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Birth success isn’t as simple as ending up with a healthy baby & mother

I’ve read various articles about whether home birth or hospital birth is the ‘best choice’ recently.  Moving on from the fact that the choice of birth location differs from woman to woman and from birth to birth, what has deeply concerned me is that so many articles state , as Jenny McCartney did recently, that “so long as mother and baby are alive and undamaged, it can be counted a great success”.

Obviously a birth that ends up with a healthy mother and baby is a success but how do we define healthy and how do we take into account the impact on the mother of a birth that, whilst it may have ended up with both her and the baby surviving, was upsetting or even traumatising?

An awful lot of the births I hear about are described in fairly negative terms.  There is little of the empowerment, fulfillment or even ecstasy that some schools of thought would have us believe is possible.

Frequently I hear of mothers being left to labour without midwife care for hours, having to beg for pain relief or to be believed that their labour was developing rapidly.  All too often I hear of mothers being told that they ‘must’ be induced to save their baby and then of a seemingly inevitable cascade of interventions ending in major surgery.  Regularly I hear of mothers not ‘permitted’ to labour actively, of being strapped to a monitor on their back and their feeling that they couldn’t be in a position that was comfortable for them.

All too often I hear of women being told what they cannot do and their resentment that they were not able to listen to their bodies and do what felt right.

I also hear of an insistence on internal examinations that are painful or humiliating, of medical procedures, like a stretch and sweep, being done without consent and inaccurate information given to push them into a decision that they may not have made with full knowledge.

But what I don’t hear about is anyone caring what these attitudes and this form of care can do to the mother.  How it can make her question whether she wants any further children, how it can leave her in pain for weeks after the delivery, how it can leave her with flashbacks and terrors about being left helpless again.

And what is more, we don’t get to hear the voices of the men that attend these women – today in our overstretched maternity system, fathers enter the hospital and become birth partners, bridging the gap in midwifery cover whether or not they want to be there.  Its a brave man that takes on the system and says that he does not want to be present at his child’s birth but several fathers I have met have been traumatised from having to watch the woman they love go through labour – be it an uncomplicated delivery or a full scale medical emergency.  Often talking to them they are reluctant to be involved again but feel that they cannot leave their partner alone to go through it.

Are we setting the bar too low for maternity care? 

Isn’t what we should be aiming at is a birth experience that makes both parents feel supported and nurtured by their carers, that has a healthy and a happy outcome?  Should we aspire to the gentle, loving care given by midwives like Ina May rather than just getting the baby out in one piece?  Should we start to push for more doula involvement to give men the option to not have to act as a midwife? 
Should we not seek to make birth more than a process to be got through but something that can become a positive rite of passage to becoming a parent?

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27 comments to Birth success isn’t as simple as ending up with a healthy baby & mother

  • Lorraine berry

    Love,love,love this post! From personal experience as well as caring for a huge number of women over the past 17 yrs I know it matters so much how you are looked after and supported through birth. Home / hospital / section / epidural / drug free – whatever and wherever, what your care providers say and do (or don’t do) impacts massively on your perspective of that birth, how you deal with what happens and how successfully you adapt and cope with challenges of parenting. Thank you so much for this post Hannah xx

    • I’m glad you likeit – that article really got my goat, you can tell she didn’t have a good experience but just parroting ‘healthy mother, healthy baby’ isn’t the answer – we need care that remembers that labouring women are human beings too

  • Well said, healthy baby and mother are the most important thing but by no means the only important things.

  • @gourmetmummy (susan)

    So true. After I had my “emergency” Caesarian with my 1st child I kept hearing “at least you and the baby are ok”. Well, obviously that’s important BUT emotionally I felt like I had had my birth experience ripped away from me, along with my dignity.
    Happily, i’ve gone on to have 2 wonderful home births, the last one a water birth just 5 weeks ago. I’ve written the story on my blog. I am happy that I was supported by 2 great NHS midwives.
    I wish that it were possible for every woman to have a positive experience.
    A great post xx

    • Exactly, part of it for me is about realising that women are more than just bodies, there is a very important emotional element that needs to be taken into account

      Off to have a look at your birth story right now

  • Great article, your words are so true. I still have traumatic flashbacks to the lengthy induction I was railroaded into. One bit that really haunts me was when things got v serious, a male dr was stood between my legs ready to use ventouse and one female medic turned and asked another, as if I wasn’t able to communicate or didn’t count, why I hadn’t wanted a male doctor (I’d actually asked for only midwives to do the copious internal exams). Baby ended up in intensive care, my dignity and heart in tatters. NHS clearly needs more funding to facilitate safe and dignified birthing experiences for both mum and baby’s sake. Baby is now a fit, healthy tinkerous toddler btw

    • Oh I’m so sorry you had to go through that – what horrid insensitive treatment

      It wouldn’t cost anything more to act differently, its not a factor in terms of time or money but would have meant more to you

  • I had two birth experiences that were both equally traumatic for different reasons – and yes, I would have loved more support from the midwives and especially the postnatal ward afterwards, which was horrible. I think the problem is that the NHS is very very overstretched (especially in London) and in the current climate I don’t see how they could possibly afford to do more – I can’t see this government giving extra funding for something like this, and one can only hope they don’t cut things back even more. But I do think we sometimes forget that only 100 years ago, many women and babies died in childbirth. Hospitals were a big step forwards, and OK they are not perfect, but I can why it’s said that having healthy mothers and babies is the priority.

    • Obviously no woman or baby should die unnecessarily but it does worry me that some medical staff seem to forget that women are people and don’t treat them accordingly – I don’t think that would cost more but would make a difference

      Obviously in a perfect world there would be more resource and one-to-one care but even in the absence of that respect and empathy would go a long way

  • nikhknight

    Yes, yes, yes. I really feel that I was pushed into an elective section (breech baby) with my first – I was made to feel that attempting a vaginal delivery was too much of a risk. The op itself and my recovery was actually fine, but I felt so cheated and disappointed for a long time. It still hurts now if I think about it. And of course, the beauty part is that this time, I’ll be a VBAC candidate, so again, I face having decisions taken out of my hands or else having to fight for what I want. It would be easier if I could afford a private midwife, but sadly that’s just not an option for us.

    • Its horrid having to fight for what you feel is right for you (for me a homebirth with our first and as non medicalised birth as was possible was Littler) but do please consider doing it – I believe that if some of us don’t stand up then the options will get reduced even further

  • Reading this made me feel incredibly lucky to have had the births I had. Yes, I never managed to get my requested epidural, but I always felt fully supported by the midwives around me and had full confidence in them.

    I was especially lucky to have a super smooth home birth with my third.

    I know this is not the case for everyone, but I cannot fault the care I received each time from midwives and the hospital. xx

    • That’s great to hear – I’m not trying to talk down the NHS, there are so many good medical staff in it, but more that we need to remember that women are people and have feelings whilst they are in the care of medics

  • The healthy mother, healthy baby is a huge bugbear for me and a source of massive distress. I cannot tell you how grateful I am for my beautiful children whom I love with all my heart and being. I am luckier than LOLA. However, I was treated horribly. Twice. I have a nub of hate and fear and ANGER so strong in me it is poisonous and twisted and I sometimes fear I will never, ever, ever lose it and will always feel like throwing up or throwing myself under a vehicle when I think about. I was alive. My baby was alive. But I was f*cking broken. Physically, mentally, psychologically, morally perhaps given my hateful anger. Who is that good for? How is that a success?

  • Lorraine berry

    Listening to women and valuing them / their opinions, knocking on the door before entering a birthing room, explaining reasons why x is recommended, respecting that not everyone will want to go along with what is recommended to general population, discussing options with women, not using bullying / intimidating tactics, not being patronising ….none of these things cost the NHS more in terms of time or money. They are basics of CARE that can and should be provided. It takes very little additional thought to actually help preserve dignity and a sense of control and choice over what happens to u’s during pregnancy and birth. No, we are not always going to have the “perfect” birth as we wanted on our birth plans, but the way we are treated / spoken to can make a world of difference and I don’t think it is too much to ask that we be treated with kindness and respect. We are not pieces of meat or walking incubators!
    I have personally experienced the impact of having non-caring, thoughtless staff during the birth of my last baby – tho a normal birth (not even a stitch), I have suffered postnatal repercussions. To me a healthy baby and mother shouldn’t just be about the physical – it is the emotional and mental health as well, which can have a far reaching impact on not just the mother, but the whole family.

  • Thanks so much for this – I love how often you seem to capture my half formed, lazy thoughts and pin them so brilliantly to the page! The ‘healthy mummy, healthy baby’ argument is obvious and trite, and the binary “hospital = good, home = bad” or vice versa is also nonsense – it comes down, as you say, to what is right for a particular mother and baby in their particular context.
    For my own part, I have had three truly wonderful births, which I feel almost evangelical about, but which I find it’s difficult to talk about because conversations about birth have become so riddled with implied moral judgment that it’s hard to strike the right tone and not sound moralistic or just plain old smug. But in the interests of perhaps encouraging people who only hear the scare stories, and also – perhaps – pulling out some strands we might learn from, here’s a summary …
    I had all three of my children at home, in water, with no pain relief, supported by independent midwives (who, yes, I was lucky enough to be able to afford – just). All three were big, healthy babies – 10lbs +, and I was lucky to have straightforward pregnancies (there’s a lot of luck involved).
    With my first child, my decision to stay at home was prompted not by any great hippy convictions, nor by reckless impulse, but by a deep dislike of hospitals, and an even deeper desire for privacy – I couldn’t bear the thought of strip lighting, student doctors and my arse hanging out of a paper gown – sounds silly, but it really bothered me. So instead I had a birth plan taped on the fridge and memorised by my husband, candles, lavender oil, oi va voi on the stereo and apple juice on tap. None of which meant it wasn’t the most painful, shocking, bad-word-inducing and challenging experience of my life, but all of which did mean that I felt safe, loved and in control throughout the whole experience.
    I had my subsequent children at home because the first experience was so great. The second was harder by far, in large part because I basically thought “oh yeah, birth schmirth” and didn’t prepare at all.
    The third one was the most wonderful of all, because I mentally prepared my socks off and knew what to expect.
    So, my reflections, on writing all that are ….
    a. We disempower mothers right from the outset of pregnancy, infantilising them, trying to control information flows, scaring them, making assumptions, and making birth sound like something wrong that needs to be fixed, rather than a natural event – tough, yes, but entirely normal.
    b. The most powerful thing we could do to transform birth would be to give women the power back, by encouraging a mindset from the outset which allows women to make informed choices, to think hard, and to prepare for a birth that suits them and their context – always recognising that you can’t control birth per se.
    c. Preparing is vital – not in a control-freak way, but because you need to get your mind and body around the enormity of what is going to take place.
    d. Being comfortable in your surrounding is also vital – otherwise you can’t get out of your own head enough to get out of your body’s way and let it drive.
    Brain now entirely crashed so will stop now. Thanks again for your good thinking. xx

    • Great points – that process of removing information, of not letting women work off the basis that, except in a few cases, our bodies can do it. Yes its not pleasant but its part and parcel of life and something we just have to do and making sure they own the birth and their decisions – that they have information and educate themselves so that they can make choices that suit them and their approach

      And yes, being comfortable and feeling safe is so key – I had my first at home because I was scared by the rate of interventions friends encountered in hospital and I didn’t want that to happen to me so did everything I could to educate and inform myself so I stood the best chance of avoiding it

  • I had two c sections both emergency. My first birth experience was very positive but to be honest I was having twins and for that you get a lot of medical help and support. Second time was a whole difference experience as I gave birth on the busiest baby night of the year. The care was naff and I spent a lot of time crying whilst beig forgotten about. My midwife was honest they were simply under staffed….

    • Tragic isn’t it – I know of midwives that have left hte NHS because they can’t stand being so overstretched and not able to deliver the care they want

      Out of curiosity, what’s the busiest night of the year?

  • I love your post.I feel very lucky to have had two water births at our local hospital.The care was well,too. I felt empowered and fantastic. I always encouraged friends to go for natural birth however both my sister and another friend had a more medicalised approach from their doctors and were very disappointed.I felt very sorry and have now decided not to speak about labour with anyone else.Because it relies upon so many factors,hospital policy,midwives,doctors, not to mention the position of the baby etc,I have now undersotod you really are lucky if you had the birth you dreamed for.

    • Its hard isn’t it – wanting to share that the process can be empowering and you can take control of it but knowing that it may not work out and not wanting to let people down by telling them something that may not work out

  • liz

    I personally feel that something that should be totally focused around mother & baby’s whole well being both emotionally & physically just isn’t happening – well i can’t speak for everyone but it didn’t happen for me.

    Not only the birth which i felt i had no control over (2 c sections) but the stay in the ward after and the terrible time i had learning to breastfeed. I so wanted to learn this special thing with patience and dignity but the midwives in hospital were truly terrible; and being in a room with another lady where our babies seemed to cry in a relay was terrible for us both.

    I am grateful to the NHS as i’ve got 2 beautiful children & the majority of staff work their butts off; but sometimes i feel the odd few shouldn’t be a midwife if all their empathy has been used ……

  • Great post – so well put! I had a straightforward pregnancy until my 36th week, when a minor complication was (I now realise) blown all out of proportion and my birthing centre birth was refused… Luckily baby decided to help me out by arriving early so I wasn’t induced in the end, but I wasn’t allowed an active monitor so had to lie on my back, was left alone, and when I refused a student midwife (the room was too crowded) I was told off by the head midwife who insisted I have her! My sister and the lovely midwife I ended up with had it out with her as I couldn’t speak at that point. I am sure the postnatal pre-eclampsia I suffered (which meant another 2 week stay in crappy hospital) was a result of the stressful birth situation. Unfortunately its really put me off having more. Or at least at that hospital… My baby is worth it though – a sensitive soul already at just 5 months.

    My mother was a midwife and we used to talk about her work a lot – she was really saddened by the way some of her colleagues treated mothers. There don’t seem to be many like her now.

    • Argh it makes me so cross when women say they ‘weren’t allowed’ – why should we have to fight to labour as we feel most comfortable but that may make it slightly harder to monitor (I had a session with the consultant midwife for normality at our hospital and it was all ‘no you can’t’ and we were ‘well how about we try this’ and them going ‘we hadn’t thought about it like that’)

      Its horrid that the process has put you off – different places can make it a better experience

      And yes, there are some people working as midwifes who probably shouldn’t be

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