UK trying to push women into homebirths that they don’t want

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For many years, UK midwives and natural childbirth advocates insisted that a significant portion of women would choose homebirth if it were available to them. That hasn’t turned out to be the case. Despite increased promotion of and access to homebirth, despite research tailor made to promote the “safety” of homebirth, the UK homebirth rate has not increased very much at all.

But UK homebirth advocates haven’t given up. Their latest effort to force women into homebirths that they don’t want comes courtesy of NICE, the National Institute for Health and Clinical Excellence, who have decreed that pregnant women must be informed of interventions rates in all hospitals.

The promotion of homebirth rests on the belief that women’s agonizing pain in labor can be ignored.

An article in The Daily Mail lays out the “problem”:

Statistically, home births or those in a small midwife-led unit are just as safe as hospital deliveries for women at low-risk of complications.

But most still choose to go to hospital, where doctors are immediately on-hand in case anything suddenly goes wrong.

Imagine that! Women want to give birth at the place best equipped to handle life threatening emergencies. We must discourage them from putting safety first!

The purported “solution”?

Guidance from NICE states that GPs or midwives should provide expectant mothers with information about the safety and risks of complication ‘specific to their local or neighbouring area’.

The information would state how many needed interventions such as forceps or caesareans, or suddenly needed to be transferred to hospital – if at home or in a midwife-led centre.

This may also include the numbers of stillbirths and women who died in labour – although these are likely to be very low.

Furthermore, these figures may not be accurately recorded as women who suddenly suffer a serious complication would be transferred.

The reason, of course, is to save money, though NICE denies it:

The watchdog insisted it wasn’t a cost cutting measure even though home births are far cheaper.

Figures show that a hospital delivery costs about £1,631, falling to £1,450 for a midwife centre and £1,066 for a home birth.

But hospitals are only cheaper when you don’t factor in pediatric costs for babies who are injured or die and when you ignore the fact that homebirth requires far higher levels of midwifery staffing than hospitals or birth centers do.

The real problem, though, is that the guidance is based on two very ugly premises. The first ugly premise is that birth without interventions is a worthy goal. It’s not; birth without DEATH OR INJURY should ALWAYS be the primary goal and the number of intervention is irrelevant. So called “normal birth” is a self-serving goal of midwives and they are trying to ram it down the throats of pregnant women. There is NO virtue to avoiding interventions merely to be able to say that you avoided interventions.

The second premise is even uglier and deeply misogynistic. The promotion of homebirth rests on the belief that women’s agonizing pain in labor can be ignored. I don’t notice anyone promoting home vasectomies or home transurethral prostatectomies even though the pain from those procedures is arguably less. What’s the difference? Men’s pain is always considered worthy of treatment whereas women are left to suffer, encouraged to suffer, and supposedly “improved” by suffering.

Effective pain relief is a human right, not just for men, but for women, too! The belief that women ought to endure pain or, worse, are improved by pain, is profoundly, irredeemably sexist in the extreme.

Homebirth is being forced on women because the government thinks it can save money and because the extremely powerful midwives union, the Royal College of Midwives, is more interested in promoting their autonomy and employment than promoting the comfort of women and the safety of babies.

And that is arguably the ugliest fact of all.

  • MrG

    Instead of saying: “The first ugly premise is that birth without interventions is a worthy goal.. ” what they actually say is that “.. birth without the availability of interventions is a worthy goal.” This is much more ominous. They don’t just say they want less interventions, but very deviously they say interventions should not be available at home births.

  • Brooke

    Holy freaking Christ. What’s actually misogynistic is the idea that women are too weak and feeble to withstand the pain of childbirth; too stupid to know what to do without half a dozen nurses, a doctor and machines telling them what to do when in the hospital. What’s misogynistic is that women are told long before they ever get pregnant that while their bodies and breasts are made for sex, they are broken when it comes to birth and breastfeeding. What’s misogynistic is the idea that when it comes to pregnancy, birth and breastfeeding an inexperienced doctor is considered more credible and knowledgeable than an experienced woman about her own body. Giving women education on the benefits of homebirth and giving them an OPTION is not misogyny.

    • Amazed

      What’s extremely selfish and privileged is your idea that you’re sooooo knowledgeable and experienced about your own body but you still want the inexperienced doctor to be there to catch you from your NCB thinking or downright homebirth if things go south. In doing so, you admit that doctors know more. You just want them to be on your beck and call, worshipping at your false altar of superior knowledge.

      You know what, oh Experienced one? Go unassisted. With the tiny detail that should something go awry, you and your baby don’t get to use ’em inexperienced doctors. This planet is overpopulated anyway. I think it’s a good way to cut the number of privileged brats and future privileged brats short without murdering anyone.

      • Brooke

        According to an article in the Guardian the risk of complications during a homebirth is about 9 in 1000, the statistics I’ve seen previously for unassisted birth show the most common cause of death is intentional infanticide. So…if that’s your plan for eugenics it’s going to fail miserably. I actually had my son unassisted by accident. We were completely healthy following the birth and I regret going to the hospital because they treated us like an emergency case, they took my son to the NICU for observation even though he had an apgar score of 9 (according to EMS) and hooked me up to an IV just to pump me full of saline even though I repeatedly asked for it to be removed as I was capable of eating and drinking. They came into check our vitals every 30 minutes around the clock, so we didn’t get any sleep the entire 48 hours I spent in the hospital. Again I don’t think you understand that no one is against doctors in an emergency situation. Birth isn’t an emergency situauon for most mothers and babies. If you got rid of your god complex maybe you could see that a dismissive attitude towards women’s knowledge of their own bodies doesn’t help anyone to provide good care. If a woman says, hey, something doesn’t feel right every healthcare professional should listen to her because she might actually know something about herself and know something is wrong. I’m actually surprised my first child wasn’t born unassisted because they sent me home from the hospital because they didn’t believe I was actually in labor. My sister came to my house after that and started counting my contractions, she was the one who took me back to the hospital and insisted I stay there until my daughter was born.

        • Eater of Worlds

          If you didn’t want to be there and you felt you had no reason to be there why didn’t you just leave?

        • Azuran

          Seing as where I live, women typically stay 24-48hours in the hospital after even uneventfull vaginal birth, I don’t see what you find wrong with the fact that they kept you and your baby for 2 days to make sure you were fine.

        • Amy Tuteur, MD

          Yet you bragged in your birth story on BabyCenter entitled “Well we did it!” (http://community.babycenter.com/post/a58970614/?cpg=0#c0):

          “After a few hours of labor I gave birth to my son, in my bathroom of all places! I actually was having a lot of bleeding so I called my birth partner when I *thought* I was in early labor so he could take me to the hospital. He turned out to be 45 minutes away and had walked to go get breakfast so it look a while for him to walk back to his car. He got to my apartment with his friend whose a nurse, as I felt something coming out. I was super freaked out because my son was born in the amniotic sac so a million horrible things crossed my mind, thankfully after 3 involuntary pushes he was out and I was so relieved that he was an actual normal baby. I broke the bag and he had the embilical cord around his neck. I unwrapped it and he started to scream. Again I was so relieved. My birth partner had called the EMTs and his friend who was a nurse was trying to follow instructions on the phone for how to clamp the cord.

          My son was born a healthy 6 pounds, 15 ounces with Apgar scores of 9 and 10.

          I feel like if I had not researched unassisted birth and all the things that can go wrong I wouldn’t have known what to do when my son was born and wouldn’t have gone to the hospital any sooner because my rushes felt like downward pressure like I needed to go to the bathroom so I didn’t even know I was in active labor! By comparison my daughter’s birth was crazy painful and 24 hours long.

          I had a horrible horrible experience once we got to the hospital and I’m considering filing complaints. When I got home (sorry I know this is TMI) and actually looked at the towels and stuff that got blood on them…and yeah I overreacted. I should have just stayed home and maybe had my placenta encapsulated or ate it (always kind of grossed me out though) to replace whatever nutrients I lost.

          I don’t want to go into all the horrible stuff that happened at the hospital but if anyone has concerns about that and wants to know the challenges we faced I’d be happy to talk about that privately. “

          • PrimaryCareDoc

            I want to know who gave the baby the one minute Apgar score? Brooke?

          • Roadstergal

            From her post above:

            “an apgar score of 9 (according to EMS)”

            Yer friendly local first responders arrive within a minute of birth and give APGARs in Brooke-land, I guess.

            Also from that post:

            “they treated us like an emergency case”

            What on earth does she think the “E” in “EMS” stands for?

          • Nick Sanders

            “Extraneous”, maybe? Or possibly whatever it is Amy thinks the “C” in CPM stands for.

          • Bombshellrisa

            OT but there are people who “do their research” and think that apgars of 4 and 5 are perfect. Case in point, this birth story written in defense of a “sister in chains” (she really is, her name is on the website). I will not post the notes from the state hearing from one of her cases (it is horrifying) but I will share this because this guy has no clue what he is talking about: “I did some research on planned (vaginal) breech delivery, including extensive critiques of the Term Breech Trials which indicated – to me – that the risks to the baby of a planned vaginal breech delivery were significantly less than the risks to the mother from a surgical birth. The only problem was our current midwife would not support us in going this route (in part because she lacked the training, but probably for political reasons as well).” So they found a midwife to attend the wife’s HBAC, apparently she doesn’t believe in using dopplers “the delivery was stalled with our little Pema spreading her two legs out – as if to say…”this is going to happen my way!”. She was never in any distress though. Shaheeda was monitoring vital signs using a somewhat antique listening device called the human ear, aided by a funnel!” They transferred to the hospital and baby was born via c-section. The doctor did what should have been done and reported the midwife “The surgeon field a claim with the State against Shaheeda, citing malpractice. The rationale behind the malpractice claim, as best as I can remember, is that she should never have allowed Upel to attempt a vaginal breech birth at home. Pema’s Apgar scores at 1 and 5 minutes were something like 4 and 5 respectively (practically perfect), not indicative of a stressed baby.” An apgar of 4 and 5!

          • Who?

            Same crowd who dish out Apgars of 10 when the baby is delivered at home.

            The stupid burns. That poor baby.

          • Megan

            Interesting the mention of CPS involvement for cocaine in the cord blood in the comments.

      • Nick Sanders

        I just can’t do that to the babies. It’s not their fault if one or both of their parents is an utter shit.

    • Dr Kitty

      Ah yes, trusting people to know their own bodies.
      This would be the general public: people who don’t know where their spleen is, or why taking aspirin and ibuprofen together on an empty stomach is a bad idea, who think that the baby’s umbilical cord joins onto the back of the mother’s belly button, and who have an average reading age of 12.

      • Angharad

        I’ll admit I have a pretty fuzzy idea of where exactly all my internal organs are. Of course, that’s why I tend to trust a doctor to take care of anything beyond “I have a headache that goes away with Tylenol” or minor external injuries.

        • Brooke

          How would you feel if you had a headache and your doctor told you that wasn’t possible and it was all in your head? That’s what pregnancy can be like for a lot of women.

          • Dr Kitty

            How would you like it if you were in agony, and were repeatedly told by your midwives that it was all in your head, and what you’re feeling are “rushes”. That is what labour is like for a lot of women.
            No?

          • Lizz

            What exact part of pregnancy are doctors telling women are all in their heads? The closest thing I ever got to that was a series of nurses telling me I couldn’t be in that much pain. In being a doula my major issue is doctors,midwives and nurses not telling people all of the possible issues till shit hits the fan.
            The “don’t worry about it” attitude is a real issue and what I sincerely appreciate about Dr.Amy not pulling punches on risks.

          • The Computer Ate My Nym

            Um…if I have a headache and my doctor told me it was all in my head I’d be inclined to believe her. Where else would a headache be?

          • Sue

            If a doctor told me that my headache was “all in my head”, I would say that they were correct, both literally and metaphorically. Also anatomically.

          • Angharad

            Well, I have an anxiety disorder and sometimes I have panic attacks where it feels like I’m dying. When the doctor told me it was anxiety causing my symptoms, I was glad to know the root cause and get strategies to help manage it. It wouldn’t have been appropriate for them to treat me as someone in cardiac arrest, no matter how much that’s what it felt like to me.

    • Sarah

      Pretty much the dictionary definition of misogyny is referring to a woman who either can’t or doesn’t want to suffer the pain of childbirth as being ‘too weak and feeble for it’.

    • fiftyfifty1

      “What’s actually misogynistic is the idea that women are too weak and feeble to withstand the pain of childbirth”

      Personally I was more focused on my baby’s vulnerability than my own. I DID consider him too helpless to risk forcing him to withstand the pain of slowly smothering to death.

      • Maya Markova

        Very true. I wasn’t outraged that I was not offered pain relief until my births were over, but I would kick and scream if the System had suggested me to give birth out of hospital and/or without a doctor.

    • Angharad

      Nobody said women COULDN’T withstand the pain of childbirth, just as nobody has said that men COULDN’T withstand the pain of kidney stones. The point is not whether the pain will drive you crazy/kill you/whatever, it’s about not making people suffer through hours of pain when there are safe and effective alternatives.
      And giving women false information about the benefits and no information about the risks of homebirth to push them into making the choice you want is at least awful, and possibly misogynistic.

    • Amy Tuteur, MD

      When it comes to stupid, it sounds like you cornered the market.

      Aren’t you an unassisted birther?

    • Azuran

      What is so special about labour pain anyway?
      Was I feeble and weak when I had general anesthesia to reduce an open fracture? Or when I had local anesthesia to remove my wisdom theeth? Or when I take ibuprophen for menstrual pain and headaches?
      Labour is painfull. It’s not any special kind of painfull, it’s just pain. If you want to feel the pain, go for it, it doesn’t make you any better than anyone else. Any women who wants effective analgesia during labour has the right to get it. Just as any man or woman who wants analgesia for just about anything else has the right to get it.

      A doctor knowing more than you about your body is not misignystic. They are trained medical professional, they do know more than you about your own body. Sorry honey, but your body is not special.

      Of course, women have the right to choose. But for them to make a real decision they need to know the thruth: Birth is painfull to the majority of women and there are always risks during birth.

      • DelphiniumFalcon

        Here’s the icing of the cake.

        According to Brooke’s posts, Brook identifies as male.

        Normally this go one ear and out the other because why should I care that someone identifies as a gender they feel reflects who they truely are?

        Except that Brooke is calling misogyny when they’re someone that identifies as a man and comes in here to tell a bunch of people that identify as women what to do with their reproductive organs and bodies.

        What the fuck? I’m still trying to reconcile all of that and I’m sure this vomitting of words here shows that. But am I the only one that feels conflicted about this?

        Just because Brooke has a uterus that has squeezed out a baby doesn’t mean that they’re exempt from mansplaining if they identify as a man in my opinion. It’s just a whole new level of it.

        Let the flaming begin but you can’t run into a thread and shit all over the place and the claim immunity because of a protected status.

      • Michelle Singleton

        It’s just a flesh wound!

        I have a VERY low tolerance for pain. But I have a very high tolerance for pain meds. Pisses my PCM off because the doses she gave me of T3 for my hip & migraines did next to nothing to touch said pain. Now my hematologist is pissed because I take way more tylenol and midol than I should just to relax enough to not cry as much and my liver has a “bruise” because of it.
        I’ve said it before, but I wanted a home birth but Hubs said no. So I said water in the hospital and he agreed. When I found out I was carrying 2 monkeys my “perfect” birth went out the window. In the same vein of home birth weirdos are the people who like to scare the hell out of moms of multiples. I was convinced that my girls would be micro preemies, would need to be in the NICU for months, and that was after having an emergency c-section. My girls were 38 weeks (my OB said that was “late” for twins). They were healthy and perfect. Did I have the section? Yes. Baby A got stuck after me pushing for 2 hours. I wouldn’t change a thing.

    • Lisa

      I was very offended when the surgeon who removed my husband’s kidney cancer said it had to be done under anesthesia! How dare she imply that he was too weak and feeble to withstand the pain!

      • Maya Markova

        What do you expect from the wicked Big Surgery? But it was your fault. You and your husband should have stood up and demanded a medicine man who would remove the tumor at home. Anesthesia? Maybe some mushroom.

      • Bombshellrisa

        You mean the doctor wouldn’t perform the surgery with your husband floating in a pool surrounded by candles with a kidney stone doula to help him cope? Did you tell the doctor that you would be totally willing to offer your husband food, help him change positions and that it would be ok to leave your husband alone so he could scream to help deal with his pain? Mean doctor, doesn’t he know that your husband knows his body better and therefore is an authority?!

    • crazy grad mama

      LOL, what? A doctor with years of medical training, who’s attended countless births, is “inexperienced,” and I, with my Internet reading and that one vertebrate anatomy class I took in college, am “experienced”? I’ll take the doctor and the half-dozen nurses, thank you very much.

    • Michele

      “Benefits of homebirth” like my baby being more likely to die than in the hospital?

      Lol, my body is shit at pregnancy (and lots of other things) so I’ll take every advantage I can get. That includes doctors, nurses, and any applicable machines in the hospital.

    • crazy grad mama

      Also, you know what’s REALLY misogynistic? The idea that sex or birth/breastfeeding are the only two options for my body.

    • Tim Holland

      Take a look at the UK’s approach to infant feeding if you think the long-term goal is to present home birthing as an “option”.

      http://news.bbc.co.uk/2/hi/health/8166735.stm

      http://www.nursingtimes.net/lack-of-bottle-feeding-information-putting-babies-health-at-risk/5003991.article

      You still have options. But Tuteur is absolutely correct, this campaign is all about women toughing it out to save a few pounds.

      • Roadstergal

        How can anyone possibly think this is ethical?

        And, of course, negative outcomes from a lack of information on proper bottle-feeding will be attributed, by the lactivists, to the evils of bottle-feeding as a method.

    • momofone

      Brains are part of bodies too. At least your beliefs are consistent with your behavior–you don’t appear to use that part much.

    • Nick Sanders

      the idea that women are too weak and feeble to withstand the pain of childbirth

      Silly me, and here I was thinking that the idea was that the pain was unnecessary and avoidable, and that forcing people to endure pain that is unnecessary and avoidable is wrong, so if they want to avoid it, they should be allowed to make that choice.

      Edit to add:

      Giving women education on the benefits of homebirth

      Lesson 1: There aren’t any. This concludes your course on the benefits of homebirth.

      Wow, that was fast.

      • Roadstergal

        Very concise.

        My (female) ortho didn’t think I was too weak and feeble to handle my post-op pain, she just thought it would be rather nice to avoid it. I’m sure I’m less bonded to my collarbone now.

    • Paloma

      What is really misogynistic is the idea that a woman doesn’t deserve to have her pain acknowledged and treated seriously just because she has to go through childbirth. It is also incredibly misogynistic to tell a woman she and her child don’t deserve all the medical care available to go through a moment like childbirth as safely as possible. As a woman I am incredibly offended by someone thinking less of me just because I decide IF I want to feel any pain during childbirth.
      Also, just in case you haven’t been to a hospital lately, most doctors, specially in OB, are also women. We don’t start growing a penis in med school, contrary to popular belief. We also get pregnant, have children, go through childbirth and parenting. And even with all that, our training as doctors is what gives us the authority to recommend and intervention or not, regarding any medical or physiological process.
      And let’s learn about benefits:
      . Benefits of homebirth: comfortable sorroundings, possibility of tweeting live and very explicit photographs
      – Disadvantages: lack of access to emergency life-saving procedures, lack of monitoring mom and baby, lack of access to effective pain relief, lack of access to trained professionals who have seen and cared for thousands of labouring women, lack of access to pediatritian and/or pediatric ICU, and finally, having to clean up after (in case you have never seen someone give birth, it is MESSY).
      When you give an informed consent, you have to give ALL the info (good and bad), another thing we learn as inexperienced doctors (how dare we?).

    • Alenushka

      IF you are puritanical Christian and against sex, that is good for you but not for me. It is really misogynistic to tell me that my breasts are for breastfeeding body is for childbirth and not sex. I decide what and when and for which my body is.

  • Princess of Boston

    I notice the Duchess of Cambridge (Kate Middleton) gave birth in a hospital and had a doctor rather than a midwife. When it’s the heir to the throne, there’s no mucking about with homebirth.

    • mabelcruet

      She had two midwives (one of the them a Professor of midwifery and head of Maternity NHS England-not your average old midwife), and 4 doctors (all consultants of course-2 surgeons-obs and gynae, a neonatologist and a general physician). I don’t think they released any information about who actually caught the baby, but I think they all got OBEs or knighthoods or something for not dropping the kid.

  • sdsures

    The lengths the RCOM will go to try to promote its agenda under the guise of “saving money” is ridiculous. 🙁

    • Erin

      The cynic in me says it’s nothing to do with saving the NHS money and everything to do with saving their jobs. I mean if every woman decided she wanted a c-section or an epidural or anything else you need an actual medical degree to do… what would happen to all the lovely ladies who make up the RCOM.

      Slightly bizarrely a friend of mine was told when expressing sadness about the birth to a midwife that she needs to have a “re-birthing” ceremony in the bath with her emergency section daughter. I ended up with a half a glass of juice up my nose when she told me.. but apparently it’s very serious and I should try it.

      • sdsures

        I am profoundly glad I was not drinking a glass of water when I just read this!

        (She didn’t just tell the mother to put the baby underwater, did she? I’d call the cops!)

        • Roadstergal

          Maybe she means the friend should stuff the baby back up her vagina??

          • Erin

            I hope not, she’s over 20 lbs now. Even the thought of that has me curling up into a ball shuddering.

          • Amazed

            Think you’re joking? Remember that loon who, upon her mother’s very needed hysterectomy, felt sad because she missed her first home? Still unclear if she intended to move back in.

          • Angharad

            I didn’t see that one. That’s a really weird way to think about your mother’s body. I’ve heard people say similar things when their mothers have passed away, but I’m pretty sure they were referring to missing the feeling of home their mothers provided, not that they missed her womb specifically.

          • FrequentFlyer

            Who? What? Every time I think I have seen all of the crazy there can possibly be, I come here and find more.

          • Amazed

            It might have been on Dr Amy’s Facebook page. Someone posted the trial of a woman mourning her mom’s hysterectomy because yes, she missed her first home.

          • Nick Sanders

            I thought it was before the Facebook page came about?

      • mabelcruet

        Re-birthing therapy is banned after a poor child died. Some idiot therapist wrapped her up in blankets and then piled 3 adults on top of her and she had to fight her way free-to represent fighting her way out of the birth canal-except she didn’t, she suffocated. Murderers. Dangerous idiots.

        • Erin

          From what she said, I think it’s more this:

          http://www.essentialbaby.com.au/birth/birth-stories/born-again-the-practice-of-rebirthing-20140115-30txo.html

          Which sounds safer but still raises the question of how essentially having a bath with your baby fixes your bonding issues?

          • Megan

            My doula suggested that to fix our breastfeeding problems. I never tried it. I doubt it would’ve done anything other than put us to sleep.

          • Angharad

            I mean, I guess spending cuddly time and caring for your baby can help with bonding, but I’m really not clear on how the “rebirthing ceremony” is at all different from a regular bath with the baby or why it would be magic.

      • MaineJen

        There is a *very* funny episode of Bob’s Burgers where Louise and her mom do a re-birthing ceremony 🙂

        • monojo

          Here comes the hair, here comes the hair/ Where is Harry Truuuman/ he’s dead in the ground, he’s dead in the ground/ he’s dead dead dead dead dead 😉

          • The Bofa on the Sofa

            Burma shave

      • Sarah

        TBH I’m not sure that’s it. The NHS are supposed to provide one to one care for all women who’ve had epidurals fitted. They certainly don’t manage that for all those in established labour now. If lots more women had epidurals, they’d need more midwives in order to meet this standard.

        • Dr Kitty

          No, I’m pretty sure it isn’t really about money, or staffing levels.
          It is that midwives in the UK believe that “normal birth” is better for women, and that any attempt to suggest otherwise must be resisted at all costs.
          Not only are they saving women from interventions and doctors, they’re saving them from themselves.

          “Imagine how empowered you’ll feel when this is all over and you’ve done it without drugs!”
          “But I want the drugs!”
          ” You only think you do, just wait and see, you don’t need them and you’ll be so proud of yourself if you don’t give in”.

          That kind of thing.

          • Wren

            I would have thought it was a combination of money and midwives’ beliefs. It’s not just the midwives pushing for this.

          • Bombshellrisa

            You just described what I went through during labor with my first.

          • mabelcruet

            I don’t know if its specifically a midwife thing, or a general nurse thing. I had surgery about 6 months ago, and post-operatively I was asked about pain. I said yes, the pain was really quite bad and could I please have something for it as it was really, really quite bad. The response was we won’t give you anything yet, but we will come back in an hour to see if it settled. Er, no-I’d a ruddy great hole in my guts, I needed drugs!

          • Azuran

            I’d say it really varies with people, their beliefs, their experiences and their education. Pain relief is ‘relatively’ new. In general, younger practicionner will be more understanding of pain and more eager to treat it because they were thought more about it.

            Unfortunately some people sadly still have the old mentality regarding pain.

          • EmbraceYourInnerCrone

            What the hell!? How is that good patient care? That’s kind of barbaric. ..

          • Inmara

            I had minor surgery a few weeks ago in national cancer hospital (had to remove suspicious mole – fortunately, it turned out to be just a mole, not melanoma, but doctor was worried enough to do it under GA because local anesthesia could push malignant cells in bloodstream if there happened to be any). I noticed immediately that staff there was really compassionate and not skimping on pain relief in any way – in the evening nurse came in the room and asked: “Ladies, what would you like for night? Pain relief, sleeping aid? Injection, pills?” Apparently, when you’re working with cancer patients, pain relief sometimes is the only thing you can give and thus nobody is trying to “empower” them.

          • Dr Kitty

            I just found it…weird. This idea that pain magically disappears because you are breastfeeding and being sent home. Sure… You were on 4hrly Sevredol until discharge, but you don’t need any opioids for home…

            I got a week’s worth of 30/500 co-codamol for a Mirena insertion under GA, which I didn’t need AT ALL.
            I got a week’s worth of Oxynorm after a laparoscopic appendicectomy/ovarian cystectomy, I needed 48 hrs worth.
            But 48hrs after a CS they tried to send me home with just voltarol and paracetamol, because I was breast feeding ( I basically threw a tantrum until I got some DHC).

            Now, I’m the sort of person who takes unused opioid medication to my local pharmacy for disposal, which is why I didn’t have Oxynorm and Cocodamol lying around at home, but the current policies regarding maternal analgesia aren’t exactly encouraging that.

        • Erin

          I was thinking more of our community midwives/the ones I had the pleasure of on the post-natal ward who seemed to think that being a “Doctor’s lackey” on the labour ward was totally beneath them. Apparently it was too “icky”… I had a lot of interesting conversations with the post-natal ones as I was on “suicide watch” and some of the stuff they came out with had me questioning their choice of profession.

      • Eater of Worlds

        The guy who created the rebirthing movement is horrible. His book, Parenting with Love and Logic, and his ideas helped some kids die from being wrapped up while being “rebirthed”. Foster Cline is his name, he lost his license to practice, he created “Attachment Therapy.”

        • Dr Kitty

          Parenting with Love and Logic has *some* good ideas.
          Like allowing your children to fail at small things so that they can cope with real challenges later, following through on any threats you make, giving your children limited options with more choices as they get older, and not involving yourself too much in fixing your kid’s problems for them but allowing them to do it themselves in order to foster resilience and independence. That is all sensible stuff.

          The stuff about putting your kids out of the car and driving away if they misbehave, or if they don’t feed the pet dog allowing it to go hungry for a few days to see if the kids notice before taking it to a shelter if they don’t, or about corporal punishment for the under threes or any of the “rebirthing”…not so much.

          It is NOT a parenting book I recommend, simply because it requires serious common sense to get anything useful from it, and although personally I found some of the strategies helpful, I disagreed with vast swathes of it.

          • The Bofa on the Sofa

            You gotta figure, if you have the sense to be able to sort the wheat from the chaff in that book, then you probably don’t need a book in the first place, right?

          • Dr Kitty

            The book was a gift from my mother in law, along with a book about putting the baby on a strict schedule from day 1.
            I’m not entirely sure what I was supposed to take away from either, except, possibly, that whatever I did would be considered wrong by someone. I think it might have been some sort of test…

          • Who?

            The lesson that there will always be someone to criticise parenting styles and choices is a good one to get under your belt early.

          • Azuran

            Animal abuse as a form of education for your children? How nice.

          • Dr Kitty

            Yep.

            We can all get behind “don’t make meaningless threats or promises you won’t carry out”. Not really with allowing a pet to starve because a small child forgot to feed them after you said that the dog was their responsibility.

            It’s that kind of book.
            You nod along to something quite sensible like “give pocket money to encourage financial responsibility” and then you’re spitting out your coffee at something crazy like “if your children misbehave in the car, put them out and drive away. When you return in 15 minutes they’ll have learnt their lesson”.

            Anyway parenting books are written by people who aren’t you and aren’t raising your kids. Most of us just will muddle through and make it work without abandoning kids at the roadside or starving a helpless animal for a teachable moment.

          • Nick Sanders

            When you return in 15 minutes they’ll have learnt their lesson

            Assuming they haven’t been hit by a car or gone off looking for help after being ABANDONED, I’m pretty sure the only lesson in that is “My parents are psychopathic abusers.”

          • Who?

            I think the resulting conversation with the local police about child rearing techniques would be fairly short.

  • Commander

    “But most still choose to go to hospital, where doctors are immediately on-hand in case anything suddenly goes wrong.”

    Well, duh! That’s why they make that choice! I certainly would want a doctor nearby in the event of a sudden complication!

    (first comment after lurking for awhile, hi everyone! I love this site. So nice to see common sense in the world of childbirth and parenting for once.)

    • The Bofa on the Sofa

      So nice to see common sense in the world of childbirth and parenting for once.

      I’m just here for the refreshments. I keep hoping there is going to be an open bar.

      • Roadstergal

        What was that motto you came up with? “Come for the science, stay for the vagina?”

        • Bombshellrisa

          Wasn’t that fifty fifty’s saying? Love it no matter who came up with it : )

          • Roadstergal

            Oops, I think you’re right!

        • Amazed

          Come for the vaccines, stay for the vaginas!

          Fiftyfifty1. And it brought us Nick. I’m quite pleased that he stayed!

          • Nick Sanders

            Aww, thank you so much!

      • Squillo

        Hell, you can get a contact high just from some of the parachuters.

    • sdsures

      Welcome to the dark side! The cookies are over there. >>>

  • Montserrat Blanco

    Congratulations!!!

  • Tumbling

    Woohoo!!

  • Sue

    Well done! Congrats!

  • crazy grad mama

    The NCB / lactivist line of thought seems to go like this: If everyone knew what we know, they would make the decisions we think are best! If people aren’t making the decisions we think are best, it must be because they don’t have all the information!

    It’s why so much of the effort to increase breastfeeding rates goes into telling us again and again how wonderful it’s supposed to be, and why the NCB folks go on and on about “informed consent.” They just can’t imagine that anyone would make a different decision with the same information.

    • mythsayer

      Funny…that’s how most of us feel about all those evil interventions.

    • Sue

      Great point.

      Then there’s the anti=vaxers’ line: We are not anti-vax, we are pro-choice, BUT, IF EVERYONE ONLY HAD THE RIGHT INFORMATION NOBODY WOULD CHOOSE TO VAX!!”

    • SarahSD

      But it’s not always the same information, is it? Not many NCB people are going around talking about the risks of vaginal birth or the benefits of pharmacological pain relief (unless it’s an outdated mode of pain relief that midwives are allowed to use, ie laughing gas, in which case they champion it as an option).

      • Valerie

        If you share information about the risks of NCB-supported practices, like TOLAC or avoiding inductions for postdates, it’s fear-mongering.

        • crazy grad mama

          And if you share information on the real benefits of breastfeeding (real but minor for full-term babies), then you’re being unsupportive and are clearly getting kickbacks from formula companies.

    • Squillo

      True, but to be honest, I think that’s a common sentiment. The problem, as I see it, is that some folks omit or manipulate facts in service of their particular flavor of evangelism.

      • crazy grad mama

        Or dismiss facts that disagree with them as conspiratorial or tainted, yes.

        But lots of professionals don’t. Personal example: at my annual exam today, I asked my OB-GYN about the possibility of TOLAC if I were hypothetically to get pregnant in the future. She said I would be a good candidate (my CS was for a breech baby) but told me about the chance of uterine rupture. It wasn’t in a “there is only one right answer here” sort of way, just a “this is a known risk that you can choose to accept or not.” I’m sure she’s seen women choose both ways, and even if she might make a certain decision herself, she understands that others might choose differently.

        • Abby

          This behaviour has been firmly stamped out where I used to work by the local medical committee, ie all GPs agreed not to do it, there was a Obstetrician as hospital representative on the committee who was horrified when it was discussed that GPs were still being asked! They had told them no years before.

          • crazy grad mama

            I’m not 100% sure what you’re responding to here. By “this behavior,” you mean TOLAC? Offering choices? Not all U.S. hospitals and OB-GYNs are comfortable with VBACs, which is why I asked in the first place.

          • Dr Kitty

            I wondered if this comment was actually replying to mabelcruet’s stiry of her GP friend being asked to prescribe Pethidine to a mystery patient…

          • crazy grad mama

            That makes a lot more sense, thanks.

          • Abby

            Sorry yes was the pethidine thing! Not what you said!

          • crazy grad mama

            No worries! It happens to everyone.

  • PInky

    The only form of pain relief not available at home or mlu is epidural. Water, tens, entonox and opiates can be used in both places and if a woman decides she needs more then she is transferred.

    Really Amy you need to look at what really happens and not continue to feed this misinformation to your readers.

    • Nick Sanders

      what really happens

      Do tell.

    • Amy Tuteur, MD

      They’re offered because midwives can offer them, not because they’re effective (they aren’t) and not because that’s what women need. That’s the problem; the midwives think birth is all about them and the patients are just there as props.

      • Abby

        The home birth issue in the uk is completely ridiculous, here the midwives are probably more equivalent to labour and delivery nurses in the US (from my ER viewing!) and they work in hospital on labour ward, postnatal wards and in the community doing prenatal care, working with the O+G consultants. If you are low risk your care is community based and midwife led, high risk consultant led or ‘shared care’. You can choose to have a baby in the hospital either consultant led unit or midwife led but in both you will be looked after by midwives. Practically most MLU are next door to the consultant led units so you are very close to help. This all sounds very sensible no? We have a national health service without infinite resources , midwives are cheaper than doctors so most people are cared for by midwives with smaller numbers of doctors on hand for where they are needed, for instrumental/operative delivery. You are in a hospital so have access to anaesthetists for epidurals if required and paeds close by, how sensible! But no, the lunatics at the RCM with their NCB ideology and the managers who want to save as much money as they can, have decided that home birth is the way forward. You need 2 midwives to attend a home birth, which is a ridiculous waste of resources when there are not enough midwives to safely staff labour wards and the birth rate is increasing

        • Abby

          This is an ongoing rant but this issue makes me so angry! The whole NHS is chronically underfunded and under staffed and they want to spread resources even thinner! It’s a completely selfish choice from that point of view to have a home birth here apart from taking bonkers risks with your unborn child. It’s a perfect storm of NCB and short term money saving in which women are the losers. Women are supposed to be discouraged from epidural as they need 1-1 midwifery care and anaesthetists available, it’s purely to save money but they will spend loads on hypnobirthing crap, so fits perfectly into the RCM ideology and general misogyny that women’s pain is not worth spending money on. Ditto for avoiding c sections and increasing instrumental deliveries . Short term savings and who cares about destroying a woman’s pelvic floor? Sorting that out won’t come out of the maternity budget, although paying out compensation for brain damaged babies will….but that’s probably a different budget as well so let’s not that get in the way of an ideological but nonsensical drive to reduce c section rates!.

    • PrimaryCareDoc

      So, the safest most effective form of pain relief is the only one that isn’t offered. sounds great.

    • mythsayer

      A tens unit. Yup. Sounds like great pain relief during labor (not).

      Honestly…if it sounds good to someone, GOOD FOR THEM. They can have at it with that tens unit (in the water, right????? /s).

      Dr. Amy’s point is that the NHS is pushing homebirth a with lesser forms of pain relief on women who might not be interested. As soon as a woman says “I’d like to give birth at a hospital”, the conversation needs to end right there. There’s no need to persuade that home is better.

      • Who?

        I had the tens, found it irritating frankly. It was dialled up to torture and it was just one more bit of discomfort. I get it might be useful if you have a long slow start, but for actual labour, don’t bother. And the silly thing is, unless they are now wireless, you have to be strapped to the machine. Isn’t that just the Worst Thing Ever in this world?

        • Bombshellrisa

          That sounds terrible

          • Who?

            At the time it was all so painful and foreign I couldn’t do much about it, and didn’t want to waste valuable entonox time talking, but yes in retrospect, worse than hopeless. Didn’t start with it for the second one.

        • Mishimoo

          My nan-in-law had a physio insist on doing it as part of a EPC visit. Poor nan’s legs had shooting pains and didn’t work properly for a few days afterwards, and she never wants to see a physio again.

          • Who?

            Miserable, poor thing. I’ve had it since for middle aged neck, didn’t think it did much good but the physio seemed to be keen to try it.

          • Sue

            Terrible story, but, at least TENS is plausible for musculoskeletal pain, using gate theory of pain.

            For the visceral (organ smooth muscle) pain of agonising uterine contractions, though, how could it possibly do anything?

          • Mishimoo

            The use of the TENS machine, regardless of the validity of the science behind it, rather reminds me of Major Payne’s pain management technique. Most people I know who have tried it reported pain/irritation and I wonder if the distraction of the novel sensation provided by the TENS unit is what is being sold as ‘relief’.

          • Sarah

            I liked the buzzing!

          • araikwao

            That’s awful!! I hope the physio received feedback about the very bad outcome. I have used TENS exactly zero time during my many years of physio practise, partly due to the areas I’ve worked in but also partly because I hate the sensation and think the benefit is pretty limited.

          • Mishimoo

            Sadly, no. Nan doesn’t like to make a fuss and I don’t know which one she saw. We’ve just talked her into seeing our doctor, so once her other health issues are sorted, I might be able to talk her into seeing my lovely physio.

      • Sue

        TENS (transcutaneous electrical nerve stimulation) has very questionable effectiveness for any painful condition, let alone the agony of labor.

        A systematic review in BJOG found ” Randomised controlled trials provide no compelling evidence for TENS having any analgesic effect during labour.”

        Really, Plnky should look at real evidence and not continue to promote misinformation.

    • Monkey Professor for a Head

      How much of a delay is there in getting an epidural when a woman transfers in from home? After they make a decision to have an epidural, they have to arrange transport – either private or ambulance, get from the house to the vehicle (which can take quite a while when in labour), travel to the hospital (probably not much fun when you’re in labour), get from the vehicle to the delivery ward, the midwife has to hand over the patient and the patient has to be assessed, and then finally the anaesthetist will be contacted. It wouldn’t surprise me if that all took at least an hour. So that’s at least an hour of severe pain that this woman is suffering unnecessarily.

      As part of informed consent for home birth, will women be told about the potential major time delay in getting an epidural if they want one?

      • Jessica Nye

        An hour? Ha ha! With my youngest, I got to the hospital at 9PM after a 30 minute drive, stated I wanted an epidural immediately, and then had to be assessed, and had to get a bag of IV fluids so I could have the epidural. I got the epidural at 11:15. He was born 20 minutes later.

        • Monkey Professor for a Head

          I thought an hour was pretty conservative alright. Plus if you have a particularly NCB minded midwife then you will likely be dissuaded from going to hospital for as long as possible. And then when you do arrive at hospital the anaesthetist may be busy.

          • Amy M

            Or they’ll tell you the anaesethetist is busy.

          • KeeperOfTheBooks

            Or not there at all. Or the midwife might “forget” to page him. Or…

      • Angharad

        I can’t see how it could be any less. I’ve clocked the drive from my home to the hospital where I delivered at 6 minutes. My daughter’s pediatrician has an office at the same hospital, and I have to make sure we leave the house at least 30 minutes before her appointments are scheduled to account for strapping her in, traffic, parking, and getting to the office and checking in. .
        Also it took 20 minutes for the anesthesiologist to be available when I requested an epidural in labor, and I was already in the hospital being monitored with an IV in place and had let them know I would definitely be wanting an epidural.

      • Erin

        I asked for one on admittance to the labour ward… took three hours to find an anesthetist (he was in theater and then there was a queue). Took him 40 minutes to site it (apparently my back doesn’t like catheters) and then he left. Told them it hadn’t worked, was told to wait half an hour… an hour later everyone agreed it hadn’t. Anesthetist back in Theater…. four hours later he came back by which time I was fully dilated and off my face on gas & air. It took him another 40 ish minutes to get it working and then he stayed with me until we were all agreed that I was mostly pain free (had a patch in my right thigh which stayed painful but at least helped me know when to push). An hour sounds hugely unrealistic in a busy hospital regardless of how you get there.

        Also I don’t think midwives believe in informed consent. When I asked at my debrief why wasn’t all the risks of vaginal births versus c-sections discussed… I was told it would scare women into making the “wrong” decision. Patronizing much..

        • sdsures

          That sounds horrible what you went through!

          • Erin

            “Luckily” I had so much gas & air, I can’t actually remember. Apparently I thought I had a snake wrapped around my thigh at one point and was warning the student midwife in case she got bitten. I also apparently treated them to a rendition of “Let’s go fly a kite” so I assume I knew I was a little out of it or I just associate Mary Poppins with being high.. not sure. Could barely remember my date of birth when it came to signing the paperwork for my emergency section but despite what followed, I’m glad I persevered with the epidural even though I’m also missing accurate memories of my son’s arrival.

            (Plus my husband feels so guilty for putting me through it, he’s been trying to spoil me rotten ever since.. .)

        • mabelcruet

          The medical profession has worked very hard over the last few years to get away from paternalistic behaviour-hopefully there is none of the ‘there, there. let me worry about that, dear’ attitude any more. Its much more of an equal partnership with shared decision making. So how on earth do midwives get away with not providing all the information their ‘patients’ need?

          • Erin

            I wish I knew. At my ante-natal class.. all first time mums, average age 35, one person with high blood pressure, one with GD, at least two that I would describe as obese and one with a pre-existing heart condition we weren’t allowed to discuss c-sections or forceps deliveries despite our multiple attempts to do so. The focus was entirely on “normal” birth which for various reasons most of us didn’t manage and breastfeeding which half the class had no intention of doing. I think it does a huge disservice to women not to mention being insulting, however I was fobbed off when I raised it as part of my “complaint”. Apparently what I thought was common sense.. i.e. you give women all the information and let them make their own decisions is frightening to the average woman.

            I know multiple people who sit on the hospital’s Midwife Liaison Committee (both lay members and Obstetricians) who have tried to tackle the problem only to be flattened by a juggernaut of midwifes.

          • Dr Kitty

            Yeah, I had “does not want to VBAC” on my referral letter at six weeks, and they STILL insisted I “discuss my options” at booking, and again at 28, 32 and 36 weeks. Thankfully my OB was sensible and our “discussion” was “still want a section?” “Yup” “OK then”.

            I suspect if I wasn’t an assertive GP I might have got more of a hard sell about it, but “seen a rupture with a bad outcome firsthand, liked my first prelabour section, not interested in VBAC” combined with my resting bitchface was enough to shut it down, although not without some serious side-eye from the midwives.

    • sony2282

      They can give IV opiates to a laboring mother at home!? Does not sound safe!!

    • Azuran

      Somehow I doubt that a CPM has the right to carry opiates around, those are both prescription drugs and controlled substances.

      • Inmara

        CPM is a thing only in US, and Dr. Kitty explains nicely what pain relief options are legal for UK midwives. I guess they have more equipment and skills in regards of rescuscitation, stabilizing PPH etc. so their outcomes are not as bad ar for US lay midwives. Still doesn’t make it right to push homebirth as equally safe option.

    • Sue

      Plnky: we know “what really happens” from the UK Birthplace Study. Three times as many babies died from first-time births at home as opposed to hospital. And they didn’;t even measure or report hypoxic injury or other disability.

      That’s ‘what really happens”.

    • Allie

      IV opiates administered at home without any monitoring equipment?
      That`s SO unsafe I cannot possibly imagine it`s even allowed in any healthcare system on either side of the Atlantic.
      You clearly have no idea what you are talking about.

      About the water and TENS: that`s just a placebo. About as useful for full blown labor pains as a chocolate fireguard.

      • Who?

        Or it could be a variation of normal?

        Water plus TENS would bring things to a halt pretty fast, either by mass electrocution or power fallure. Birth by candlelight, what could go wrong?

      • Sarah

        I must say I found TENS reasonably useful in the early stages. Not later, of course, but the buzzing was quite soothing. I don’t know if that makes it a placebo or not? Also my labours were in my back, I’m not sure how well it would work for a woman who feels the pain more in the middle, iyswim.

        • sdsures

          Or you can’t remember exactly how bad the pain was and want to reassure us that labour pain just isn’t that type of pain?

          • Sarah

            Oh it was definitely that type of pain! But I think finding them useful in the early stages is a fairly mainstream view? In my unscientific survey, women I know seemed to be split 50/50 about whether they liked them or wanted to throw them at the wall as things got going.

        • Busbus

          A good amount of women have now said that TENS or water were useful in the early stages of labor. What good is pain relief that only works in the early stages of labor!? That’s not when you really need it!

          • Sarah

            That argument only works if someone’s suggesting that TENS/water is enough for the whole labour, though. If you’re going into labour without being induced, and you find even the early twinges painful, it can be extremely useful to have something you find helpful until things get established. Even if you know you’ll be able to access an epidural as soon as you want one, there are still realistically going to be contractions while you travel to the hospital and sign the relevant paperwork. Some of us would much rather have something to take the edge off that. Pain relief that only works in the early stages is a perfectly useful and valid thing in itself. The problem only comes when it’s billed as a suitable replacement for more effective pain relief, for those who want something more effective in the later stages.

    • mabelcruet

      I’m afraid it’s you spreading misinformation. IV opiates cannot be used at home, the last doctor to do so was GP Harold Shipman. Even end of life palliative care patients receive opiates via subcutaneous syringe driver, not IV.

      • nata

        In UK we don’t do IV opiates in maternity. Only IM and many trusts allow to use them at MLU and (possibly some) at home.

        • Dr Kitty

          Correction..
          I work in the UK.
          Midwives can administer IM pethidine in an MLU or at home.Pethidine is not a very effective analgesic, as far as opioids go.

          In our local consultant led unit IV Remifentanyl is often used.
          It isn’t as good as an epidural, but it is better than Pethidine. However, it has to be prescribed by a Doctor, and it isn’t available in MLU or at home.

          Your Trust might not allow IV opioids in labour, mine most certainly does, but not at home or in the MLU.

          • Dr Kitty

            In fact, Pethidine is so inferior to other opioids, that labour pain relief is almost the only time it IS used. Occasionally it gets used for renal colic or something, but it has mostly been superseded by newer, more effective drugs.

          • PInky

            Some trusts use .meptid or diamrphine. But you know that “Dr” kitty. Shame on you

          • Dr Kitty

            My Trust doesn’t allow any opioid other than Pethidine to be used be midwives at home, because local GPs and consultants won’t prescribe it, as they aren’t happy to be held clinically accountable for the use of it by midwives in MLU or at home, when they aren’t in control of how it is used.
            It’s just Pethidine here.

            You weren’t aware of IV Remi use, I wasn’t aware there are doctors willing to sign off on midwives using IM diamorphine PRN at home during labour. Colour me surprised.

          • Dr Kitty

            Unless you meant on consultant led units?
            In which case why would you want IM opioids instead of IV? My Trust uses IV Remi on the CLU, no IM opioids at all, as they are considered unreliable and less effective, with multiple patient satisfaction surveys in favour of that policy.

            My mother (a doctor) is already planning how she can persuade my sister to come back and have her babies here instead of in London, because the state of English maternity services scare her and my sister isn’t even married yet.

            This would be the mother who did her obstetric training in Zimbabwe in the 1970s, and has seen everything that can go wrong when Mother Nature is left to her own devices.

          • araikwao

            Oh geez, we are really practicing bush medicine in my (major) city n Aus then! IM morphine (even pethidine still in some places) is administered by MWs , i would consider it the second step on their pharmacological pain ladder after nitrous.

          • DaisyGrrl

            There are doctors in the UK willing to sign off on diamorphine for labour at home? I find that astonishing. I would have expected that a doctor would be required to examine a patient before prescribing the medication and that’s difficult to do if the patient hasn’t been to hospital yet.

            It may be my North American sensibilities (diamorphine is very very difficult to access here since it’s not an approved drug), but I find it shocking that diamorphine would be viewed as a safe at-home pain relief option for labour and that there would be adequate controls in place to allow midwives to carry some in their kit “just in case.”

          • AllieFoyle

            Wait, so epidurals are bad and dangerous, but home diamorphine is fine?

          • sdsures

            Say what??

          • PrimaryCareDoc

            Oooooh, she broke out the scare quotes. She’s serious now, Dr. Kitty! Better watch out!

            Love,

            Primary Care “Doc”

          • Linden

            I had an opiate given to me during labour (in a hospital). It wasn’t pethidine, it was something else (they told me, but I was in too much pain and had had too much entonox to pay attention).
            It didn’t even make a dent in the pain. And don’t even talk to me about water or TENS. And especially not entonox, which afforded some relief at the start, then completely failed me.
            IMO the options for pain relief at home or at an MLU are completely inadequate.

          • Sarah

            This is the problem. Entonox, TENS and the like are highly individual. They work well for the women they work well for. You don’t know whether you’re going to fall into that category or not until the time comes, given that every labour is different.

          • AllieFoyle

            Right. So if they don’t work for you and you are at home or in a MLU, you’re out of luck. True, maybe you can transfer, but that sounds like such an unpleasant and uncertain prospect, why wouldn’t you just want to be somewhere with effective pain relief to start?

          • Sarah

            I don’t think the transfer from an MLU is likely to be particularly unpleasant, since they’re typically down the corridor or one floor away from the CLU. It’s more the worry that you might not be ‘allowed’. And I can hardly think of anything worse than transferring from home if I’m already at the stage where I need an epidural!

          • Ash

            My understanding is that there are alongside MLUs which are next to obstetric units. There are also freestanding midwifery led units that are an entirely different building than a hospital (standalone)

          • Sarah

            Yes, I believe they’re normally referred to as FMLUs. I’ve only ever seen MLU used to mean the ones that are not stand alone.

          • Busbus

            Honestly, at this point I wouldn’t even want to deliver in a MLU if it was right next to an OP. I just wouldn’t want to deal with anyone trying to delay pain relief or shoving their ideology down my throat.. but I get it, that’s just me 😉

          • Sarah

            That is something that put me off too.

          • AllieFoyle

            It just adds time, difficulty, and aggravation. Why should a woman have to convince other people that she wants to transfer and go through all the rigamarole involved in that? It’s just a needless delay. It’s labor, for goodness sake — severe pain is not exactly an unpredictable event in that situation.

          • Sarah

            Well, MLUs are well and good for women who want them and are suitably low risk of course. The problem comes, as I say, when a woman who wants an MLU becomes a woman who doesn’t, and this isn’t respected.

          • sdsures

            Kidney stones are predictably painful too. Should we deny people who have them adequate pain relief, too?

          • sdsures

            And even if they worked well in a woman’s, let’s say, first labour, there’s no guarantee they’ll work for the next time she has a child.

          • Sarah

            Yes, exactly. There’s no guarantee with anything other than a form of pain relief that numbs entirely.

          • Abby

            They work for women who are not in that much pain in labour…..

          • Sarah

            I dunno, I still found the TENS quite useful even when I was in what I’d say was a fair amount of pain. My threshold is probably quite low, and these were both labours that were starting to go a bit wrong, so I’d say even prior to established labour I had gone beyond ‘not in that much pain’. They were certainly no use once things kicked in properly, but based on my sample size of one what you say about TENS isn’t the case. Can’t speak to the ‘working’ or otherwise of Entonox because it did nothing but make me sick in both early labour and during delivery.

          • Wren

            I found TENS useful early on with my first labour, only because it was early on. It was more distracting than pain relieving. The spinal was much, much better.
            I forgot to use it with my second, but that labour I went from very slightly ouchie contractions 10 minutes apart to “these are really quite painful” practically one on top of the other in no time. It took me 15 minutes to walk down the stairs once those started.

          • PrimaryCareDoc

            I find it amazing that pethidine (that’s Demerol, right?) is used so freely by midwives in the UK. In my experience, we hardly ever use it here in the US because of those pesky side effects, like serotonin syndrome leading to seizures and/or death.

          • fiftyfifty1

            It is strange isn’t it? The midwife party line is that epidurals are an “intervention” with an unacceptable risk profile. But somehow a med that has been largely discarded because of life threatening seizures and serotonin syndrome (not to mention respiratory depression) is just the thing to be given, even at home away from any medical backup.

            It goes back to what Dr. Tuteur always says: If it takes a doctor to administer it, it’s “unnatural and dangerous”, if a midwife can do it it’s “natural and safe”. Such bullshit.

          • Roadstergal

            “The midwife party line is that epidurals are an “intervention””

            That’s a good point. If epidural use is measured as a negative outcome in hospital birth, why isn’t TENS/gas/opiate/etc use measured as a negative outcome in home birth?

          • Sarah

            Weird because use of opiates in hospital is measured, I think. Not aware of any stats on use of TENS or entonox usage for any birth setting, so that’s consistent at least, but I can’t see why opiates would need to be measured in one setting but not another.

          • mabelcruet

            My best friend is a GP-she is at endless war with her local midwives. She isn’t contracted to provide maternity care at all, and yet they keep asking her to provide pethidine prescriptions for their ‘clients’. Apparently she is the only GP in the area who refuses (which she isn’t, its the line that they regularly trot out). These aren’t her patients, but she would end up carrying the can if anything went wrong-they try and get her to prescribe ‘just in case’ so the midwife can carry it, no named patient, no recommended dose, no timings, just a script for a patient she doesn’t know and has never assessed. And they think that she’s being the unreasonable one.

          • KeeperOfTheBooks

            I’m not sure what the medical malpractice repercussions are over there, but I can totally see an attorney who specializes in medical litigation here absolutely SALIVATING over a situation like that. Lunacy!

          • Dr Kitty

            Yup.
            My medical indemnity covers me to attend childbirth only as a Good Samaritan, I don’t want to pay thousands of pounds extra a year just to sign scripts for a very (very) occasional home birth, thanks all the same.

            Legally, if my name is on the script for misoprostol or syntocinon or NO or Pethidine I am responsible for how it is used. Since I will not be attending the labour or birth, I cannot control how the drugs are used, so I will not prescribe them.

            All of our local GPs, having taken the same advice from our indemnity providers, are on the same page, and we have emails to prove it, so the MWs can’t pull the “everyone else does it” card.

            Locally, any drugs a midwife wants to take to a homebirth come from the hospital pharmacy, on a hospital script, signed by the patient’s consultant obstetrician.

            Because, interestingly, although the midwives here want to be the lead professional, when the consultant obstetricians suggested that this meant that patients under midwifery led care NOT have a consultant assigned, the midwives were very unhappy. They still wanted the buck to stop somewhere else…

          • Azuran

            If everyone else is doing it, why are they asking you?

          • Monkey Professor for a Head

            Do midwives also carry “just in case” naloxone?

          • fiftyfifty1

            “‘just in case’ so the midwife can carry it, no named patient, no recommended dose, no timings, just a script for a patient she doesn’t know and has never assessed.”

            My god!

          • Squillo

            It works for me when I go to the ED to have my locked knee unlocked (a semi-regular occurrence before I had the remaining cartilage removed.) They give it to me IM, then a few minutes later, the muscles relax and the thing clicks back out of the joint.

            But in the meantime, it does bupkes for the pain and makes me vomit.

          • nata

            Correction accepted. We also use Remifentanyl PCA. But it is very rare. Usually it’s either pethidine or epidural. In more than 2 years at the trust I saw it used once for someone who needed an instrumental delivery but the epidural was contraindicated.

      • Dr Kitty

        Generally speaking, IV opioids cannot be used at home.
        BUT
        I carry 20mg of morphine in my bag for emergencies.
        I’ve never had to use it, but if I attended a palliative patient in agony, or someone with a ruptured AAA that had been considered unfit for surgery, or in the middle of an acute MI, or having haematemesis as a terminal event or I come upon a horrific car accident on a rural road, I’m not hanging around waiting for the ambulance or district nurses to arrive with a syringe driver, they’re getting a big whack of IV morphine ASAP, Shipman or no.

        • mabelcruet

          Yes, but you’re a sensible GP and not a murderous psychopath. Are the rules about keeping scheduled drugs really complex? I know my GP friends complain endlessly about them, and CQC isn’t making life any easier.

          When I was a proper doctor (with live patients), I was on a rota for the cardiac ambulance as a medical SHO in a rural area. We carried lots of lovely drugs like diamorphine and I have no memory whatsoever of having to sign them out, or account for how much I’d given the patient-I’m sure its toughened up a bit now.

          • Dr Kitty

            Strict, but totally do-able.
            I have a drug book in my bag, with the amount of drugs and serial numbers/expiry dates on the vials.
            If they go out of date I return them to a pharmacy and the pharmacy disposes of them and signs my book.
            If I use them I have to document the date, dose and patient’s name.
            If I order more than 3vials a year of IV controlled drugs on a stock script for my bag the local prescribing oversight body puts a red spot against my name and I may have to present evidence of of why I’m using too much.
            At my annual appraisal I have to show my drug book and any vials of controlled drugs in my possession and my appraiser will check that the details and amount match.

            Since all I’ve ever done is replace out of date drugs and show my appraiser new vials, it has been dead easy for me.

            I also was in a cardiac ambulance in a rural area, which my boss at the time helpfully called “the mobile death certification unit”. All our CDs were signed and witnessed in and out.

    • SporkParade

      In my personal experience, water does f*** all, TENS machines do f*** all, and the entire reason I took a natural childbirth course was to avoid opiate analgesia in the event I couldn’t get an epidural. Epidurals are really effective and really safe, and I really don’t get what NCB activists find objectionable about that.

      • sdsures

        I don’t get it, either.

    • Sarah

      A woman in the MLU who wants pain relief will be transferred if the midwife decides to co-operate. The problem is, as many of us in the UK know, they don’t always.

      • sdsures

        RIP Joshua Titcombe.

    • Abby

      Oh right yes that would be pethidine would it? The worlds most shit analgesic? Only ever offered as a sop to labouring women to try to prevent them getting an epidural because y’know, epidurals are expensive and women’s pain isn’t that important..IV paracetamol is better than pethidine! Anyway you are mistaken, for labouring women to have pethidine it would have to be prescribed by their GP ‘just in case’… Which may have happened in the past but nowadays snowballs have a better chance in hell than that script being done, no one will take that crazy Medico legal risk, and funnily enough the consultant obstetricians are not keen either!

      • araikwao

        An anaesthetist lecturing us once said something along the lines of “and then there’s pethidine, which you won’t use unless you’re a midwife or a dinosaur”

      • Jen

        I’ll put my hand up and say I loved the pethidine with both my syntocin-induced labours. It was exactly what I wanted and needed.

    • Busbus

      It’s just that epidurals happen to be both the safest and most effective form of actual pain relief. But you’ll almost never hear a midwife admitting to that. Why do you think that is?

  • sdsures

    Fantastic!!

  • sdsures

    It’s even uglier when you realize that the Daily Fail is the source for the NCB tripe. Right-wing rag not good enough for loo roll.

    • KeeperOfTheBooks

      To be just, they did cover the Joshua Titcombe story. No doubt it’s a case of stopped clocks or something, but they did at least cover it.
      (Apologies for not being familiar enough with UK politics to know what right-wing vs left-wing means in that context.)

  • Who?

    Well done you!!

  • Mishimoo

    Congratulations!!

  • Liz Leyden

    I really hope the NHS puts the intrauterine intervention rate into perspective. My local hospital has the highest c-section rate in the state. It also has the state’s only MFM team NICU. My kids were born at a hospital with New England’s only level 3 NICU, attached to a hospital that treats some of the sickest babies in the country. I would expect them to have a high intervention rate.

    • Joy

      They don’t. At least not in my area. My friend was told all about the main local hospital, compared to the other choice we have in the area and how high the rates were and all that. Not mentioned that the main hospital gets all the high risk cases and there are more older women in the area around the main hospital.

  • EmbraceYourInnerCrone

    Congrats!

  • Monkey Professor for a Head

    Congratulations!

  • mabelcruet

    There is a stand alone midwife unit in my locale-I was at a perinatal mortality meeting recently and the obstetrician was presenting their maternity stats (number of sections, number of twin and higher multiples, number of waterbirths etc) and the midwife unit presented theirs-they delivered 20 babies in one year. 20! How on earth can they maintain their expertise when they do so few deliveries?

    When it opened, I offered to come and talk about miscarriage and stillbirth, and the role of an autopsy to investigate the cause. The response was ‘we don’t need it, nothing like that will happen here’. Hmmm…

    • Roadstergal

      That’s exactly the attitude that will raise the likelihood that just something like that will happen there. Ugh.

      • Amazed

        Alas, you’re so right. Magical thinking and other sweet stuff.

    • Gene

      Twenty? In a year? I delivered almost that many as a MEDICAL STUDENT in four weeks.

      • Angharad

        On the day I had my daughter, my OB told me she had seven other women in labor. I’m sure not every day is like that, but that’s 20 in three days!

        • Busbus

          Wouldn’t it be nice if the homebirth and birth center midwives in the UK were there to help the moms in the hospital, who probably don’t get one-on-one care…?

      • mabelcruet

        Yep, 20. They said it was because they had very strict guidelines on when to ship women out to the main hospital, so a lot of women would have started Labour there, and at the first sign of trouble they got bussed to hospital. On the one hand it’s good that they recognise their limits, but surely it’s more stressful for a woman to be whisked away by ambulance half way through labour, so why not just start labouring in hospital in the first place?

        • Dr Kitty

          Yep.
          The free standing MLU near me delivered about 20 babies last year. It is losing money hand over fist and is a huge waste of resources, but as it was opened to much fanfare it isn’t likely to be closed.

          Their criteria for attempting labour are:
          Multips, but not grand multips.
          Age 18-34
          BMI 20-25 at conception
          No GBS
          No GDM in this or any previous pregnancy
          No pre-eclamptics on medication
          No previous IUGR or macrosomia
          No VBACS
          Spontaneous labour 38-41 weeks
          Singleton, head down, normal baby with normally sited placenta with EFW between 11th and 90th centile.

          Transfer criteria during labour include:
          Any risk factor requiring CEFM
          Meconium
          Maternal hypertension requiring medication
          Maternal pyrexia
          Prolonged ROM
          Failure to progress
          Maternal exhaustion
          Maternal request
          Foetal distress
          PPH
          APH
          Prolonged second stage/ need for operative vaginal delivery

          Even if you WANT to deliver there ( and as I said, very few of my patients do) it is quite likely to be risked out before or during labour.
          And they’ve STILL had at least one disaster…

          • Sarah

            The one in Salford, Greater Manchester, is also underused. In a way I’m glad as it does mean they’re very strict with their risking out, which of course they should be as it’s the only way the system can work, but it does rather give the lie to the idea that midwife led birth costs the NHS less.

          • KeeperOfTheBooks

            That sounds rather like the only homebirth practice in the US that I’ve ever heard of with a considerable amount of common sense. Their risk-out list is virtually identical. I still think homebirthing is a bad idea, but at least that group isn’t doing HBA5C with a morbidly obese, elderly mom with GD.
            (Which right there says quite a lot about the screwed-up state of homebirth midwifery here.)

          • Ash

            Do they at least have clinic appointments there or other services? If it was only deliveries, that building must be empty all the time.

          • Dr Kitty

            The FMLU I’m thinking of is in a community hospital that has outpatient clinics, a minor injuries unit, a few step-down elderly care beds, some outpatient dialysis beds and an X-Ray department for GP ordered X-rays.
            It was built at great expense a few years ago, when the medical consensus is that we should be closing small community hospitals and centralising services in big, busy centres. Sadly, politicians decide what to do based on popularity with voters, not evidence based patient safety.
            Voters like little hospitals on their doorstep.

            It’s a 45 minute journey by road to the nearest hospitals with an OR and a NICU an hour journey in the opposite direction to the third. Maybe faster with lights and sirens in an ambulance, maybe slower with bad weather and traffic…

            Personally, you couldn’t pay me to have a baby there.

          • Sarah

            Is that Mater Infirmorum? I looked them up and saw they did 190 births in 2013-14, when there are about 6000 yearly in Belfast. A very low percentage even considering that they’re (quite rightly) pursuing an extensive risking out policy.

          • Dr Kitty

            The Mater downgraded their CLU to a freestanding MLU, and transfer to RVH if there are problems (about 15 minutes by road).

            L downgraded their CLU to a FMLU and transfer to the Ulster.

            D never had a CLU, was a purpose built FMLU.
            They transfer to the Ulster or Daisy Hill, depending on beds.

            Google Map will tell you the distances.

          • mabelcruet

            Another local DGH has a ‘home from home’ unit. Its absolutely lovely-every room is ensuite with an enormous jacuzzi bath, honestly, it looks like a fancy hotel! But its on the same floor as the consultant led unit and (from my experience as an outsider), the midwives and consultants have a good relationship and work together. It seems to be popular with mums, and seems to me to be a good compromise.

          • Sarah

            Gotcha

          • Dr Kitty

            PS, I’ve worked in the Mater (but not OBGYN). Fun Times on a band 2A rota with no onsite senior cover and some of the sickest patients I have ever met from one of the most deprived areas in Western Europe. Fuel of nightmares.

          • Sarah

            That’s Belfast baby

          • Dr Kitty

            Our A&E consultant would regale us of the bad old days when they’d have people who had been blown up, or the IRA would find out that someone they’d tried to kill was still alive and masked gunmen would come to the hospital to finish the job…

          • Sarah

            You young doctors have it so easy these days!

  • Megan

    Hooray! Congrats!

  • namaste863

    Way to go!

  • attitude devant

    Brava!!!!

  • moto_librarian

    Congratulations! How wonderful!

  • Amazed

    Congratulations, Dr! THAT is something to be proud of!

  • Amazed

    “Hello from the dark side…”

    https://www.youtube.com/watch?v=aSf2C1Pd2Ns

  • Dr Kitty

    Congratulations!

  • Gatita

    New Yorker piece by a woman who had a stillbirth while travelling in Mongolia

    I had been so lucky. Very little had ever truly gone wrong for me before that night on the bathroom floor. And I knew, as surely as I now knew that I wanted a child, that this change in fortune was my fault. I had boarded a plane out of vanity and selfishness, and the dark Mongolian sky had punished me. I was still a witch, but my powers were all gone.

    That is not what the doctor said when he came back to the clinic in the morning. He told me that I’d had a placental abruption, a very rare problem that, I later read, usually befalls women who are heavy cocaine users or who have high blood pressure. But sometimes it happens just because you’re old. It could have happened anywhere, the doctor told me, and he repeated what he’d said the night before: there is no correlation between air travel and miscarriage. I said that I suspected he was being a gentleman, and that I needed to get out of the clinic in time for my eleven-o’clock meeting with the secretary of the interior, whose office I arrived at promptly, after I went back to the Blue Sky and showered in my room, which looked like the site of a murder.

  • Amy M

    Huh. Here I am, not even close to a genius, but my first question would be: What bearing does the rate of X intervention have on my personal situation?
    Despite my lack of mensa membership, I think the answer is: very little. I imagine that most women could reach this conclusion on their own? If so, it wouldn’t really increase homebirth rates any.

    Who cares what the rate of Csections or epidurals is at a given hospital? If the Csection rate at a certain hospital is 50%, that does not mean that a given woman’s personal risk of Csection is 50%. The only good I can see, coming from disseminating such data to all pregnant women is so they can figure out which hospitals are most likely to give an epidural when its requested.

    I hope there’s a backlash against this sort of nonsense soon—that women (and men) can work together to insist that labor pain should be treated in a timely manner. I mean, if a woman doesn’t want an epidural, fine, but if she does, she should be able to get one, even if that means she has to pay something out of pocket.

    • Roadstergal

      “If the Csection rate at a certain hospital is 50%, that does not mean that a given woman’s personal risk of Csection is 50%.”

      But so many people don’t get that. They think the C/S rate is higher than *arbitrary number they think it should be* because the docs rush women into C/S for their own convenience. I’ve heard college-educated women, women with PhDs, all trot that out.

      • Dr Kitty

        Right.
        You can bet that the tertiary hospital beside the children’s hospital, with the regional fertility centre, where ALL the high order multiples and micropreemies and babies with congenital defects are delivered is going to have a much, much higher rate of neonatal deaths and interventions than the midwifery led unit down the road that only takes low risk multips with singleton head down babies at term.

        Does that actually help you decide where to have your baby?

        Not necessarily.

        • Amy M

          Exactly. Personally, I’d rather be at the hospital with all the interventions as long as their mortality/morbidity rates are good considering the high risk population. Those people definitely know how to handle emergencies.

          • Dr Kitty

            There are two maternity hospitals nearby.
            One is the aforementioned tertiary hospital, which was built about 75 years ago.
            The other is brand new, with a MLU with birthing pools one floor down from the consultant led unit.

            When patients ask where they should go (after deciding against the freestanding MLU) I ask if they are glass half full or glass half empty people. If they are more reassured by all interventions and experts being onsite or by birthing pools, private rooms and electric blinds.

            It isn’t up to me to decide for them, I’ve found that asking people whether they are “expect the best” or “prepare for the worst” really helps.

          • Amy M

            I live about 5 miles from a major teaching hospital, and there is another, smaller hospital pretty much across the street from part of the teaching hospital complex. A decent number of women in this area go to the smaller hospital, and my understanding is that its a fine place to have a baby.

            I made sure I picked an OB who worked at the teaching hospital, because with twins, I wanted to be sure they could get to the Level 3 NICU (which the smaller hospital doesn’t have) asap, if necessary. Someone told me that my OB was “Csection happy.” I don’t know her personal rate of patients who need Csections, but I do know she’s a very experienced doctor working in a teaching hospital where higher-risk patients go—she should have a relatively high Csection rate.

          • fiftyfifty1

            I do find all the emphasis on interior decorating in L&D to be funny. Until I got the epidural, I was blind with pain. You could have locked me in a dark shed with spiders and a dirt floor and I barely would have noticed. Then after the epidural I spent the next few hours half asleep in a stunned state of exhaustion and relief. Whether the blinds were electric or manual (or not there at all) I did not notice.

          • Megan

            Agreed. The only thing I cared about as far as the room was the fact that it had its own thermostat, which I made hubby turn down, down, down as labor progressed… Poor guy was probably freezing. I’d have been just as well off in an igloo.

        • Azuran

          That’s like saying that ICU doctors are less competent because they have a higher rate of death or complication than the dermatology department.

          • Gatita

            I met one of the best ICU docs in the country and he told me their death rate is about 20%. Man, it must take a very special person to go to work every day knowing you’re going to confront that much death.

          • Azuran

            I guess you have to look at the positive side, you saved the other 80%.
            Still I can’t believe the mental strength necessary to work through that every single day. I don’t lose patients often, but whenever I do I spend days thinking about it and thinking back to each and every single decision I made, trying to figure out what I could have done differently. And I don’t even treat humans!

          • mythsayer

            That’s exactly what I said before I read this comment!

          • BeatriceC

            When my youngest was in the NICU (24 weeks, 504g) one of the nurses explained it to me this way: when she started in nursing, nearly every single baby in that unit (and a food many of the mothers) would have died. Now she gets to watch most of those babies go home. The loss of the ones that don’t make it is tragic, but the joy of saving the rest of them makes her job worth it.

          • mythsayer

            They probably look at it like they are saving 80% of the really critical people. I’m a total pessimist but even if look at it that way instead.

          • Dr Kitty

            From what I have read by Gawande US ICUs seem willing to take patients (e.g. elderly, demented, end stage oncology patients) who would never get in to an ICU in the UK.

            Given that, 80% survival seems amazing.

        • Liz Leyden

          When I found out I was pregnant, I wanted to deliver at a hospital about an hour from home because they have private recovery rooms, which my local hospital didn’t have at the time. When I found out I was carrying twins and would need access to a NICU, I resigned myself to the local hospital, which had a NICU, despite the lack of private recovery rooms and an infection control policy that banned suitcases. When I found out about my daughter would need open heat surgery right after birth, which meant delivering in Boston, I felt like I was getting the best of both worlds: a facility that handles a lot of high-risk pregnancies and a private room.

        • Who?

          See, I want to be the low risk multip with singleton head down, but will behave like the other one-I want the lot, on hand, just in case.

          Or, to put it another way, I want to be the most medically boring patient, certainly of the week, ideally of the month. Give me the doc and organisation who could do the straightforward thing in their sleep, thanks.

      • Amy M

        That just frustrates me to no end. If they just stop and think for a minute….Woman A is pregnant and everything is low risk and going fine. The hospital she is to deliver in has a 40% Csection rate. Its not like she’ll suddenly develop life-threatening complications merely by setting foot through the hospital door.

        We might as well say the ice cream shop next door has a 50% rate of people buying cones vs. cups. If you want a cone, does that fact that half the people there want a cup force you to get a cup? Of course not, you’d only get a cup if there were no cones left.

        • The Bofa on the Sofa

          If my wife is pregnant and the baby is breech, the chance of a c-section is 100%.

          Actually, now that she has had a c-section already, it doesn’t matter, the chance of her having another c-section is 100%, because she has no interest in a VBACS.

          Of course, the chances of my wife getting pregnant are slim-to-none, so if she is pregnant, before she has the c-section, she has some ‘splainin’ to do….

          • Amazed

            What’s up with you men today? I just had a conversation with the Intruder who described my SIL as a “furry horned thing” (in her hearing, mind you), now you mention some improbablilities… Is it something in the air? Is that the problem?

          • The Bofa on the Sofa

            There was a text message message sent out last night…

      • EmbraceYourInnerCrone

        Don’t people stop and think that if a hospital has a high C-section rate maybe it’s because they are for instance, a university medical and research hospital that all the people with complex problems choose to deliver at? The one with the specialized NICU and all the experienced Neonatal experts?
        And if a hospital has a 10 percent CS rate maybe its because they don’t do very many deliveries and they send all the complex ones to the Uni hospital that’s 6 miles down the highway? This is what happens where I live because the community hospital has a nice birth center where you can have a midwife but if things might go pearshaped you want to be at the place with all the experts!

        • An Actual Attorney

          I was just thinking of this analogy. One of my mentors is a death penalty defense lawyer. She’s an amazing lawyer. Roughly 90% of her death penalty clients have been sentenced to life in prison. About 10% walk completely. In other words, in her entire career, she’s never had a client sentenced to death.

          Doesn’t mean if I talk her into representing me on some stupid misdemeanor, like drunk in public, that I’m 90% likely to get sentenced to life in prison. Instead, it means that even though I was caught peeing my pants and puking in the park, holding three empty Stoli bottles, I have a good chance to getting off.

          Note, that was a totally theoretically example as I’ve never been THAT drunk in a park.

          • mythsayer

            Wait…is she a defense lawyer or specifically a death penalty phase lawyer? I assume she is a criminal defense attorney who handles the possible death penalty cases, right? Just clarifying. I think that’s what you meant. Totally off topic…just curious.

            So she gets 10% of the death penalty criminal defendants off entirely? That’s pretty good. Hard to do. She must be really good in the penalty phase for the other 90% to have never had a death sentence handed down. She knows how to present her clients to a jury.

          • An Actual Attorney

            Sorry, I wasn’t clear. She’s a criminal defense attorney that almost only takes cases charged as capital offenses. She will take a complex non death case if it’s really compelling. So almost all her clients are facing possible death. She taught me stop much about preparing cases, telling stories, and (germain to CPMs) not whining that something is hard or inconvenient when your client has so much more on the line than you do.

        • Erin

          The short answer would be nope! The hospital my son was born at is a teaching hospital and the only one with a NICU, epidural access and operating theaters which run 24/7 for a fairly large area of the country in which I live. It’s c-section rate is approaching 50 percent but everyone with a prior section scar is sent there unless they choose to stay at home. Numerous people told me I was stupid for wanting to deliver there.. and after my section (for failure to descend) told me it served me right. Apparently had I been anywhere else my pelvis would have been more suited to childbirth and he would descended. I don’t know about baby brain but obsessing about natural birth seems to do something to brain cells.

        • Sue

          That’s the issue with hospital statistics in general. Unless outcomes are adjusted for the patient-level risk, the data are meaningless. Otherwise, big teaching hospitals with specialist units always look bad because they have the highest risk and most complex patients.

          • Azuran

            I see this in practice every day. Most of my medical textbook and medical statistics are made using data from the various teaching hospital. They are where all the worst cases of everything get sent to.
            As a result, my surgical and medical success in treating or managing various illness is often higher than what is reported in the literature.

        • KeeperOfTheBooks

          EXACTLY. One of the best VBAC hospitals near me has a near-50% CS rate. That sounds horrendous, until you realize that that hospital is *the* place you want to be for a high-risk pregnancy, preemie baby, and/or sick baby or mom. Of course their CS rate is high! In a shocking turn of events, when most moms hear “I don’t think your preemie baby with X, Y, and Z congenital issues will tolerate labor at all well” they tend to say, “Right, so when are we doing the CS?”

    • EmbraceYourInnerCrone

      why should she have to pay out of pocket though? Are people expected to pay for pain relief in other situations? Also wouldn’t that mean that if you are well off you can get pain relief, but if you are poor, oh well guess you get to suffer..

      • Azuran

        It seems to work like that if you are american and have bad or no insurance.
        God I love my public health system.

        • Gatita

          No, it doesn’t work that way in the U.S. Half the pregnancies in the U.S. are covered by Medicaid. Pretty much everyone else has some kind of insurance. Even if you don’t, if you walk into a hospital in labor they will care for you and give you an epidural even if they eat the cost because you can’t pay. It’s not a great system but the overwhelming majority of US women have access to pain relief in labor.

          • Bombshellrisa

            Wasn’t there a state that was trying to get Medicaid to NOT cover epidurals for vaginal births? Utah?

          • Gatita

            Apparently it was three Utah legislators and they were basically laughed at/shouted down by their fellow Republicans.

          • Bombshellrisa

            I couldn’t remember the exact details, but it showed an ignorance that you wish was a gigantic joke,

          • KeeperOfTheBooks

            I should bloody well hope so!

          • sony2282

            California used to not cover epidurals in their free/cheap state insurance- MediCal. Patients had to pay upfront for one. Then they decided that was cruel and unusual and started paying, minimally, for it.

          • KeeperOfTheBooks

            Aside from the serious issues with that, did not a one of them pause to think about just how screwed up that was going to sound as part of an election ad by an opponent? “Senator Smith lodged a bill to deny poor women pain relief during labor” sounds like an awesome way to ensure that a hell of a lot of people will want to tell Senator Smith what he can do with that bill and any chances of future election–needless to say, without an epidural.

          • Azuran

            That’s very good to hear.

          • KeeperOfTheBooks

            It’s also true of some other medical facilities.
            I once, thanks to a rather epic screwup on the part of a doctor’s office, had some labwork (unnecessary and unauthorized) sent to a lab not covered by my insurance. I figured the lab wasn’t at fault, since they merely processed a test that someone asked them to, but called them up nonetheless to see if we could negotiate something because the bill was…large. As soon as I’d briefly explained the situation, the person on the other end offered to settle for less than 10% of the total! Needless to say, the next words out of my mouth were “My credit card number is…”

          • Gatita

            I also wish more people knew they can negotiate payments with the hospital. Often they’ll accept a lump sum that’s less than the billed amount and then write off the rest. Or they will set up a payment plan with you. The worst thing to do is ignore the bills until they land in collections. Another option is declaring bankruptcy, which is underutilized in the U.S.

          • Ash

            You might have your epidural done by an out of network anesthesiologist though–and in that case you are SOL

          • Ash

            They’re not going to necessarily eat the cost.

            They can send you to collections, which tanks your credit. You can also be served with a debt collection lawsuit.

          • Gatita

            Yes, but speaking from personal experience, if you reach out to them and work out a payment plan or lump sum payment, they’d rather work with you than send it to collections. I was able to discharge a lot of debt that way. And in retrospect I should’ve just declared bankruptcy. It’s not as dire as people think it is. After seven years your record is wiped clean.

      • Amy M

        I’m not saying she SHOULD have to, but realistically, that’s a more likely situation. And people are expected to pay for pain relief—its included in the cost of the surgery or whatever. I’m American, and my insurance is pretty good, so it would cover at least most of the pain relief, but not all insurance is equal and plenty of people don’t have insurance. I also imagine that in some countries, the access to pain relief is entirely based on ability to pay—that doesn’t make it right, and I don’t think any countries should adopt that system—but yeah, the poorer people do get to suffer, in places like that.

        I know the UK, Canada and Aus. have public health systems where the pain relief absolutely should be covered, just like it would for any other pain relief. But even though the women may not have to pay extra in the public system, there are stories coming at least from the UK, where the women were denied pain relief. My understanding is that there is a private system in those countries as well, where those with the ability to pay may have access to faster care/better care/maybe pain relief too.

    • DaisyGrrl

      “What bearing does the rate of X intervention have on my personal situation?” This is what drives me nuts about the c-section rate whiners. Are you a 25-year-old multip with no risk factors who went into spontaneous labour? You do not have a 30% c-section risk! Are you a 40-year-old obese primip with gestational diabetes and a breech baby? You c-section risk, should you somehow show up in spontaneous labour, is also not going to be 30%!

      I want the straight goods from a doctor. What is the likelihood of x happening to a patient with a similar risk profile as mine? What are the risks and benefits of these interventions? Here are my personal priorities, how does this affect the treatment plan? None of these things have anything to do with the rate of an intervention in a particular health care setting.

  • Roadstergal

    !!

  • momofone

    Congratulations!

  • Roadstergal

    “The information would state how many needed interventions such as forceps or caesareans, or suddenly needed to be transferred to hospital – if at home or in a midwife-led centre.”

    *%#$ meaningless *$#$% numbers without the $#%*( rate of death, oxygen starvation, and brain injury.

    “This may also include the numbers of stillbirths and women who died in labour”

    Oh, _may_ it, now? Thank you so fucking much.

  • namaste863

    I have said it before, and I will say it again; The whole point of the entire process of pregnancy and childbirth is to send mum and bub home alive, healthy, and with brain function in tact. WHO CARES if it takes an “Intervention” or two to make that happen? It’s a pitocin drip, not a nuclear explosion for chrissakes! Whining about something so inconsequential makes these people seem like entitled, spoiled brats, IMO.

    • LaMont

      Well they see interventions as dangerous in themselves, leading to worse outcomes. It’s anti-vaxx-type lunacy but they do believe it, and actual information will never slow them down. If even ONE person had a worse outcome because of an intervention, the fact that thousands or millions have positive (and even life-saving) outcomes from it means nothing to them, it’s unsafe medical tyranny at work.

      Also they see doctor/patient relationships as entirely adversarial, so if something is positive for the doctor it *must* be negative for the patient – doctors like monitoring/management/patients not screaming in pain? Then those things must be harmful!! Nothing could ever be a net positive for doctors and patients!

      • Roadstergal

        “Also they see doctor/patient relationships as entirely adversarial”

        There’s a trend I’ve noticed in the last several surgeries m’boy and I have done (yes, I tried asking for a frequent-user punch card). The specialists come out, introduce themselves, and tell us what their goal is. “I’m —-, I’m the anesthesiologist, and my goal is for you to have a painless procedure with no post-operative nausea…” etc. It’s a bit wasted on us, but I wonder if it helps dispel some of that.

        • Mel

          My husband and I had fun with that when he underwent a gastric sleeve procedure.

          He would reply with “HI! I’m Nico and I would like to have most of my stomach removed, please. Will you make sure my extra stomach pieces go to a good new home?”

          The doctor would looked confused for a second and then I would say overdramatically “Yes, Nico. Your stomach pieces are going to a nice farm in the country where they can run and play with other stomachs.”

          😀

          • Roadstergal

            Ha, yes. They asked m’boy about what he wanted from the experience, and he said, “Um, to not have a plate in my shoulder anymore? And waking up would be nice.”

          • namaste863

            Waking up is muy, muy importante.

          • Roadstergal

            The things they’re doing with nerve blocks these days are just wonderful. So little GA needed!

          • namaste863

            In the shoulder? How do they do that?

          • Roadstergal

            We both got collarbone plates removed (me last Thanksgiving, him on Monday) and had a nerve block with light general. I was up and walking less than an hour after they closed me up.

          • namaste863

            But which nerves do they block? Where do they stick the needle?

          • Roadstergal

            I dunno which ones, but it was a big needle in the neck for both of us.

          • namaste863

            Wicked!

          • Charybdis

            Were you aware when they got you with the needle? I felt mine going in. Kinda surreal, realizing you are being stuck in the neck with a needle.

          • Roadstergal

            Yes, it was wacky and cool for sure.

          • Charybdis

            I apparently have an elephant’s tolerance for anesthetics and they have to give me a whole hell of a lot to get and keep me under. Enough that it makes me violently nauseous even with the preventative measures taken. So I tend to remember the first bit of surgeries. But feeling that LONG needle being inserted into my neck while I was still pretty conscious was decidedly odd.

          • Roadstergal

            🙁 🙁 I am lucky in being quite small, so it doesn’t take much to knock me out. I am less lucky in having a raging metabolism, so it doesn’t last. I proudly showed my ortho that I could move my arm in post-op, and she said “Start taking your pain pills _now_…”

          • PeggySue

            Years ago when I had my one and only major surgery (so far), the anesthesiologist apparently believed that the chief worry for patients would be “waking up” during surgery. Thus he went on and on about how I would be SO DEEPLY ASLEEP that it would be IMPOSSIBLE for me to feel ANYTHING. I, who am if anything oversensitive to sedatives, was getting paler and paler as he talked. He finally quit and asked what questions I had and I asked, “Will you be able to wake me up at the end???”

          • BeatriceC

            Your boy and my boys would get along well. The two affected boys go in for surgery a couple times a year and make light of it by making morbid and silly jokes. The youngest told the last Doctor that his goal was to come out with both legs, and the same length would be nice, but not necessary. The oldest jukes about his “off switch”; a bone tumor situated in a place that could be lethal if he got hit in just the right spot but is too dangerous to remove.

        • Erin

          I imagine not. However I don’t think adversarial is the issue.. I mean, I don’t have much to any faith in Doctors however should I be pregnant next year, I will be mostly listening to what they have to say, I may then disagree but I will at least listen. They might get a bit of snark and/or a lot of questions but I’ll be there, adversarial or not because if I’m putting myself through that, I ideally want a live baby.

          The problem at least in my eyes lies with the women whose response to a c-section or any sort of birth they deemed traumatic is to birth at home next time as far away from proper help as possible. You can’t fix that by explaining what your job is and how you want to help because you don’t see the patient until something catastrophic has happened and by then it’s potentially far to late to fix the doctor/patient relationship.

          • Who?

            I think this is right-just because you really don’t like something, is no reason to avoid it when it is the safest or otherwise superior option.

            Your first para describes people who confuse what they feel comfortable with with what’s going to provide the optimum outcome for them.

      • namaste863

        Or else they define their worth as females by their body’s ability to pop out said bubs without “Intervention.” I don’t get that mindset, personally. I would much rather be known for my intellectual pursuits than for receiving style points from the NCB brigade for a biological process. But that’s just me.

    • sdsures

      If my baby stops breathing, I sure as **** want an “intervention”!

      • The Bofa on the Sofa

        Heck, I would take the intervention BEFORE the baby stops breathing if it is going to prevent it.

  • Dr Kitty

    As soon as I say “well, if something goes wrong it’s a twenty minute ambulance ride to the maternity hospital, and there has already been one baby that suffered serious brain damage because that twenty minutes was too long. The family sued, but didn’t get much money because they were aware of those risks when they opted to give birth there” women decide they don’t actually want the free standing MLU after all…

    Funny that…

    • Megan

      Informed consent is an amazing thing. I imagine NICE won’t be mentioning those things.

      • Roadstergal

        Considering that the release mentioned death as one of those ‘meh, tell them or not’ things, I doubt brain damage will even blip the radar.

        • Angharad

          What’s a little brain damage compared to an epidural?