In addition to this we have an 'instant access' generation of young women who expect everything to happen straight away... Putting up with pain, labour and everything else isn't part of this world view
Jenny
Sent from my iPhone
On 8 Jun 2015, at 15:05, Louise Silverton <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Thanks Mary. Nice to know that The work of Margaret Mead is alive and well!
Clearly there is a lot here about fear of the unknown and the need to control that uncertainty. This is tied in with a societal (Men and women) lack of acceptance of pain in almost any circumstance. I have noticed that some of today's mothers seem to find the pain of even early labour hard to tolerate. I don't think that this was my experience years ago. I suggest that young women manage dysmenorrhea by liberal use of analgesics and/or oral contraceptives. If early labour and even Braxton Hicks elicit negative responses how much harder is it to encourage a woman to take labour as it comes and to see how she responds.
Louise
Louise Silverton
Director For Midwifery
Royal College of Midwives
Sent from my iPad
On 8 Jun 2015, at 08:45, Stewart Mary <[log in to unmask]<mailto:[log in to unmask]>> wrote:
This is, as Sheena pointed out, a great discussion!
I have been struck by some of the comments about the need to address what seems to be some women’s deep-rooted fear of childbirth. I wonder whether the issue begins even earlier (i.e. pre-pregnancy). I’m conscious of the fact that there is increasing cultural and social pressure on young women to sanitise, control and, in some ways, infantilise their bodies i.e. the seemingly intractable ‘demand’ that women remove most/all of their pubic hair, presenting themselves as pre-pubertal while overtly sexualised in other ways; the continuing taboo around ‘leaky’ bodies and the reality of bodily functions, including menstruation etc.
A couple of years ago I was very struck by a conversation with a young friend in her early 20s – the daughter of a good friend. I know that this young woman has been taught to feel comfortable with, and proud of her body without feeling the need to bow to social pressure. However, we had both read an article in the paper about labiaplasty and my young friend was wondering aloud whether this was something she ‘needed’ to have done. She knew, in her rational mind, that labiaplasty is madness and yet she felt there was something quite wrong with her own labia and that maybe she needed to get it fixed.
If young women are absorbing such relentless messages about the unsatisfactory nature of their own bodies, then perhaps it isn’t surprising that they cannot face the prospect of subjecting that body to vaginal birth – knowing that their body will be inspected by others and may be found wanting, and that the body they have spent so many years cultivating will be out of their control.
Maybe as midwives/doulas/interested parties we need to start thinking about addressing some of these issues way before young women and men start thinking about pregnant and birth.
Very best wishes
Mary
Consultant midwife - antenatal care
Guy's and St Thomas' Hospital NHS Trust
10th floor - North Wing
St Thomas' Hospital
London
SE1 7EH
Phone (internal): ext 55471
External: 0207 188 7188 ext. 55471
________________________________
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Maggie Banks
Sent: 07 June 2015 21:18
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
It is interesting to see how low the maternal request for Caesarean section is in Sheena’s link MailScanner has detected definite fraud in the website at "ow.ly". Do not trust this website: http://ow.ly/2btkjf<http://ow.ly/2btkjf> . Like Soo, I don’t believe women have a deep-seated fear of childbirth and it hasn’t been my experience that women want CS – and I am talking about the many I have contact with beyond the homebirthers of my own practice.
kind regards
Maggie Banks
PhD, RM, RGON
15 Te Awa Road, RD 3, Hamilton 3283, New Zealand
Phone 64 7 8564612; Email [log in to unmask]<mailto:[log in to unmask]>; Website www.birthspirit.co.nz<http://www.birthspirit.co.nz>
Post-dates Pregnancy Workshop (Online)<http://www.birthspirit.co.nz/postdates-pregnancy-workshop-online/> 10 - 17 July 2015
The Spirit of Birth: Nature, Nurture and the Evidence Workshop (Online)<http://www.birthspirit.co.nz/the-spirit-of-birth-nature-nurture-and-the-evidence-workshop-online/> 7 - 14 August 2015
Water Birth Workshop (Online)<http://www.birthspirit.co.nz/water-birth-workshop-online/> 4-11 September 2015
next available Breech Birth Online Workshop<http://www.birthspirit.co.nz/breech-birth-online-workshop/> 2-22 November 2015
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of SHEENA BYROM
Sent: Monday, 8 June 2015 2:17 a.m.
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
Hi everyone, great debate - thank you!
Not sure if you’ve seen this? It’s causing a flurry of panic on Twitter, by some obs in US! MailScanner has detected definite fraud in the website at "ow.ly". Do not trust this website: http://ow.ly/2btkjf<http://ow.ly/2btkjf>
With very best wishes
Sheena
sheenabyrom.com<http://sheenabyrom.com>
Twitter: @SagefemmeSB<https://twitter.com/SagefemmeSB>
On 6 Jun 2015, at 15:55, Nicky McGuinness <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hi all,
Your comments about the impact of cultural conceptions of time and birth timings really struck a chord with me. I' ve just written a literature review on expected dates of delivery and its impact on women’s experiences. The review was interested in looking at the psychological impact of the EDD on women’s experience, and the wider implications for the usage of the EDD in antenatal care.
I was only able to locate a couple of bits on the psychological impact of the EDD and the significance women attach to it. Van de Kooy (1994) reporting on her survey of midwives, describes how women felt upset and disappointed when their EDD was changed. Authors have also discussed how women can find it hard to tolerate waiting past their EDD and may expect IOL in order to end being in a ‘time limbo’, or even ‘elect’ caesarean sections as they become anxious about the possible harm of ‘too much pregnancy time’.
I reached the conclusion that normality of gestation length should be assessed in relation to the individual context, to the ‘normal for her’, rather than exclusively to the population average. The importance of individual factors, or ‘biologic variability’, needs to be considered in order to better calculate the EDD. In addition, the argument for moving to an expected due range rather than EDD, may well have positive outcomes for women in how they conceptualise and approach their gestation time.
Anyway just thought I'd share....
Best wishes,
Nicky McGuinness
(Student Midwife, former social researcher, including Birthrights Dignity in Childbirth survey)
________________________________
From: "Hall, Priscilla Joy" <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Friday, 5 June 2015, 16:37
Subject: Re: FW: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
I would like to chime in.
It seems that we are having a conversation about whether women should have the right to choose and elective cesarean, when the real issues are further upstream, as some of you have pointed out.
I wonder what would happen to requests for elective cesareans if we addressed women's fears about labor, if they felt more confident about their body's capacity for birth, and if they were able to experience greater agency during birth, so that they can shape the birth experience according to their own needs and wishes. I like your comment, Soo, about childbirth practices that make birth so frightening for women. We need to address that issue first, and then see what happens to elective cesarean requests. Then perhaps the elective cesarean problem will go away or nearly go away.
I wonder if we need to study women's perceptions of the meaning of time in birth. The timing of birth is uncertain-the due date, the beginning, how long labor lasts but women are accustomed to having their life scheduled in discrete time slots. Physiologic labor doesn't fit in very well, and a scheduled cesarean is over in 45 minutes. There is no uncertainty.
Priscilla Hall RN CNM PhD
Emory University
Nell Hodgson Woodruff School of Nursing
1520 Clifton Road NE
Atlanta, Georgia 30322
224 805 8673
________________________________
From: Soo Downe [[log in to unmask]<mailto:[log in to unmask]>]
Sent: Wednesday, June 03, 2015 4:24 AM
Subject: Re: FW: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
Nicky, I think this is a good reflection on the issues. And I think where there is genuine fear of childbirth, there are probably going to be more benefits than risks in a CS for a woman – but maybe not for her baby. I also think (and I suspect you might agree?) that there is misinformation in the text you cite below, as, whatever prevailing medical/midwifery opinion is (and we have been wrong about so many things in the past – twilight sleep, routine use of CTG, putting babies on their bellies to sleep…) the evidence is clear – elective CS for physically and psychological healthy women carries more risk for the baby with no associated benefits, and more risk of serious life-threatening events for the mother. This is even without putting into the mix the growing evidence on the microbiotic and epigenetic benefits of physiological labour and birth for the baby into its adulthood.
If we have made childbirth so extremely frightening for women that they are willing to take these risks (and if they understand them fully) then yes, we as midwives do need to support individual women who choose CS in this situation. BUT - it then also becomes our absolute responsibility to resist/reverse childbirth practices/models/values and attitudes that render it so scary for such women.
However, in my earlier email, I was really reacting to situations where women don’t really have a deep seated fear of childbirth, they just don’t fancy going through it, and they see it (due to media representation?) as just another option – like a woman in the Trust I was working in some years ago who had a CS as she had pedigree dogs and wanted to show them at a particular show, so she wanted the baby out in time for her to be able to do this.
Fascinating discussion!
All the best
Soo
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Nicky Grace
Sent: 03 June 2015 08:44
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: FW: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
Please excuse me writing on my phone. This subject is close to my heart. I'm currently looking after a nulliparous woman who is planning a private el lscs through fear of birth basically. Thank you Alison for drawing our attention to this organisation. It seems to be the brainchild of one woman who has also written a book. Her philosophy is:
'The risks involved with any surgery are very real and should not be underestimated, but neither should the risks inherent with pregnancy and childbirth in general. We want to highlight the growing medical opinion that elective cesarean risks are favourably comparable with vaginal delivery risks in healthy women. We do not suggest that every woman should consider elective surgery and fully support a woman's choice to give birth vaginally. We just ask that both choices are equally respected. Most of all, we want to help you make a more informed choice about elective cesarean birth, by providing you with data, research, interviews and opinion that you may not be aware of. You will still need to discuss your individual risks and benefits with your own physician, and we also suggest that you research other websites and books too. We welcome visitors from around the world, and wish you all the very best with the birth of your baby and look forward to hearing about your experiences in the near future.'
Every instinct of mine rebels against el lscs but it isn't straightforward is it? As midwives we are duty-bound to support women's choices. If we believe they have the capacity to choose, for instance, VBAC or home birth when not entirely low risk, then it seems logical to accept their choices when they veer towards the more medicalised options such as elective induction or caesarean. If course it's not as simple as that because from a feminist perspective we could say that it is a matter for consciousness raising or in the case of fear, psychological and emotional support... Regarding Soo's point comparing the right to smoke - good point! I think you're right though it seems an extreme analogy. The difference must be in the acceptability of the issue culturally. Plus I guess there are are few positives to women smoking from a health perspective (though you could argue stress relief?) whereas there are arguably some health benefits to elective caesarean eg fewer vaginal lacerations? (albeit a very large abdominal laceration!)
Just a few thoughts...
--
Sent from myMail app for Android
Tuesday, 02 June 2015, 04:00pm +01:00 from "Macfarlane, Alison" <[log in to unmask]<mailto:[log in to unmask]>>:
In October 2013, I wrote an article on variations in caesarean section rates, based on data which had been published in May 2103 in the Euro-Peristat European
Perinatal Health Report for The Conversation. http://theconversation.com/hard-evidence-who-carries-out-the-most-caesarean-sections-19674 The Euro-Peristat Report, plus a more recent much more detailed article in BJOG on variations in mode of delivery can be found on our web sitewww.europeristat.com<http://www.europeristat.com/>
Recently, the response below was posted on The Conversation by an organisation I hadn’t heard of previously, electivecesarean.com<http://electivecesarean.com>. The author says I should
have been more positive about access to elective caesareans. I haven’t replied yet and if anyone else would like to do so, please go ahead. Is this a new organisation?
Alison Macfarlane
From: The Conversation [mailto:[log in to unmask]]
Sent: 23 May 2015 05:40
To: Macfarlane, Alison
Subject: electivecesarean.com<http://electivecesarean.com> commented on "Hard evidence: who carries out the most caesarean sections?"
electivecesarean.com<http://electivecesarean.com> commented:
Re: "NHS maternity units in England should all follow a common set of guidelines published by the National Institute for Clinical Excellence (Nice), which stipulates among many other things, that
women should not be automatically offered caesarean sections which are not clinically necessary."
This statement appears to misrepresent the NICE Clinical Guideline CG132 and subsequent June 2013 NICE QS32 publication. While NICE does not say 'automatically offer' a caesarean, it does say that
one should ultimately be offered if that is what the woman wants.
The CG132 recommendations read:
"Maternal request for CSWhen a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support
to help her address her anxiety in a supportive manner.
For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable
option, offer a planned CS.
An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS.
NICE QS32 recommends offering a “promptly arranged [discussion] following a request”, “consultant involvement in decision-making” and “dedicated” lists that provide “protected surgical and anaesthetic
time and appropriate staffing” for planned caesareans.
The author could and should have been much clearer on this point given some of the other information that is presented as part of the article. NICE is an evidence-based organisation and a significant
number of organisation stakeholders were involved in writing the CG132 guidance.
To add your say go to http://theconversation.com/hard-evidence-who-carries-out-the-most-caesarean-sections-19674
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