I hate gynaecology stories, but this is slightly related to something I was talking about with Contra in the chatbox, so here goes:

Quote:

I remember being at a party when I was eight months pregnant with my first child. I got into conversation with three experienced mums. They looked at my round belly, and smiled conspiratorially as they unleashed their birth stories. They divulged everything – the baying, the blood, the fear, the chaos, the agony. They seemed to want to outdo each other's horror and as they talked they were transformed into electrified, possessed creatures. I was terrified. The adrenaline rush sent my baby into back flips inside me. I have never talked about the births of either of my two children. There are plenty of reasons. Most of them are pragmatic. Birth pitched me into motherhood. Suddenly there was no time, certainly not for dwelling on the past. The births were behind me, the children ahead. At least it's what I tried to tell myself. I had given birth twice. Each had produced a beautiful, healthy boy. Why linger on them? People went through far worse. It seemed churlish to brood, especially when so many women were unable to conceive. But my experience remained locked inside me, refractory and unexamined. If birth came up in conversation, I would stay mute hoping the subject would move on. I knew that writing this article would be hard. I would have to face raw memories and all the old unanswerable questions. Above all, it would mean describing the actual births. I wondered whether the article should have a subtitle: not to be read by expectant mothers. I asked my mother about her births and she said she never talked about them to anyone. She said the reason was obvious (my mother's second pregnancy ended with a stillbirth, and the unspoken grief still lives inside her after 50 years): birth was so dreadful that it had to be forgotten, or no one would go through it more than once. I don't believe women forget their birth experiences. I certainly haven't forgotten mine. Many women do talk about their births. Plenty of my friends recount them openly, especially if they went well, and I've noticed that even among those who had difficult births, talking about it can be a way of coping with the trauma. There are a multitude of responses, but mine, like my mother's, has been silence: not because of how dreadful the births were, but because at some level I couldn't acknowledge my feelings about them. I felt ashamed. I felt I had failed because both of them went "wrong". It was the due date for my second child. The birth of my first had been by emergency caesarean, and I was keen to try for a natural birth. We had chosen a female obstetrician with a good reputation and discussed Vbac (vaginal birth after caesarean), which she was confident I could have. My husband and I arrived at her surgery for a cervical sweep, whereby a doctor or midwife uses a finger to stretch the cervix to stimulate labour. My consultant cheerfully inserted a finger. "Push against me," she said. I did. It hurt. It hurt a lot. "Ah," she said, smiling, "I've broken your waters!" She pulled out her hand. Her face went pale with shock. My skirt was drenched in bright red blood. I couldn't understand where it had all come from. "It's frank blood," she said. "Where's your car?" We ran red lights all the way to the hospital. I was put in a birthing room and strapped up to various monitors. The bleeding subsided. A slow flow of clear fluid ran between my legs. It was amniotic fluid, my consultant reassured me – a good sign. She went back to her surgery to see more patients. When she returned four hours later, I had started to have mild contractions. She asked me to stand up and move around the room. As I stepped from the bed, I suffered a huge loss of blood. I had been haemorrhaging internally since the sweep. The blood had merely collected inside me. The clear fluid was not amniotic fluid but serum from still, separating blood. I remember a blur of green gowns, a drip in my arm, the hospital corridor rushing past, my husband's terrified face, the bright coldness of the operating theatre, the mask going over my nose and mouth. My husband waited in the corridor. After five minutes, a nurse emerged with a baby. He put it under his jumper to keep it warm and waited for three long hours. The memory still makes him cry. The doctors were too busy to tell him what was going on. He remembers someone rushing out and shouting, "We need blood!". He thought I was dying. I suppose I was. Only a massive transfusion saved me. I have struggled with hundreds of questions about it ever since. Why did it happen like that? Looking back, I can also see that I had put myself under enormous pressure to have a normal delivery. Why? Why didn't I choose an elective caesarean? The answer is that in having one with my first child, I felt I had somehow let myself down. On the internet, women chatter anxiously about every aspect of birth, from pain relief to whether an epidural can affect the baby's brain, from cultural differences in birth methods to whether having a caesarean can save your sex life. The voices seem uncertain: dismayed by choice, and fraught with the worry about getting it right. The previous generation had no such choice. My mother's first birth was a lonely and scarring experience. My father was not allowed to be present. She was strapped to a bed on her back, her feet hoisted into stirrups. She was given ether for the pain and the baby was yanked out of her birth canal with metal forceps. Her vagina ripped badly, and she felt alone, ashamed and frightened. She said she was treated like an animal. Her baby was taken away to a separate room and only brought back to her when the staff deemed it necessary. It is not surprising that after such experiences the natural childbirth movement sprang up. Women wanted control. Birth was a natural process, they said, and a joyous one. They wanted the sense of community that could surround a woman giving birth: midwives, partners, doulas. The hospitalised degradation our mothers had suffered was a thing of the past. Birth should be a positive experience. Ten years ago and pregnant with my first baby, I found myself caught up in that idealisation of birth. My friends were the same. We practised squatting, breathing, and massaging. We were encouraged to indulge our bodies. It was a special time. Not least because we felt we were discovering a new faith; in nature, and in ourselves. My husband and I sat on bean bags in the National Childbirth Trust (NCT) class, taking copious notes on an A4 pad. We learned that drugs could harm the baby. They could make it sluggish, and slow to feed. We heard horror stories about epidurals. We learned that the increasing rates of caesareans were due to doctors fitting them into their shifts. Birth had become over-medicalised and modern women were becoming "too posh to push". The NCT offered an attractive alternative. Birth was not just a matter of having a baby, it was about remaining in control. I made my birth plan. No pain relief, it said. The teacher took my husband to one side. "Make sure she sticks to her plan," she told him. "When she's screaming for drugs, it's not what she really wants, it's what they want." He dutifully made a note of it. We were both suggestible. I was hormonal. We became so convinced of the evils of hospital we decided to side-step them altogether and opted for a home birth. We paid for an independent midwife. She came to the house and showed me a video of a Brazilian woman giving birth. The woman got down on her haunches by a tree and pushed. The head of the baby crowned between her legs and it slipped out, easy as a pea from a pod. I am relatively small in stature and my bump was enormous. "I'm worried my baby is too big," I said. "You must trust in nature. Babies cannot be too big," the midwife retorted, as though I had dared question the faith. We had candles, mood music, a birthing pool. We knew how to breathe. We had massage oils. We were ready. My waters broke at night and I went into labour. My contractions were fierce. I was soon 10cm dilated. The contractions came every 30 seconds, pain grinding down my lower back. I felt I would crack open. My baby did not slip out like the Brazilian woman's. I laboured for 36 hours. There is no describing the agony. The midwife put her hand inside me to turn the head, but still the baby did not come. I didn't want candles or massage or music. I just lay on the bathroom floor and wanted to die. My husband told me that the midwife had stood in the kitchen at a loss. By midnight on the second night, he insisted we went to hospital. Within three minutes of arriving, I had been given an epidural. Fifteen minutes later, the duty doctor told me that the birth was not progressing and I was exhausted. He would deliver the baby by emergency caesarean. The independent midwife didn't stay. This would not be a natural birth. Following standard procedure, the surgeon cut my skin through to the layer of fat until he reached the fascia, the shining inner skin that supports the abdomen. He made a small incision and widened the cut. He parted my muscles underneath and pushed through a sheet of tissue using his finger. He stretched the hole open and cut carefully into my womb, just enough to allow the baby's head through. The sight of my baby suddenly lifting above the curtain and screaming loudly with flailing limbs, is scored into my memory like a sunrise. I reached for him, despite the surgeon telling me to lie still. The nurse laid him on to my breast, and the instant he touched my skin he was quiet and still. Lying in the hospital ward afterwards, my body swollen with fluids, and the pain in my abdomen severe, I became deeply depressed. I was in a busy ward. My husband was not allowed to stay. I remember staring at my baby in the clear plastic tub next to me. I wanted to lift him but I couldn't move. A nurse reprimanded me. Why had I not bothered to put a nappy on baby? I was disoriented and could barely understand her. She stormed off and got a nappy and wipes. She dumped them on the bed beside me and passed me my son, streaked with meconium. I cleaned the molasses-like excreta from his perfect skin and cried through the night. Perhaps with birth experiences like these it's not surprising that I wrestle with the idea that birth is one of the most natural things we do. I was told afterwards that my first son had the umbilical cord wrapped tightly around his neck. If he had come out normally, he would have been strangled. He would have died or suffered severe brain damage. I had always prided myself on being in tune with my body, fit and strong, and this felt like a dire failure. I'm not sure whether birth is comparable to other "natural" things that we do. Unlike other mammals, our babies do not have a straight trajectory into the world. Evolution dictated that our pelvises became narrow in order for us to walk upright, but at the same time our craniums were growing larger to accommodate our burgeoning brains. For a baby to be born, it must turn as much as 40 degrees so that its large head can squeeze through the birth canal. It is a difficult manoeuvre. I recently read a book about the Piraha people in the Amazon. There was a description of a woman going into the forest alone to give birth. The baby got stuck and she cried out in agony all night long. No one went to help her. She was found lying dead by the river, the next day, her baby still inside her. The book says that no one mourned her. I'm not sure I can believe that, but it certainly seems true that for the Piraha, death in childbirth is simply an unavoidable fact of life. Death has always shadowed birth. In the 1600s, if the baby didn't emerge, doctors drilled into their heads to make their bodies easier to extract, piece by piece. In the 19th century, women preparing for birth were routinely told to pray and beg forgiveness in readiness for death; 19th-century novels are littered with mothers dying in childbirth. I am deeply grateful that I live now, when medical intervention has kept me and my children alive. I also know how important it is that the NCT and similar organisations exist to support and empower women. But in my experience, the division between health practitioners who advocate the natural way, and those who encourage a more medicalised route presents its own danger. It carries with it a sense of good and bad, a gulf in which women can get caught. It is part of our culture to want choice and to be in control, but with birth, this is probably impossible. My friend Georgia, who was pregnant at the same time as me, was induced three weeks early because of pre-eclampsia. Her cervix did not dilate and she was forced to have an emergency caesarean. I asked how she felt about the whole experience. She said she was fine, just happy to have a healthy baby. From the start she had never expected the birth to be anything but a nightmare. Sceptical by nature, she had stopped going to her antenatal classes because she disliked all the false promises about perfect births. She chose not to make any kind of plan. As a result, when things went wrong she did not feel any disappointment. It made me realise that, in some way, my silence was about mourning the birth experience I had wanted so much but was unable to have. No doctor can predict how a birth will turn out. It's hard to know how best to prepare. To misquote another novelist, there are as many different birth experiences as there are babies. It has taken a long time for me to understand that it was not that my births that were wrong, but my expectations. My birth stories are extreme but they are part of who I am. It is good to acknowledge them but I still feel drawn to silence. I don't know why, exactly. It is not about shame or feelings of failure any more but perhaps because ultimately birth, like death, is so intimate, so ordinary and yet so epic that it is beyond our expression.

For me this "you must embrace nature and be healthy" obsession is all a big myth based on morality and conformism. Like organised religion except solipsistic.

So, to resume: Giving birth is a shitty experience. Artificial flavourings taste good. Drugs make you feel better. We are fat and ugly. Positive thinking doesn't cure disease. Unconditional love is bullshit. Your kids are stupid and ungrateful.

However, society insists otherwise - in the example given, trying to get a child out of yourself is a joyful experience that should happen in a natural environment with no scientific intervention. Anything else makes you a shallow person and an all-round failure.

I'd try to convince people to ignore social norms and just do whatever makes life easiest for them, but I realise that if you're a naturally neurotic person this isn't going to happen, and of course you can't just accept it and lie back and enjoy being neurotic either, for obvious reasons. I guess you're just screwed. If anyone wants me I'll be over by the ether.

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So we have birthing ideological warfare on top of everything else. My first wife produced three healthy children by natural childbirth without anaesthetics, but she went to birthing pain management courses for several months before each one. She has reasonably broad-boned hips that enabled adequate birth canal space to open up.

But not all women are built that way or have received the same training.

The Economist reports this week:

Home births in Hungary

Difficult delivery

Mar 11th 2010 | BUDAPEST

The pioneer of home births in Hungary faces jail

IF HISTORY were a guide, obstetrics in Hungary should be wonderful. In 1847 Ignac Semmelweis pioneered mother-friendly childbirth, insisting that doctors should wash their hands between autopsy and delivery rooms (they objected to this slur on gentlemanly cleanliness).

Obstetric care in Hungary is indeed excellent today. It is tightly run by skilled doctors, with low mortality rates. But those who challenge the medical profession still face problems. Agnes Gereb, a pioneer of home births, is facing up to eight years in jail. Prosecutors are going after her over one fatality in childbirth, one case in which a baby died some months after birth and two births that ended up as emergency hospital admissions. In the eyes of many Hungarians, such incidents show that home births are insanely risky and that those who promote them are little more than irresponsible cranks.

That view may seem outdated in the West, but not in the ex-communist East, where birth is a medical problem not a natural process, and where abortion has long been commonplace. Such procedures as episiotomy (cutting the vulva) are standard, whereas Ms Gereb says she has performed it in just ten out of 3,000 home births. She criticises hospitals for their frequent use of drugs to induce labour, which suits doctors’ timetables rather than nature’s. Women in Hungary also expect to pay, formally or informally, to be looked after in hospital, and especially for pain relief.

Outsiders who unsettle the obstetric cartel meet clannish (and even self-interested) opposition. Ms Gereb’s supporters are inviting international experts to testify that home births can be quite safe and that her record is commendable. But the court may choose to take expert opinion only from the obstetricians’ trade body, which dislikes home births—and also Ms Gereb. An obstetrician herself, she has often clashed with her colleagues. In 1997 she was suspended for the outrageous act of allowing a father into the birthing room. Things have changed, but in Hungary only one birth in a hundred happens without some form of medical intervention. Ms Gereb thinks that many more could be natural, given a bigger role for midwives and a smaller one for bossy doctors.

Semmelweis went mad and died (of an infection) after being beaten up by warders in an asylum. Ms Gereb does not face that fate—and she flinches modestly at any comparison to the great man. But, she notes, he might have sympathised with her over one big problem: the surprising difficulty of changing medical routine.

It is a common, and I think justified, complaint, that male obstetricians have taken control of the birth process and medicalised it to the extent that it makes them very wealthy. In the US and increasingly so in other nations, trial lawyers have taken control of birth mishaps and, as apparently in Hungary, turned them into a lucrative industry.

But then that's the same thing again:

Home births = Good
Going to a hospital = You're a mindless, shallow dupe of the evil Capitali$t system and you probably hate your baby

Fuck that shit. Just do whatever you want and don't let either the doctors or the hippies boss you around.

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except that it's hard to ignore doctors' opinion. Personally, I'd apply the same philosophy as to birth as to everything else. Have a plan (whatever you'd like to happen), be prepared (know what can go wrong and plan alternatives) and, above all, be flexible i.e. never stick to something that is not working, be ready to change plans at the drop of a hat...


In an another domain, martial artists are fond of telling you to not bother anticipate a fight but just "be there" and react fast to whatever is happening during the fight...

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Originally Posted by Gilles de Rais

except that it's hard to ignore doctors' opinion

Just like it's hard to ignore society saying that you're worthless for listening to the doctors' opinions.

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The Cochrane Collaboration has over a thousand evidence-based articles relating to aspects of childbirth:

Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factor. Evidence-based clinical practice is an approach to decision-making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best. Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

I am not about to troll through it tonight to research best practice in childbirth, since that is not one of my personal issues, however for anyone for whom it is, this note on the origin of the Cochrane Collaboration may be of interest:

Archie Cochrane was born in the Scottish cloth-manufacturing town of Galashiels in 1909. He studied natural sciences at Cambridge, and completed his medical studies in London after serving with a field ambulance unit during the Spanish Civil War. He spent most of his career as a medical researcher in Wales, conducting several long-term epidemiological studies into tuberculosis and other chest diseases among the coal mining communities of South Wales. The success of these studies earned Cochrane the respect and admiration of his peers, but his international renown is founded on the publication in 1972 of his book ‘Effectiveness and Efficiency: random reflections on health services’.

Cochrane’s wartime experiences as a Captain in the Royal Army Medical Corps profoundly shaped the ideas he articulated in his book about the nature of evidence and effectiveness in health care. He was taken prisoner of war (POW) in Crete in 1941 and spent the rest of World War II in POW camps in Greece and then Germany. As medical director of these camps, Cochrane was forced to practise in difficult circumstances and without access to the medical treatments he had been taught were necessary. In this extract from his autobiography One Man’s Medicine he describes caring for prisoners with tuberculosis:

What I decided I could not continue doing was making decisions about intervening (for example pneumothorax and thoracoplasty) when I had no idea whether I was doing more harm than good. I remember reading a pamphlet (I think from the BMA) extolling the advantages of the freedom of British doctors to do whatever they thought best for their patients. I found it ridiculous. I would willingly have sacrificed all my medical freedom for some hard evidence telling me when to do a pneumothorax ... This was certainly the birth of an idea which culminated in Effectiveness and Efficiency.

Cochrane continued to be critical of the medical profession for failing to seek evidence to support treatment recommendations. In a paper published in 1979 he famously wrote, ‘It is surely a great criticism of our profession that we have not organised a critical summary by speciality or subspeciality, adapted periodically, of all relevant randomised controlled trials’.

In response to this challenge, a group of researchers spent most of the 1980s gathering together and reviewing randomised trials of care during pregnancy and childbirth. In 1989 (the year after Cochrane died) they published systematic reviews of the effects of nearly 300 interventions in the landmark two-volume book Effective Care in Pregnancy and Childbirth and a paperback summary entitled A Guide to Effective Care in Pregnancy and Childbirth, which was written for women using the maternity services. To keep the reviews up to date, they began electronic publication of 6-monthly updates in the Oxford Database of Perinatal Trials.

This work was well received and, in 1992, the recently established NHS Research and Development Programme in England funded a Centre to facilitate the extension of the methods used in pregnancy and childbirth to other areas of health care. A year later the Centre convened a meeting in Oxford at which the international Cochrane Collaboration was formed.

The time when medical patients accept advice solely due to highly educated jerk's opinion is drawing to a close.

Originally Posted by roadkill

The time when medical patients accept advice solely due to highly educated jerk's opinion is drawing to a close.

Hence the increasing numbers refusing vaccination. Whoop de doo.

Come on, get real. What percentage of the population have even heard of Cochrane reviews, let alone are capable of searching out and understanding one? A greater percentage are refusing medical advice because our society propagates pseudo science and tells everyone that their opinions are worth something, even on subjects they know nothing about.

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Quote:

our society propagates pseudo science and tells everyone that their opinions are worth something, even on subjects they know nothing about.

And we can see what happens:

Measles: UK named and shamed for vaccination rate failure

Published Date: 07 January 2009
By John von Radowitz

HOPES of banishing measles from Europe by next year may have been dashed by poor vaccination rates in a handful of countries that included Britain, researchers claim.
A new study has documented more than 12,000 cases of measles in Europe in the two years spanning 2006 and 2007.

All but 15 per cent occurred in just five countries – the UK, Germany, Switzerland, Italy and Romania – and most were infections of unvaccinated or partially vaccinated children

In Britain, a slump in vaccine take-up has been blamed on unfounded fears about the possible side-effects of the triple measles, mumps and rubella (MMR) jab.

With measles infection rates rising, this has led in turn to concerns about the possibility of an epidemic.

The new research, reported in an online edition of The Lancet medical journal, looks into the World Health Organisation's stated goal of eliminating measles from Europe by 2010.

It concludes that if the situation does not change, achieving this target will not be possible.

"The sub-optimum vaccination coverage raises serious doubts that the goal (of] elimination by 2010 can be attained," the authors wrote.

Dr Mark Muscat, from the Statens Serum Institute in Copenhagen, and colleagues analysed measles data from 32 European countries.

They found that in 2006 and 2007, a total of 12,132 cases of measles were recorded with 85 per cent occurring in just five countries. Although the vast majority involved children, almost a fifth of cases were adults aged 20 or over.

But people like this have entered the New Age Stupidity and Fear Paradigm (NASaFeP), where their belief in anything is inversely proportional to the possibility that its source is factual. There would be no point in their being aware of Cochrane.

Originally Posted by Zichao

I hate gynaecology stories, but this is slightly related to something I was talking about with Contra in the chatbox, so here goes: For me this "you must embrace nature and be healthy" obsession is all a big myth based on morality and conformism. Like organised religion except solipsistic.

Oh I don't disagree. But firstly, I don't think this is a really big societal trend, and secondly, I don't think your position it contradicts what I was saying in the shoutbox.

As the article points out, the way childbirth was treated provided the initial momentum for the natural birth movement, and it's an argument not totally without merit. But I would not and have never argued that we eschew "artificial" aids or the tools and techniques produced by science etc. The anti-modernist, nature-worshipping, homeopapthy-taking stuff is clearly a sort of reaction against problems we do have, but I still consider it mostly witless.

Of particular concern was the idea that if the author of the OP changed her mind about painkillers she should be refused for her own good. That's a nonsense. I've known several people who had children attempt a home birth with plans for a rapid trip to hospital on standby; that seems a reasonable enough position to me.

At any rate, when I talk about being comfortable in your body and stuff I'm definitely not riffing on this rejectionist stuff. I don't see any contradiction between being fully aware of being biological, and being a sort of ape, and also being high tech.

Sure, but my more general point is that the counter culture is just as influential and doctrinaire as the mainstream now.

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