Newsletter number 7
June 2023
As far as I am concerned the most difficult problem with childbirth is that it is often very tedious.
Long, Boring and Tedious.
First labours can last anything from 24 – 48 hours or longer, quite normally. What I have realised in 47 years as a midwife is that Doctors cannot do Long, Boring and Tedious. It does their head in.
Doctors in 2023 are Action Man (or woman), they get things done. They excise your cancer, they regulate your heart beat, they sort out your kidneys, they enable your broken bones to heal together and we are all the better for it. We all live longer than ever before when they interfere, intervene and progress a process. Doctors are all about intervention.
The two areas of medicine where this approach is not appropriate is where we need patient and calm support, where we need nothing “done” to us, where we just need comforting and encouraging, when we are dying (another long, boring and tedious process) and when we are in labour. These are the two areas of medicine where the modern approach of “hurry, hurry, hurry” does not work in the interests of the patient.
Women are mammals. Mammals are exceptionally good at giving birth and at protecting their young. We conceive our babies inside our bodies so that they are protected from Day One. We grow them inside our bodies and we produce hormones that enable our ligaments to stretch and accommodate the growing fetus. When we are ready to go into labour a hormonal flood enables our bodies to stretch and open, our pelvis to move and accommodate the twisting and moulding baby. All mammals (unless they are pedigree dogs who have been bred to conform to an unusual stereotype) have very few problems with childbirth (think of cats, goats, sheep, elephants, giraffes). So not only is human childbirth long, boring and tedious, it also usually needs very little intervention. So what do Obstetricians have to do to ensure that they have employment? They have to sabotage labour and birth to enable them to “rescue” women in their distress.
Labour as I know it, after 47 years as a midwife is very lacking in drama, it is hour upon hour of encouragement. Sweetened liquids, toast and honey to keep her blood sugar levels up, distraction “Let’s go for a little walk”. Movement, “Let’s try walking up and down the stairs”. In nearly 50 years of looking after women at home I have had to transfer a woman in her first labour to hospital in an emergency on only one occasion. That is not to say that I haven’t transferred a lot of women having first labours to hospital because the labour is lasting so long, or that they want an epidural, but the transfers have not been emergency transfers – there has been no rush, no panic, we have just moved lock stock and barrel to another facility where other comforts are available.
We are seeing at the moment a horrendous clash in philosophies and cultures. Less women are giving birth in the UK. In the 1980s 2300 women gave birth every day, today 1900 women every day. But instead of less doctors we now have five times as many as we had in the 1980s. And in order for them to have something to do when they are at work they have to deflect women’s labours from the start. Hence between a third and 50% of women are being induced, or accelerated, or delivered surgically. Every intervention increases the pain of labour and women’s need for extra help or extra pain relief. This may give doctors more to do but it certainly makes labour more difficult and more hazardous for women and their babies as is shown by the figures and the survey by Mumsnet published in the Times 28/05/2023 where a third of women felt traumatised by their birth experience.
Midwives feel forced into coercing women to comply with the prevailing ideology which they don’t agree with and feel is cruel and unnecessary. They are like wardresses in a Concentration Camp, carrying out unkind and harsh actions which go contrary to their professional opinion and knowledge.
Women are never told the truth.
For instance “You are 41 weeks pregnant, we are going to induce you on Wednesday”. This phrase should, of course, be “You are 42 weeks pregnant, we are offering you an induction of labour on Wednesday, and here is a list of the data behind our suggestion, and the advantages and disadvantages to you of this course of action so you can choose whether to go ahead with it or not.”
So the woman turns up at hospital on Wednesday for induction. She thinks that she will be having her baby on Wednesday so she is excited and pleased. Invariably she is sent away because the Induction Clinic is full and she needs to return tomorrow. She returns the next day.
It often takes three days to get labour started artificially. Three days when she is on her own because partners are often excluded from induction clinics. Three days of discomfort, her vagina really sore from the artificial hormones , very poor nutrition, dehydration, boredom and lack of decent sleep. Very depleted and tired she finally goes into labour on Saturday, because the hormones are artificial the labour hurts more than it should, she is not producing the endorphins that natural oxytocin triggers and she is shocked at how badly she is coping. She is denied adequate pain relief because she is not “dilated enough”. Finally she gets a decent epidural but by now the baby is feeling the stresses of artificial hormones or her dilatation stops -whatever the reason, she ends with a caesarean section.
She has a major abdominal operation, she loses more blood than her body should, she starts motherhood exhausted and depleted, she finds breast feeding incredibly difficult because she is utterly exhausted and her body is busy trying to replace the blood she has lost. Motherhood, the most important job in the world starts in a complete mess. No wonder so many women have post traumatic stress following this ordeal. No wonder midwives are leaving the profession in droves.
In actual fact, we have more qualified midwives in the UK than in almost any other European country, but they are invariably being something else. Working at John Lewis, being Health Visitors, Teaching Assistants, Carers, Doulas – anything to escape the toxic atmosphere of the maternity Unit.
There is copious research showing that women fare better when they are looked after by midwives, especially midwives who they have been able to form a relationship with, especially when they are booked for a home birth.
The Ockenden Report has highlighted the ghastly outcome for many women of modern maternity care but sadly instead of highlighting positive ways forward it has suggested stopping all progress in humanising maternity care “until we have enough midwives”- a pipe dream at the moment. The media has fastened on the term “natural birth” as if there is a conflict over “natural birth” and caesarean birth. This is not about natural birth at all. In 2023 natural birth does not exist unless a woman slips into the hospital in spontaneous labour in the dead of night and gives birth within a very short period of time before anyone can get their hands on her, or she gives birth at home unassisted (happening more and more I’m sorry to say because women have lost faith in midwives).
Women need to be told the truth. That by booking for a home birth they are booking themselves into a different standard of care whether they actually end up giving birth at home or in hospital. According to the Lancet (2020) they will have 40% less caesareans, 55% less stitches, 75% less infections and 50% less forceps. We have known these figures for three years or more – are women told them, NO. Women are being pushed through an industrial process which is being dominated by too many Obstetricians. When the system is humanised and women are able to form a relationship with their midwives the results are outstanding. The wrong type of care is being given in the maternity services and sadly, midwives are voting with their feet.
