I’m not going to sit on the fence about this issue – I’m getting more and more cross with Project Fear in our maternity services and specifically related to birth choices.
The last few weeks I’ve been supporting a few mums planning to make choices against what their Health Care Professionals are supporting. These mums are traumatised and anxious from their first births due to the number of interventions they received. They don’t want to birth again in the hospital. The thought of going through what they went through before is making them feel panicked, anxious, scared and frighted. Even visiting the hospital and triage is enough to trigger panic attacks and anxiety. These women have researched their choices, have looked into the acutest of details what their risks are, have made EDUCATED decisions and are subject to Project Fear.
I’m a massive supporter of our NHS. We have an amazing health case system, maternity care without a doubt, saves lives – staff, interventions, the care they receive, etc etc etc. I am not for ignoring these and I have at times spent times with women assessing the benefits of a c-section as an informed choice over a vaginal birth for a woman who was scared that her vagina would rip open and she would never be able to have sex again….. I am totally pro-choice. I believe all births hold equal value and I make no judgements on how women choose to births. In fact, if these women had come to me and said can you help me plan a c-section, I would have got out my gentle section planning tools and we would have gone there.
However, these women and MANY MANY MANY MANY MANY (did you get that – we’re talking thousands) of women every day across the NHS in the UK who spend hours and hours research the birth they want and making their choices, only to go along to see the midwife or consultant to be totally dashed….. and in walks Project Fear…..
Project Fear in maternity services is where a health care professional comes in mum is made to feel stupid, like a silly girl, that she is making a massive mistake by not listening to whatever their advice is, usually getting stronger and stronger with the fear factor to the point the mum totally loses her confidence that she knows what’s best for her body/baby/family. If she’s lucky enough to have Dad there, maybe looks at Dad who is then totally bamboozled about what’s just happened.
Now here’s my thoughts on this.
- No one know what’s best for mum and baby EXCEPT mum – always
- Protocols and guidelines are exactly that – guidelines
- Very few protocols and guidelines are actually evidence based – that means they are NOT informed by research – why – because there is very little good research done in the area of birth as it’s too hard to get proper results (if you want to know more about this – then I suggest you read the AIMS publications)
- No women should ever be made to feel stupid because she is questioning the system – surely she’s entitled to ask questions again and again and again
- Listen to a women – she knows – she’s the one that knows her body and what she wants – put that trust back in her
- Women when pregnant need to have their anxiety levels remaining at point 0 – they have enough to worry about – treat them like how you wish to be treated – with dignity and respect and if you’re really worried – speak gently and kindly to them and listen – do not attack (yes, that’s an emotive word but it’s what happens) them again with the SAME figures and not look at the other side of the story. Kindness goes a long way to achieving a good birth together.
- Present fact not fiction – give statistics, where you have them (see 2 and 3 above)
- If a woman has spent all that time researching her choices, she is EDUCATED meaning, she’s probably educated on the risks too – why don’t you ask her…..
- Informed choice means that she is informed about all the benefits, risks, alternatives and science and then she can make her choice – that does not mean she is educated by the protocols (see points 2&3 above)
- Women experience birth trauma where they feel out of control on their decision making. Whilst some women experience birth trauma where there is an actual emergency, the majority of birth trauma isn’t a result of emergency situations – it’s interventions gone wrong – where women have gone along with the HCP, where they have been made to feel stupid, have lost their voice, don’t feel they can air an opinion, don’t know what’s happened to them and then they research after their birth and they get bitter….. That is the majority of birth trauma. So let women take control of their birth by helping them navigate their own decisions properly including step one where you “offer” an intervention.
- Women have a right to choose where and how they birth – that is their human right
- Women have a right to decline ANY intervention
- Birth is a monumental time of transition, make it the best it can be
- It’s a women’s choice to take risks – she has the most to loose where things go wrong – let her make her decisions – give her the power – she’s unlikely to take any stupid risk except where she feels back into a corner and is angry…..
- The less we interfere with birth, the better the outcomes on so many levels
- Save money, HCP time, stress and anxiety
Here’s some common scenarios that I hear daily:
VBAC – your scar will rupture – currently the evidence of the scar rupturing is less than one in 200….. know your facts and that you are so much more likely to have an unpleasant side effect from a repeat c-section….. see picture… what bugs me is that I have yet to hear of one consultant telling a women the risks of a repeat c-section……. and if you scar does rupture, this does not mean that any harm will come to you or your baby and generally it is known BEFORE it becomes an emergency situation… real emergency, whilst it happens is RARE…. so please, if you are a HCP reading this, then give the full picture and that then becomes INFORMED CHOICE…..
Induction – 40 weeks plus 4 days, mum is then told that she’ll be booked in for an induction at 40 + 10 days…. errr hello… what about… you’re a few days overdue – why don’t you go off and do xyz, and phone me back in a few days and we can talk about your choices such as induction or waiting… the moment you start giving the fear to mum that that she is overdue and will NEED an induction, then she will hold on to that baby…… the mind is a powerful thing… if you look to see when most babies are born you will find a peak around 41 weeks so no, mum is not overdue at 40+4… she is perfectly normal… and whilst the risks of harm coming to baby or mum do increase…. these are tiny and because of the massive intervention that happens all the time there is NO evidence on what is normal….. (go to 10 month mammas facebook group if this is you). And there’s no discussion what the risk are of induction (which are: Hypotension (low blood pressure), Postpartum haemorrhage, Water intoxication, Hypertonic uterus, Uterine rupture, Uterine inversion, Stillbirth, Abnormal heart rates, Nausea and vomiting, Diarrhoea, Anaphylaxis – taken from BellyBelly). And that doesn’t include the increased risk of c-section which in some places looks to be as high as 40% – ie you are induced and you’re chance of a c-section is 40%. Now bearing in mind that your risk of stillbirth does increase going past 42 weeks – I’ve yet to hear someone being told that one of the risks of induction is stillbirth. So what is the alternative… possibly increasing monitoring and waiting and seeing if labour can spontaneously happen…. perhaps??? I would never say to anyone to take any risks so if you do want to wait, can you do increased monitoring instead so you are taking no risks at all…… Oh and I forgot to add here there is the emotional risks related to induction – lack of bonding with baby and PND – they don’t tell you that…..
Cannula in the back of a hand for previous post-partum haemorrhage… here’s another one – mum has maybe had a long difficult birth (due to induction – see above!), and she’s haemorhagged…. without a doubt, a serious incident and something to be aware of. However, induction is a massive factor for blood loss… so if mum isn’t induced…. really, will she have that need for a cannula which will stop her moving and immediately signal to her medical intervention etc….
I could go on and on, all I’m trying to say is that things need to change. The only people who can make that change are the women – by being informed, by getting along to your local positive birth group, hiring a doula or independent midwife, by asking the questions and reporting what’s happening to their to their MSLC.
In the words of my lovely doula bestie, Allison Tate, Women need to take back birth – they are the ones who own birth – not me, not my doula tribes, not the midwives and not the consultants – women own birth. Own your birth. Be informed. Be the change.
Much love, Tricia xxxx
I offer one to one coaching packages, consultancy for birth, full birth support and postnatal support. If you’d like to know more, book in for a FREE 30 minute telephone or skype session where you can find out more with no obligation.