NICE birth guidance

I’m not an advocate of any particular kind of birth other than that which ends up with a healthy mother and child. The problem is, of course, that no particular one kind of birth delivers that in all cases. Birth is an inherently dangerous procedure. The fact that it is natural, the fact that women are designed to labour and deliver and babies are designed to be born does not negate the risks involved for both. Nature, in its wisdom, has seen fit to make something which can be gloriously straightforward and empowering something which also can, on occasion, be excruciating, complicated…and fatal.

How could I be an advocate of any particular kind of birth, or in any way define my identity by one, when I have had three completely different experiences? Before I was even expecting my first I knew that I would deliver at our local hospital, and so – after a textbook pregnancy and early labour – I did. But it became apparent as things progressed that his head – which would turn out to be above the 100th centile line for size – had, for whatever reason, turned sideways. Some babies may come out ear first, but I’d warrant not many. He wasn’t one of them, anyway. Had we not had access to a surgical theatre (prompt, rather than emergency) he, and quite possibly I, wouldn’t be here. I support a charity now, Fistula Foundation which supports women in the developing world who weren’t as lucky as we were. I don’t take risk in birth lightly, or ever forget how fortunate I was to have had that risk in my case dealt with so expertly.

The simple fact of having had one caesarean section, though, meant that there were tough choices when I was pregnant a second time. Scans showed that this baby was much smaller. My midwife, consultant and I all knew that I’d laboured spontaneously and productively and that there was no reason to think that the same thing would happen again. I didn’t want another caesarean unless it was medically necessary. They are amazing and life saving operations, but they have their own risks and recovery would have been complicated with a 19 month old. So I chose to try for a VBAC (vaginal birth at caesarean) at another hospital which had a specialist team and which had the reassurance of obstetric-led care if there was a problem. This time, though, there wasn’t.

I expected the same thing with my third, though at a different and much bigger hospital,  till my community midwife asked if I’d thought about a home birth. I hadn’t, I had always assumed that it wasn’t a practical option in my circumstances. Supported by her, though, I read and read and read (and agonised and agonised and agonised) and decided to go for it.

It was a difficult choice to make. I don’t know now if I’d make the same one again – not least, because pregnancies are so very different even when it’s the same woman having them. Nor, although it was a positive experience for us, would I ever recommend it to anyone – there are so many factors to take into consideration – although I would certainly encourage them to look into it for themselves.

What I eventually realised through all that reading and agonising was that there was no such thing as an absolutely safe birth. No-one can guarantee that there will be no complications. No amount of preparation or precaution can eliminate all risks – whether immediate or subsequent. The risks in each case are different in type and severity, of course. For me, there was the very concrete fear of a sudden catastrophic problem at home (highly unlikely, but possible) versus the risks that could arise from having a very managed, medicalised birth in a hospital setting. We want, at this moment of all moments, to be given a definite answer – but there isn’t one. We can only (and not many of us, myself included, are very good at this) take on board the statistics and the evidence and calculate the exact risk/benefit ratio that we are comfortable with.

The new guidance from NICE this morning, that second-time mothers with low risk factors are as safe birthing at home/midwife-led unit as they are in a hospital, is interesting, but already is being lost in a welter of finger-pointing and hurt. Perhaps naturally, people with strong feelings (and painful experience) on both sides are being heard the loudest; each side trying to get across its passionate convictions as to the “best” way – which, equally naturally, leaves those who have different and opposing experiences feeling judged.

Some things go without saying. There is a shortage of midwives. There is a lack of certainty that there will be continuity of care. There’s huge pressure on resources and there are too many women who are frightened and traumatised by their experiences in birth. All of these things need to be addressed. But the answer is never to oversimplify the decisions which a woman has to make, even with the best of intentions. Instead, it’s to try to turn that passion into pragmatic, practical support. To help her to assimilate all the facts and make the decision that is right for her and her child – and to make sure that there is an infrastructure and culture which don’t blame or make her feel guilty if things don’t go as planned.


2 thoughts on “NICE birth guidance

  1. Indeed there is no such thing as a 100% safe birth. However a plethora of research tells us that those risks are reduced for most women when they stay away from hospitals and the patriarchy of doctors whose main concern is the potential pound to be made from women who now in submission when they innacurately throw around the ‘risk’ word.

    Women who live at a reasonable distance from the hospital take no longer to get to theatre than those on labour ward. It is rare to need a real crash section. Furthermore, those staying away from the hospital are lessening their risk of operative delivery.

    Unfortunately women are exposed to both ends of the extremely varied options. Either the doctor telling them they are irresponsible and putting their baby at risk for choosing homebirth, or the ‘hippy’ midwife and homebirth advocate who recommends homebirth irrespective of risks. Both are dangerous but this is what women are accessing.

    I purport the answer is for better ante-natal education. Evidence-based non-biased education to enable women to make their own INFORMED decisions about what is best for them and their family.

    1. Absolutely. I also think that those attending women (and I wish there were more like you) were more upfront in validating and respecting a woman’s choice made in consideration of all factors. I completely agree that the two extremes seem to prevail – and that is dangerous and damaging

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