwife who is able to practice safely whilst remaining in touch with her heart. Every midwife should have the right to think, feel and work openly without her hands being tied by protocol and fear.

~ o ~

To find out more about Becky Reed, please visit the Facebook page: Justice for Midwife Becky Reed
To find your nearest Independent Midwife, please visit www.independentmidwives.org.uk
To find out more about our midwife Tara, please visit www.mindfulmidwifery.co.uk