Blog February 2013


​21.02.2013


If you want my opinion, I’d say “You’re right”

Today, someone I know announced her pregnancy to a group of dab-hand mums. This is her first baby and ​immediately the advice started flying around. Opinions, experiences, anecdotes and old-wives-tales. I have ​to admit that I joined in, only to add my positive tuppence-worth as I felt I had to balance the inevitable ​negative comments that people didn’t even realise they were making. You rarely hear someone say, “Wow, ​congratulations! You’ll love childbirth, it’s the most amazing and fulfilling experience. Prepare well and enjoy it.”

So what is it that compels us to give opinionated advice? And what makes us think that we are entitled to impress it in the first place, let alone on an impressionable woman? It’s not as if she stood there and openly asked a group of mothers to bombard her with stories. That was just an unavoidable repercussion of sharing the pregnancy news.

When I’m teaching antenatal childbirth classes, I often ask couples to write their birth story as if it has already happened. Of course stories range from “…pop and the baby just fell out, simple…” to “…it was long and challenging, but we did it and we’re very proud.” Sometimes the story talks about fear and coping. Sometimes yet not unusually the couple have a mental block around thinking how birth might be, so the story says nothing of the birth but more of the joy postnatally. Never has the story been one of horror like the ones the couples have been subjected to by their friends, families and even health professionals. Who, in their right mind, would write a self-fulfilling prophecy of doom?

One of the most obvious reasons that people give their advice is their own need for validation. They want to validate their past experiences. They want someone to say that they did it the right way and there was no other way. They want someone to say “that’s exactly what I would have done”, and what it really means is that they are dissatisfied with their experience. What benefit is it to a newly pregnant woman, for us to lay guilt and dissatisfaction like that on her? It’s a very selfish thing that we do.

Sometimes, I wonder if it’s the old adage that bad news sells. We seem obsessed with sensational, scandalised stories. The bad news programmes on TV relentlessly report about war, murder, violence and organised crime. The news generally undermines our confidence in our leaders and society in general. Even these journalists have realised that they must then soften their depressing reports at the end, so the “And finally…” good news story was invented. Having driven around the M25 many times, I can safely say that sometimes the traffic has been reasonable, sometimes at a standstill and sometimes I’m surprised that traffic is faster and freer flowing than I anticipated. The M25 has gotten a reputation as London’s car-park. And yet I have never returned home and announced to whoever will listen that I had a wonderful journey around the M25 today! No. But I will gladly moan about the traffic, the lane closures, the road works, the incompetent road users. Just like the editors of the TV programme One Born Every Minute, I have chosen to censor the good news and promoted the bad news. For the record, I liken the aforementioned programme to being in Big Brother: A self-selected group of people some of whom are eager to have their vaginas on television. A programme where watching the uncut version for 24 hours would be utterly boring, yet can be edited down to a one-hour interesting show for prime time viewing. Where the consenting adults have been cast for being interesting and different from the norm. In a specifically selected setting where interventions are expected to take place.

Part of qualifying as a childbirth educator meant I had to debrief my own experiences of birth and parenting because self-disclosure is generally not a helpful thing. It’s like saying that you have to do what I did, because that’s the right way. When people say “take all the drugs you can get in labour” or “let the baby cry themselves to sleep”, what they mean is “that’s what I did, and if you do something different, then you’ve decided that I did it wrong.” That’s just not true. We all make our own decisions and what’s right for you might not be right for me. What works for my family might not work for yours. But the point is that there is no right or wrong way. If there was only one way, there would only be one book on the subject. If you walk into any book store, you’ll find there’s a whole section on childbirth and parenting. The consensus is that there is no consensus.

All good childbirth educators know that what counts above all else is good quality research-based evidence. Quoting evidence that was badly researched, or has been outdated is at best unhelpful, and at worst dangerous. Anyone can write a bad piece of research. Only good quality, robust research should influence what we and our health professionals do.

Often, it can come across as childbirth educators are just preaching about homebirth or breastfeeding, on their own mini crusade. It then comes as a surprise that a great many childbirth educators have birthed by caesarean, experienced stillbirth, conceived by IVF, had an induced labour with epidural, fed formula milk to their babies and tried controlled crying. All professional childbirth educators have a responsibility to share what they now know with their clients. And what they know is that there are choices. Those choices belong to the couple and no one else. Others, including health professionals, may offer information and advice which we can only hope is based on good quality and up to date researched evidence. Others may help to guide the couple. But ultimately, the only right choices are those that the couple make.

Most choices a couple make will be to do with what is in the best interests of the baby and/or the mother. And I’m going to stick my neck out a bit here. Sometimes, the choices a couple might make are in the best interests of the mother but are purported to be for the baby. For example, during my classes, a lot of couples begin to explore the benefits of provisionally booking for birth at home. They know they don’t actually have to birth at home and can choose at any time to transfer in to a hospital. They also know that provisionally booking for home will halve their statistical chances of having a caesarean birth which, for a vast majority of people, is not their preferred mode of birth. During these discussions, a defensive couple set on a hospital birth will usually justify it by saying they want doctors and equipment nearby in case the baby needs it. Yet I have never asked anyone to justify their decisions. They are justifying it to themselves; but why? And then I wonder to myself, why they have chosen a hospital with only a special care baby unit (SCBU) rather than the one with a NICU (neonatal INTENSIVE care unit). Really, I suspect that any hospital will do if you just want drugs in labour. And that leads me on further to wonder; why make an effort to be healthier in pregnancy, avoid soft cheese, raw eggs, alcohol and cigarettes, only then to have all the drugs at the end. Before anyone points the finger at me, I will freely admit that I fell into these categories too.

I’m not planning on expanding my family any further and all this information buzzing around in my head is clearly of no personal use to me. So why do I bother to impart what I know for the sake of others? My motivation is that couples are satisfied with their experiences. That they know what their choices are, and that when they make choices they feel it was the right choice for them at that time. There’s little point in thinking about what could’ve or should’ve been, it’s all about the preparation.

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