The Truth About Antenatal Classes

// 27 May 2009

A report out from Sweden says that attending classes teaching breathing techniques and relaxation methods has exactly no effect on your likelihood of needing an epidural. And no impact on your likelihood of needing a C-Section. And no impact on your overall satisfaction with the birth.

Now that’s not to say that there aren’t some worthwhile things to be taught to expecting parents. To get the low-down I spoke to my sister (Lynda) who had a baby almost a year ago and attended both NHS and NCT (National Childbirth Trust) classes before the birth. She said neither even mentioned breathing techniques or relaxation as discussed in the Swedish report. But she did have some good points about several aspects of them. Here is what she had to say:

1) NHS classes: free but a total waste of time. Around 40 individuals and couples in a theatre-style auditorium. During question and answer sessions she couldn’t really hear what other participants were saying and they ran out of handouts. Pain relief methods were discussed briefly as more or less a list of options.

2) NCT classes: £140 for 2 days and one evening, much more useful. Eight individuals and couples with practical opportunities to try things, etc. The most useful thing was the focus on the emotions around birth and new babies, for instance talking about how the mother’s partner might feel coming home to find the house a mess and the mother exhausted and desperate to hand the baby over. Provided lots of useful advice for the birth itself – such as bringing along glucose sweets for energy and a kneeling cushion if you wanted to try a kneeling position. Probably much of this is available in books on maternity but also in this class friends were made and a support network accumulated.

As far as pain relief was concerned she was expecting there to be real pressure on women to reject pain relief. In the event there was a run-through of different options with participants asked to make a list of the pros and cons of each type. This might sound even-handed but in fact the “cons” is a long list of unlikely medical complications while the “pros” is one single item “reduces pain” which applies in most cases. Drawing the list like this gives the impression that one pro equals one con when in reality cons like “baby may be sleepy for first hour after birth” may well be pretty trivial against the pain thing.

Worryingly they were told that using the pain-reliever pethidine gives your child a greater risk of becoming a drug addict later in life. Both Lynda and I doubt this statement – though there may be a correlation between hospitals in underprivileged areas who dish out pethidine when they don’t really have enough midwives around to cope with all the women in labour and the hospitals where kids turn up eighteen years later with a drug problem. In any case the information is nothing more than a scare tactic unless it says how much the risk increases and where the data is from.

3) Pain. No class can prepare you for the pain. To quote Lynda directly “The only way they could explain to you in a class what the pain is like is if they made you stand barefoot on upturned drawing pins while they loaded you with heavy sandbag after heavy sandbag to weight you down and the only way to make it stop was to shout ‘EPIDURAL’!”. …and I am supposed to be the comedienne in the family!

4) Reality. The one thing no class really told despite asking repeatedly at the NHS one was what the most likely outcome was – what percentage of women manage without pain relief, etc and what percentage of pain relief interventions lead to problems, and what type of problems. In the end of five women Lynda is still in touch with, including herself, there were two without epidural and three with epidural. In all three of the latter cases there were complications associated with the epidural (one didn’t work – the pain continued, one the needle kept coming out and having to be refitted and one woman was left on crutches for several months with a small baby to look after!). Of course without access to the relevant data we just can’t know how much of that is to be expected from an epidural and how much is down to bad luck or overworked staff, etc.

5) Birth plans. Apparently the NCT went on and on about how important it was for women to write a “birth plan” to take with them to hospital. Now it’s understandable that women would want to have a document in hand to tell nurses what they want in different scenarios, to avoid having procedures they didn’t want forced upon them when they are in too much pain to discuss things. However of those in the group who made a “birth plan” (Lynda refused despite repeated demands by class instructors) 100% ended up not sticking to it and then feeling they had somehow “failed” to have the birth they wanted. In any case who would write a birth plan that says “experience extreme pain, demand an epidural, discover it’s too late, baby’s heart rate slows, rushed in for emergency cesarean”. Everyone writes “no pain relief, baby slips out in 2 minutes, I look stunning”, and then nobody lives up to it. So sure take in some notes about particular things you’re worried about seems to be good advice, but stay open minded about what happens – don’t make too many plans!

6) What they don’t mention. There were a few things that didn’t seem to get mentioned. Particularly some of the graphic details. Like for instance “you will definitely sh!t yourself at some point”. Not to freak women out but so that when it happens they know not to be surprised or embarrassed. Maybe just reading out a few accounts from women who have had babies recently would help.

So in conclusion, there seem to be some real positives from a supportive class covering what to expect throughout maternity, birth and the first year or so of a child’s life, although clearly such classes should be available freely (although the NCT does offer discounted classes if mothers have financial difficulties). Information on pain relief doesn’t seem to be getting through so well. What is needed in this area is accurate information about all the options and how likely the various outcomes are both nationally and by hospital and clinic so that women can make a considered choice. What is not needed is a load of piffle about trying to relax while you’re in excruciating pain.

Footnote: The moment I put this up someone messaged me on Facebook to say they read it. This friend of mine said she had a planned cesarean because of problems identified earlier in the pregnancy. When they told her this she felt … relieved. What a shame that a woman can’t just decide she wants a planned cesarean and discuss that with her antenatal teacher. What’s so bad about not wanting to go through a lot of pain? Give women all the information and let them choose what they want for themselves.

Comments From You

Kirsten Turner // Posted 27 May 2009 at 9:53 pm

Here is the study they’re referring to:

A sleepy baby can have serious consequences for establishing feeding long after the pain of labour is over and feeding getting off to a bad start can cause mother a great deal more pain and upset than labour.

Ruth // Posted 27 May 2009 at 10:35 pm

Long, long time since NCT classes for me: they definitely did put pressure on people then to treat labour as “discomfort” (ha!) and go for the crunchy home/water birth options. Guerilla tactics for ambushing rude and pushy midwives/obstetricians and making them actually listen to you, would have been nice, and that you could actually choose a different maternity unit than the local (which for No 2 offspring I duly did: much better!).

I echo the cry for realistic information, and saying that, am rather disturbed by this comment:

What a shame that a woman can’t just decide she wants a planned cesarean and discuss that with her antenatal teacher. What’s so bad about not wanting to go through a lot of pain? Give women all the information and let them choose what they want for themselves

The point is, Caesarian section is a *major operation* and not to be thought of as an alternative to a day or less in labour – which, yes, hurts like b*ggery at the time, but is usually soon forgotten – otherwise who would have another? :-)

Post-op pain and other problems can be very severe, last for days on end, even weeks and the recovery time really eats into one’s strength and freedom of movement (no driving for some time, for example). If one can possibly avoid recovering from surgery while caring for a newborn (exhausting in itself), it makes sense to do so, and really only genuine risk to mother or child justifies a C section. The problem is, fear of childbirth is rife in modern society the more it has become hidden and medicalised, until it can really seem better to have a ‘nice, safe, operation’. Giving someone all the information to make the decision depends where one gets it from. Myths about labour and fear are not good teachers.

Kate Smurthwaite // Posted 27 May 2009 at 11:17 pm

I have a friend who had an elective cesarean (privately) and I completely respect her decision to do so. Of course it is a major operation – but that is part of the true and accurate information that I think women are entitled to. I think to tell women they “can’t” consider that option if they really want to.

As to the point about the difficulties of having a slightly sleepy baby, I can see what you mean. Now what I think should be provided to women are the statistics on (a) what percentage of babies born under each pain relief option have difficulty feeding, (b) how serious those difficulties can be and (c) the long term implications for the child’s health. I mean bottle-fed babies don’t do quite as well as breast-fed babies, but the difference is hardly cataclysmic as I understand it. Women should have this info readily available – not a bunch of scare-mongering, which sadly it seems some places are providing.

joanne // Posted 27 May 2009 at 11:25 pm

And with the very first comment we already have a ‘feminist’ trying to discourage women from having any kind of pain relief. I honestly believe so-called feminists are almost entirely to blame for this culture of women being too terrified to ask for pain relief or being made to feel like failures if they want a c-section or can’t/choose not to breastfeed.

It baffles me that women who support the right to abortion until the third trimester of pregnancy (as I do – I’m 100% pro-choice) are often the same women who will harass and at times attempt to coerce women who choose to give birth or take care of their babies in ways they deem unfit into doing things their apparently superior way.

This ridiculous obsession with ‘natural childbirth’, ‘exclusive breastfeeding’ and all the rest of it needs to stop. Just because certain feminists dislike ‘the medicalisation of childbirth’ simply because it (sometimes) involves men making decisions about womens’ bodies does not mean that they get to be equally oppressive in trying to force their views of how the experience of pregnancy/childbirth should go on women who simply and quite naturally want to make their own decisions without being made to feel like bad mothers before they’ve even given birth.

And before I get accused of being anti-feminist/a troll, I would suggest reading ANY of the pregnancy/breastfeeding posts on this blog if you want to see the lengths that militant anti-interventionists will go to to make women hate themselves.

Kate Smurthwaite // Posted 27 May 2009 at 11:48 pm

I think that’s very true – I do find the “medicalisation” of pregnancy frustrating – but I think as feminists we can all agree that women need fair and accurate information. i think when they get that they will make the sensible decision for them.

Emma // Posted 27 May 2009 at 11:50 pm

I didn’t attend any classes, partly due to the inconvenient times they were held, and partly due to my ‘I don’t need/want to discuss this horrible thing that’s about to happen to me’ attitude… I did however feel guilty every time a midwife mentioned them, a little like a school-girl who’d skived PE. Whilst in the birthing pool though, my very lovely midwife assured me that ‘classes cannot teach you what your body will do naturally” i.e push when it wants to push… she just said they may have been useful for a) knowing the stages of labour and b) the types of pain relief – but from your comments above, I may not have got this info anyway, and did get it from various books I had read. As for C-sections – 8 months after having had an emergency section, after 4 days of a very painful and stressful labour, I am all too willing to opt for one ‘next time’, yes I couldn’t drive for 6 weeks, but my recovery was pretty quick considering – but, I do also admit that so soon after that experience (and it being very, very fresh in my memory) my judgement may be a little skewed – each to their own… I was just glad of some help in the end, and that my little Sid got here safely, at last.

Noble Savage // Posted 28 May 2009 at 12:19 am

So many things are running through my head at the moment that I want to say but I’ll try to keep it focused.

First of all, the study (or at least the article about the study) doesn’t say who funded the study and what controls they set out other than the type of antenatal classes taken. There are so many unknown variables. Were these all first time mothers? All hospital births or any home births? All low-risk? What were their education levels and class statuses? How many were induced for being “late”? How many were subject to continuous foetal monitoring or an IV drip while in labour, restricting their movements and confining them to bed? How many received continuous care from one central figure and how many were passed around to various midwives and doctors on shift? How many had doulas?

There are many factors that contribute to whether a woman uses medication for pain relief or not, to whether she gets an epidural or a c-section, and whether she has a good birth experience or not. It’s not as cut-and-dried as putting it all down to what she learned in antenatal class. This is entirely too simplistic and ignores all of the factors and components that, together, make up an individual birth.

Secondly, “relaxation and massage techniques” is an all-encompassing term that nearly all natural childbirth methods are lumped under together but are, in fact, very different from *active* birth techniques which focus on keeping a labouring woman moving and on her feet rather than sitting or laying passively in a bed. All the massages and slow breathing in the world won’t make much difference when hard labour kicks in if you’re strapped to a monitor and laying in a hospital bed, unable to move through the contractions. Relaxation and breathing *are* important, particularly in early labour, but it’s not necessarily meant as a way to manage pain but FEAR. Fear creates stress hormones and makes the body tense up, making labour much more painful as the fear (of the unknown, of what is to come, of the pain increasing, of being out of control) takes over.

By the by, I recommend an excellent book called “Birth Skills” by Juju Sundin if anyone out there wants a natural birth but wants some more solid, practical ideas for pain management other than “breathe and relax.” I used a few of the book’s techniques for my son’s birth at home and felt completely in control and ‘with it’ the whole time, even when the pain was pretty intense. This was a marked contrast to my first birth (in hospital; pethidine; episiotomy; ventouse delivery) which made me feel out of control, whacked out and scared.

As for saying that natural birth and breastfeeding advocates “need to stop” and are “obsessed” and “making women hate themselves”….what a load of crap! Yes, there are a few who take things too far and are tactless in their approach but they’re just assholes. There are assholes in any group of people. To trash us all as self-righteous, hate-mongering, judgmental women who are obsessed with something as “ridiculous” as birth and breastfeeding is nothing short of offensive. Rising c-section rates mean more women die. Full stop. Decreasing breastfeeding rates means more babies die. Full stop. There is no judgment in that, just facts. Exploring the ways in which we can make childbirth safer, more enjoyable and healthy for mothers and babies isn’t ridiculous or petty, unless you think mothers and babies are inherently petty too.

joanne // Posted 28 May 2009 at 1:56 am

As for saying that natural birth and breastfeeding advocates “need to stop” and are “obsessed” and “making women hate themselves”….what a load of crap! Yes, there are a few who take things too far and are tactless in their approach but they’re just assholes. There are assholes in any group of people. To trash us all as self-righteous, hate-mongering, judgmental women who are obsessed with something as “ridiculous” as birth and breastfeeding is nothing short of offensive. Rising c-section rates mean more women die. Full stop. Decreasing breastfeeding rates means more babies die. Full stop. There is no judgment in that, just facts. Exploring the ways in which we can make childbirth safer, more enjoyable and healthy for mothers and babies isn’t ridiculous or petty, unless you think mothers and babies are inherently petty too.

The problem is it’s not just a few. If it was just a few, then why do SO MANY women have such a negative childbirth experience? Do you really think it has nothing whatsoever to do with the ridiculously unrealistic expectations of ‘natural’ childbirth that ultimately only make women feel like failures when they ‘give in’ and have epidurals and c-sections? The fact that you even refer to it as ‘natural childbirth’ only emphasises your hate for the alternatives – so women who have medical interventions of any kind have *unnatural* births? How do you think that makes women feel?

Furthermore, despite a rise in c-sections in the UK and relatively low breastfeeding rates, women and babies ARE NOT dying en masse and I would be extremely surprised if you could come up with any evidence to suggest otherwise. This is yet another scare tactic used to convince mothers that if they dare deviate from the radical feminist childbirth ideal OMG YOUR BABY WILL DIE! Well I call bullshit on that.

I don’t think people like you care at all about keeping women and babies alive or giving women safe, enjoyable childbirth experiences. I think you care about furthering an ideology at whatever cost necessary and I think feminists of all people should know that extreme ideologies are never very far away from oppressive.

Kate Smurthwaite // Posted 28 May 2009 at 2:11 am

Wow – clearly a high-emotion issue. I think (hope) we can agree that basically as feminists we believe:

1) More and better, clearer information for women = good.

2) Absolute freedom for women to be given access to that information and then be given the resources they need for the kind of birth they want = good.

Also there seems to be a lot of discussion of what other feminists are doing or want, but I think to some extent we’re putting words into people’s mouths. Tell me what YOU think and between us we will build up a picture of what WE want. Other groups may have a feminist front-woman but scratch the surface and all sorts of other motives emerge (as so often with women’s rights).

joanne // Posted 28 May 2009 at 2:23 am

1) More and better, clearer information for women = good.

2) Absolute freedom for women to be given access to that information and then be given the resources they need for the kind of birth they want = good.

I would like this to be true (I certainly agree with both points), but I think it’s already been demonstrated here that there are plenty of feminists who do not want women to have the births they want, but rather the births certain feminists think women *ought* to want. It’s also clear that some feminists are willing to spread misinformation in an attempt to control what women actually know, so sadly I’m afraid I can’t agree that feminists ‘basically’ believe any of what you suggest.

Kate Smurthwaite // Posted 28 May 2009 at 2:35 am

I disagree – I think that those feminists who are arguing for less cesareans are actually arguing that women would benefit from less cesareans – and i think what they are asking for is better and fairer information out there and greater choice for women, which they believe will inevitably lead to less women choosing c-sections. i don’t think anyone is arguing that women should be kidnapped at 8 and a half months and held against their will without access to pain relief until they give birth.

i think one of the issues is that for most women the birth of their first child is the first birth they ever attend (excluding their own, which they don’t remember). i think centuries ago women would have witnessed their neighbours giving birth and this would have affected their fear. but the solution is to show women videos and provide lots of information but of course ultimately allowed to make their own choice.

also i am not sure about describing everyone who comments on here as “feminists”. i mean if anyone is advocating forcing birth choices on women against their will – and i don’t believe they are – i think in my world i would not consider them a feminist.

Becky // Posted 28 May 2009 at 7:46 am

I think it depends on where you live as to the quality of your NHS sessions – there were only about 6 or 7 couples in mine. And they were all couples! The information we received was good, we went into a lot of detail about pain relief and could ask any questions. I did have issues with the fact that the midwife running them kept saying “So, your husband, I mean, partner…” to the whole group when clearly I had neither! She was nice enough, and very approachable, but just not used to single-parents-to-be attending. As for NCT classes, I didn’t even try them because a) I had nowhere near enough money and b) I don’t think I’m exactly their target audience! I do know people who have attended (in a couple, obviously!) who have got a lot out of these, mostly the social aspect. What I never received, or was never offered, was advice on what it would be like being a single parent – it made me feel incredibly alone and scared. It seemed like everyone else had ‘someone’ and I was trying to prepare myself to go through it alone. This made me feel a lot less able to stand up for myself in hospital, and I was just told what I wanted by the midwives.

On another note, my mum has had both a c-section (with me) and a vaginal delivery (with my younger sister) and she has always said she couldn’t believe how quickly the pain went away with my sister. She could hardly feed me properly, she couldn’t walk, her scar got infected. Oh, and she nearly died under the anaesthetic during the procedure! I know plenty of other people who have had totally different experiences, and I would never suggest that it was the right thing for everyone, but I’ve always been way more terrified of procedures like caesarian sections.

Noble Savage // Posted 28 May 2009 at 8:46 am

The problem is it’s not just a few. If it was just a few, then why do SO MANY women have such a negative childbirth experience? Do you really think it has nothing whatsoever to do with the ridiculously unrealistic expectations of ‘natural’ childbirth that ultimately only make women feel like failures when they ‘give in’ and have epidurals and c-sections? The fact that you even refer to it as ‘natural childbirth’ only emphasises your hate for the alternatives – so women who have medical interventions of any kind have *unnatural* births? How do you think that makes women feel?

Are you honestly trying to purport that the bad birth experiences of women can be fully attributed to other women “making them feel bad” that they didn’t have a ‘natural’ birth? This is the most ludicrous thing I’ve ever heard. Have you ever even talked to women who have had bad birth experiences? I am involved in helping women who have suffered birth trauma and I think it’s safe to say that someone telling them that the only reason they “feel bad” is because of some sense of guilt that was forced upon them by birth advocates and not because their wishes were ignored and their actions controlled in the delivery room is, again, nothing short of offensive.

Secondly, you are inferring things from my post that I never said. When did I say I was against pain relief? I have no idea how you got the idea that I “hate the alternatives” from what I posted. I am absolutely, 100% for effective pain relief being made available to all labouring women. The problem is, not that many women get all the information about the different kinds of pain relief. Their risks are not all equal, nor are they inconsequential. That doesn’t mean women shoudn’t use them, only that they are not being made aware of the pros and cons so that they can make an INFORMED choice.

Many women don’t know about the side effects of epidurals that Kate mentions — headaches, nausea, back pain, temporary or permanent disability. Sometimes they don’t even work, or only work part-way. Chances of infection are greater and once you have one in, you can’t get up and move around, which can decrease the baby’s heartrate, which is a leading reason for emergency c-sections. The risk of these things happening isn’t monumental but it isn’t negligible either. Epidurals can provide very effective pain relief and that should be equally considered when looking at one’s options. How is making this information available “hateful?” What I find hateful is infantalising and patronising women to the point where you don’t think they could handle all of the information and should be kept in the dark so as not to make them “feel bad.” How in the world is THAT feminist?

Furthermore, despite a rise in c-sections in the UK and relatively low breastfeeding rates, women and babies ARE NOT dying en masse and I would be extremely surprised if you could come up with any evidence to suggest otherwise. This is yet another scare tactic used to convince mothers that if they dare deviate from the radical feminist childbirth ideal OMG YOUR BABY WILL DIE! Well I call bullshit on that.

Actually, yes, the maternal mortality rate *is* increasing in the UK, and many studies and statistics bear this out. The mortality rate for maternal deaths from Direct causes of death was 6.24 per 100,000 maternities (compared to 5.31 in 2000-2002). In the US, the mortalities are increasing at an even more alarming rate. With first rate healthcare in both countries, what is the cause for this? Rising c-section rates. The UK’s rate stands at about 25% right now and in the US it’s 31%. The World Health Organisation considers a safe, normal rate to be 10-15%. When numbers double and treble that, there is something wrong. Our bodies are not broken, we are no less able to give birth vaginally than we were ten years ago so what explains this increase? If you think that being alarmed at these figures and wanting to help women avoid unnecessary surgery and the risks associated with that is arrogant, ridiculous and un-feminist then so be it but I think that’s dangerous and elitist thinking, seeing as it is poor women and racial minorities that are most at risk of death from complications in birth.

I don’t think people like you care at all about keeping women and babies alive or giving women safe, enjoyable childbirth experiences. I think you care about furthering an ideology at whatever cost necessary and I think feminists of all people should know that extreme ideologies are never very far away from oppressive.

Even though you insulted me, I will try not to take that personally because it’s very obvious that you are angry at the system and that has nothing to do with me, or other birth advocates. I wouldn’t spend a lot of my time helping victims of birth trauma and advocating for pregnancy and birth rights if I didn’t care about women or babies. I have no “ideology” I’m trying to push onto people, unless you believe that advocating safe, informed birth that leaves women feeling empowered and happy in their choices (whatever they may be) is “ideology” and not just a normal, healthy goal.

Kate // Posted 28 May 2009 at 8:48 am

Yes, bullying other women into choices they don’t want isn’t feminist, but I would argue that neither is accepting that the choices women make in the status quo are totally free and informed.

I had two home births without pain relief. I hated giving birth, but it was fine – for me, quick and without many lasting physical issues. I do find myself advocating for home births as an option mostly because many people don’t know they *can*, and for me, a medico-phobe, the alternative would have been very traumatic.

The issue about caesarians that hasn’t been raised is the same one that makes breastfeeding a tricky feminist issue: not only is vaginal birth on average more healthy for the mother, it’s also associated with better outcomes for the baby. That doesn’t mean it isn’t still the woman’s choice – until the foetus is out of her body, it isn’t a person and doesn’t get to choose. But for most women giving birth, the healthiest baby possible is desirable.

I still feel that we haven’t worked out any *good* feminist framing for talking about motherhood, when it’s so tied up in the unique role of the mother in the life of her child. She feels differently about her choices, and there are constraints on them that there aren’t on most others. And of course, society has more opinions on a mother’s choices than on the average woman’s. And other people’s opinions do act as constraints.

The hippie mother in me would like to point out that, while it’s wrong to bully women into home birth or unwanted breastfeeding, the prevailing culture does a whole load of, more overwhelming and so less visible, bullying too, and it’s hard to put arguments that go against such power. Let’s none of us stop being feminists – which I feel is all about an analysis of power structures – just because (especially because) we’re talking about something so emotive and personal.

Joy // Posted 28 May 2009 at 9:06 am

Currently expecting baby no.1 any day now. Personally i have opted for a home delivery with as little intervention as possible. I just want to get it over and done with and not deal with the after effects that most interventions bring. It may hurt like hell, but once it’s over it’s over. No recovery from major abdominal surgery is a good thing in my book! I think what we need is more emotional support on the NHS. I think it’s high time childbirth was reclaimed as the rite of passage it can be for women, instead of having it taken away from them and framed as a problem that needs to be dealt with by a patriacal medical system. Woman can give birth and feel a sense of accomplishment as a result, i believe, instead of being disempowered by those in a position of authority at a time when they need all the support and encouragement in the world.

JenniferRuth // Posted 28 May 2009 at 9:36 am

My mother had five children and refused all pain relief.

My sister had five children and all by cesarean.

My sister-in-law wanted to have her first child “naturally” but ended up having an emergency cesarean

All children turned out just fine.

In the end, it is what is right for the individual woman, yeah?

Alex T // Posted 28 May 2009 at 9:43 am

My NHS class was pretty good – much like the NCT class described above, but free! There were just 5 couples, we all practised different labour/delivery positions, our partners practised massage on us and although I left feeling there was nothing there I hadn’t read in a book, I live in a fairly poor area and with a population largely for whom English is their second language, and I think that whilst I was well-read on everything, the class was great for the rest of the women there, who seemed to be learning much of this for the first time (not to mention 100% of the fathers, including my husband! Much more likely to sit up and take notice in a class than to sit a read a book at home!)

Funny, I’ve found the opposite pressure regarding pain relief – as soon as birth is mentioned, someone always pipes up, rather dismissively, “Oh just have an epidural”. Well, I don’t want one, thanks, I’d quite like to be able to move around and feel my legs. Until I read about the various pain relief options, I thought I’d go for ‘all the drugs’, but looking at the pros and cons of each, I realised there was no drug I particularly liked the sound of, and that non-invasive pain relief methods (water, massage, TENS, Entonox – all of which are self-administered) were much more appealing.

The hospital where I plan to give birth are really supportive of women’s choices, as far as I can make out. They have a birth cantre which is supposed to be halfway between a home birth and a hospital birth, but from what the midwives say it hardly ever gets used as to receive pethidine/an epidural you have to be in the labour ward.

Anyway, just thought I’d share my thoughts – baby is due in a fortnight so all this really touches a nerve with me. I may well have changed my mind about everything in a few weeks’ time as well!

Aimee // Posted 28 May 2009 at 10:56 am

“As for saying that natural birth and breastfeeding advocates “need to stop” and are “obsessed” and “making women hate themselves”….what a load of crap! Yes, there are a few who take things too far and are tactless in their approach but they’re just assholes. There are assholes in any group of people. To trash us all as self-righteous, hate-mongering, judgmental women who are obsessed with something as “ridiculous” as birth and breastfeeding is nothing short of offensive. Rising c-section rates mean more women die. Full stop. Decreasing breastfeeding rates means more babies die. Full stop. There is no judgment in that, just facts. Exploring the ways in which we can make childbirth safer, more enjoyable and healthy for mothers and babies isn’t ridiculous or petty, unless you think mothers and babies are inherently petty too.”

I call bullshit too. I also dislike to assertion that a woman’s ‘class status’ (and I am disturbed to notice people still using such an archaic term) might have anything to do with how they choose to give birth. I think there IS a ridiculous expectation upon mothers to breastfeed and the have ‘natural’ births. My midwife wouldn’t let me leave hospital until I had ‘shown’ her I could breastfeed, even though I had told her I didn’t want to. That has nothing to do with my ‘class status’ or my ‘level of education’ at all… it was simply a personal choice. I find yours an extremely elitist attitude. Babies do not *die* from not being breastfed. This is bullshit. It’s propraganda designed to make women feel insignificant, whilst other women can revel in their smug sense of self satisfaction because they’ve done ‘the best’ for ‘their babies’, so they can look down on other women who they perceive have not. I’m sorry but it’s absolute shit to assume that we can be ‘educated’ into have the idealistic birth experience that people like you feel we should all want to have. Maybe that’s not what I want?! Maybe that’s not my personal choice!? Surely you should be respecting my choice instead of telling me that my choice is wrong, but pitying me because i’m not ‘educated’ or middle class enough!

Women do not need to be told what is right for them. What they need is for smug, self satisfied, up themselves so called ‘professionals’ to get down off their high horses and stop telling women what they need and start respecting a woman’s choice to decide for herself what she needs.

Sorry if I sound angry, I am simply incredulous that women are still chiding women for not living up to the standards of patriarchy.

Jane // Posted 28 May 2009 at 11:20 am

“Rising c-section rates mean more women die. Full stop. Decreasing breastfeeding rates means more babies die. Full stop.”

Exactly the kind of bullying holier than thou attitude that Joanne identified. Yes women do die in childbirth, 500 000 to be exact and 99.9% of those are from countries where basic midwifry is unavailable. The leading killers during pregnancy or childbirth include massive blood loss, high blood pressure, an unsafe abortion, an untreated infection and obstructed labour – where the woman’s body is too small for the baby to pass through the birth canal. The vast majority of women who die are from Africa, not wicked western women who choose c-sections and bottle feeding for God sake.


Evie Wallace // Posted 28 May 2009 at 11:43 am

Can I also add that the World Health Organisation has estimated that 2 million women in the Sub Sahara continent are suffering from obstetric fistula which usually happens when a very young girl gives birth with no medical help, tearing a hole between her anus and vagina. It develops after many days of obstructed labour. And guess what – it can be prevented by the evil c-section! Days and days of the ‘birth experience’ and ‘the discomfort’ of pushing. Perhaps you anti-drug messiahs could nip along to the next birth on the floor of a dirt hut in Nairobi and suggest a few breathing exercises for the 14 year old who’s been in labour for 48 hours. Perhaps tell her that she should let go of the fear and embrace the experience. And then afterwards you can lecture her on breastfeeding too!

Clare // Posted 28 May 2009 at 12:29 pm

I’m responding to Kate’s suggestion that we should talk about what we want or experienced individually rather than prescribing what others should do or feel. Labour is a very personal thing and none of us knows how we will respond until we are there doing it. Many people are surprised by their own reactions once they’re in the thick of the action.

Personally I am very glad that I live in a time where safe C-sections are available and that pain relief is available for those that want it. I am also glad that we live in a time where women are allowed to make informed choices – even twenty years ago this wasn’t the case so much.

My own personal experience was a natural water-birth labour both times – once in a midwife lead unit, the second at home. This was a decision I took because I wanted to feel in control and be able to feel the labour (odd as that sounds). I also wanted my recovery time to be fast afterwards. My mother had told me that she had felt very cut off whilst she was in labour with me as the pethidine not only cut out (some of) the pain but also meant that she couldn’t push. She wasn’t allowed to let her own waters break in due course (although there was no evidence to suggest I was in danger) and was expected to follow a very rigid time frame for labour. This resulted in a botched episiotomy from a rather arrogant and unsympathetic doctor and a rather traumatic delivery.

I know I was lucky in that both of my labours went well and I wouldn’t do it any different now but I also know that it wouldn’t be so for some women. As I said, labour is very personal.

The thing that helped me the most to make my decision and be confident enough to follow it through were great NCT classes and “Misconceptions” by Naomi Wolf which introduced me the idea that I could be assertive in asking for what I wanted – whether that be more pain relief or for people to just butt out and let me get on with it.

That may be one area where birth plans sometimes go wrong. Lots of midwifes suggest that you take the labour chronologically, saying what you would like at each stage. In the real world though labour can diverge very early on from the plan leading some to feel that they have “failed”. Perhaps if women were encouraged more to think about what kind of labour they want, what they are prepared to consider to make that happen and it what circumstances then there might be less of a feeling of having strayed from the rather exacting standards we sometimes expect of ourselves.

Anoushka // Posted 28 May 2009 at 12:47 pm

Laura, what reaction are you hoping for with this article?

I’m four months pregnant with my first child. Obviously, I’m hoping for the best birth possible, for the baby and for myself.

I think the author has failed to grasp what is meant by ‘natural childbirth’ in the same way that some people mistake ‘feminism’ as a movement that seeks to promote women’s rights over men’s rights.

Yes, I am terrified of birth (thanks in no small part to anecdotes of the drawing pin variety, thanks for that) – but I do find that the more I read, research and listen to mothers’ experiences, the more confident I feel in my ability to give birth.

As far as I can tell, the ‘natural/active childbirth’ model is focussed on informing and thus empowering women, whereas what we might call by default the ‘medical model’ is about removing autonomy from women and placing all power in the hands of care providers.

Articles like this one are diminishing. What is the basic conclusion? Childbirth is so terrible for every woman that cesareans are the birth we should all be opting for? That, frankly, seems a very misguided conclusion to reach.

Kate Smurthwaite // Posted 28 May 2009 at 2:37 pm

Alex T – that’s all very interesting stuff. I know you’ll be super-busy with the new baby but if you get half a minute to yourself after the birth I would LOVE it if you logged back on and let us know how it went!!

maggie // Posted 28 May 2009 at 2:38 pm

Go into any bookshop or library and you will find a huge amount of books detailing what to expect during pregnancy, childbirth and beyond. Women are intelligent enough to read these and choose for themselves what is right for them. Nothing prepares you for the event itself though. If you know what pain relief measures are available to you then you can choose what to have. My childbirth years are well behind me now but I still know what pain relief measures are out there.

There will always be the ‘breast is best’ and ‘too posh to push’ crusaders. My advice is to ignore them.

G // Posted 28 May 2009 at 3:01 pm

There’s no right way to give birth, I just find it a crying shame that so many women are down on themselves and think they’re failures if things didn’t go according to plan. Pain varies between women and even for one woman, no two labours are the same.

In my experience, on the internet and elsewhere the risks of pain relief in labour are often overstated, and this isn’t on, women deserve to have accurate information – and that includes a true picture of the risks and benefits. Having worked in abortion care I saw a great deal of pro-lifers talking about ‘risks’ of abortion (breast cancer, spontaneous uterine combustion). It would be a shame to go down the same route with pain relief options.

A feminist and obstetrician-to-be (yes, the two can exist together!)

Noble Savage // Posted 28 May 2009 at 3:29 pm

@Evie Wallace – Wow. I don’t think I’ve come across a more hateful comment on The F-Word before. I have tried to remain respectful in putting forth my views, despite the completely unwarranted vitriol and anger directed my way, but this just takes the cake. Feminists advocating for lower caesarean rates and informed choice should just shut up because young girls in Africa get fistulas?! Are you freakin’ serious? I don’t even know how that comment was allowed through moderation because it isn’t feminist-friendly and it wasn’t respectful.

No one — NO ONE — has said that all c-sections are evil, or that they aren’t sometimes necessary or shouldn’t be an option for women who have all the information and decide that’s how they’d like to give birth. Simply saying that the rate, as it is, is too high and stating the fact that they ARE major surgery and can lead to serious complications is unfeminist, cruel, judgmental and barbaric of me….how?

Also, I’m actually quite offended that people continuously mock my drug-free vaginal birth without a second thought, calling me a “hippy” or “crazy” or “martyr,” or, as you’ve done “anti-drug messiah.” I have NEVER judged anyone for having the birth they wanted but am rarely afforded the same respect. I’m quite tired of hearing (often from women who have never even given birth themselves) about how I must think I’m holier-than-thou and that all I want to do is make other women feel bad about themselves by talking about it. Same with breastfeeding. I can’t say that I nursed my daughter until she was 18 months without being scorned for making women who weren’t able to “feel bad.”

I’ve been a long-time reader and supporter of The F Word but the way it continues to allow hatred directed towards feminist mothers is appalling and shows how mothers aren’t welcome here unless they’re shouting “Give me the drugs! Breastfeeders are nazis! C-sections are great!” Well screw that.

With that, I’m done.

Noble Savage // Posted 28 May 2009 at 3:44 pm

Just one last note: The only reason I mentioned ‘class’ and ‘education’ as factors in how a woman’s birth goes is because poorer women (or those perceived to be poor) have worse outcomes in birth because of prejudices held by their caregivers that affects the care given to those women, not because I think these women are incapable of having good births.

Also, no one is talking about the women who DIDN’T “choose” c-sections. A lot of them are emergency sections and were not a ‘choice.’ For these women, reducing the possibility that this will happen to them again, or to find out how it might’ve been prevented in the first place is a very real, very serious issue, one that is minimised and dismissed when we talk about all c-sections as if they were a choice.

I’ll leave you to your birth and breastfeeding bashing now.

Mephit // Posted 28 May 2009 at 3:49 pm

I think that the quality of advice you get from available classes varies between areas and even particular group leaders, so I’m not sure that one person’s view of them gives a fair picture.

My experience was that birth plans were recommended (but not pushed enlessly) to get you thinking about what sort of pain relief and where you would like to have your birth etc. It was very much emphasised that this should not be something you set in stone or idealise, but should be flexible and loose.

I’d agree with Alex T, my experience was also that people I met socially were far more likely to suggest epidurals than apply pressure to go without.

It’s all very subjective and clearly from the other comments, very emotive. I don’t think anyone’s choices in birth are “wrong” per se; it’s what is best for the individual. What’s best for me may not be what suits another woman.

Anon // Posted 28 May 2009 at 3:54 pm

Aimee, I think part of the issue is your midwife won’t have seen you as her only patient, she has a duty to do what’s best for your child as well. That will be why she was pushing breastfeeding. And given that a lot of women complain about not being shown how to breastfeed (the main reason women give up early is because of a lack of practical support) I think it’s great she considered you knowing how to do it (hey, you may have changed your mind) to be so essential.

Kate Smurthwaite // Posted 28 May 2009 at 4:17 pm

i think evie’s point (robustly made, i accept, but my sense was that she was putting her case strongly, not attacking anyone in particular) is that in some cases cesareans are vital and life-saving.

i felt she was warning against an approach which was critical of ALL cesareans – which when the aim is to “reduce the number”, sadly this can mean that because healthcare organisations are trying to hit targets, the wrong women lose access to those services – and also making the case that more lives would be saved by providing quality healthcare in the third world than by encouraging a small number of women in the UK into a different birthing choice.

i think – from my own experience – i have met mothers who managed to have a birth with little or no intervention and there are certainly those who just feel “well that’s how it worked out for me and i was glad it did” and those who do adopt a “holier than thou” attitude belittling mothers who don’t choose or stick to that path.

i don’t think anyone on here is telling women that they must have pain relief or mustn’t breastfeed. i think the important message though is you don’t have to and you don’t have to feel bad if you choose or later decide not to.

Kate Smurthwaite // Posted 28 May 2009 at 4:32 pm

I guess I also want to react to those people insisting that what is written in comments or blog posts constitutes “F-Word” policy. I don’t think the blog as a whole has a single policy on maternity. I’m a guest-blogger, if you don’t like what I say you can write to the F-Word and let them know and they may not invite me back. If you think I am too liberal in my comment-publishing policy you can also let them know.

If on the other hand you like a good (or bad) super-heated debate then as I explained when I started my guest-ing stint – please come over to my website.

Kate // Posted 28 May 2009 at 5:09 pm

NobleSavage, I got frustrated with the way birth and breastfeeding were presented on the F Word, too, so I pitched an article and it was accepted and published. Honestly, while I disagree with many people writing about pregnancy, birth and parenting here, I do find that the F Word is open to alternative submissions. Do it!

I was yelling “yes!” as I read your comment about being unable to talk about drug-free/ home birth without being dismissed. I was called an “extremist” the last time I tried. And honestly, scared first-timers like Anoushka need to hear from the majority who had healthy, bearable experiences of labour and birth. Like successful breastfeeding stories, those birth stories are not an insult or a put-down to women who didn’t have that experience.

Let’s be very, very clear that caesarians save lives. They’ve saved the lives of a couple of friends of mine, and also the lives of a few babies I know. But, like any other operation, that doesn’t mean that everyone should have one. There are reasons why everyone doesn’t have preemptive tonsillectomy or appendectomy, after all. Modern medicine is great; wholesale medicalisation of life can do a lot of damage.

Aimee // Posted 28 May 2009 at 5:30 pm

“I think it’s great she considered you knowing how to do it (hey, you may have changed your mind) to be so essential.”

Do you? Because I didn’t. I felt uncomfortable, stressed out and deeply distressed about the whole thing. But I suppose that doesn’t matter because I should have been doing ‘what’s best for baby’… *sigh*

Aimee // Posted 28 May 2009 at 5:38 pm

I am not bashing natural birth or breastfeeding! I am saying that those are not always an option and women should not look down on other women for not having actively strived for that perfect, idyllic, drug free birth that i’m sure we’d all loved to have had, but couldn’t, didn’t or won’t. It’s all very well saying ‘well babies are sleepier after drug assisted births’ or ‘c sections cause greater infant mortalities’ or whatever, but who the hell is that helping? Are you helping the mother who simple does not feel comfortable breastfeeding by telling her that not breastfeeding makes your baby ill in later life? are you supporting and encouraging her autonomy over her own body and her ability to make her own decisions? No. You are bullying her.

v // Posted 28 May 2009 at 6:20 pm

Just weighing in to agree with noble savage. I had an emergency c section forced on me. Second time round, I educated myself and had a home birth. I wrote a very detailed birth plan covering every eventuality I could think of, the process of doing it was part of my education, was part of my taking responsibility for my own labour. After the shitty experience I had the first time round, it was necessary. Those women who feel empowered by less power – well who can argue with that logic?

Feminist Avatar // Posted 28 May 2009 at 11:04 pm

For people who want information, some data:

What are women opting for: [yes this is one link]

Mortality stats for infants and what affects them [mainly social deprivation]: [skip to p.24]

On vaginal birth v caesarean [vaginal birth is marginally better, but not huge difference in outcomes]:

What pain meds are women using?

An online book- this book has a very comprehensive discussion of the steps in childbirth and an interesting section [chapter 34] on pain-relief methods [there are more than you might think] and it discusses the outcomes on the long-term health of the child and mother for different types of pain relief- and the conclusion is that more research needs to be done, but also a suggestion that often the person whose long-term health is often most effected by the various medical interventions in childbirth are the mother, not the child.

Laura // Posted 29 May 2009 at 1:52 am

A friend’s neighbour died recently after something went wrong with a C-section a week or so after the birth. So in case people doubt what Noble Savage is saying, it really does happen.

Now obviously if the choice is die in childbirth or face a small risk of dying from a C-Section later then there’s no choice. But people having elective C-Sections should be aware of the fact that it’s a major operation that is not without risk. If *for whatever reason* they want to have one anyway, then it’s up to them, but they have a right to the information.

Sara // Posted 29 May 2009 at 5:06 am

Perhaps things are different in the UK because home birth is an option supported by the NHS, but I rarely encounter anyone (in real life) trying to sell other women on home birth here in the US. On the other hand, there seemed to be no shortage of people—women of all ages, men, strangers on the street—who flat out called me “crazy” to my face for not getting an epidural or not giving birth to my second child in a hospital. It was appalling. I don’t know that I’ve ever told someone to their face that they were crazy except in jest.

As a woman who had a traumatic hospital birth, I [was unhappy with] Joanne’s comments. It’s a toned down version of telling another woman who had a traumatic first sexual experience that the only reason she had a traumatic experience is because there is an invisible army of people promoting that sex is a positive, beautiful, natural experience. Might as well call her stupid for buying into a fantasy that sex can be an empowering event in which she retains full personal agency and feels supported and loved WHILE physically surrendering to the power of the moment.

In other words, “[xxx] Birth sucks and you only feel disappointed because someone else played a cruel joke on you by telling you that it didn’t.”

I can assure you that the trauma I experienced had nothing to do with not living up to an ideal and everything to do with the environment, the bullying, the lies, the lack of informed consent, dumping drugs into my IV without my knowledge or consent, separating me from my baby for 25 minutes for no reason, telling me that I was putting my baby at risk for laboring in advance of the cesarean they scheduled for me because of a suspected big baby without any scientific studies to back that recommendation and the complete and total lack of continuity of care.

So why do “SO MANY” women have negative experiences in childbirth? I can say without hesitation that it’s not because of public health literature that highlights risks associated with epidurals, c-sections, narcotics, formula, whatever. That is just epidemiology, not judgment. It is because women are stripped of any control over their bodies by arrogant, unnecessary medical treatments.

[This comment has been slightly edited for tone – as indicated in square brackets.]

Ariane // Posted 29 May 2009 at 5:48 am

I’m right there beside Noble Savage too. Real, unbiased information is hard to come by, and the information we are often handed seems to over-represent both ends of the extremes.

Pethidine causes drug addiction in the offspring? I was told nitrous did the same thing! I literally laughed out loud in the ante-natal course.

On the other hand, too many people I know have been given little or no choice in having a c-section.

My personal experience is that I had 3 kids, all with nitrous, the latter 2 with pethidine as well. In my case (just me, it doesn’t generalise) the pethidine actually assisted the labour, and brought me through transition in literally a fraction of the time without it. I have no affection for the term “natural” but they were all vaginal and my recovery was unbelievably fast. And every single one of them sucked. I hated giving birth. The only bit that was good was the baby actually coming out.

I wouldn’t change my decisions, just because it was a period of hell, followed by almost instant normality. That worked best for me.

Then I have a friend, who, whilst lamenting a not-quite emergency c-section asked her mother with some anger “What did they do before ceasars?” to which her mother quite accurately replied “They died.”

There are more people with agendas surrounding birth than you can poke a stick at. If I was god for a day, I’d wave my magic wand, make all information free from bias and implant a deep understanding of the emotional and physical consequences of lack of agency in all professionals.

And Becky? I utterly agree that there is nowhere near enough support for single parents. I remember thinking on about 35,000 occasions “I am so lucky I have a partner, it must be so tough to do this on your own.” That, and “When will this first year be over?”. Definitely a valid cause for feminists – doing it alone needs more support from the rest of us, not less.

Feminist Avatar // Posted 29 May 2009 at 4:24 pm

Caesarean births are not new; they appear to have been performed in the Roman period and certainly in western Europe since in the 16th Century. What is new is that mothers now survive them. This is not because the midwifes were necessarily less skilled at performing such procedures, but that without antibiotics post-operative infection was impossible to control. As a result, it was only done as a last resort when the mother was likely to die anyway- and of course in complicated childbirth, maternal mortality is higher anyway- today as in the past [which is also one reason why more women die after a caesarean today]. It is also worth noting that some women did survive caeseran birth in the past, because if the operation went well and you had no infection, you could make a good recovery, just like any other medical procedure in the past.

You might be interested to know that the early transition from childbirth as a woman’s job, performed by skilled midwives (who trained under other midwives in an apprenticeship scheme like other occupations), to early male doctors, in the first step of the medicalisation of childbirth, did not show improved survival rates for women- in some cases there was notable decline. Good midwives often had very good survival rates (in a context of high child/ mother mortality).

What has transformed childbirth in western Europe is better health due to better nutrition (so women are less likely to have a small pelvis or bone disorders, like rickets and polio complications, that stop vaginal births being possible) and anti-biotics that mean that post-birth infections – what appears from the surviving evidence to be the main killer of women in childbirth in the past. We also have better understanding of sterilisation generally (which is not to say that past societies were necessarily unaware of the links between cleanliness and infection), but it was known for new babies to die of tetanus because their ambilical cords were cut with rusty knifes and similar problems.

polly styrene // Posted 29 May 2009 at 9:09 pm

Most caesarean births WILL be higher risk because caesareans are usually performed because of pre existing problems. It’s the pre existing problem that causes the complications, not the caesarean itself.

So you”re not really comparing like with like. But women can die after vaginal deliveries too. My friend nearly died after her second child was born ‘naturally’ because she developed septicaemia.

Most caesareans carried out in the NHS are emergency, not elective.

But ‘elective’ caeasareans can still be because of anticipated complications, not just because women are ‘too posh to push’.

I really don’t think it’s helpful to make women feel bad or scared about having caesarean deliveries. Sometimes it’s unavoidable. But I know someone who was heavily into the NCT who became very depressed after having to have an emergency caesarean with her third child. So how exactly is that helping anyone?

Annika // Posted 29 May 2009 at 11:42 pm

I can only speak for myself and my own experience. I gave birth to my daughter just over 4 weeks ago. This is my first child.

The antenatal classes I went to were held by my midwife, and were really informative. She went through the different kinds of pain relief available, we talked about pros and cons, and she even passed an epidural needle around!

I also went to a free relaxation class, run by a physiotherapist, who advised us on positions during labour and breathing techniques.

I didn’t write a birth plan, I intended to, but never did get round to it. Instead, I discussed it with my partner as to what I did/didn’t want during labour.

I had my daughter in a birthing pool, in a midwife led centre at the hospital. The midwife was fantastic through out, and I found that being in the pool helped me with the contractions a little bit. I had only gas and air. I had been tempted by a nurse with pethidine, but I had declined because I wanted to deliver in the pool. I had no tearing, luckily enough, and my daughter was born within about 5 hours of me being admitted.

I am damn proud of my birth story, because it is MY birth story and I have my beautiful child to show for it. I feel I was given enough information in my antenatal classes for me to decide what kind of birth I wanted (and even then, you can never be definite about what you want as you may feel different during labour).

I attempted breastfeeding, failed miserably as my daughter wasn’t latching on properly, and so we decided to bottlefeed instead. My midwife was great throughout.

I feel my experience was positive.

I honestly believe that the midwife who helped me deliver my baby, made my experience positive.

Everybody will have a different experience, some good and some bad. I think women need to be given lots of information and support, so they can make informed decisions.

One thing my midwife said in the antenatal class was: “Don’t be afraid to ask for what you want, it is YOUR delivery. We, as midwives, are privileged to be a part of YOUR labour, not the other way round. Don’t let anyone push you into anything.”

Was a big help, to me anyway.

Also, hats off to anyone who goes it alone. It is hard work going through pregnancy, labour and motherhood even with a partner, I can’t imagine how difficult it must be for single mums. More support needs to be offered, definitely.

And ditto what Noble Savage said.

Thats my two pence worth.

Eleanor T // Posted 30 May 2009 at 5:15 am

Alex T’s sister here.

I’ve just given birth (twelve days ago) and while labour was not exactly the length I’d hoped for (a whopping 55 hours, if you include the hour of pushing), it was the most incredible thing I’ve ever done or experienced and I can’t believe how proud of myself and my body I am. I put this down to a few small things:

1) I was open to change, although I stubbonly stuck to my guns on the issues that were really important to me. I DID NOT want a c-section, I DID NOT want an episiotomy and I DID want pain relief. All of this happened because I was vocal about my wants.

2) I had a female doctor present at the birth. While my primary doctor had been male throughout my pregnancy, he wasn’t on shift while I laboured, so a wonderful, compassionate female doctor stepped in. During pushing, I breathlessly insisted I DID NOT want an episiotomy, and she just shrugged and said, “Oh, I don’t do those. In the last year I’ve only done three, and one of those didn’t count.” How amazing is that? She lubed me up instead (sorry to be graphic) and I birthed without a tear or forced extraction.

3) I had support. I knew I’d be terrible coping on my own, so having my husband present throughout the entire 55 hours was really, really important. I was able to delay the serious pain relief measures until I really needed them (about 35 hours in) because he helped me to focus, got me moving about and was just a major, major source of comfort. If women don’t have a partner, they really ought to consider having a friend or family member help them through it.

So, those are just my thoughts. It’s all very fresh in my mind right now. I did attend a childbirth class but I felt it focused too long on the labour (seven hours of the total ten) and not enough on newborn or postnatal care. My other criticism was that we were pressured into making choices, but being prepared to have to change them last-minute. Fair enough, but I stuck to my guns during a loooong and difficult labour and I got the experience I wanted. It can be done.

Now for the fun part: looking after my new son and bringing him up to be a feminist!

Shea // Posted 30 May 2009 at 2:13 pm

@ Pollystyrene – totally agree with you.

There certainly is a lot of vitriol flying around for other women’s choices. I really think it is no ones damn business if a woman wants a natural delivery or a caesarean (or has an emergency one), breastfeeds or doesn’t. It is her body and her choice.

Both this

“Rising c-section rates mean more women die. Full stop. Decreasing breastfeeding rates means more babies die. Full stop.”

[ Cite your sources please]

and this:

“Perhaps you anti-drug messiahs could nip along to the next birth on the floor of a dirt hut in Nairobi and suggest a few breathing exercises for the 14 year old who’s been in labour for 48 hours.”

are total hyperbolic b/s.

Firstly because where you are having a c-section, counts, whether your pregnancy is low risk or not, counts, whether it was an emergency or elective caesarean, counts. In the West, it doesn’t make a difference not to breastfeed, its a different story in sub-Saharan Africa. The material point, as made by Feminist Avatar, is that better nutrition (and the presence of a midwife) is the key to reducing maternal mortality rates.

(Maternal mortality: who, when, where, and why

The Lancet, Volume 368, Issue 9542, Pages 1189-1200

C. Ronsmans, W. Graham)

Secondly, because how about better aid and infrastructure and better access to maternity services in the first place?

Maybe those with so much passion could find a better place to put their fight, i.e campaigning for our government to meet the Millennium goals on reducing maternal mortality rates worldwide?

Really, there are plenty enough people out there just waiting to jump all over women for their choices, does this site have to be one of them?

@ Feminist Avatar – very interesting stuff, thank you. I remember reading in amasement about the history of epidemiology and the fact that one of the factors that led Ignaz Semmelweis to understand that puerpal fever was an infectious disease, were the starkly different maternal mortality rates on two obstetric wards. The one attended to by midwives had a drastically lower rate of mortality, simply because they had better practices (such a handwashing, not handling infectious agents during autopsy etc). Quite revealing I thought.

v // Posted 30 May 2009 at 7:09 pm

My c section was an ’emergency’. It was even under general anaesthetic so I was unconscious throughout. I have the files and i’ve been through them with a fine toothed comb. I’ve heard many similar stories to mine – our ’emergency’ c sections were not just avoidable but were caused by the hospital environment.

Examples of how this happens:

– the drugs they give often cause problems with childbirth, slowing it down or speeding it up, which then often have to be followed with drugs to do the opposite.

– The stress of going into hospital plus the inhospitable environment and the lack of power and feelings of helplessness, which are all minimised if you stay in your home environment, which to some extent, you ‘own’. Those stresses cause labour to start and stop, making it more likely it will go on for longer, days even, and therefore increase the chance of ’emergency’ c section.

– The hospital works to its own timetable and many an ’emergency’ c section is scheduled to fit into that time table, rather than because it is medically necessary.

-The position the labouring woman is in. In a hospital, she is more than likely to end up sitting or lying down on a bed, possibly the least comfortable and labour friendly position. Rather than on an exercise ball (£4 to buy, if you’re at home), or crouched down on your heels, or on all fours, or in the bath. This too has an effect on the labour, how painful/comfortable it is, the likelihood of it starting and stopping.

So yeh, many an ’emergency’ c section is completely avoidable. Needless to say, I had a home vaginal birth after doing months of research into it all. The difference in the quality of the birth was incredible. But you have to be confident and informed to have the home birth because believe me, NHS midwives, they tend not to be too supportive.

I’d recommend AIMS for more information on all of this stuff (Association for Improvements in Maternity Services), on the politics of maternity services. If you want to inform yourself about it, if you’re planning a birth yourself. They are really supportive and give decent advice.

Ruth Moss // Posted 31 May 2009 at 8:10 am

I’m sorry, but in comment threads about birth and by extension breastfeeding, from now on I’m going to take a suggestion from the one and only Queen Emily.



PINK [word edited out by kate!] UNICORNS (oh, sorry, they’re pink, lactating, home birthing unicorns, did I say?)

Rita // Posted 31 May 2009 at 10:46 am

I resent the assertion that if I was ‘educated’ enough I would be having a beautiful gentle homebirth in my own surroundings (talk about infantilising women – poor little girls, the big bad hospital and horrible doctors just mess with your bodies and hormones too much!)

I endured enough of that when I had my abortion (no dear, if you were really ‘educated’ about what abortion was about, you’d keep the baby!) and I certainly wasn’t willing to put up with it when I had my son.

I like to think that I am educated enough thanks to my background which has taught me how to read scientific papers correctly and draw the correct conclusions from them, not just by reading or an abstract in a paper which has completely different conclusions to what the results actually say.

Yes, every different type of birth has benefits and risks, but don’t assume that women who go down the epidural/c-section/whatever you don’t like path is somehow uneducated, disempowered or even wants the same birth as you. That’s just plain insulting.

v // Posted 31 May 2009 at 10:56 am

“In the West, it doesn’t make a difference not to breastfeed”

That’s not true. Breastfeeding provides a number of health benefits for the baby, theyre pretty widely available so I won’t link what you can google. I’m sure there are reasons specifically not to choose formula, vegans probably have some, people wary of whats in formula or the companies that make and sell it probably have some more. Just because some women, some feminists even, make a choice, doesnt mean it suddenly becomes ethical or above analysis or criticism. There’s no pretending that both choices are equal in value to the baby. They’re not.

Something else that really annoys me. I did extended breastfeeding too. We’re not really allowed to talk proudly about that without someone taking offence that they are being judged for not doing it. We’re called the ‘breastfeeding mafia’ if we dare speak about the positive side of it. But I couldnt really give a stuff whether some other woman chooses not to do it, I just want room to speak with pride and positivity about the time and energy I put into it.

I’ve seen women give up early because they cant imagine how the months ahead are going to be. There are times when its painful, exhausting. But it get’s easier and easier the more regular food a baby eats. The first couple of weeks are the hardest. The first six months are the most exhausting. As soon as they start on solids it get’s way easier, by the time they’re a year old you’re talking a couple of feeds a day which are really easy to work into whatever schedule you have. I’ve had several women tell me privately that they wish theyd have kept going but one bad weekend, one bad week of being exhausted and not getting enough support, just put a stop to it.

I’ve also heard women talk about being grossed out by it. I’ve heard of boyfriends and husbands that won’t allow it. I’ve heard women talk about their priority being to get their figure back. Really, if we’re going to talk about choosing not to breastfeed, the various reasons should be relevant to the discussion?

It’s tiring watching feminists obsess over consumer choice without analysis (deemed ‘judgment’ even when it is clearly not), rather than looking at why women make the choices they do, and how we can change things for the better, eg, more support.

Ruth Moss // Posted 31 May 2009 at 11:55 am

v –

Don’t do it. Seriously, don’t do it. Don’t get into a discussion about the reasons for breastfeeding and what it does for woman and baby. Because you will just wind yourself up, your blood pressure will rise and you will achieve nothing. I can wholeheartedly suggest sites like (yes, sorry, it’s a plug) Mothers for Women’s Lib as excellent places to discuss birth and breastfeeding. Not everyone will agree, of course, but for some reason it does tend to get less heated.

(There are other sites too, not just ours!)

Because much as I do love the F word, I’ve seen these types of discussions here get really hurtful and nasty so quickly in the past, and I’ve worn myself out trying to be reasonable and even getting called – the perennial favourite – a breastfeeding nazi.

It’s not the fault of the OP, nor the F word itself I don’t think – just that these discussions never end well and you walk away bruised and bloodied and for what? You won’t change anyone’s mind.


Aimee // Posted 31 May 2009 at 12:23 pm

Am I too ‘uneducated’ for my comment to be published? :S

[Aimee – I have published every single comment on this article – I have edited a few but refused none. However I have this thing called a job and I was in Manchester on Sunday and got back to London late on Monday and went straight to work and got home late and went to sleep and now if the first chance I’ve had to publish stuff…}

Zoe Bremer // Posted 1 June 2009 at 6:40 pm

Whatever happened to offering women twilight sleep? I know it was stopped because their reaction frightened the doctors and there’s good grounds for not using morphine (suppresses foetal respiration) but surely if dentists can offer it routinely so can obstetricians? There must be plenty of modern drugs to take the place of the morphine. The hyoscine doesn’t need to be changed. Women in the 1920s were given it so why isn’t it available now? They suffered no pain and had no memory afterwards of giving birth. That also means that they wouldn’t sue the hospital. Surely someone can see the logic of reintroducing this form of analgesia?

Aimee // Posted 2 June 2009 at 5:16 pm

Kate – Yeah, fair enough! Sorry, I think I had a bit of a strop on. :) Sorry ’bout that.

My comment still hasn’t been published though :)

[weird – for some reason the system didn’t notify me about your post. hope this is a one-off problem rather than something i’ve been unwittingly doing for years. all fixed now – k]

Kristel // Posted 2 June 2009 at 6:13 pm


UK Dentists are no longer allowed to give people general anaesthetics. I think it’s the law now that only qualified anaesthetists are allowed to do it and only in a hospital setting, not a surgery.

Wouldn’t it be incredibly risky, this ‘twilight sleep’, (even with a safer modern drug) for a woman in labour? General anaesthetic is risky for anyone.There are so many things that can (not necessarily will, of course) go wrong in labour anyway, and that would be one more danger. It sounds scary. Besides, despite the pain, I’m sure a lot of women would hate to have no memory of the moment their baby was born.

Zoe Bremer // Posted 4 June 2009 at 2:38 pm

Twilight sleep is NOT a general anaesthetic. It is widely used on horses (M99 being the main drug used), along with local anaesthetic. The patient remains semi-conscious throughout. As one gynaecologist who used twilight sleep put it in 1952 “My patients want to have babies: they just don’t want to be there at the time”. Dentists routinely use twilight sleep nowadays but I assume that an anaesthetist is there to supervise the patient. The point I was making was that women got better treatment in the 1920s to the 1950s than they do today because they suffered no pain and had no memory of giving birth. They just woke up the next day and it was all over.

Noble Savage // Posted 4 June 2009 at 5:24 pm

The idea that women don’t want to be (or shouldn’t be) mentally present and emotionally aware at their children’s births is propaganda pushed by an outdated, patriarchal model of obstetric care. Twilight sleep was not for the benefit of the labouring women, it was mainly for the benefit of the doctors delivering their babies. A woman who is only “semi-conscious” doesn’t make a fuss, refuse certain procedures, require emotional support or make noise. A semi-conscious patient is the ideal patient *for the doctor* but not for the patient herself.

There are other forms of pain relief that don’t render a woman unable to remember the birth, or what happened to her during labour. Birth is not a medical event that should be passively endured, it is a spontaneously-occuring biological process that most women want to be present for. That doesn’t mean they can’t have any pain relief but to assert that twilight sleep (i.e. surrendering control of their births to others) was good for women is ridiculous.

Kristel // Posted 4 June 2009 at 5:30 pm

Sorry, Zoe. My mistake/ignorance.

I still think most women wouldn’t like to have no memory at all of the birth of their baby though. And I don’t think they routinely got better treatment in the 1920s and 50s.

Zoe Bremer // Posted 5 June 2009 at 7:14 pm

I wonder why so many women think the NCT’s view of obstetrics, which suggests that 36 hours of agony is somehow “good for the soul” is somehow positive. Would we praise patients for having an appendicectomy without adequate anaesthesia? I don’t think so. Besides, for your information, twilight sleep was abandoned because it scared the doctors. I’m sure that midwives even in the Middle Ages knew how to use hyoscine and laudanum (both have been used in this country for at least 700 years). I’m sure that if you asked 1,000 women who gave birth under the influence of twilight sleep whether they felt they “missed” anything the majority would reiterate the feelings of the obstetrician that I quoted (and he was simply expressing the opinions of his patients) and in the 1920s, even homoeopaths supported the use of twilight sleep. However, I take the point about modern drugs. Even so, I think most women would be happier, if having an epidural, if they were to be blotto as well and plenty of modern drugs can provide the necessary state of mind without threatening the health of the baby, for example ketamine (which is widely used in neonatal surgery).

I wonder why, with all the availability of modern medicine so many women want to give birth under the guidance of semi-qualified quacks (i.e. midwives, who don’t even need to be nurses nowadays) in conditions that threaten their lives and their long-term health. My neighbour is an anaesthetist who teaches student midwives and she is horrified at the lack of even basic medical knowledge that they exhibit. You only have to read the Derby Evening Telegraph to learn how many women giving birth at Derby City General Hospital die, or are permanently maimed as a result of this lack of professional care. Most would be better staying at home and calling in the local vet.

Quite frankly I doubt the sanity of any woman who would willingly suffer pain or a 36-hour labour knowing that the average gorilla takes 2-3 hours to give birth and that women having babies in the 1930s could do so in the firm knowledge that they would not suffer during the process. Even Queen Victoria used chloroform during parturition. Have we really not moved on since the mid-19th century?

Noble Savage // Posted 7 June 2009 at 9:23 am

I don’t know why you think all labours are “36 hours of agony” but can only assume this is either a personal experience or what you’ve come to believe through mainstream media, which nearly always shows birth as a horrendous, bloody, screaming event. Look, no two labours are the same. Some women have hardly any pain at all, for othere it is excruciating. Some women are in labour for days, others one hour. You cannot lump them all together as “36 hours of agony.” 36 hours is not the norm. 12 hours is the average length of active labour for a first-time mum, usually even less for subsequent babies. I was not in agony at all in my second birth, though I attribute that to being in my own home, relaxed, mentally present and in control instead of laying drugged up and terrified in a hospital room as I had with my first.

That you openly deride women who find their births spiritual or emotionally important is exactly the kind of so-called feminist attitude I’ve spoken about before; wherein women who want elective c-sections and epidurals upon arrival are celebrated for having “choice” but those who don’t want medical intervention and drugs and who want to be mentally present and in control of their births have their sanity doubted, as you expressly stated. I find it absolutely incredible that you would defend women who want drugs in one breath and then go on to criticise the thought processes of those who don’t in the other. Can you not see the hypocrisy in that? Just because you think natural childbirth is some kind of hippy-dippy joke gives you no right to tell others that it doesn’t matter or that they’re crazy to want it.

The most empowering thing I ever did was push my son out of my body without any beeping gadgets, instruments, needles or numbing drugs. Just me, my body and my baby, all working together. I had a fantastic birth experience and the fact that I’m not allowed to talk about it because it is deemed “unfeminist” makes me incredible angry. Having one experience and feeling one way about something does not mean I look down on people who have had different experiences and have different feelings towards birth. I would never, ever take anyone’s choices away and respect all women’s rights to make fully informed, conscientious decisions. Yet I am not afforded the same respect? My sanity and feminism credentials are openly questioned, all because I found giving birth naturally was the right choice for me? Bullshit.

This is the kind of thing that makes me understand why people sometimes say feminism has “gone too far.” From what you’re saying, it seems you think we should reject anything and everything that is inherently female and suppress our biological processes just to serve some kind of equality or “progress?” If medicated, semi-conscious, surgical births are the future of feminism and women wanting natural birth are labeled insane, then count me out. With “friends” like these, who needs enemies?

Aimee // Posted 7 June 2009 at 11:58 am

Zoe, I am inclined to agree with you on many points. It’s strange that so many women are expected to nobly suffer 36 hours of needless agony, when there are medical procedures availiable which would allow the woman to be in considerably less pain. It seems very odd to believe that a good mother is one who shut up and suffered, wheras a woman who accepted pain relief is supposedly selfish and less worthy of motherhood.

Having said that, I think we need to be careful about comparing childbirth to medical procedures such as appendectomies. Childbirth isn’t an illness or an affliction. It is a natural process which women have been doing for hundreds of thousands of years, and to lump it in with other ‘medical’ afflictions is a bit insulting. That doesn’t necessarily mean that there shouldn’t be any intervention which makes the experience better for women. At the end of the day what’s important is what’s best for women and what women want to happen to them during childbirth. No one has any right to tell an individual woman what she should want and what she should think is best for her. That is her decision.

Jane // Posted 7 June 2009 at 11:58 am


Well spoken.

I had a mobile epidural for my first baby – these are wonderful things. You still have a degree of movement – but the drug is topped up as you need it in smaller doses. I was able to walk around, while my mid-section was numbed. So because I could move and stay upright – when it came to the pushing bit, I was able to push the baby out myself. It’s not true to suggest that all epidurals mean you are ‘strapped to monitors’ – most allow movement and the vast majority of birthing women stay upright. There is a false idea that an epidural means you are somehow held prisoner to a monitor and have to lie flat. You can move around, sit upright and stay in control of your labour, just minus the pain.

Jehenna // Posted 7 June 2009 at 1:06 pm

Noble Savage, I can really identify with what you’re saying about your experiences and feeling they are invalidated by feminism. But personally I think you are giving far too much credence to one poster to allow her to speak for feminism, and to disenfranchise your own experience.

Isn’t the real strength (and weakness) of feminism that there are almost as many versions of it as there are women?

I think its important that we each define feminism for ourselves and not get too concerned if someone represents views which are different or even diametrically opposed and propose that their view is feminism. They have no more determination over the movement than you do. They may think they’re being a gatekeeper to the ‘true path’, but that’s okay. Most of us think we’re right :)

Personally I find your story very reassuring – my best friend had her second child in hospital, but when the time came, there was no opportunity for any pain relief, as once he started coming, he was out in less than thirty minutes. She said she felt like a wild viking woman :)

My sister’s baby was born through caesaerian when they realised that the baby was in breech position and not going to move again – after a perfectly placed position before that, she moved in the last couple of days.

I think this is one of those topics that women are going to really have difficulty with each other – regardless of feminism – because there are so many different views of what is best. And that’s before you even get to the question of privileging the child’s experience before the mother’s, or vice versa.

I think it would be good if we could debate these issues without it becoming a case of ‘I’m more feminist than you’, or ‘my views are better than yours’, but I think that’s very hard once people get passionate about a topic.

Maybe we’d be better looking at ‘why’ people make these decisions, and maybe that will help us come to a less confrontational debate, reliant on personal experience and viewpoint rather than generalisations.

That would leave me out of it though – I haven’t had a child yet :)

Feminist Avatar // Posted 7 June 2009 at 3:01 pm

I wrote a rather lengthy response to this post at:

polly styrene // Posted 7 June 2009 at 3:41 pm

Queen Victoria was of course also a keen user of cannabis, which was also used as pain relief in childbirth. So maybe she was amused occasionally.

Ariane // Posted 8 June 2009 at 12:52 am

Jehenna, I think the “why” is exactly what needs to be discussed, but it ends up in the same personal defensiveness.

People have repeatedly stated that there are medical procedures that can save women from all that pain, and I am quite willing to believe that it is possible for that to be the case, without any significant negative consequences for mum or bub. However, the way they are mostly delivered in most places in the western world by most doctors is not like that. Statistically speaking, at least, intervention leads to more intervention. Some of that statistical correlation is indeed caused by higher risk pregnancies to begin with, but at least in Australia (the only data I’ve seen), when risk in pregnancy is controlled for, epidurals (for example) are more likely to result in c-section. Now that’s not an issue if you are happy to accept that, but I think many women have had the experience that the truth about what *actually happens* is misrepresented to them.

Now the problem with this, is that no-one wants to be told that they have been duped. And of course, not all women who have chosen to have interventions have been. Nor have women who have chosen not to use pain relief. So you still end up with defensiveness even when you discuss the motives of the medical practitioners, and those who enumerate the evils of interventions. And I understand that.

I think if we could create the perfect pain relief that had no nasty side effects for anyone, ever, most people would make use of it. No doubt there are natural child birth advocates that want it to be natural for “natural”s sake, but I doubt they are the majority. Most people choose it because it results in the best outcome *for them*.

I chose to use some pain relief, and the medicalisation of that possibly demonstrates why so many women are suspicious of the motives of the medical process. I had pethidine for 2 out of 3 kids. For the last one, there was a massive hoo-haa about assessing whether the baby needed narcan, implying she was in danger of an overdose. There was no such concern for the second. I am extremely skeptical that the risk actually changed. If I hadn’t complained, they would have given her narcan without considering the need.

In other words, women who choose natural child birth (or kinda sorta natural, like I did) aren’t necessarily choosing pain over no pain, they are choosing pain over loss of control and infantilisation. Of course, not everyone experiences that loss of control in a hospital, but enough women do to make the choice to avoid it not one that implies a lack of sanity.

Laura // Posted 15 June 2009 at 3:55 pm

Been following this debate from the start, but recently moved to Burundi for a couple of months, where everyone I’m friends with seems to be pregnant or married to someone who’s pregnant. One thing I’ve found interesting is the different focus people here seem to have when it comes to ante-natal and childbirth issues – rather than talking about what’s good for the baby, people talk almost entirely in terms of what’s good for the mother. Of course in many cases those will be the same thing, but there are differences in focus – rather than being told off for having a beer, women are encouraged to swim because ‘it’s good for pregnant women and it makes the birth easier’. And there is almost no sense of lecturing – it’s ‘my wife found swimming helped in the last month’ rather than ‘you should go swimming’. This partly a factor of being in a country where, even for the well-off, giving birth is far from risk-free, but that said I have to say I find it refreshing after what in the Western world can seem a bit like making the mother a sacrificial lamb for the baby’s interests. Should point out I’m not saying this in relation to any comments on this thread in particular, just that I hadn’t realised how oppressive I found it until I came out here and found it removed.

Aphie // Posted 9 July 2009 at 8:17 am

Zoe, it’s nice and all that you consider midwives to be quacks based upon your own personal experience in your own country, but please bear in mind that’s not the truth, the Western world over.

Midwifery in Australia is generally a specialised subject that nurses must take further training (yes, on top of their years of medical study!) to become accredited for.

Sweeping generalisations are not this thread’s friend.


Elodie // Posted 9 July 2009 at 1:07 pm

I completely agree with Zoe on this one.

Childbirth can be quite legitimately considered a medical event (and that should not be a controversial statement; least of all by feminists) due to our size at birth, a unique trait among mammals that means fully embracing “natural” birth is to accept that maternal death is a part of the process. Doesn’t sound especially feminist to me, and it also implies that labouring women should have much greater access to staff who are more qualified to deal with the situation than midwives are. In most cases, you’d hope that would just someone specialised in anaesthetics, but that should really be the minimum expectation really, and there should be no sense that these people’s time is wasted on something as trivial as birth. That is certainly the case nowadays, as most of my friends who were duped into thinking they could ‘get through it’ discovered when it turned out they needed epidurals.

Which brings me to my second point: pain. Until childbirth stops being accepted the horrifically painful event that it is for most women, we’ve pretty much lost the battle as a sex. Toothache is “natural”, yet dentists who try to fix it without anaesthetic are struck off. Why is this? Because women are a lower priority than that and are conditioned to think they can handle it. It makes me weep to think how many of my own friends went into the experience in good faith thinking they could (or indeed should) deal with the pain only to find that they needed relief. Of those who managed to get it, not one of the dozens of women I’ve spoken to would ever attempt to do it “naturally” again and are perplexed as to what made them think they ever could. Personally, I can’t consider starting a family until I have enough information on this matter to know that I won’t end up denied the pain relief I know I’ll need, much as I badly want children. That last point is important, as I think that’s how the system has got away with denying women as long as it has: “they’re fine once they see their baby”, etc. I do wish that rather than taking this misogynistic view it had continued more along the lines it was going down in the ’50s and invested more in lessening the trauma.

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