Monday, 9 March 2015

10 (+1) Things Not To Say To A C Section Mum

Whatever the Telegraph may think, most Caesarean sections don't happen because "posh" women want to schedule them around their manicures or business meetings. They are usually undesirable, often unexpected and occasionally downright terrifying. I was lucky enough to come out of my emergency c section with a healthy baby, without the surgery the outcome would have been very different.

Yet still, I got some pretty unhelpful comments. Some were well meant, but in the fog of the situation they seemed to hint at something else, something I was already deeply troubled by - that perhaps a caesarean birth, maybe anything other than an all natural drug free birth, was seen as a failure. Others just came right out with that opinion.

Whatever your own beliefs about childbirth, there is absolutely nothing to be gained by making a woman feel bad about how her baby arrived in the world, especially not if it's only just happened. So here are my top ten things NOT to say to a C section mum and how they might actually sound to her:

1- What they say:
All That Matters Is A Healthy Baby.

What it sounds like:
It doesn't matter if you had a hideous time, shut up about it and stop being so ungrateful.

I was acutely aware of how lucky I was to have a healthy baby. But that isn't the only thing that matters. The future wellbeing of that healthy baby is symbiotically linked to the health of the mother. If she is physically or emotionally damaged by a traumatic birth, that matters to the baby. Oh and another thing - a mother is still a human being, if she is hurting that matters too.

2- What they say:
Oh what a shame

What it sounds like:
What a shame you didn't do it properly. What a shame you missed out on one of those wonderful "birth experiences". What a shame modern medicine saved your lives. (?)

3-What they say:
It's not really birth

What it sounds like:
You didn't give birth to your baby, he/she was just surgically extracted.

There was a baby in my belly, it came out of a hole in body. Therefore I gave birth.  It may have been a sun roof delivery and assisted by a surgeon rather than a midwife but it was still a birth and no less special for the angle of exit.

4-What they say:
You should have tried yoga, hypnobirthing, a doula, a waterbirth etc. etc.

What it sounds like:
You didn't do it right, so it's kind of your own fault.

Actually I did try all those things (well apart from the doula). They can be great and many women who've had straightforward births swear by them. But no individual can ever know for sure if it was the yoga/hypnosis etc. that made the difference, it could have just been good luck. None of these things offers a 100% guarantee. If dumb luck deals you a really bad hand then no amount of affirmations or pregnancy sun salutations will change that and plenty of women have perfectly straightforward births without any of them.

5-What they say:
I never thought that would happen to you!

What is sounds like:
I always thought women only have C sections because they don't try hard enough, are too posh to push or freak out at the first twinge of pain. I didn't think you were like that... but now I'm wondering if you are.

6-What they say:
It was probably an unnecaesarearn!

What it sounds like:
I don't believe that your C section really saved anyone's life. You were tricked into it by the doctors and too weak or stupid to stand up for yourself.

If a women tells you she had a life saving c section then to her, it was necessary. Perhaps is was possible that a vaginal birth would have been fine too, but if she decided to endure major surgery rather than take any risk with her own life or her baby's, then it was necessary to her. End of.

7-What they say
Let me tell you about my amazing home waterbirth...

What it sounds like:
Hey look at what you could have won if you were just like wonderful me!!

It's great that many women have had wonderful experiences of birth, but those of us who haven't really don't need them ramming down our throats uninvited. Many women feel a sense of loss at not having had the kind of birth they hoped for. Maybe in time hearing positive stories will be helpful, but it has to be about what the listener wants to hear, not what about the speaker wants to say. If a woman asks you to share your story, do. If not, shut the heck up for now and go find a facebook group to share it with.

8-What they say:
That's nothing, listen to my horror story...

What it sounds like:
Stop whining! What happened to me was way worse, you have no right to be upset.

There are no medals for childbirth martyrdom, there is no ranking system for who had it worst. A two hour labour may sound like a dream if you were in labour for days but for the woman concerned it could have been brutal and shocking. A C section may sound like an easy option if you endured a difficult forceps delivery and vice versa. If someone believes their experience was traumatic, then to them, it was.

9-What they say:
You'll always have to have C sections now you know.

What it sounds like:
You have no options now.

This might have been the case in the past but it certainly isn't now. The way the surgery is now normally done means the scar is quite strong and many women go on to have straightforward vaginal births. About 70% of VBACs (vaginal birth after caesarean) are successful. In some cases another Caesarean may be advised but most C section mums should have a choice over future births.

10- What they say:
Well at least you didn't have to have stitches!

What I say
Ok I know what you mean and yes, most c section mums won't have had to endure a tear or cut "down there", I know they can be pretty awful, but er, what exactly do you think is holding my entire abdomen together right now? 

oh and one last one, this may just be me though-

11- Well, I know it was a big baby but you're so tall it should have been fine!

Yes, I'm tall, but my baby was a whopping 33% bigger than the average baby girl. I'd have to be 7' 7" (232 cms) for the two to compare. But even ignoring that - here's the thing, er, the length of the mothers limbs isn't exactly the vital statistic here is it??

PS. Of course every woman's experience is different - do you have any more "things not to say" to add to the list? Do you disagree with any of mine? Comments are always very welcome!

Tuesday, 3 March 2015

Angels and Demons, Some Thoughts On The Morcambe Bay Scandal

I've been reading about the Kirkup inquiry into the deaths of mothers and babies at Furness hospital with great sorrow today. I wish I could also say I was shocked but I'm really not. I've not read the full 209 page document but one part of the executive summary really struck me.

"...working relationships were extremely poor, particularly between different staff groups, such as obstetricians, paediatricians and midwives; there was a growing move amongst midwives to pursue normal childbirth ‘at any cost’; "

There are many many wonderful midwives out there. Midwives who work tirelessly to care for women, to make their births safe and joyful experiences and who fight to improve services despite being overworked and under staffed. I've been lucky enough to be cared for by some of them. But in all the years I have been researching health issues around childbirth I've regularly seen two particular ideas being spread that worry me.

The first is that  "normal birth" ie. vaginal birth with no interventions or pain pain relief, is best. Targets should therefore be set to achieve more of them, individuals and entire services should be judged by the proportion of their births that meet these stringent criteria. Midwives (and others) who encourage women to have "normal births" are lauded. I've never been comfortable with this. Of course interventions are rarely welcomed and an unmedicated vaginal birth will be the best possible option for many women. But there are now many kinds of birth, both by choice and necessity. Sometimes the best possible birth is planned caesarean section, sometimes it needs an induction to get it going, sometimes a women may just decide that she is in dreadful pain, and as there is a really good, safe way to make it stop, she might as well use it. When so much effort is focused on promoting and achieving only one kind of birth there is surely a risk that all the others will be neglected. When people, especially midwives, publicly heap so much praise on this one kind of birth and endow it with benefits far beyond those that are scientifically proven, is it any wonder that many mothers who don't meet these expectations feel like they have failed and perhaps let down their babies? The best birth is one where mother and baby feel safe and well cared for, where both emerge healthy and there is no lasting harm, physical or emotional, to either of them. That can't always be achieved vaginally and drug free.

The second idea is pretty much a meme amoungst advocates of midwife led natural birth, here's just one example:

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Essentially, midwives are wonderful, nurturing women. Doctors are cold and uncaring men, devoid of human sympathy. They have no interest in mothers or their babies, and just want to get those births over and done with as quickly and clinically as possible (without any chance of getting sued). According to this belief, midwives and doctors aren't two medical professions working together , they are two utterly opposed ideologies. 

True, there are plenty of great midwives and a lot of rather aloof and callous doctors, but no profession is made up entirely of angels or demons. There are some pretty damned unsympathetic midwives out there. I've been on the receiving end of some of their "care". I've also met some lovely doctors, including two male obstetricians who showed enormous sensitivity when I burst into tears during their busy clinic and took great care to reassure me and give me options about my care. Not only is this "Midwife good doctor bad" meme inaccurate it's also does a huge disservice to the great many women who turn out to need care from a doctor. In the UK, a woman with a low risk pregnancy will normally only be cared for by midwives, both before and during the birth. But what if she turns out not to be low risk?  She will most likely already be worried about whatever that risk is. If she's also been taught to believe that the doctors she will have to deal with will be uncaring and even dangerous, how much more fear will that place on her? How much harder will it be for that woman to work with her doctor, and make informed decisions about her care, if she is expecting a fight before they even meet?

Sadly, at Morcambe bay these two ideas seem to have run to their extremes. Instead of working with doctors the midwives set themselves apart. They held the ideal of normal birth so high that lives were sacrificed to it. The individual midwives were not the only ones at fault of course. The doctors should have spoken out but they didn't and at many levels problems were ignored and hushed up for years. Mistakes happen, but these mistakes were systematically hidden away and so they continued to happen and more and more families faced going home with empty arms.  We only have the Kirkup inquiry because of the astonishing bravery and determination of some of those families, such as James Titcombe, who's baby son Joshua died of sepsis after a shocking lack of care which was then covered up. 

I absolutely stand with those who want to improve women's experience of childbirth. I owe a huge debt of gratitude to everyone who fought to move us away from the "do as you're told, doctor knows best" attitude of the past. I know that there are many wonderful midwives and that "normal" birth is the best possible birth for many women. But perhaps it's time for a little reality check. Midwives aren't all heroes, they are human beings after all. Exalting them as something apart from everyone else and from other medical professions might feel nice, "empowering" even, but it helps no one. Not the midwives who want to be great and what they do and who need to be able to learn from mistakes. Not the doctors, who have to deal with women who walk in their door already scared or angry with them. And certainly not the families, who need a kind and knowledgeable team to guide them through they most physically and emotionally demanding events of their life.