Tuesday, April 03, 2007

British battle royal

There is a fascinating debate raging in the UK right now. The National Health Service has decided that there should be one midwife per pregnant woman in the next few years. NHS is also on a kick encouraging home birth (which is why the call for more midwives.) At the moment, there is a serious shortage of midwives, who are still the primary attendant for laboring women, even in the hospital. Below is a column that ran in the Times of London. My comments are at the end of the column.


From The Times (London)
April 4, 2007

Natural birth! Hello? This is the 21st century
Let’s have fewer pious midwives, not more

Alice Miles

A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her “confinement” (where do they find these male presenters born so many, many generations ago?).

We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. “It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible,” writes Ms Hewitt. Her junior “Minister for Care Services”, Ivan Lewis, adds: “I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent.”

A “normal” birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth “naturally”.

Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.

As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her “quite a lot of grief” because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: “A lot of women want to follow their favourite celebrity.” Then she asked whether I was doing it at my husband’s request to keep myself perfect for him “down there”.

There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.

Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child’s life in only a blur of exhausted depression and trauma. Does maternity not “matter” for them, too?

Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the “down there” issues that Maureen referred to, either.

Yet the whole thrust of government policy is towards making that — the best choice for many — less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the “natural”. Ouch!

Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has “failed” to have a “normal” birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed “birth plans”.

One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: “Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family.” So irritated were many “pull yourself together, girl” readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): “In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a ‘natural birthing yoga’ class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong.”

Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women’s birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don’t, choose drugs. Choose a Caesarean. Choose life — any way they want it.

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So that's the column. My issue is that she is perpetuating a horrible post-modern myth that c-sections are not painful. They HURT. They can lead to horrible and hard-to-treat infections. And they are not safer unless there is a true medical issue with mother or baby. Scheduling the operation just to "put it in the diary?" Squeeze out one more column in advance? This is the plague of women of my generation. We are control freaks.

Having looked at how cultures around the world have given birth throughout time, I can say with great authority that there is never an easy way out of giving birth. On the one hand, it may seem easy to say, well if this is what she wants, fine, no skin off my back. But unfortunately, as more women clammor for c-sections, they become increasingly standard procedure; they're easy for doctors; they can manage their time and their patient flow more effectively. But once the operation becomes so common (1 out of every 3 babies in the US is born by section) it effectively limits the options of other women. That would be a shame.

1 comment:

Dara said...

It is absolutely necessary that all women educate themselves when it comes to their options in child birth. It is clear to me that the vast majority of women in this country are highly under-educated in this arena and place full trust in doctors because they are doctors and see midwifery as midieval. Why is there such misunderstanding when it comes to the roles and practices of midwives and doctors? Why aren't the American women crying out at the disempowerment and abuse they suffer in a traditional hospital in NYC and throughout the country?
Realize that a nearly 30% cesarean rate is hardly because of the "too posh to push" disaster, but rather because all the well meaning interventions and pharmaceuticals that interfere with the natural cascade of hormones and autonomic nervous system that guide and regulate labor likely cause the majority of the very emergencies that rush women into the OR. Perhaps giving birth to a child through undergoing major abdominal surgery is the wave of the future.

I highly suggest that for those of you who do not want this to be the case for you to educate yourself on the state of American obstetrical practice. Know that we have the highest cesarean rate and maternal/perinatal mortality rate in all the western countries. Know that we also have the lowest number of births attended by midwives of all the western countries as well. Know that there are certain developing countries with a lower maternal death rate that we boast. Why fear a midwife and her lack of medical technological interventions and clearly superior clinical skills? Perhaps you should just go ahead and schedule that c-section.

A fantastic book that all American women can read in order to fully understand their options and the reality of the state of birthing in the US is called "Born in the USA" by Marsden Wagner, MD. the former director of maternal-child affairs for the WHO. The women of the US deserve better than the way they are currently treated. They deserve more than to continually shroud themselves in the ignorant bliss that the current maternity system blinds them with. Demand safety in birth, demand safety for your baby, demand change. But to do so, we must first empower ourselves with knowledge and freedom from fear.