Pressure to Have the "Perfect Birth"

[Smoke Jaguar]

FWIW, I do not believe that labour is the best time to be 'playing it by ear', for mother or baby. A well-thought out plan is critical to having your wishes and philosophies considered (even if they cannot be adhered to down to the letter, if you've discussed your learning and beliefs with your caregivers, they will accord you respect according to those things when it comes down to the wire) otherwise it is THEIR agenda they will follow and their agenda becomes your agenda by default, if you outline nothing else for them. Find out what their agenda is, what their policies are in each eventuality before you decide that you are happy for their agenda to be yours, is my ultimate recommendation for women who think they want to 'go with the flow'. 'The flow' is often, in these cases, not to flow of the mother, but that of the hospital - conditional upon tailored policy, funding (which influences behind-the-scenes decisions and facilities), bed availability, practitioner availability, etc). Going with 'the flow' is very much like an open cheque, as I've said before...your cheque, not theirs. Decisions are made with the best interests of the hospital right up there with the best interests of the mother (and I'm being generous here!). If you 'go with the flow', please know what it means - a new baby requires all the energy that regret can use up. You don't always have to learn by your own mistakes - you are allowed to learn from others'
Being 'empowered' is not a fashion statement (I really don't know about the 'pressure for perfect birth' fashionability, I must be out of that loop!), it's a recommendation that contributes to higher levels of wellbeing for mother and baby. That's how I see it, and that's where I'm coming from in all of this. In my own social circles, 'empowerment' is definitely not the fashionable thing, 'going with the flow' is - however, in my booby and birth circles (that I found after DS was born) it's the opposite, thank goodness, so I have great support for next time round

[Natty]

This is an interesting discussion with a lot of objective and subjective opinion. I have said before on this discussion thread that I truly believe that the best birth is the one where both the mother and baby are healthy and happy. How you achieve that is personal - based on choice, personal circumstances and hopefully, based on a fully informed/educated decision.

However, I cannot agree with you Kelly when you make the generalisation that "Midwives are the experts in normal birth. Obstetricians are not. They are experts in complications, they are surgeons, and as they say in the BOBB, they should be doing surgery, all day, everyday because that is what they are good at. They don't know how to do normal birth and it belongs to midwives" (sorry I dont know how to put in the quotes). Yes, Obstetricians have been trained in surgery, they have been trained in how to deal with complications but that does not mean that they aren't also advocates for patients having as 'natural' a birth as possible. This certainly is not my experience.

With my DD, my Obstetrician knew I wanted to try for drug free (especially as I am sensitive to a lot of drugs and was fearful of having a reaction). When the pain was too much for me to bear after 8 hours and I requested an epidural, he sat down with DH and I to make sure that this was really what I wanted. He wanted to make sure that I was happy with my decision to have a labour assisted with drugs. In the end, it was good that I did because DD had the cord wrapped around her neck and after 2 hours of pushing and no results she had to be vacuumed out. But my Obstetrician was very supportive of me having a 'drug free' birth and this time around, has automatically assumed that I will be trying for the same.

Secondly, my Mum who had drug free, absolutely 'pain free births' certainly was happy to have a 'go' at me for having a 'painful' birth. She could not understand why it was painful and four years later continues to hype the fact that she has a better 'pain threshold' than me. This is not the case - every pregnancy and every labour is different for every person and it annoys me to the core that I am made to feel inadequate by my Mother and other people for having a painful labour and for taking drugs. This time around, my baby is big for its size and whilst my Obstetrician is strongly encouraging me to have a vaginal birth, I will not hesitate to have a c/s if at the end of the day either my baby or I need it. I work in the largest private maternity hospital in WA and am fully informed and educated about the risks associated with vaginal, c/s, drug free, drug assisted etc etc births and I will make my birthing decisions based on my circumstances with my Obstetrician keeping me fully informed of where my labour is at.

One thing we must not forget, is that maternal and neonatal deaths have dramatically declined over the last century and even over the last two decades, something which is directly attributable to the 'overmedicalised' Obstetric fraternity.

For my part, I dont give a flying f*&% how anyone else has their child I only care that when I have my babies that they are healthy and ok and so am I. So lets just stop admonishing people for how they give birth and let them make their own informed choices. And if they dont want to be informed, well thats their decision too. If they want to be led by their Obstetrician, that is just another type of decision made.

Lets also remember that when your son or daughter is 21 years of age they wont be saying in their 21st speech - 'thanks Mum for having a drug free, vaginal birth' - or 'thanks Mum for having that c/s' the main point is that they were born healthy and that they were nurtured, loved and disciplined throughout their childhood, adolescence and into adulthood and that they become good, happy people.

[Georgi]

Thanks NATTY My point exactly. You just don't know how you're birth will pan out, so be prepared for the different options.

[Smoke Jaguar]

by Georgi:

be prepared

precisely. I don't see how this contradicts anything that's been said about how to approach birth

[BellyBelly]

Yes but by making informed choices it can pan out better than wait and see. If you want a natural birth (the majority do) but choose private hospitals and obs, well you have chosen something that is most likely to land you intervention and c/s. And most of those women think they are getting continuity of care so don't bother with doulas or any other experienced labour support, then they realise that their Ob only comes to check on you once if at all, to catch the baby or for complications. Who helps you keep on track with your labour? Your partner who has never seen birth/supported a woman before? The midwife who has 8-10 women to care for at the same time and has to write so many notes she can't hold your hand? We have one of the highest c/s rates in the world, higher than the US - you cannot wait and see and expect a natural birth unless you fluke it.

No matter what your persuasion is, I would love to hear your opinions AFTER watching the Business of Being Born. If you watch it and remain unchanged, good on you. But if you don't then great too.

I don't mind if you disagree with me natty - thats fine. You are disagreeing with lots of people, not just me In fact Obs in the BOBB too! One well known US Ob who actually says, 'Midwives actually do a better job than we do at the normal births. We aren't excited at normal birth... etc' and he wasn't alone. Everyone who hasn't - see it - I dare you Then lets have a pow wow

[Snacks]

I think Natty makes some interesting points, and if its ok, I'd like to respond to a couple.

This is an interesting discussion with a lot of objective and subjective opinion. I have said before on this discussion thread that I truly believe that the best birth is the one where both the mother and baby are healthy and happy. How you achieve that is personal - based on choice, personal circumstances and hopefully, based on a fully informed/educated decision.

I heartily agree.

For my part, I dont give a flying f*&% how anyone else has their child I only care that when I have my babies that they are healthy and ok and so am I. So lets just stop admonishing people for how they give birth and let them make their own informed choices. And if they dont want to be informed, well thats their decision too. If they want to be led by their Obstetrician, that is just another type of decision made.

Exactly. Personally, I don't think I have heard anyone telling anyone else that they have made the 'wrong decision' for their birth. I have heard lots of women passionately declaring their views on the topic, and rightly suggesting that we all be supportive of each others choices and differences. When people point out the dangers of intervention, they are trying to offer information that will assist in educating a person's decision. I am SO glad that these people offer this information (even when it makes me uncomfortable) because it makes me MORE SECURE in my decision for the birth I WANT.

Lets also remember that when your son or daughter is 21 years of age they wont be saying in their 21st speech - 'thanks Mum for having a drug free, vaginal birth' - or 'thanks Mum for having that c/s' the main point is that they were born healthy and that they were nurtured, loved and disciplined throughout their childhood, adolescence and into adulthood and that they become good, happy people.

Drugs can cross the placenta and affect your baby's health. Like anything, we weigh up the risk against the benefit. If the benefit is greater than the risk, it is the right decision. For me, the risk was too great, but I had a very normal pregnancy, birth and baby. I know Natalie won't thank me for it, but I don't care. I'm confident I made the healthiest choice for my baby. There are going to be other decisions I make for her health that she won't thank me for either. But I will again choose what's best for her in that situation, regardless of whether she ever acknowleges that decision. So will anyone as a parent.

Can I also add a general point: there are loads of people on here (and people I've met IRL) who are passionate about informing others of the dangers of intervention because they feel horribly let down and traumatised by their experiences. To say that in every birth situation the only thing that's important is a healthy mother and baby is insensitive and hurtful to these people. If that is all that matters to you, fine. Again, the whole point of education is to help you make a decision you are happy with. But there are countless cases of women having to undergo unnecessary medical procedures, having the choice taken from them, and being psychologically and/or physically damaged for the rest of their lives. Their passion is warranted IMO, and I don't think they are selfish for feeling incredibly ripped off and wanting to prevent the same thing from happening to their friends.

[Natty]

Snacks - thank you for your comments. When I say that the only thing that matters is that the final outcome is a happy and healthy mother and baby I am in no way meaning to be insensitive to mothers who have been traumatised or upset by the type of labour they had. I in no way had a pleasant experience. I was in agony, I watched my daughters heart rate drop with every contraction because of the cord, I was exhausted and I had an epi. For a long time after my birth I was upset by it but I guess for me, and for many of my female friends who also didnt find their birth experience enjoyable, the best way we can accept it and go on to have other babies is to say well it wasnt enjoyable and it wasnt what we wanted/planned but at the end of the day, we and our babies are ok. One of my girlfriends even set up a support group in Qld because she was so traumatised by her birth experience and yet she even says that at the end of the day, to her, the main thing is that her and her baby were ok. I guess it is a way of accepting our birth experience and moving forward. And thats ok, because that is how we choose to deal with it and its not being insensitive to others, its being sensitive to how we feel. Its like anything, other people can choose to look at it that way, and they can choose not too.

Kelly - my experience differs to the one you suggest with private hospitals. My Obstetrician was in an out of my delivery probably every half an hour to check up on me and yes, he walked me through my labour - he wasnt there just to catch the baby. Furthermore, my midwife was with me from 6am in the morning (the minute we walked in) to the minute I left the room for the ward at 8pm at night. She didnt have any other patients to care for. Just me and my husband. And she is going to be my midwife this time around again.

And yes you are right, we have the highest c/s rate in the industrialised world. And no its not right. I work in a private hospital and we are doing everything that we can to reduce the c/s rate to get it to a level that is acceptable. However, although we develop and print brochures to inform our patients, work closely with our Obstetricians, make doulas known and available to our patients, provide education sessions to women and their partners, a lot of them (for reasons which we know but which I will not go into in this forum) CHOOSE to have an elective c/s. Even in our c/s education sessions we encourage women to consider vaginal delivery as an option. From a quality and risk perspective for our hospital, high c/s rates are an ongoing issue which we are continually working with our Obstetricians to reduce. Yes, there are some 'old school' Obs that dont want to know about vaginal delivery's - I admit that, but as well there are quite a few Obstetricians that are keen to reduce the c/s rate (at least at our hospital) and encourage the 'natural' approach to birthing.

[MantaRay]

I really think the most important point here, is that women need to educate themselves about the options, and the consequences of those options. And this is more than just hiring an ob and listening to what they say. It means listening to other people's experiences and lots of reading. When people share their experiences, it might seem like they are "pushing" their ideals on to you. If that's the case, see past that to understand what they are saying and why. People who are passionate about something usually have a good reason for it. The one thing I can say from experience, is that going in expecting to "go with the flow" is not good enough. It's just not that easy.

I went into my first labour not wanting an epidural, but being prepared to 'go with the flow'. I was pressured into having one and gave in easily for two reasons. One was that while in labour I was in no position to make a decision and secondly was that I really didn't know the implications of having one. Had I known then all the effects that I would experience from having an epidural, I would have gone into labour with a firm plan to avoid it. I didn't go into labour with a firm plan, or with anywhere near enough information. So what I am sure would have been a quick, easy birth like DS2, turned into a cascade of interventions.

My waters were artificially broken before I knew what was happening. Labour was then so intense that they encouraged (I would almost say forced) me to have an epidural. Which made my labour slow and my baby go into foetal distress. So I'm pushing while lying on my back (as I couldn't feel my legs, and my bp was too low from the epidural to sit up) and it's not effective. I caused myself life long problems with haemorrhoids as a result. Forceps were needed so I got a tear and episotomy. This caused stitches and a lot of pain for weeks after the birth. For 2 days afterwards I felt unwell, and getting around was really hard. I was pretty much confined to bed for the first day or so and didn't even change my own baby's nappies myself. So mum and baby were both healthy afterwards, but it still could have gone so much better.

Fast forward to my second labour. I have read lots here on BB and books like New Active Birth. I go into labour and find a comfy position. Baby arrives quickly and easily (so to speak LOL!!) in 3 hours. I have a small tear which I felt no pain from after the event. Straight after the birth I can get up and move around, and I feel fantastic. The difference between the two births was amazing. And the only real difference was the extra knowledge I had second time around in order to help myself birth in a better way.

This is why I want people to know of other's experiences. Because you don't know what you don't know. And I don't want people to be disappointed, and I don't want people to end up with life long problems from unnecessary interventions. And gathering information before the birth is so critical to the outcome. Sure, at the end of the day we all make our own choices and we will all make different choices. That is ok. All I hope for is that people are able to make INFORMED choices. And getting information about birth, good information, is not so easy.