Tuesday, 13 May 2014

New Nice Guidance - The Correct Birth Choice



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:



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This has all come from new draft guidance issued by NICE, the body who evaluate the effectiveness (and cost effectiveness) of NHS treatments.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"
Genesis 3:16

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.

SBx
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)

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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!  

4 comments:

  1. I was told that as a low risk pregnancy I would be giving birth in the mid-wife led unit in Kirkcaldy. I was never really told I had options. Fortunately, I never felt the need to question it after I was advised that the unit was physically attached to the obstetric ward and if things started to go awry I need only pass through one set of double doors. I was low risk, had a normal labour and was fully dilated but I did end up having an emergency c-section when my baby presented face first and got stuck. I think the idea of mid-wfe led units is great but so many are an ambulance ride away from medical intervention and you just never know when that might be necessary. Perhaps a move towards making them an additional part of the medical ward or at least within the grounds of the hospitals would be a positive step towards easier decision making for mothers-to-be.

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  2. southwarkbelle13 May 2014 at 20:39

    Thanks for commenting. I absolutely agree, alongside midwife units seem to offer the best of both worlds and if these guidelines are to be acted on then they need to be available to everyone, although women should be aware that they have choices. I also started out in a midwife unit, I actively chose this and I also had to transfer. In my case that transfer was a slow walk down a corridor, it honestly felt like the longest walk of my life but I'm so glad I wasn't in an ambulance instead. The transfer rate , especially for first time mums is very high but that's often overlooked in these debates.

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  3. Hey thanks for this post SB! It is very well put, and I can't really add to it other than wholeheartedly agree. I was featured on an ITV news piece today, talking (briefly!) about my experience and how I was very very glad to have given birth in a large hospital, with doctors and psychiatrists on hand. They saved our lives. Women should not be made to feel that a hospital birth is a "failure" of their womanhood, or that if only they had just tried harder they would have had a lovely empowering natural birth. My obstetrician explained that there was no physical way my son would have gotten through my cervix. He very nearly didn't make it out the c section way either, he was so stuck! This was random chance - bad luck. If we had been a few hundred years ago neither of us would have survived. I wish NCT would remember that, next time they make women feel cowardly for choosing to access modern day healthcare.

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  4. southwarkbelle14 May 2014 at 14:14

    Hi thanks for commenting. Is there anywhere I can see you on the news?
    I think the NCT have done a great job in many things and moved us on from forced medicalisation but now they and others risk swinging things too far the other way. In putting so much emphasis on championing home/normal/natural birth they ignore or even criticise those for whom this ideal isn't desirable or possible. Personally I experienced far more pressure to do things naturally than to medicalise, even after an emergency c/s.

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