Well damn it all, looks like I was totally wrong when I said that there was no one "right" way to give birth and women should have clearly presented evidence to make their own decision. Just look at the news today:
More Women Should Give Birth at Home - The Guardian
NHS Push For Home Births - Daily Mail
This has all come from new draft guidance issued by NICE, the body who evaluate the effectiveness (and cost effectiveness) of NHS treatments. It uses the evidence from the Birthplace Study and, rather than saying all women should have a home birth, it says that all low risk women should be advised to give birth away from a hospital obstetric unit, in midwife led unit or (if they aren't first timers) at home.
"Midwives should explain to the mother-to-be that she may choose any birth setting... and support her in her choice"
(Quote from Nice as it appeared in the Daily Mail piece above)
The fact that many news stories have chosen to focus on home birth rather than midwife units is unsurprising. Its guaranteed to whip up arguments, there are plenty of evangelical supporters of home birth and a whole host of others ready to shout them down as hippies. In fact the guidelines themselves cover far more than just place of birth. But beyond the headlines the language is crucial here. Women should be given unbiased, clearly presented information about the risks and benefits of each setting and they should be supported in the choice they then make. But the guidance states that women should be "advised" to give birth away from obstetric units.
There is a fine line between advised and persuaded and it's not far from there to coerced.
I for one do not believe that there is anything inherently wrong about wanting to give birth surrounded by 21st century doctors, medical equipment and pain relief. It is true that there is a greater risk of intervention in hospital and women must be made aware of this. Low risk women should not be forced into an obstetric birth if it's not their choice and they shouldn't be scared into it because they erroneously think it's the only safe option, but it should BE an option and there shouldn't be any judgement attached to that.
"To the woman he said, “I will surely multiply your pain in childbearing; in pain you shall bring forth children"
I for one increasingly feel that there is far too much judgement. A woman who gives birth with no pain relief or interventions is now somehow the feminine ideal, empowered yet a part of nature's great plan. To read some of the descriptions it sounds like a pseudo-religious experience, the ancient, biblical image of "mother " enduring pain as she's supposed to. Those who want to make use of modern medicine are portrayed as weak and selfish, giving in to the cold, artificial, masculine temptations of science and technology and missing out on the true wonder of what their bodies can do. Perhaps I'm getting carried away here, I feel like I should be throwing in the word patriarchy at any moment. But this isn't just coming from a male dominated media. News websites of course want to get people angry and commenting, but us women and the groups we trust to stand up for us are colluding in this and egging it on.
I listened to a bit of a radio phone in on this story, (before I got cross and turned it off). But the host raised an important point. What about pain relief? At home or in a midwife unit you can't have an epidural. Of course many women won't want one anyway, but some will plan to use it from as early as possible, many more will plan not to but change their minds during labour (how many of us who have been through childbirth really knew what to expect?) One caller, though she tried not to, typified how judgemental we women can be of our own. She talked about her wonderful natural births and when asked about pain relief said that women in hospital were likely to use it, "just because it's there". Basically she didn't use it, brave, strong, empowered her, so anyone who does must just be weak. It's the obstetric equivalent of raiding the fridge on a dull Tuesday evening.
Inevitably Belinda Phipps of the NCT (and go to "voice of the mothers" for anything pregnancy and birth related) was also on the show. She responded to a question about epidurals by warning of the dangers - the risk that they would lead to more interventions. When asked about women who didn't plan to use one and then changed their minds she dismissed the question, saying that even if you were in hospital there probably wouldn't be anyone around to do it in time.
Well, sorry sisterhood but I just don't agree with either of these women.
Yes there are potential downsides to epidurals, (more information can be found here) nothing in life is risk free, especially not childbirth. But there are advantages too, they make the very hurty thing stop hurting, they let you rest and maybe get something to eat when you've been pacing in agony for days and overall they are pretty safe (kind of like home birth really) it's a trade-off of risks and benefits so if a woman makes an informed decision to have an epidural, why is that not a perfectly valid choice? Certainly some women want epidurals and don't get them because of staff shortages, I can vouch for that myself, after 24 hours of unremitting contractions I waited several more before an anaesthetist was found, and drugs made up. But rather than dismissing epidurals because of this problem why aren't the NCT campaigning for more anaesthetists as well as for more home birth midwives?
As for the caller? Well it's great that her births went well, if she feels proud of herself for that, then good for her, she's been through a tough thing and come out the other side. But does she really think that her experience is typical for everyone? That anyone could have births like hers if only they were as brave? as strong? as "empowered"? You can be all of these things but dumb luck has the final say.
The guidance may be trying to help women but much of the response to it does exactly the opposite. It's time we stopped judging mothers by how they give birth and we need to look to ourselves for that, not just the media. It's great that we have moved on from the 1970's where women were flat on their backs doing as the doctor ordered, I thank all the women who fought for that change. But we risk a new, self imposed oppression if we call for choice, then dictate that only one of those choices is right.
PS. There is still time to vote for me in the Health category of the BiB awards! Click on the badge below and fill in the form (pretty please)
PPS. I also feel I should apologise for begging for votes then not posting for ages - I'm currently on chicken pox lock down so although I've not left the house in days I have very little time to write!