Childbirth.uk

This is going to be one of those ranty posts. If you don't fancy that sort of thing, you may wanna skip this one.

As a man, I honestly never gave much thought to childbirth. It wasn't something I'd have to deal with, so much like how to survive in a malaria-infested jungle, I mostly dismissed the idea as something others might have to contend with, but not something I needed to think about.

Then I married a girl who wanted a baby and so we started talking about and researching childbirth. What I've learnt in the past 6 months has been horrifying. If you have a uterus and are planning on using it to make a baby, you may want to buckle up. Here's a shortlist of the stuff that happens to you that we don't generally talk about:

Tearing

53-79% of women tear their vagainas during childbirth. For the lucky ones, this is only a 1st or 2nd degree tear which rip up your mucosal tissues (no stitches), labia minora (stitches... if the midwife notices), the perineum, or the area between the vagina and the anus.

For the unlucky ones, 3rd and 4th degree tears can extend all the way to the anus and even the anal sphincter. This is the sort of thing that you never truly heal from.

Breaking your tailbone

This is what we call it colloquially, but you're really breaking the joints in your tailbone which, if you're lucky (again) will heal after a few weeks of pain. If you're unlucky your tailbone will never heal correctly, you're forever in pain, and not even surgery can help you. [Source]

Incontinence

Ignoring the possibility of fistula from the aforementioned tearing, incontinence (the inability for you to control when you pee) is extremely disproportionately common in women vs men, in large part resulting from pregnancy and childbirth.

Painful Sex (dyspareunia)

Loss of pleasure or even painful sex, is another one. A recent study here in the UK showed that 7.5% of women suffer from this, with that number fluctuating between 5.3% and 10.4% depending on the age of the woman. In another study, 49% of all women experienced pain up to 6 months after birth, and 3.5% continued to suffer after that.

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The reason we don't talk about this is multidimensional, but much of it can be attributed to a combination of taboos around sex, and a general lack-of-interest in women's health as a society. Most men don't know what a perineum is, or even that childbirth typically involves tearing, not to mention all of those other risks.

That's not the whole story though. If it were, I'd end the post here. Instead, I want to talk about our experience with the UK's midwife system, how backward, irrational, and dangerous it is, and how I sincerely believe it represents a system of women oppressing women.

Some Context

In the UK, we have the National Health Service (NHS), which is a form of single-payer health care much like Canada's Medicare system. Like Medicare, the NHS is struggling to keep up with demand, but unlike Medicare, the NHS is cripplingly poor. They're so broke that people aren't replacing the lights in the hospitals, there's regular shortages of staff, and a surplus of beds, as there's not enough people to staff them. Doctor strikes (to varying degrees) are a real concern.

It's in this climate that the NHS has adopted midwifery to handle the childbirth process. Over the years they've brought in less-rigorously trained midwives to do jobs the more experienced (and better paid) doctors were doing, freeing the doctors up for other work and thereby reducing the overall cost of baby-making on a national scale. These days, childbirth typically doesn't even involve a doctor and roughly 2.1% of births are done at home.

A midwife might be a trained & experienced registered nurse who chose to specialise in midwifery, or they could just be someone fresh out of high school with a C-average who liked the idea of being a midwife and showed up for a whole 3 years of training. There are no national minimum academic entry requirements for entry into pre-registration midwifery degrees.

Once trained, the midwives are posted to general practises around the country, where would-be parents are sent directly to them. From the moment you pee on that stick, the midwife is the gatekeeper between you and the NHS. She decides if you can see a doctor, if your needs are sufficient that you might go over her head to someone with an actual medical degree.

Feelings, not Evidence

None of this would be a problem really if the midwives were actually thoughtful, rational people, but everything we've seen to date tells us that the opposite is true.

Our midwife has flat-out lied to us on multiple occasions about Christina's health risks and personal welfare. Whether those lies were out of ignorance or ideology, there's no way to know, but the result is an immediate distrust of the only person you're permitted to talk to within the National Health Service.

When your midwife tells you that "vaccination causes whooping cough", there's no recourse for you to find a health care professional that isn't a dangerous idiot. In fact you're encouraged to come to them with everyday questions about your health, your risks, and those of your baby, and you're expected to take their advice at face-value. She is the "professional" after all.

When in Doubt, Make it Up

One of my favourite logical fallacies, the "appeal to nature", is the blind assumption that whatever is "natural" must be the best option. When it comes to baby-making, this means ignoring the fact that childbirth is fucking dangerous and has killed and maimed hundreds of millions of women over the centuries. Prioritising "natural" over man-made practises by virtue of their "naturalness" is not a rational choice but an emotional, and therefore irrational one.

In the context of the NHS midwife system, this takes the form of your only available "professional" giving you advice like the following:

Note: these are actual examples of advice given by midwives to us directly:

• "Hypnobirthing works!" It doesn't.
• "Aromatherapy works!" I'm not even going to dignify this the a refuting link.
• "Avoid 'unnatural' sugars like chocolate or candy, and instead opt for 'natural' ones like honey because 'the sugars are different' and 'natural sugars won't make you crash'." The truth is that honey and sugar are both carbohydrates composed primarily of glucose and fructose, and that if anything, the opposite is true.
• "Water births reduce tearing". While it's true that water births tend to involve less pain, fewer drugs, and a faster process overall, they don't reduce tearing. In fact, a UK study showed that water births had a 12% higher rate of perineal tears, and a 23% lower rate of episiotomy (when they cut you to avoid tearing). The reality is that it's a terrible method to use if you expect anyone to help monitor the process, because no one can see what's happening and work to prevent damage.

• "Every woman can breast feed". This is also false and was the subject of a particularly galling incident during a prenatal class we attended last weekend:

  One of the attendees asked "what if you can't breast feed?" and the woman responded: "Why would you think that?" and went on to lecture him about how ignorant he was about women's bodies, that every woman can indeed breastfeed (false) and suggested that his wife was just lazy and wanted to sleep. She then went on to insist that we shouldn't bring formula to the hospital and that if they felt it was appropriate they would provide some.

  Finally, she claimed formula is so hard for a baby to digest that it can cause constipation for up to 4 days. In fact, it's normal for breast fed babies not to poop for as much as 5 days, and formula too has unpredictable results in "regularity". I could find no study citing a correlation (let alone a causation) between constipation and the method with which babies were being fed.

• "Forceps don't increase tearing". Well of course the forceps don't cause the tear, but inserting them into you, widening you to fit a baby's head & forceps certainly does. Risks to mother and baby with completely dodged or glazed over despite multiple requests for more information.
• "Midwives don't perform episiotomies". Except that when you press her for details as to who is cutting into you with a scalpel, she confesses that midwives, with all their years of medical training do in fact perform them.

On top of all of this, our experience with their examinations would be laughable if it weren't terrifying. Different midwives have "examined" Christina and found:

• The baby hadn't grown in 2 weeks.
  • An ultrasound, performed by an actual doctor, showed that the baby was fine. The midwife just wasn't measuring properly.
• The baby had turned. The midwife pointed to the location of the head, feet, etc.
  • An ultrasound, performed by an actual doctor, showed that the midwife had a completely backward notion of where the baby actually was.

These are the "professionals" you expect to protect you and your baby from injury and death. These women cut into you and make critical life-and-death decisions. The women who lie when the facts don't suit their worldview, and demonstrably don't have the skills (or perhaps just the interest? It's unclear which is worse) to gather the evidence needed to perform the work for which they're responsible.

Women as Baby-Making Machines

The above is disturbing for anyone headed into a life-threatening medical procedure, but unfortunately it's just the start. Imagine a situation where your appendectomy surgeon says to you: "What's really important here is that we save that appendix". You would be understandably alarmed. Surely the doctor's job is to make sure you survive the procedure... right?

If there's anything that's made abundantly clear though our dealings with NHS midwives it's that they don't care about women. Concerns about pain or long-term disability are either shrugged off or met with the same response:

Don't worry, worst case scenario, you won't be able to have another baby for a couple years.

That's right, you had a question about whether your sexual organs would ever be able to work properly again, and the "professional" let you know that the real question is whether or not you'll be able to give birth again soon.

To the midwife, every woman is just a baby-making machine.

The midwives have told us that they operate under what they call "assumed consent" during the birthing process. In other words, you're given the opportunity to outline what your needs are during childbirth, what your red-lines are around things like forceps and C-sections, and then those requirements are promptly thrown out in favour of what the midwife feels is best in the moment. The same professional that couldn't tell you where the baby was a few weeks ago.

If the aromatherapy and hypnobirthing hasn't done the trick and labour goes bad, the midwife makes the call as to whether she'll try to cut your perineum, or if she'll call the doctor to come with the forceps. C-section is typically off the table unless the baby is in real danger. Even more exciting is that these choices are time-sensitive: once the baby is far enough down the birth canal, a C-section becomes very dangerous -- but they might do it anyway.

You don't get a say in any of this. Your consent is assumed, and for the parts where legally your consent is still required, try standing up for your rights when you're hemorrhaging in a bathtub.

The Realities of Geography

So that's the state of things in this backward country. Christina had her final scan at 28 weeks and now we get to depend on the expert opinions of the midwives as their magic fingers somehow figure out if the baby has turned and if it's likely to be small enough not to irreparably harm her.

If somehow the complete lack of knowledge of the situation fails to produce a smooth & uneventful birth, it's unlikely that we will be able to refuse the use of forceps. We just get to hope that the overworked, underpaid doctor using medieval tools to operate on a woman he's never met and knows nothing about won't accidentally maim Christina, kill the baby, or just cause her brain damage.

Hope. In twenty fucking eighteen, people in the UK don't have pre-natal scans to determine child position and size, or properly educated medical help, but they have hope, because hope doesn't cost money.

Statistically speaking, the UK is a disaster on this file compared to other European countries. In countries with high rates of C-sections (either elective or as a first go-to for emergencies) forceps births are much, much lower:

	Vaginal spontaneous	Vaginal instrumental	Elective Caesarean	Emergency Caesarean
Germany	62.2	6.4	15.4	15.9
Italy	58.6	3.4	24.9	13.1
Romania	62.5	0.5	3.8	33.1
England	62.8	12.6	9.9	14.7

Source: Royal College of Obstetricians and Gynaecologists

What's Next

We've been told that the hospital here flatly denies maternal requests for C-sections, despite the fulfillment of such requests being officially part of the NHS guidelines. We've talked about it, and Christina is comfortable with the "natural" method so long as she can trust that in the event that things go wrong, that forceps will not be used, but rather she would go straight to C-section.

But that's the problem: trust. There just isn't any between us and these budget midwives. They've lied to us, pushed an agenda, demonstrably ignored evidence and best practise in favour of ideology. They're grossly unqualified to cut into another human being, and have directly stated that they have no intention of adhering to Christina's wishes. I don't know what we're going to do, what we can do in this situation.

This is a Feminist Issue

Critically, and as a feminist, I find much of how we treat childbirth outrageous. From where I'm standing I see a bunch of crazy people, crazy women, imposing their whacked-out religion on other women under the guise of "taking back" pregnancy & childbirth from the evil doctors.

It's framed as a battle between "women know better because women" and "doctors want to medicalise everything for profit", but this is a preposterous comparison. The UK is suffering from shortages of nurses and doctors. There's no drive -- especially in a nationalised health care service -- to medicalise anything for profit. The motivation is quite the opposite, so this a blatant myth, a myth fact-phobic hippies are using to beat women into submission.

If this were a prostate cancer treatment, you can bet there'd be outrage. Men aren't socialsed to shut up and put up with whatever society foists upon us, but women are a different story. Women are being fed this lie that childbirth is safe & magical, that massage, hypnosis, and essential oils are just as good as ultrasounds because they're "natural".

Most importantly, women are told that to deny this myth is a betrayal of the feminine, that good mothers sacrifice for their children and so they shouldn't be concerned about what happens to them. This is bullying and oppression, by women, of women.

If this was an organisation of unqualified men insisting that bullshit snake oils were all women needed, that the risks weren't real, and that any concern for the mother's health made her a bad mother, we'd all know what to call it. But it's women pushing this fantasy, and so we play along. We set public policy to fund treatments that don't work, to employ people that lie to their patients.

I'm seething. I'm angry that the state would do this to my wife, but I'm even more angry that society has bought into this fantasy so much that getting professional help for a dangerous procedure is near impossible.

We can hope everything will be alright, but I think any rational person would take knowledgeable professionals over hope any day.

Update: 2018-12-24

As we've spent more and more time in the midwife system here, we've realised that there's effectively two types of midwife in the NHS. There's the hippy-dippy anti-vaxxers, and the battle-hardened, evidence-based decision makers. The line appears to be drawn between the people who give advice & visit you at home vs. the people who actually deliver the babies in a hospital. Much of what you see in this post comes from our experiences with the former, but since this post was written, we've had the opportunity to sit down with a few not-crazy midwives -- one of whom was visibly disturbed when we talked about our experiences above.

We're feeling a lot better about the process now. The biggest hurdle for us was one of trust: whether the midwife on-site during the birth would have Christina's best interests at heart, or whether she would let ideology and logical fallacies drive her decision making. Now that we've had a chance to sit with the not-crazy midwives, we have a lot more trust in the system.

This isn't to say however that there aren't some seriously dangerous idiots in the midwifing system or that they don't enjoy an undeserved amount of cover for their insanity under a stolen banner of feminism. There's no excuse for "medical professionals" to be recommending homeopathy under any circumstances and these people need to be fired. I just don't want to tar all midwives with the same crazy brush. It would seem that a few (far too many) bad (hippie) apples are reflecting poorly on the rest.