Saturday, 25 June 2011

Birth Stories

My daughter, born at the Royal Free Hospital in 2003, arrived two weeks late. The natural birth I had planned at the Edgware Birth Centre was annulled when I went ten days past my due date. Late babies are considered a ‘complication’ and so I was referred to the Royal Free where I was promptly booked in for an induction. I had very little idea of what this meant other than they would artificially prompt my baby to be born and that the whole process would be quick and not- I was assured- hugely different to a normal labour. It was anything but. I arrived at hospital on a Monday and was examined by a string of doctors and shifted from one room to another for a total of five days. I was tired and stressed and cried a lot. I was reprimanded by a midwife, who warned me that if I carried on the way I had been, I would end up with a caesarean. My husband felt helpless and quite often angry. By the third day I was so exhausted that I went home (against the wishes of the hospital staff) to try and get some rest. I knew this baby wasn’t ready and I was certain that the doctor’s repeated efforts at inducing her were becoming more detrimental than effective. When she did finally arrive, after countless gels, injections and the artificial rupturing of membranes (but no Caesarean- had I behaved like a good girl after all Mrs Midwife?) we were made to feel lucky because at least she was healthy.

My stay in the maternity unit left me feeling weak, undernourished (the hospital food is another element of the NHS that is leaves a lot to be desired) and as if I had been completely undermined by most of the staff.  Stories like mine are regretfully plentiful. Back in March I read how the author, Maggie O’Farrel, found herself at the hands of an incompetent team who left her haemorrhaging and close to death. Like me, O’Farrell gave birth to her first child eight years ago at the Royal Free hospital in Hampstead, an occasion that was marked, not by the euphoric, joyful emotions that childbirth should bring, but instead by fear, anxiety and pain. The moment in which she undergoes her emergency Caesarean is described in terrifying detail: the doctors rummaged inside her like ‘people who had lost something at the bottom of a suitcase’. O’Farrell returned to the Royal free six years later for the birth of her second child, only to find it as mismanaged as her first. Despite her obvious trauma, she is quick to talk down her own experiences as inconsequential compared to parents who have lost babies. Perhaps she is right to- loosing a child must be one of life’s greatest tragedies and yet there is nothing remotely marginal about O’Farrell’s experiences. Her life was endangered at a time when it should have been safeguarded and nurtured. There should have been no risks involved. O'Farrel was having a baby, not a triple bypass surgery. People have babies (and often by Caesarean)  every minute of every day… so why are we not able to handle this reality in the UK?

Cases of negligence are rife in hospitals across London. I have spoken to women who have sustained birth trauma (physical and/or emotional) at hospitals such as St. Mary’s (Paddington) Queen Charlotte’s and Chelsea (Hammersmith) and Barnet. My sister’s experience at St. Mary’s is one such case. Her son was born in 2005, premature and unable to breathe due to a congenital condition called choanal atresia where the nasal airways are blocked  by body tissue.The doctors tending to his birth acted with efficiency and speed, rushing the baby to intensive care and in effect saving his life but it was the after care of the parents that was badly handled. Soon after her labour, my sister was abandoned in a wheelchair in the corridor, forgotten by the midwife who was supposed to be caring for her. She was alone and distressed, separated from her husband who had been told to go home because  ‘visiting hours’ were over. Eventually she was wheeled to the postnatal ward where she was forced to  wait for news of her sick baby whilst listening to the other mothers’ cooing with delight over their newborns.

Stories of maternal neglect also make regular headlines in the press. Last year, a mother died from a cardiac arrest after she was induced at Queens Hospital in Romford. Sareena Ali suffered a ruptured womb, which led to massive organ failure. Doctors were then forced to carry out an emergency Cesearean but the baby was stillborn. According to her husband, Mrs Ali was in agonising pain before the cardiac arrest but his desperate attempts to rouse attention were dismissed by the “uncaring, incompetent” midwifes. Five women including Mrs Ali have died at this hospital in the last eighteen months. An independent inquiry is now being held.

These are shocking stories. We are not, after all, living in a third world country. How is it possible that women are still enduring birth trauma or at worst, facing the possibility of death? Of course, we have to accept that any birth can take a sudden, dramatic turn. Complications can arise- erratic foetal heartbeats, large babies, breech babies, but surely we have the medical expertise to deal with such problems?

Of course amongst the ‘horror’ stories there are also many tales of positive hospital births. I have friends who gave birth at St. Mary’s, Barnet and the Royal Free amongst others and were impressed with the high level of care they received. My sister went on to have her second child at the Royal Free in 2010 and did not have a single complaint about the care she received before, during or after the birth of her daughter. These women chose a hospital environment for their first, second or third babies because they knew they would feel safer there. For many people a hospital is the natural environment in which to give birth.

Regardless of how or where we decide to give birth, there is I feel, a principal element behind what is so wrong with maternity care in this country: the profound lack of communication and sensitivity between the medical teams and their patients. Parents are often left feeling misinformed, confused, helpless and ultimately let down by the very people who are supposed to be supporting them. The repercussions from such negligence can be detrimental, affecting the bond between mother and baby or mother and father and also possibly triggering the onset of postnatal depression or PTSD (post-traumatic stress disorder).

Antenatal care is often also poor in the UK, with many women seeing a completely different midwife at each check up and for as little as ten minutes on each visit. Then there is the problem of the ‘rigid’ birth plan.  Expectant parents are encouraged to write down a birth plan without ever being warned of all the possible outcomes. Women become fixated on a specific idea (particularly that of a natural birth) and are then left feeling worthless and incompetent when the birth does not go according to their expectations. I have spoken to many mothers who felt hugely disappointed by their first birth experience. They all shared similar views and emotions: they felt anger towards the staff who had misunderstood or mistreated them but they also blamed themselves for not being more active in the choices made during labour. As a consequence many of these women were then struck by guilt, self-doubt and postnatal depression.

For months after my daughter’s birth, I felt anxious, paranoid, depressed and haunted by my ‘decision’ to have the induction. I also blamed my husband for allowing the induction to go ahead. At no point had I considered that I would not have the type of birth I had so neatly laid out in my birth plan. This may sound na├»ve but nobody prepares you for the myriad of eventualities that might come your way. Now I realise that a single birth plan is inconceivable. I wish that somebody had had the foresight to talk me through every eventuality. Isn’t this what prenatal care is all about? As a result parents are entering the moment of labour completely uneducated and unprepared. Some people may argue that nothing can prepare you for the mysterious miracle that is birth. But as miraculous as it may seem, it is no mystery! Doctors and midwifes have been delivering babies for centuries.

Last year my son was born at home. Unlike O’Farrel, I knew that I could not have another baby in a hospital environment. Not because I had any wish to martyr myself with the act of a natural, pain free birth (having taken drugs for headaches, flu and period pains most of my life I was not about to dismiss the value of drugs when necessary!) but because I knew that I would labour much better if left to my own devices, without a string of doctors, midwives, other patients or even student doctors (yes, first time round I actually had a group of trainees gawping at me during one of my more miserable moments!)

I spoke to as many mothers as I could and trawled the Internet in the hope of discovering stories that would give me the strength and confidence to have a baby with as little medical interference as possible. I visited local birth centres and researched the possibility of a home birth. I knew that this time round, I would wait the full two weeks after my due date. I was even prepared to go for longer if I felt that the baby’s health was not going to be compromised. I was aware that in countries such as France women’s due dates are set around the 41st week mark instead of 40. This time I would not be bullied into booking an induction. 

I decided to have the baby at home, encouraged by the wonderful midwifery team at the St. Mary’s Birth Centre. From my first appointment I was made to feel confident and in control of my own pregnancy and the forthcoming labour. My midwife came to visit me at home every week for the last two months, staying for as long as I wished her to. She brought with her remedies, laughter and much wisdom. I have many friends who wished they had received such friendly and loving care.

My decision to have a home birth was met with a wide range of conflicting emotions amongst family and friends. Many were shocked, particularly my father-in-law who felt we were putting ourselves in danger. My parents remained silent and I knew this meant they were worried. At least three close friends (all with children) were horrified that I would be willing to witness all the blood and gore of childbirth in my own living room. Anther good friend asked if, please, would I not reconsider and get myself to hospital when the time came.

My son’s arrival into the world was a profoundly positive experience. Of course like most births it was not without its moments of drama. I panicked when the contractions sped up massively and our midwife was still not with us. My husband saw his (not so happy) future flash before his eyes when, for a couple of painstaking seconds, the midwife couldn’t locate a foetal heartbeat. In the end our baby boy arrived safe and well, into the hands of my husband who immediately passed him to me. Our daughter, woken by the commotion, came downstairs to meet her baby brother. After his birth we all sat snuggled on the sofa (the very place he was born) in a cocoon of love and wonder. Our midwife took photos, made us tea and left us to it.

Six months later and I am still full of amazement at how smoothly and gently my son was born. I felt euphoric for weeks after labour and have not been plagued by a single moment of self-doubt or depression. 

Of course many of you will be thinking… But what if? What if our son had not been breathing and the midwife had been unable to resuscitate him? What if there had been a major complication and the ambulance arrived too late to save me or the baby. What if? What if? All these questions point to the principal problem that we face when dealing with birth in this country: Fear. Scaremongering. We have been brainwashed into feeling anxious and frightened about giving birth.

We need to take action in order to educate and empower ourselves so we can move towards creating a nation full of positive and active birth stories. We- mothers, fathers, doctors, midwifes- are intuitive and talented beings, capable of making sure that our babies are delivered safely and holistically whether it be in a hospital, a birth centre, at home or if nature intends, on the seat of a taxi or the floor of a shopping mall. Our bodies are designed to bring babies into this world. There should be no fear, no horror involved.

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