Childbirth and infant feeding: why the war?

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The polarisation of opinion with regard to these topics is growing by the minute…and there is much to debate. For this post my thoughts are focused on childbirth, although both subjects are absolutely interlinked.

My initial response when I read condemnations for those who promote and support normal physiological childbirth or breastfeeding is of sadness and shame. Sadness that there has potentially been some degree of personal distress for the one proclaiming their opinion. Shame that my profession is often part of the ‘problem.’

I see and hear opposing yet valid viewpoints about childbirth on almost a daily basis, mainly via blogs, Facebook and Twitter. We are all entitled to our opinion, and it’s good that there can now be a degree of open debate via social media channels. The problem arises when journalists and high profile individuals sensationalise a particular topic through mass media, basing their opinion on their personal experience. This can be inadvertently damaging, especially when related to childbirth.

Kirstie Allsopp’s response to the recent ‘too posh to push’ coverage in the Telegraph is an example of this. I can fully understand Kirstie’s retaliation to the implications that the Caesarean Section (CS) rate is higher in middle class areas, there may be something personal in that. The fact may have an element of truth, but the reasons for the increasing unnecessary intervention and related CS rates aren’t as simple as this. There are other suggestions for the relentless shift.

As stated in the Telegraph article, and in opposition to what the article headline actually suggests, women choosing to have major surgery instead of giving birth naturally are in the minority, and if there is a request is it usually for a very valid reason, usually associated with unprecedented fear.

Instead, the evidence and debate on the declining normal birth rate points to factors such as increasing maternal age, complexities of pregnancy, increased numbers of multiple pregnancies due to assisted conception, lack of senior doctors to make decisions on birth suite, low midwifery numbers, midwifery skill mix, focus on risk factors, women’s uninformed choices, inappropriate use of clinical ‘guidelines’….the list goes on.

For decades, childbearing women have been marginalised. I witnessed this during the thirty plus years I worked as a midwife, as did (and still do) my midwifery colleagues throughout the UK and beyond. Women’s belief in their ability to birth their babies is declining rapidly as a result of unnecessary medicalisation in maternity care. This was recognised as a growing problem more than thirty years ago, and midwifery organisations such as the Association of Radical Midwives and service user organisations such as the National Childbirth Trust thankfully and successfully campaigned for change.

Whilst practices of unnecessary medical intervention in the childbirth process continues globally, there is a continued and renewed uprising; women, midwives and obstetricians are recognising the potential consequential harm to mother and baby. Childbearing women in particular are the catalyst for change. Instead of remaining afraid, women are forming organisations to support parents to be, such as The Birth I Want, The Positive Birth Movement, One World Birth and Birthrights. Doctors and Midwives are active too. I imagine if Kirstie was having her babies twenty years ago she would been amongst those initial radicals campaigning for change. But with the drive and energy for change comes expectations of parents, and when those expectations aren’t reached for whatever reason, disappointment seems to initiate the need to blame instead of pursuing further change.

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The topic is a complex one. But take a look at the chart here. The Caesarean section rate is increasing, and the normal birth rate decreasing. This alarming fact isn’t matched with improved health for mother and baby, in fact I would suggest it has had the opposite effect.

So, are we wrong to try to influence the way babies are born? I think not. But instead of arguing and blaming others, women, men and families must try to move together. The evidence is stacked high that where birth is as close to nature as possible, where women are cared for respectfully and her caregivers are respected then maternal and child health is at it’s best. Some women need intervention. Both my daughters did, and it was life saving. But we are now in a danger zone where medical advances are replacing nature, and that causes harm and was never meant to be.

So come on. Women are not ‘too posh to push’. They are strong and powerful, and if they are given respectful and supportive maternity care they will flourish as women and as mothers. But they need to know and understand the evidence behind the implications of some of the choices they make, and that others try to make for them. Those providing that information and encouraging them to achieve their goal does not mean they have a ‘luddite obsession’ and they are not the purporters of guilt. Midwives are feeling more desperate for change by the day, and they need women (and their partners) to help them to reverse the trend.

Let’s get together Kirstie, and see what we can do.

Childbirth chart BirthChoiceUK

Photograph copyrighted to SevernJonesPhotography

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28 comments on “Childbirth and infant feeding: why the war?

  1. Hi Sheena, thank you for your interesting post.

    Yes it is interesting how society tends to think that the reason why the c/s rate is relentlessly increasing is that women need it – or demand it…

    I went back to watch Eugene Declerq’s 20 min film that addresses the question why the c/s rate increases in the US (and in all the high income nations).

    He clearly shows that it is not related to women’s age, babies’ gestational age or because women are “too posh to push”. It is related to the changes in practice: “if you set up a system that focuses on the 1 percent of problems that might occur, you undermine the care of the 99 percent of mothers who don’t need those services” (Declerq).

    Eugene Declerq, PhD, Professor of Maternal and Child Health at the Boston University School of Public Health.

    The clip starts addressing the c/s question from min 11:36.

    http://www.birthbythenumbers.org

  2. Thank you Sheena for such an eloquent blog. I agree with you whole heartedly that we are a society where we are losing sight of the natural processes of child birth.
    Childbirth can be an exhilarating, magnificent experience. With all that can come complications and risk factors, but the positives out weigh the negatives. I had 2 wonderful labours, first time induced and second time I had a significant PPH afterwards, but I look back on my experiences as positive. I am thoroughly grateful for the medical intervention with the PPH, as if I’d have been at home, the situation could have been very different.
    Natural birth is one if the most empowering things a woman can do. All they have to do us believe that they ‘can’ do it. Support from midwives and health professionals can support this. I’m hoping that with the development of the ‘midwifery 2020’ document, one to one and continuity of care will enable women to have increased self belief and attitudes will change.

    • Thanks Rachel…and congratulations on the births of your children! We are indeed lucky to have skilled practitioners to keep us safe. And we must heed the harm caused if intervention isn’t necessary, or choices made result in unnecessary interference. So grateful for your comment 🙂

  3. I love this. Women are powerful and they should be informed. Having confidence and self belief is so important, and understanding the implications of decisions is too. After 2 emcs and 1 elective I finally know this!
    xd

  4. What are you thoughts on the subliminal messages give to people in the media, one that has just struck me as promoting formula feeding was the e-on advert with the kettle. The ‘Dad’ make a bottle for the baby, but it could be showing him making a drink for the BF ‘Mum’. I think it’s the insidious nature of these ad’s and society that undermines breast feeding. I appreciate that some people choose formula, and respect that, but i feel that formula is over represented on tv. Thank you

  5. Thank you for such an insightful blog Sheena.
    Unfortunately my first labour was an induced terrifying experience that resulted in an emergancy CS. I’m now expecting my second child and the fear from my first still clouds my judgement.
    I have explained my fears to my health care providers and I can honestly say I feel dissapointed in their lack of support or willingness to provide help.
    If it wasn’t for the support of other mothers in real life and through social media I would have signed up for an elective CS weeks ago! However, thanks to their support I’m hoping to have a natural birth and I’m finally managing to put some of those fears to rest.

    • Hi Haley, You might want to check out tellmeagoodbirthstory.com if you haven’t already for support and inspiring positive birth stories. Like you, I had a first labour involving induction and it resulted in an emergency CS. I had so many fears and doubts about my second pregnancy I was considering an elective CS as well. My birth buddies from tellmeagoodbirthstory helped me put my fears and concerns to bed and have an AMAZING natural birth at home. Good luck with your birth and new baby! xo

  6. Keep writing Sheena, your words are so powerful. Great post. It is so hard to get across why this issue is so important, but you’ve done a great job.

    Nicola Philbin

  7. Hi Sheena, Thank you for such an elegant and informative blog.I agree with everything you have said and look forward to the debate.
    Best wishes,
    Lesley

  8. Great blog Sheena. I firmly believe that the higher caesarean rate among more affluent women (at least here in Australia) is directly related to the fact that these women are more likely to be under the care of an ob/gyn during pregnancy, not because they’re ‘too posh to push’. I had a traumatic vaginal hospital birth just over 10 years ago which resulted in a non-consentual episiotomy, a ventouse extraction and a messy 3rd degree perineal tear which became infected requiring surgery at 6 weeks (during which the local anaesthetic didn’t work) before it finally healed at 7 weeks post partum. I was left with PTSD and ongoing urinary and sometimes even faecal incontinence, and I was told by 2 ob/gyns that I would never give birth vaginally. I had my 2nd child last year at the age of 41 and immediately planned a homebirth with an Independent Midwife. I was diagnosed with a thyroid condition at 7 weeks pregnant, and sent off to an obstetrician as a result. He was atrocious – as soon as he heard I was planning a homebirth he went on and on about the risks (which are the same as for a hospital birth mind you). Before I could even finish the abridged story of my 1st birth, he had recommended an elective C-section to avoid another perineal tear – I was stunned and I never went back to see him again. But other women (including women I know) just take this sort of advice as gospel because these specialists are seen as the ‘experts’ and most women don’t know any differently. I read Ina May Gaskin, Michel Odent and Sarah Buckley and with the assistance of my wonderful midwife and my husband, I gave birth to our daughter last July in 6 hours at home in our spa after only an hour of pushing. I had a minor 2nd degree tear because I really did push my girl out quickly due to the pain in my back, but it didn’t require stitches and healed in a week. It was the most healing and empowering experience of my entire life. I am now on a mission to ensure that the women I know are aware of their pregnancy care and birth choices and where to go to find the latest evidence based information so they can make informed decisions for themselves and their babies.

    • Oh Susan, thank you for telling me your story here. I was sad to read about your first birth and the issue surrounding it. It’s good to know you have had a positive birth that appears to have healed you somewhat, and that you feel strong to help others. I know about the private system in Australia as my niece is a midwife there.
      I really appreciate you taking time to comment on my post, Sheena

  9. Hi Sheena
    Just wanted to say thank you. I am fairly newly qualified and now work in a consultant led unit. I constantly turn lights off and try to create a calm environment for women. The lights usually get switched back on by someone noisy! It’s hard sometimes not to get overwhelmed by the medical conveyor belt!

    But by hearing people like you remind us that the ‘experience’ of families is important and that our job is to support and empower women really helps us remember about the part of our job that we love. Its refreshing and uplifting and we need that sometimes.

    So thank you for helping us think about our practice and how we can be better so that women have an amazing and positive birth, whatever that is. After all, birth is pretty amazing!

    • Hi Claire,
      Good to hear from you. Do you know the switching lights off and on scenario has been going on for years! I remember in 1989 when I was transferred from working in a birth centre to a consultant unit (because it closed) one midwife always switching lights on without asking. It took me a while to pluck up courage to challenge her, but eventually I did….
      Anyway, keep strong and be the change you want to see!
      Sheena 🙂

  10. I don’t understand your graph, shouldn’t the two lines add up to 100?

    I had a baby last year, and I hear where Kirstie is coming from. My NCT classes were more practical than some of the stories I’ve had from other friends, but out of the 8 of us, only one had the natural waterbirth that most of the sessions were about (one ELCS, 2xEMCS, then a variety of induction/monitored for meconium/pre eclampsia/forceps). When a good half of the sessions were building up to the perfect drug free waterbirth, there felt little that could be said of the usefulness of the classes… But hey, at least we can all practice having contractions to whale music.

    • Hi Jennifer,
      Thanks so much for taking time to respond. It’s a pity couples feel their antenatal classes are less useful than they expected. I can’t comment on the class leaders capabilities in general, but I wonder why women complain so much when I would’ve thought they attend birth preparation sessions to get the best information to achieve their goal? It’s similar to an athlete competing in an event. Their coach gives them the appropriate information and training to help to reach their aim, and disappointment is inevitable if it’s not achieved. If the athlete doesn’t succeed due to the crowd watching, another participant or the environment, he can’t blame the coach. I agree that it’s important to prepare for all eventualities, especially in birth preparation classes, but the focus should be on strategies to help couples achieve what THEY want. I actually attended NCT sessions many years ago when I was starting to deliver antenatal classes as a community midwife. The NCT tutor (Clare Harding) was amazing, and she asked couples what they wanted during the first session. In my experience of delivering sessions to women and couples, most wanted to know as much information as possible on how to achieve a ‘normal’ birth, and to just touch on ‘what if’ scenarios.

      In the developed world, unnecessary intervention rates in childbirth are soaring out of control, a fact reflected in the stats from your group. I reckon it would better to focus our energies on improving the environment, other ‘players’, and decisions made before and during the childbirth journey. This will be much more fruitful than blaming those who try to help parents negotiate that unnecessarily complex journey. Like practising contractions to whale music. I’ve seen that work so well, many times-and not just for labour! Thanks again-and congratulations on your new baby! Sheena 🙂

  11. Isn’t it strange how things are changing? I now feel guilty if I say that I gave birth to my second in a midwife led centre taking only two paracetamol (which I promptly threw up!), breathing through contractions and finally giving birth in the water. I don’t want to be told how brave I was or how unusual it is, to me it was a natural experience with a supportive midwife there almost as an observer.

  12. Pingback: Why women don’t often get the birth they want: my thoughts on the topic | SHEENA BYROM

  13. 47% ‘normal’ delivery and 25% c sections. What’s the rest? Totally crap graph. What the flying pig is a ‘normal’ delivery anyway? I’ve had two, would like a third and all I want is a healthy me and healthy baby. First. World. Problems.

    • Thanks for your reply Joanna! Take a look at http://www.birthchoiceuk.com where the graph came from, it will explain it better, including instrumental births. Great that you would like another baby, good luck! And we share objectives! Healthy mum-healthy baby…and then we may have less world problems! Best wishes, Sheena 🙂

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