Wednesday, 20 March 2013

Am I Ill or Damaged?

And so the too posh to push argument continues...

On Monday The Times published a letter* from Prunella Briance. It had been written in response to the Kirstie Allsopp articles that I mentioned in my last post. Briance claims to have proof that 97% of women can give birth with no medication or "interference". The remaining 3% are: "usually ill or damaged". My first caesarean was definitely unavoidable - I wasn't ill, does that make me damaged? hmm.

But why am I even bothered about the opinion of Prunella Briance? Frankly, she sounds like a conspiracy theorist (if there is a proven way to achieve a 3% C-section rate why on earth has it been hidden from us?). I'm bothered because in 1956 she founded an organisation called the Natural Childbirth Trust. It's now called the National Childbirth Trust (the NCT)** and is hugely influential on childbirth issues in the UK. It would be very worrying if this was still their opinion. The NCT haven't formally responded to Briance's letter, but  Belinda Phipps, their CEO, did answer a question about it on twitter*** saying:

 "Prunella NCT's founder 57 years ago - lots has changed since them (sic)".

Good. It's understandable that Briance holds strong, but outdated opinions. In the two decades prior to the foundation of the NCT the maternal death rate in the UK had plummeted thanks to various factors including antibiotics, and greater access to professional medical care. But unfortunately, for many women giving birth at the time, there wasn't a cheery east end Nun in sight. It was a clinical procedure and they were expected to just shut up do what they were told with no emotional support whatsoever. You can read about Briance's own traumatic experiences of birth in this interview from 1996. Briance blames the medical staff for what happened to her and, although I can't agree with her letter this week, there is no doubt that women today have a lot to thank her organisation for. So it was heartening to read that the NCT continue their good work, while putting aside the more dubious (and rather insulting) claims of the past.

I'd love to end there, but Phipps' tweet continued:

"Tho in the USA Ina Mays maternity service has a c section of 2%"

I don't know a great deal about Ina May Gaskin, but if you google her you will find no shortage of articles she's written and interviews she's given promoting natural childbirth. Her maternity service practices "spiritual midwifery" on a  farm community in Tennessee and does indeed claim a 2% C-section rate. But what does that 2% mean? We're back to confusing figures again. To the best of my knowledge, my sitting room has a 0% C-section rate, but I very much doubt that watching The Killing and eating too many Kit Kats is the answer to ensuring natural births. The 2% means nothing without a few other numbers:

How many women are transferred to hospital and then need a c-section? Are they all included in the 2%?
Are planned "elective" C-sections included or only emergencies?
Can anyone give birth there or are only very low risk cases accepted?
If complications arise during the pregnancy are women discharged to another maternity service?
What is the rate of instrumental deliveries, or other interventions?
How does the rate of serious injury or death compare to the national average? - That one's quite important!
(the total number of births is also important but is stated on the website as "over 2000")

As I said, I don't know a great deal about Ina May Gaskin, perhaps she sees a wide range of women and genuinely only 2% go on to have surgical deliveries, I hope so. I hope that the NCT know more about it than I do, have answers to the questions above and will work hard to ensure that whatever Gaskin is doing becomes standard practice here. If not, if the questions haven't been asked, if the figures are a bit dodgy then I may not be ill or damaged but I am certainly concerned. The NCT is as important now as it was in 1956 - it needs to be working from the best possible data.

SB

*Sorry for the lack of a link, The Times' pay wall is making this tricky, if you have a subscription it is in letters to the editor Monday March 18th 2013

**I expect that this debate will continue and so it is likely that I will be blogging about the NCT again. Many people have strong feelings about the organisation so let me be quite open about my own,  they are very mixed:

 I became a member in 2009, when I was pregnant with E and attended their antenatal classes. I got some great information, especially about breast feeding. I also met a group of other expectant mums who were utterly invaluable in the confusing early months of new motherhood. However our teacher strongly advocated natural and home birth. When we met two weeks after E's birth she asked how it had gone and I told her I'd had an emergency caesarean. She didn't ask what had happened, or what else had been tried, instead she wanted to see my hands. I can't remember exactly what she said after looking at them, but I left convinced that she thought that I hadn't really needed a c-section, I just hadn't tried hard enough. It seems ridiculous now, but at the time, when I still didn't fully know what had happened, it was crushing.

 If I ever seem to criticise the NCT here it is because I really want to be able to support them. We absolutely need an organisation who will speak up for the rights of pregnant women (and their partners), perhaps never more so than now, with NHS reforms, budget cuts, soaring birth rates and midwife shortages. The NCT has done some really great work, ending the obligatory enema and shave, championing the role of birth partners etc. etc. They are consulted on government policy and are the go-to organisation for any journalist wanting someone to represent expectant parents. So it is vital that their work is based on accurate,  unbiased data and that they represent all mothers -  whether or not they live up to the current maternal ideal of natural birth and exclusive breastfeeding.

*** I have a screen shot of this conversation but out of respect for the person asking the questions, who to the best of my knowledge is not a public figure, I decided not to include it in this post.


4 comments:

  1. Two things bothered me about the Briance letter. First, the dodgy 3% figure and underlying assumption that a c-section is a worst-case outcome. My two c-secs might tecnically have been avoidable, but with one baby in serious distress, labour going nowhere, and the other stubbornly transverse I'd argue that straightforward c-secs from which we all recovered quickly were very positive experiences with happy outcomes.
    The second problem with the letter is the idea that it's ever possible to over-educate a mum-to-be. Most people effectively interract with the NCT like students; the idea that they are teaching selectively to suit an agenda is something we wouldn't tolerate in our schools, so why would it be okay in an ante-natal class?
    I was relatively lucky with my NCT teacher: she covered c-secs pretty well (although still did her best to make doctors sound like villains, desperate to cut you open). She also lived up to many of the NCT stereotypes ("Home birth is obviously best" "Pain is good" etc etc). I just want them to be honest educators and credible champions for mums-to-be, but they're not going to achieve that as long as they misuse information. Keep up the good blogwork!

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    1. Well exactly. I also think it is rather insulting to women to assume that the majority couldn't deal with the facts, even the unpleasant ones, and make rational decisions themselves.

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  2. It's because we're just silly women. Too much information just overwhelms us ;-)

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    1. oh yes that's it, I forgot! Silly me, my head is too full of shoes and cupcakes to remember!

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