How to give birth in a maternity care crisis
(and avoid life-long trauma)
Last week I wrote about the childbirth of esteemed British artist Elizabeth Waggett.
Elizabeth, who hails from the North of England but now lives in Texas, had as straightforward a pregnancy as they come.
At 36, kids had never been part of the plan. But when the surprise double line popped up, she soon felt excited.
Also not part of the plan was the seventh circle of hell that she entered exactly 24-hours after giving birth to her (miraculously) healthy baby girl.
In short: she’d been left completely paralysed from the hips down as a result of nurses failing to move her legs from the lithotomy position (frog’s legs, like you’re having a smear test) for seven hours.
Her nerves were crushed in the stance while she was waiting for her baby’s head to drop, which left her reliant on a wheelchair for seven months.
Elizabeth’s story was the latest in a series of horrific childbirth stories that I’ve reported on over the last five or so years - both in the UK and in the US, where I live now.
There was the woman who sent me harrowing images of her baby’s crumpled and scarred head that had been ripped from her cervix with forceps, after a 48-hour labor that left her begging for a c-section.
Or the woman who was stuck with life-long incontinence after a misadvised vaginal delivery resulted in a 3rd degree tear (that means from front to back).
And not forgetting the countless women who’ve told of their agonising battle with breastfeeding, with nurses and midwives insisting they ‘push through’ for the good of their babies, despite the blood from their burning, brusied nipples streaming through their maternity bras.
I was also recently haunted by the story of Louise Thompson’s birth; the reality TV star almost bled to death during an emergency c-section, for which she spent the duration wide awake.
The most shocking statistic of all: black women are nearly four times more likely to die in childbirth or within the year after having a baby compared to white women.
These stories are perhaps not at surprising as they once were, given what we now know about what’s happening on many maternity wards across the UK - as well as some in the US.
Last month, a cross-party parlimentary enquiry into birth trauma in Britain concluded that good care is 'the exception’ rather than the rule, with many women treated as an ‘inconvinence’.
The report was commissioned off the back of the atrocious failures at the Shrewsbury and Telford NHS Trust - where a dangerous obsession with vaginal deliveries led to the deaths of 200 babies and nine mothers.
There were similar ongoings at a Nottingham NHS Trust, where a staggering 600 babies died as a result of internal mistakes.
I was surprised to learn that it’s not much better across the pond, although the problems are different.
The US is currently seeing mass closures of vital maternity services up and down the country. One recent report found that a third of counties are ‘maternal health deserts’ - places where there are no obstetricians or post/prenatal care specialists. Unlike the UK, where midwives are involved in the vast majority of births, the US has an obstetrician-led culture, which means patients are cared for by doctors and nurses.
In the UK, there are some 43 midwives per 1,000 births compared to America's four per 1,000, according to one report.
It means problems other than the most serious, life-threatening ones are often dismissed or not considered - like, for instance, the risks of keeping a woman’s legs held up by her ears for four hours. Maternal mortality rates have doubled in the US since 1999, mostly due to staffing and funding issues.
With all this in mind, anyone who plans to step aboard the baby train - whether sooner or later - might be feeling, well, fucking terrified.
So, I thought it wise to collate all the intel I’ve come across over the years, as well as advice from one of the most vocal campaigners on the issue, to tell you what I tell my pregnant friends.
NB: Despite what feels like an endless stream of women suffering life-ruining complications, the majority have no problems at all.
In 2016, a major review of millions of British births found that just under 90 percent of women who have had children before suffer no complication - including the use of an instrument to get the baby out, c-section, pelvic injury and haemorrhage. Unfortunately, for women who’ve never had a kid, the figure plummets to 57 percent.
YOU CAN CHOOSE A C-SECTION IF YOU WANT ONE
According to official UK guidance, any woman can choose to have a c-section if they want one. Hospitals prefer you not to have one because there are more risks of giving birth this way compared to a vaginal delivery. Having said that, much of this research is based on women who have more than one child, which used to be the norm but isn’t necassarily these days.
You might get a letter from the hospital saying they won’t perform it. But that’s fine because you have the right to choose somewhere else that will. If you are determined to have a c-section, keep pushing until you get one. So long as it’s safe according to your doctors, of course.
DON’T BELIEVE EVERYTHING YOU HEAR IN ANTENATAL CLASSES (OR SKIP THEM ALTOGETHER)
Campaigner Catherine Roy has spent the past five years studying everything there is to know about UK maternity services, following her own traumatic birth. While she’s not a medic, Catherine has elite knowledge about what goes on behind the scenes - specifically when things go wrong. Many of the horror stories she’s seen can be traced back to dodgy advice dished out by antenatal teachers.
‘Rememeber that you don’t have to have any qualifications to lead an antenatal class,’ she says.
‘And stay away from instagram. There is a lot of misinformation out there which you’ll want to block out. Every pregnancy is unique so anyone who tells you what applies to someone else also applies to you isn’t to be trusted.’
I recently heard of a doula with no medical qualifications convincing a woman in late-stage pregnancy to ignore doctors’ recommendations for an induction. She followed the doula’s advice to wait and, subsequently, the baby died.
Engage with your assigned healthcare professionals (nurses, midwives, OB/GYN) as much as possible, says Catherine.
‘Go to all your scans, blood tests, urine tests. Focus on your antenatal medical care and block out everything else.’
REMEMBER YOU CAN GO TO ANOTHER HOSPITAL - EVEN AT THE VERY LAST MINUTE
I’ve heard countless stories of women who speed up to hospital when their labour begins, only to be told to f off home.
I have never given birth. But I can imagine how utterly terrifying and isolating this must feel. Sometimes, women might prefer to labour at home for as long as they can. But, if you feel safer and more comfortable in a hospital, you can choose any hospital that will take you.
‘You can go whereever you want,’ says Catherine. ‘Legally they can't turn you down if you are in labour.’ She adds that it’s especially important to hot foot it to any hospital if you get the sense your baby isn’t moving.
‘Also, if you’re in a lot of pain and you need medication. No woman should have to suffer through it. Demand to be seen at the hospital and don’t take no for an answer.’
IF YOUR WATERS BREAK, MOVE QUICKLY
Most women will go into labour within about 12 hours of their waters breaking, and give birth within a day or two. The waters ‘breaking’ actually means the amniotic sac has broken and is no longer protecting you and the baby from potentially deadly infections, which can lead to sepsis.
While timings vary depending on the pregnancy, the American College of Obstetricians and Gynecologists say labour should start within a day to be safe, which could mean inducing you. It also means this is when you should be in a sterile environment to avoid infection.
IF YOU’RE NOT HAPPY ASK FOR THE MANAGER
There appears to be a depressing theme among the women I’ve spoken to, all of whom have given birth in UK hospitals. They say staff don’t listen to them, and shoo away their complaints as if they’ve moaned about the soup being too cold.
‘If you’re on the ward and they’re not listening to you, escalate your concerns,’ says Catherine. ‘Ask to speak to the manager of the ward or, if it’s midwife run, ask to speak to a doctor.
‘Put pressure on them by asking what’s happening next and when it will happen. It’s important to have a time-frame. Be insistent and be ready to argue.’
Admittedly, this can be tough to do when you’re writhing in pain. It’s helpful to have a stubborn advocate beside you who is not afraid to be a Karen.
YOU SHOULDN’T BE PUSHING FOR HOURS ON END
There’s an interesting debate among obstetricians regarding how long is an appropriate (and safe) amount of time for a woman to be pushing before the medical team decide enough is enough, and take her to theatre for a c-section.
Years a go, the accepted logic was that it was far better for a woman to be pushing than undergoing a major operation that subjects her to life-threatening risks including major hemorrhage.
However. Scientists have since discovered the life-ruining impact of prolonged pushing on the pelvic floor - namely nerve damage, horrific tissue tears and muscle destruction that can leave a woman with permanent disabilities including incontinence.
There is also the risk of infection mentioned above.
Doctors have told me that two hours is probably the absolute maximum a woman should be pushing for, and ideally no longer than 20 to 30 minutes.
MOVE! …REGULARLY!
This brings me on to my next tip, informed by the story of Elizabeth, who I mentioned above.
The lithotomy position is the stance that you will likely take while pushing the baby out. But regular movement is crucial, as staying this way for too long puts extreme pressure on the sciatic and femoral nerves in your pelvis and hips, putting them at risk of damage.
A Facebook community for women who’ve suffered nerve damage as a result of childbirth boasts 2,500 members - and many of them have partial paralysis because of the injury.
US guidelines recommend that women are moved every 30 minutes to an hour to safeguard the nerves, but in a busy labour ward, this doesn’t always happen.
It’s especially important if a woman has had an epidural, preventing her from being able to get up and walk about - or even straighten her legs - independently.
BREAST IS NOT ALWAYS BEST
If there’s anything I know about motherhood, it’s that, most of the time, you feel like you’re not very good at it. At least that’s what my own mother tells me. And it strikes me that struggles with breastfeeding is one of the earliest triggers of this belief.
I’ve received letters from new mothers telling me they’re consumed with self-hatred because of their inability to partake in this ‘natural’ bonding experience. I find this all rather depressing.
Who says that breastfeeding makes you a better parent? Science certainly doesn’t.
Most of the studies looking at the benefits of breastfeeding are observational, which means they don’t all account for other factors that also influence the health of a child. Breastfeeding mothers are often more likely to be middle class, live in better housing and have more time to dedicate to cooking healthy, balanced meals. Perhaps these factors could explain the reduced rates of obesity in breastfed kids, rather than the ‘elixir’ that is milk from a boob.
Having said that, a recent high-quality trial involving 17,000 women found that after 11 years both formula and breast fed children were just as likely to be obese.
It is true that breastfed babies have slightly lower rates of ear infections and allergies. But the difference is minimal. In my opinion, far better to have an extra ear infection every two years if it means your mother isn’t wailing in agony and miserable about her new occupation as a one-woman pumping machine.
Just an FYI, I wasn’t breastfed and I turned out fine. Sort of.
PAIN RELIEF BEYOND EPIDURAL EXISTS
About 60 percent of women who give birth opt for an epidural. Millions of doses of the anasthetic are given every year - not just for labour pains - and, in the vast majority of cases, it is complication-free.
Studies estimate that in between one in 54,000 and one in 141,000 (a big difference, I know) cases, the treatment can lead to severe complications like paralysis. This is usually because the needle has been positioned incorrectly, or you’ve contracted an infection in the wound.
However, a far more common complication of an epidural is a specific type of intense headache known as a post-dural puncture headache. This feels like a terrible migraine which starts within a week of the epidural in around one in 100 cases.
It happens when the fluid that protects the spine and the brain leaks out of a puncture hole and affects the delicate balance of fluid surrounding the brain.
Some go away on their own. But many don’t - and medical help should be sought ASAP as if untreated, the leakage carries a risk of bleeding around the brain.
Some 70 percent of cases can be easily treated using something called an epidural blood patch, where your blood is injected into your back to seal the hole that caused the leak. Some women might need to undergo this procedure several times.
This is not intended to put you off an epidural. I think the benefits overwhelming outweigh the risks. In fact, a recent study found that women who have epidurals are less likely to suffer life-threatening birth complications than those who don’t.
However, there is little-known alternative that might be worth discussing with your team if you’re averse to the spine-needle situation.
Last year, health chiefs NICE approved the opioid remifentanil as an epidural alternative. This is potent pain relief that allows you to retain more movement and is administered via a vein in the arm, rather than a spinal infusion.
It wears off quickly so doctors allow you to top it up yourself using a nifty button - although this means you need pretty constant monitoring because the drug can cause a drop in oxygen levels.
‘The observations are more intense with this drug which means that it’s not ideal from a staffing point of view,’ says Catherine. ‘I imagine that’s why a lot of women don’t get offered it.’
Still, it’s worth asking for it. And if you can’t, that’s where your pushy birth partner comes in.