The article unfortunately confuses several issues, which shouldn’t be allowed to detract from the general argument made.
It needs correcting that there is hardly any research into the “natural ideal”. There is lots of scientific research into natural maternity care. Indeed, it was prompted by real world data showing it is generally far safer. All medical intervention carries risk. It turns out less is more for most child births. This is most simply evidenced by the safest performing maternity systems in the world having far lower rates of medical intervention and fewer c-sections. Of the Western healthcare systems, (after adjusting for obesity related complications and immigration) the USA and UK have significantly lower rates of natural birthing and very poor newborn mortality rates.
That said, natural childbirth is not to be confused with complimentary therapy or doing nothing. The article reveals an NHS maternity system with midwives that have confused complimentary holistic guff with scientifically proven techniques for managing natural birth. Natural childbirth isn’t hands off either: natural child birth requires robust medical risk screening at all stages of pregnancy including through every moment of delivery.
These maternity issues aren’t restricted to the NHS. The entirely different healthcare system in the USA is suffering the same problems. Clearly, this is a cultural problem. This cultural problem afflicts both patient groups and midwifery: the loudest voices in both groups silencing moderate voices and dictating how midwife services work for everyone. The “Guardian reader” effect.
The underlying issue is rejection of the scientific method. Instead, UK midwifery is now guided by bodies like the NCT which prioritise anecdotal experience above statistical significance. This is a part of a much broader societal malaise in the UK, and rapidly growing elsewhere in the West. It is no coincidence that the more scientifically literate societies of Japan, Finland, Estonia, and Singapore manage to combine natural childbirth with the very best, very safest maternity care in the world.
Ideology is the enemy. There is also a reluctance to give pain relief when desired. My own birth in 1946 I am told involved a battle between nurses who were reluctant to give pain relief and my father a pathologist and my mother who desired such help. So such issues are not new.
The birthing classes delivered at the hospital to my wife and me and other couples who were encouraged to make birthing plans were entirely unrealistic in the face of real needs during the actual process.
I agree it’s now culturally ingrained amongst parents and is going to take a lot of work and re-education for things to change.
I attended positive birthing group sessions, it was the only option open to me in the very rural area I live.
The attitudes I heard shocked me, women considering home births after CS, a women with a newly diagnosed heart problem determined to persevere with her home birthing plan against consultant advice.
I’m a paramedic and therefore have, limited, obstetrics training and experience, I’ve seen shoulder dystocia, and I’ve listened to traumatised colleagues recounting blow by blow accounts of transverse lies out of hospital, and catastrophic haemorrhages. But still I began to absorb the pervading ethos of hands off at all cost.
Then I went to visit a close friend, we got talking about birthing. My friend is a obstetric disaster story. Of her 4 babies one was an extreme premi due to complications of, an ultimately unnecessary, amniocentesis, one required episiotomy and forceps, the next was tragically stillborn at term due to an abruption, nobody’s fault just horrendous bad luck, the fourth was the most heavily monitored pregnancy you could imagine with a planned C section delivery.
My friends advice to me was, so long as you walk out of the hospital with a healthy baby in your arms within a reasonable time frame after the birth, how you get to that point really doesn’t matter. If it’s natural birth – fine, if baby needs a bit of assistance – fine, if you need a C section – fine.
After that I ripped up my birthing plans I’d already started and rewrote them, much simpler, and I lot more “if the midwife or doctor feels they need to intervene then they have my consent to go ahead without further discussion”.
As it was I had a natural delivery, monitored via scalp attached monitor throughout, and home next day.
The problem isn’t just silly women and midwives who are against intervention. So often in cases where thing go wrong the problem is “experts” not listening to womens’ concerns – this doesn’t t just apply to maternity care. Women need to have a voice to Improve outcomes. If you adopt a “you’re the expert Dr, you know best” attitude, what happens when you know you need intervention and the Dr doesn’t listen?
The NCT was new and therefore private in the UK when I gave birth and what I’d learned from them decidedly annoyed the NHS so I ended up being shaved, given an enema(SP?) and treated much like a farmer treats his herd so that nothing would get in the way of the obstetriction’s clean hygenic experience. Harsh lighting, noise, constant internal interference actually slows down the birth. Episiotomies were routine regardless, therefore stitches followed. Kindness was not on the agenda, a screaming woman in the shared labour ward was actually slapped. This, would you believe it, was at the EGA back in the 1970’s! Just as patriarchal as any male institution.
A thought experiment for the men here to consider. Have you tried pooing in a busy corridor with lots of other men and a doctor popping his finger up your nether regions to see how far your feaces have descened? Not at all condusive to a pleasant evacuation, wouldn’t you say?
My NCT instructor, a white South African, was frank about natural childbirth and gave a list of things that can go wrong. Her instructons were, if this happens abandon natural and go tech she warned. She continued, there are foolish romantic ideas of African women just crouching down and dropping babies without any fuss or pain. It’s not true the death rate in child birth is high, around one in six. The probem is that once the NHS got it hands on natural childbirth it became an ideology ( probably influenceed by economic presures) and so lost its basic commonsense.
I don’t see this as an either/or decision process. I want to be able to express my desire to manage my health care along with understanding that a doctor has a lot of experience that I don’t have, and is often in a better position to make a decision.
Great post. Natural is best is a pretty good heuristic, but it’s far from infallible and needs to be backed up with science. And so called “natural” practices are not always natural at all.
I suspect that part of the cultural history is that in the US and U.K., feminism became entangled with all sorts of new ageism and counter cultural currents. The natural became associated with the good and the female. The unnatural, with the bad and the male. Science was even portrayed as a kind of “rape” of “mother earth”.
This cultural trend was not as strong in other countries.
The “bad and male” also feeds into the fact that midwives are almost all female and most obstetricians are male.
Stuart Bennett
5 months ago
The NHS is probably trying to save money on consultants and medication so they can afford more diversity champions. Because god forbid any organisation would be be doing what it’s meant to be doing nowadays.
Vast sums are expended every year on other things which might be avoided – such as ever-rising premiums paid to the Medical Negligence Scheme, the NHS provision for payouts following avoidable errors resulting in injuries and deaths.
These are due to internecine battles between consultant firms, different professions and sheer damn carelessness and perennial failure to “learn lessons”. All the funding in the world won’t change those things. Personal liability would, starting with automatic demotion and retraining where negligence is found.
Childbirth is a minefield. No woman should have a certain philosophy of birth foistered on her unknowingly. Is there a problem with the education programs at the NHS? Do women understand the reasons why birth interventions are avoided as much as possible, in order to minimize further and further interventions? These women clearly felt they were voiceless in the system, vulnerable and some have even lost their babies. Ironically, it’s the natural birth movements that have steered maternity care away from a doctor based model in which the experiences of terrible harm took place and women were required to be completely passive in the process. Mandatory episiotomies anyone? Clearly women are a significant part of the birth process (!!) and the monumental reforms in childbirth practice (kitzinger, odent) placed women rightly in the centre. But women don’t deserve to be lied to. If you are having a baby, get independently educated and prepare yourself well.
Childbirth for the first time is a shock. It’s painful. It’s not at all romantic, It’s hard work. A women’s body goes into an incredible mode that is both awe inspiring and a little scary. No amount of lavender oil will hide that reality.
You mean to say ‘modern maternity care’. There have been midwives caring for women for 1000s of years. Of course medical intervention is life saving in childbirth (and is sadly lacking in many parts of the world) but for the majority of women, it is not needed. The problem is when women with healthy normal pregnancies are channelled into a system that anticipates the worst, when well prepared, these women are likely to have a straightforward birth.
Women died in childbirth in the past for many reasons. Poverty, poor hygiene, higher risk of infection, lack of access to midwives.
Many many more women will end up dying in childbirth when we’ve forgotten how normal birth takes place and become completely dependent on a surgeon and an operating table!
Quite! One thing which is now a rare creature is a fully confident, capable midwife. So many now seem to spend most of their time watching machines, rather than recognising signs.
I’ve certainly seen how one intervention leads to another, until you have a full blown emergency on your hands, with neither the woman nor the staff feeling in control.
Indeed, outcomes improved markedly with the understanding of hygiene and infection care. That alone counts for more than we know.
Peter B
5 months ago
“Most focus on funding and staffing — which almost everyone agrees the NHS is lacking.”
Always claimed. Never proven.
I for one disagree. The first order problems with the NHS are not to do with funding, but management, organisation, culture and priorities. Until we get to grips with those, throwing more money at it will only make it worse. Similar to Brooks’ First Law of software project management: “adding manpower to a late software project only makes it later” – a critical observation of the communications and organisational overhead of large and poorly managed organisations.
I disagree too, Peter.
The NHS gets 9% of UK GDP in taxpayer funding, 11% of GDP in total funding when private funds are included. Same as the health systems in New Zealand, the Netherlands, Sweden and Japan. Only France, Germany and the USA spend a higher % of GDP in taxpayer funding.
As for staffing, the Conservative manifesto in 2019 was aiming for 50k extra nurses over the course of the parliament. That target was hit in Sept 2023 with 51,234 extra nurses having been recruited. The total nurses in the NHS went from 300,904 to 352,000.
In my firm we run “lean” which means that extra resources and money are almost never available and managers need to hit their targets using their existing people. This requires a laser-like focus on the teams critical objectives, jettisoning any distractions or “nice-to-have” objectives, accurate monitoring of success and failure and only recruiting and retaining managers who can do the job – and sacking those that cannot.
That is what the NHS requires.
Vesper Stamper
5 months ago
I don’t have time to go into how confused this article is, as Nell Clover says below. As a former midwifery apprentice, childbirth educator and doula who had two home births in which complications were competently managed, it seems that normal birth—which most women can and do have—is treated as a tool of abuse.
The author states: “It seems that a cash-strapped NHS had allowed a “nature-knows-best” approach to flourish in order to conceal their inability to meet the needs of women’s medical care.”
This is a good premise, and I’ll grant that in a mandatory system like NHS one can anticipate that cost-cutting bureaucracy would, of course, want to don the mask of “natural childbirth” to justify neglect. But that’s not what I read here.
In midwifery we talk about the “cascade of interventions”, in which emergencies often begin several steps back in the childbirth process, even before labor begins at all. We don’t know why a baby ended up in distress or why a mother ended up in emergency surgery, but the message persists that childbirth is inherently dangerous, which is not true.
The nineties and early 2000’s produced reams of scientific literature about the inherent safety of the birth process and how easily interventions can cascade into a mess. But somewhere in the 2010s, it seems, we abandoned that notion in women’s health and swung back to a belief that a woman’s body—and her baby’s—is her enemy. I’m sure we can think of examples of that belief on multiple levels. But this gnostic holdover swings back into fashion every now and then and freaks us out, and we must refuse.
Emergencies and tragedies do happen. Life is disappointing and terrible and I wish we could make it perfect. But the more important thing is to examine what led early on to the emergency so that care providers can do better. Obviously not monitoring heartbeats and offering essential oils for infection is no standard of care at all—to call it neglect is to say almost nothing. But very often, these are iatrogenic issues and not the fault of the birth process itself, or else we wouldn’t be here with 9 billion people on the planet—and don’t tell me that’s because of the miracle of the epidural.
But somewhere in the 2010s, it seems, we abandoned that notion in women’s health and swung back to a belief that a woman’s body—and her baby’s—is her enemy.
Thank you for an interesting post. I don’t know enough to verify the above, but am not surprised by it. So many of these things seem to swing back and forth based on ideology and fashion rather than science. Indeed, they seem to track social trends in wider society far better than they track scientific evidence. Worse yet, sometimes the scientific evidence seems to track social trends too.
And what is science apart from our attempts to understand nature, usually through reduction, often missing the whole picture? As a mother of four I feel very uncomfortable with the idea of my body, pregnancy and birth being reliant on scientific evidence. I trusted myself and my body’s innate knowledge, and the more I did this the easier the births were. Including twins. All natural births, all over aged 34.
Thank you so much for this comment. And for your work.
David Morley
5 months ago
set up the feeding organisation to challenge thinking around a breast-is-best mentality
We need to recognise that both sides in this debate are ideological, and originate in different takes on feminism. The pro bottle side is about freeing women from the limitations of child rearing. Whether breast is best should be determined scientifically, not by an ideology. If it is best, then women should be told that plain and simple. Their choice is then an informed one.
Yes, this was one of the more head-smacking moments in the article for me. Breast is best, and yet we recognize not every woman can (for myself it took a team of caregivers to rescue my supply), and not every woman chooses to for whatever reason, and yet babies needn’t starve to death as a result. We can recognize that breastmilk is best for babies and not let it become ideology.
It should be determined neither by science nor by ideology (isn’t science in the end also an ideology?), but women being empowered to trust their bodies. As Vesper has said, things can go wrong and this is a part of life. The adoption of the upright stance in humankind has meant that women must give birth through a narrow pelvis and it is simply harder for us than for many other mammals. But things are much more likely to go wrong if we are made to be afraid, to be stressed, to think we have a kind of right to do it all pain-free.
You’re promoting your preferred ideology here, I’m afraid. If you empower women you give them information, choice and agency. You don’t set out for them the direction that should take them. That is disempowering.
And as some of the women commenters have pointed out, simply trusting their bodies would have been misplaced in their case.
madeleine muir-wyett
5 months ago
I was at my fittest when I got pregnant at 29 with my daughter. In a dance studio all day. Doing yoga and swimming and cycling. Always been slim- 8 stone and 5’5 1/2 – absolutely normal healthy physique. My labour ended up an emergency C section as my baby was big. We both would have died in days gone by as would my mother if not for medical interventions. It is nonsense that child birth is usually safe and when it is natural. Never has been. Many young women in past knew that it might be a death sentence.
Yes. But you are up against an ideological history which sees the “medicalisation” of childbirth as an invasion of female spaces by men. In the past midwives were women, doctors were men.
Even in the comments to this piece you will see people trying to deny that the involvement of the medical profession in childbirth was a good thing – putting the massive improvements in child and mother survival down to non medical issues like hygiene alone.
Stephen Bryan
5 months ago
Reading between the lines of those heart rending investigations into infant death or disability the commonest feature is failure of midwives to act on foetal distress or to not even properly monitor, and calling in obstetrician or neonatal paediatrician too late, but this is rarely made explicit in the summary. My wife and I both doctors and intended to go NHS, but lost confidence during antenatal process and went private. A middle class option not available to most. Sadly midwive training is now light on medical facts, and the trainers tend to be natural birth zealots. Obstetrics once attracted good doctors but not now, many units are made toxic by midwife vs doctor politics so not considered good career option and units struggle to fill consultant posts.
Thank you for sharing. Your post perfectly encapsulates what we experienced 16 mos ago.
Midwife in hospital failed to monitor dropping infant heart rate. Support called in very late. Emergency c-section by good docs (we were lucky there) saved the day.
Throughout labour, midwife offered opinion & conjecture, few facts … even literally arguing at bedside with anesthesiologist during labour … before angrily continuing complaining to us privately after the doc had left the room.
My parents are a surgeon & a nurse, and I grew up with a certain expectation of quality explanation and care.
The NHS antenatal process startled & alarmed me, but as my wife wanted to continue, we didn’t turn to private.
It’s an error we’ll certainly correct if she one day regains the courage to go through the process again following the trauma of this bad first one.
Rainer Zuhlke
5 months ago
It beggars belief that after a plethora of scandals the NHS still enjoys quasi-religious status among a large majority of the UK population. No, I’m not pushing a US-like health system. Several countries in continental Europa have much better health systems that the entire population enjoys. At the same or often lower cost for the state and the society.
As a side note – my first wife insisted to give birth to our first child at home because that appeared to be the “natural” way. After this experience (no details), she decided to give birth to our second child in hospital (not in the UK).
Margie Murphy
5 months ago
It seems women are at the van guard of the natural childbirth ideology. Women’s inhumanity to women can be a terrible thing. Childbirth is nasty, brutish and painful and spouting birthing women as warriors serves only to create a myth and childbirth as a means onto itself in this silly quest for female heroics. A safe delivery with the minimum of pain and trauma should be the “birthplan”. Mine were all caesarions which was totally fine by me. I won the lottery with mine. I would encourage any woman to dispense with the heroics and the theatrics and prioritise safety and comfort with out the risk of PTSD and post natal.depression which seems to be a result of many of these unnecessary childbirth battles.
I couldn’t agree more with this. There is an unsettling and bizarre masochism that accompanies the natural birth movement. Feminists took over from the misogynist birth experience of the past to box women into a very narrow, and often life threatening worldview of bringing new life to the planet. In the past young men met their death on the battlefield and young women in the process of giving birth. Not everyone met their fate this way but large numbers did. Women are the absolute worst offenders when it comes to pushing a guilt ridden diatribe around birth, nursing and infant care. Two planned sections for me and two very healthy 4000 gram boys. Only my female friends saw my experience as some sort of defeat.
We all have different experiences. I found the interventions in my birthing processes deeply upsetting and disempowering. But maybe the bottom line is whether we have come to expect technological support as a human right, and therefore to demand it and rely on it – which means we lose our autonomy and touch with our natural bodies. It’s the path to transhumanism. I’d quite like to see Mary Harrington respond to this article!
I can say conclusively that without a c-section I would have had a seriously poor outcome. Do you get your teeth pulled without anesthetic? We never used to. Is it trans human to rely on that technology or common sense? There’s a massive gap between pain reduction and saving a women’s life and having surrogates and external wombs. I believe you misunderstand Mary’s vision of transhumanism and your view further demonstrates this sort of malign derision towards women for needing medical intervention to birth. Not everyone does, but for those who do, we are eternally grateful.
I would not like to try to speak for the great Ms. Harrington and it would be valuable to hear from her directly on the topic but her published writing does speak of the very difficult time she had during the birthing process. It sounds as though her and perhaps her babies health were at great risk during and for a time afterward…. So one should not presume she would have issue with good and necessary medical support…
Catherine Farrar
5 months ago
I accept a lot of maternity care is poor and of course it does happen that staff fail to intervene when they should. I’m sorry to hear the writer had such a bad experience but I can’t accept the argument that there is a cult of natural birth when intervention rates are the highest they have ever been. Less than half of women have a spontaneous labour with more than half either planned C-section or induced and of these spontaneous labours many will then have in labour caesarian or instrumental delivery not to mention other interventions. Very few women have a “natural” birth. I’m speaking as a woman who has had interventions herself so I have no axe to grind here.
Charlie Two
5 months ago
Basically, at every level, the NHS is ideological, marxian to the core, and utterly shite.
Daniel Lee
5 months ago
Seriously, folks, the Left is going to kill us all with their civilization-eating nonsense if we don’t stop them. This piece is just today’s example.
Totally. Thank god we’ve had a Tory government running things for years and the NHS, and everything else, is going wonderfully. We should all give daily thanks to the intellectual and political colossi this has given us. Boris Johnson, Matt Hancock and Liz Truss, to name but three.
All good leaders. Unfortunately British politics seems to be full of flowers who see themselves as leaders. Not a good situation to be in when everyone has a dagger, for “ceremonial purposes” only.
The Government doesn’t run the NHS, NHS England runs the NHS. Ministers can do very little to influence how it operates, other than to accede, or not, to demands for more money.
Another disaster courtesy of Blair’s “arm’s length bodies”.
Thank you. This needs repeating again and again until it finally sinks in with the public at large. The government funds the NHS. The NHS managers manage it (with varying degrees of success). Bad managers need to be fired. But you never see it happening in the public sector.
To be fair to the managers, they are in a situation in which the lack the power they need to manage effectively. They are pretty toothless, and the medical profession is very powerful.
I honestly think it’s the wrong model. It makes users the weakest stakeholder in the whole system, by taking their money from them, handing it over to the provider, then leaving them to try and get a service with no bargaining power.
David, this is sarcasm, right? I certainly hope so!
Dionne Finch
5 months ago
It’s not just a fantasy that natural birth can be beautiful, peaceful, bonding…I had three home births and one hospital birth. The home births were beautiful, the hospital birth full of strange people, noises and smells, my baby whisked off and cleaned up before cuddles.
Yes – but we shouldn’t extrapolate from that to everyone’s experience. I was present at all three of mine, and they were all like that. And I do think a positive attitude can help. But it can still be a very tough experience.
David Morley
5 months ago
Throughout the mid to late-20th century, feminist movements interested in reclaiming women’s bodies began to have influence on midwifery.
Another good “cultural archaeology” piece, tracing current practices to the ideas, and intellectual turning points of the past. There was a time when medicine generally, and it’s relation to maternity in particular, was seen as patriarchal, oppressive and deliberately robbing women of agency. The “medicalisation” of pregnancy.
As a side note, feminism in France was very different, following both Cartesianism and existentialism in seeing nature itself as oppressive – especially to women. Older French feminists are still very critical of what they call “naturalism”.
Dougie Undersub
5 months ago
Isn’t it complementary therapies? Or was the use of complimentary a little joke about care being “free at the point of delivery”?
Cynthia W.
5 months ago
“… a picture is being painted in the NHS of a custom-made journey of self-discovery that allows women to realise their true biological and spiritual potential.”
Oy.
When the government holds the purse strings, all sense in budgeting goes out the window. Yet again, women and children are the ones being deemed expendable.
Alan Hawkes
5 months ago
I the worst outcomes, with the worst medical neglect, is there not a case for charging those medical staff responsible with manslaughter through negligence?
Daniel Lee
3 months ago
Of a piece with the Left’s ongoing assault on Western standards of civilization. They do not have the right to drag us along in their attempted cultural suicide.
Tobias Mayer
3 months ago
All four of my children were born at home, two in the UK in the 1990s with NHS midwives, and 2 in the USA, with an independent, private midwife. The private experience was slightly better, as it was with just one midwife (with support at birth time) while the UK experience was with a team, some of whom we were compatible with and some not. It was a bit hit-and-miss, but the births both went well enough. My wife was in labour for a full 52 hours with our first son, and yet being at home she was allowed to take her time, and birth naturally. In hospital they’d probably have rushed it or performed a cesarian as they would have needed the bed. My two daughters, born in the USA were both born in birthing tubs, a gentle and calm process. In all four cases we knew that if the birth started to look difficult the hospital was close by. I am a big advocate of natural, home birth. It doesn’t work though if it is a cost-saving tactic by an overworked and underpaid NHS. The problem is not natural childbirth (remember, unnatural, doctor-assisted/drug-assisted birth in the UK is only been around 80 years or so) it is a broad, and ever-dwindling misunderstanding of the natural process of childbirth, and the stress and even guilt the mother is made to feel in hospital (and now NHS home) births. Natural birth isn’t a “cult”. I’d say it is actually hospital birth—where drugs and even stirrups are frequently used, and a mother is little more than a cog or component in the ‘birth machine’—that is the cult. And the sooner we can collectively be de-hypnotised from this cult the better for society—and every mother and child therein.
The article unfortunately confuses several issues, which shouldn’t be allowed to detract from the general argument made.
It needs correcting that there is hardly any research into the “natural ideal”. There is lots of scientific research into natural maternity care. Indeed, it was prompted by real world data showing it is generally far safer. All medical intervention carries risk. It turns out less is more for most child births. This is most simply evidenced by the safest performing maternity systems in the world having far lower rates of medical intervention and fewer c-sections. Of the Western healthcare systems, (after adjusting for obesity related complications and immigration) the USA and UK have significantly lower rates of natural birthing and very poor newborn mortality rates.
That said, natural childbirth is not to be confused with complimentary therapy or doing nothing. The article reveals an NHS maternity system with midwives that have confused complimentary holistic guff with scientifically proven techniques for managing natural birth. Natural childbirth isn’t hands off either: natural child birth requires robust medical risk screening at all stages of pregnancy including through every moment of delivery.
These maternity issues aren’t restricted to the NHS. The entirely different healthcare system in the USA is suffering the same problems. Clearly, this is a cultural problem. This cultural problem afflicts both patient groups and midwifery: the loudest voices in both groups silencing moderate voices and dictating how midwife services work for everyone. The “Guardian reader” effect.
The underlying issue is rejection of the scientific method. Instead, UK midwifery is now guided by bodies like the NCT which prioritise anecdotal experience above statistical significance. This is a part of a much broader societal malaise in the UK, and rapidly growing elsewhere in the West. It is no coincidence that the more scientifically literate societies of Japan, Finland, Estonia, and Singapore manage to combine natural childbirth with the very best, very safest maternity care in the world.
Ideology is the enemy. There is also a reluctance to give pain relief when desired. My own birth in 1946 I am told involved a battle between nurses who were reluctant to give pain relief and my father a pathologist and my mother who desired such help. So such issues are not new.
The birthing classes delivered at the hospital to my wife and me and other couples who were encouraged to make birthing plans were entirely unrealistic in the face of real needs during the actual process.
I agree it’s now culturally ingrained amongst parents and is going to take a lot of work and re-education for things to change.
I attended positive birthing group sessions, it was the only option open to me in the very rural area I live.
The attitudes I heard shocked me, women considering home births after CS, a women with a newly diagnosed heart problem determined to persevere with her home birthing plan against consultant advice.
I’m a paramedic and therefore have, limited, obstetrics training and experience, I’ve seen shoulder dystocia, and I’ve listened to traumatised colleagues recounting blow by blow accounts of transverse lies out of hospital, and catastrophic haemorrhages. But still I began to absorb the pervading ethos of hands off at all cost.
Then I went to visit a close friend, we got talking about birthing. My friend is a obstetric disaster story. Of her 4 babies one was an extreme premi due to complications of, an ultimately unnecessary, amniocentesis, one required episiotomy and forceps, the next was tragically stillborn at term due to an abruption, nobody’s fault just horrendous bad luck, the fourth was the most heavily monitored pregnancy you could imagine with a planned C section delivery.
My friends advice to me was, so long as you walk out of the hospital with a healthy baby in your arms within a reasonable time frame after the birth, how you get to that point really doesn’t matter. If it’s natural birth – fine, if baby needs a bit of assistance – fine, if you need a C section – fine.
After that I ripped up my birthing plans I’d already started and rewrote them, much simpler, and I lot more “if the midwife or doctor feels they need to intervene then they have my consent to go ahead without further discussion”.
As it was I had a natural delivery, monitored via scalp attached monitor throughout, and home next day.
I’m sure you’re not suggesting that if a woman is treated without respect and dignity that’s okay as long as the baby is healthy?
The problem isn’t just silly women and midwives who are against intervention. So often in cases where thing go wrong the problem is “experts” not listening to womens’ concerns – this doesn’t t just apply to maternity care. Women need to have a voice to Improve outcomes. If you adopt a “you’re the expert Dr, you know best” attitude, what happens when you know you need intervention and the Dr doesn’t listen?
The NCT was new and therefore private in the UK when I gave birth and what I’d learned from them decidedly annoyed the NHS so I ended up being shaved, given an enema(SP?) and treated much like a farmer treats his herd so that nothing would get in the way of the obstetriction’s clean hygenic experience. Harsh lighting, noise, constant internal interference actually slows down the birth. Episiotomies were routine regardless, therefore stitches followed. Kindness was not on the agenda, a screaming woman in the shared labour ward was actually slapped. This, would you believe it, was at the EGA back in the 1970’s! Just as patriarchal as any male institution.
A thought experiment for the men here to consider. Have you tried pooing in a busy corridor with lots of other men and a doctor popping his finger up your nether regions to see how far your feaces have descened? Not at all condusive to a pleasant evacuation, wouldn’t you say?
My NCT instructor, a white South African, was frank about natural childbirth and gave a list of things that can go wrong. Her instructons were, if this happens abandon natural and go tech she warned. She continued, there are foolish romantic ideas of African women just crouching down and dropping babies without any fuss or pain. It’s not true the death rate in child birth is high, around one in six. The probem is that once the NHS got it hands on natural childbirth it became an ideology ( probably influenceed by economic presures) and so lost its basic commonsense.
I don’t see this as an either/or decision process. I want to be able to express my desire to manage my health care along with understanding that a doctor has a lot of experience that I don’t have, and is often in a better position to make a decision.
To say nothing of having the equipment and ability to intervene.
Great post. Natural is best is a pretty good heuristic, but it’s far from infallible and needs to be backed up with science. And so called “natural” practices are not always natural at all.
I suspect that part of the cultural history is that in the US and U.K., feminism became entangled with all sorts of new ageism and counter cultural currents. The natural became associated with the good and the female. The unnatural, with the bad and the male. Science was even portrayed as a kind of “rape” of “mother earth”.
This cultural trend was not as strong in other countries.
The “bad and male” also feeds into the fact that midwives are almost all female and most obstetricians are male.
The NHS is probably trying to save money on consultants and medication so they can afford more diversity champions. Because god forbid any organisation would be be doing what it’s meant to be doing nowadays.
Vast sums are expended every year on other things which might be avoided – such as ever-rising premiums paid to the Medical Negligence Scheme, the NHS provision for payouts following avoidable errors resulting in injuries and deaths.
These are due to internecine battles between consultant firms, different professions and sheer damn carelessness and perennial failure to “learn lessons”. All the funding in the world won’t change those things. Personal liability would, starting with automatic demotion and retraining where negligence is found.
As we see in today’s news, culprits simply get another job elsewhere.
https://www.bbc.co.uk/news/health-67565498
Childbirth is a minefield. No woman should have a certain philosophy of birth foistered on her unknowingly. Is there a problem with the education programs at the NHS? Do women understand the reasons why birth interventions are avoided as much as possible, in order to minimize further and further interventions? These women clearly felt they were voiceless in the system, vulnerable and some have even lost their babies. Ironically, it’s the natural birth movements that have steered maternity care away from a doctor based model in which the experiences of terrible harm took place and women were required to be completely passive in the process. Mandatory episiotomies anyone? Clearly women are a significant part of the birth process (!!) and the monumental reforms in childbirth practice (kitzinger, odent) placed women rightly in the centre. But women don’t deserve to be lied to. If you are having a baby, get independently educated and prepare yourself well.
Childbirth for the first time is a shock. It’s painful. It’s not at all romantic, It’s hard work. A women’s body goes into an incredible mode that is both awe inspiring and a little scary. No amount of lavender oil will hide that reality.
Didn’t some terrifying percentage of women and/or children die in natural childbirth before the advent of maternity care?
You mean to say ‘modern maternity care’. There have been midwives caring for women for 1000s of years. Of course medical intervention is life saving in childbirth (and is sadly lacking in many parts of the world) but for the majority of women, it is not needed. The problem is when women with healthy normal pregnancies are channelled into a system that anticipates the worst, when well prepared, these women are likely to have a straightforward birth.
Women died in childbirth in the past for many reasons. Poverty, poor hygiene, higher risk of infection, lack of access to midwives.
Many many more women will end up dying in childbirth when we’ve forgotten how normal birth takes place and become completely dependent on a surgeon and an operating table!
Quite! One thing which is now a rare creature is a fully confident, capable midwife. So many now seem to spend most of their time watching machines, rather than recognising signs.
I’ve certainly seen how one intervention leads to another, until you have a full blown emergency on your hands, with neither the woman nor the staff feeling in control.
Indeed, outcomes improved markedly with the understanding of hygiene and infection care. That alone counts for more than we know.
“Most focus on funding and staffing — which almost everyone agrees the NHS is lacking.”
Always claimed. Never proven.
I for one disagree. The first order problems with the NHS are not to do with funding, but management, organisation, culture and priorities. Until we get to grips with those, throwing more money at it will only make it worse. Similar to Brooks’ First Law of software project management: “adding manpower to a late software project only makes it later” – a critical observation of the communications and organisational overhead of large and poorly managed organisations.
I disagree too, Peter.
The NHS gets 9% of UK GDP in taxpayer funding, 11% of GDP in total funding when private funds are included. Same as the health systems in New Zealand, the Netherlands, Sweden and Japan. Only France, Germany and the USA spend a higher % of GDP in taxpayer funding.
As for staffing, the Conservative manifesto in 2019 was aiming for 50k extra nurses over the course of the parliament. That target was hit in Sept 2023 with 51,234 extra nurses having been recruited. The total nurses in the NHS went from 300,904 to 352,000.
In my firm we run “lean” which means that extra resources and money are almost never available and managers need to hit their targets using their existing people. This requires a laser-like focus on the teams critical objectives, jettisoning any distractions or “nice-to-have” objectives, accurate monitoring of success and failure and only recruiting and retaining managers who can do the job – and sacking those that cannot.
That is what the NHS requires.
I don’t have time to go into how confused this article is, as Nell Clover says below. As a former midwifery apprentice, childbirth educator and doula who had two home births in which complications were competently managed, it seems that normal birth—which most women can and do have—is treated as a tool of abuse.
The author states: “It seems that a cash-strapped NHS had allowed a “nature-knows-best” approach to flourish in order to conceal their inability to meet the needs of women’s medical care.”
This is a good premise, and I’ll grant that in a mandatory system like NHS one can anticipate that cost-cutting bureaucracy would, of course, want to don the mask of “natural childbirth” to justify neglect. But that’s not what I read here.
In midwifery we talk about the “cascade of interventions”, in which emergencies often begin several steps back in the childbirth process, even before labor begins at all. We don’t know why a baby ended up in distress or why a mother ended up in emergency surgery, but the message persists that childbirth is inherently dangerous, which is not true.
The nineties and early 2000’s produced reams of scientific literature about the inherent safety of the birth process and how easily interventions can cascade into a mess. But somewhere in the 2010s, it seems, we abandoned that notion in women’s health and swung back to a belief that a woman’s body—and her baby’s—is her enemy. I’m sure we can think of examples of that belief on multiple levels. But this gnostic holdover swings back into fashion every now and then and freaks us out, and we must refuse.
Emergencies and tragedies do happen. Life is disappointing and terrible and I wish we could make it perfect. But the more important thing is to examine what led early on to the emergency so that care providers can do better. Obviously not monitoring heartbeats and offering essential oils for infection is no standard of care at all—to call it neglect is to say almost nothing. But very often, these are iatrogenic issues and not the fault of the birth process itself, or else we wouldn’t be here with 9 billion people on the planet—and don’t tell me that’s because of the miracle of the epidural.
Thank you for an interesting post. I don’t know enough to verify the above, but am not surprised by it. So many of these things seem to swing back and forth based on ideology and fashion rather than science. Indeed, they seem to track social trends in wider society far better than they track scientific evidence. Worse yet, sometimes the scientific evidence seems to track social trends too.
And what is science apart from our attempts to understand nature, usually through reduction, often missing the whole picture? As a mother of four I feel very uncomfortable with the idea of my body, pregnancy and birth being reliant on scientific evidence. I trusted myself and my body’s innate knowledge, and the more I did this the easier the births were. Including twins. All natural births, all over aged 34.
Thank you so much for this comment. And for your work.
We need to recognise that both sides in this debate are ideological, and originate in different takes on feminism. The pro bottle side is about freeing women from the limitations of child rearing. Whether breast is best should be determined scientifically, not by an ideology. If it is best, then women should be told that plain and simple. Their choice is then an informed one.
Yes, this was one of the more head-smacking moments in the article for me. Breast is best, and yet we recognize not every woman can (for myself it took a team of caregivers to rescue my supply), and not every woman chooses to for whatever reason, and yet babies needn’t starve to death as a result. We can recognize that breastmilk is best for babies and not let it become ideology.
It should be determined neither by science nor by ideology (isn’t science in the end also an ideology?), but women being empowered to trust their bodies. As Vesper has said, things can go wrong and this is a part of life. The adoption of the upright stance in humankind has meant that women must give birth through a narrow pelvis and it is simply harder for us than for many other mammals. But things are much more likely to go wrong if we are made to be afraid, to be stressed, to think we have a kind of right to do it all pain-free.
but women being empowered to trust their bodies
You’re promoting your preferred ideology here, I’m afraid. If you empower women you give them information, choice and agency. You don’t set out for them the direction that should take them. That is disempowering.
And as some of the women commenters have pointed out, simply trusting their bodies would have been misplaced in their case.
I was at my fittest when I got pregnant at 29 with my daughter. In a dance studio all day. Doing yoga and swimming and cycling. Always been slim- 8 stone and 5’5 1/2 – absolutely normal healthy physique. My labour ended up an emergency C section as my baby was big. We both would have died in days gone by as would my mother if not for medical interventions. It is nonsense that child birth is usually safe and when it is natural. Never has been. Many young women in past knew that it might be a death sentence.
Yes. But you are up against an ideological history which sees the “medicalisation” of childbirth as an invasion of female spaces by men. In the past midwives were women, doctors were men.
Even in the comments to this piece you will see people trying to deny that the involvement of the medical profession in childbirth was a good thing – putting the massive improvements in child and mother survival down to non medical issues like hygiene alone.
Reading between the lines of those heart rending investigations into infant death or disability the commonest feature is failure of midwives to act on foetal distress or to not even properly monitor, and calling in obstetrician or neonatal paediatrician too late, but this is rarely made explicit in the summary. My wife and I both doctors and intended to go NHS, but lost confidence during antenatal process and went private. A middle class option not available to most. Sadly midwive training is now light on medical facts, and the trainers tend to be natural birth zealots. Obstetrics once attracted good doctors but not now, many units are made toxic by midwife vs doctor politics so not considered good career option and units struggle to fill consultant posts.
Thank you for sharing. Your post perfectly encapsulates what we experienced 16 mos ago.
Midwife in hospital failed to monitor dropping infant heart rate. Support called in very late. Emergency c-section by good docs (we were lucky there) saved the day.
Throughout labour, midwife offered opinion & conjecture, few facts … even literally arguing at bedside with anesthesiologist during labour … before angrily continuing complaining to us privately after the doc had left the room.
My parents are a surgeon & a nurse, and I grew up with a certain expectation of quality explanation and care.
The NHS antenatal process startled & alarmed me, but as my wife wanted to continue, we didn’t turn to private.
It’s an error we’ll certainly correct if she one day regains the courage to go through the process again following the trauma of this bad first one.
It beggars belief that after a plethora of scandals the NHS still enjoys quasi-religious status among a large majority of the UK population. No, I’m not pushing a US-like health system. Several countries in continental Europa have much better health systems that the entire population enjoys. At the same or often lower cost for the state and the society.
As a side note – my first wife insisted to give birth to our first child at home because that appeared to be the “natural” way. After this experience (no details), she decided to give birth to our second child in hospital (not in the UK).
It seems women are at the van guard of the natural childbirth ideology. Women’s inhumanity to women can be a terrible thing. Childbirth is nasty, brutish and painful and spouting birthing women as warriors serves only to create a myth and childbirth as a means onto itself in this silly quest for female heroics. A safe delivery with the minimum of pain and trauma should be the “birthplan”. Mine were all caesarions which was totally fine by me. I won the lottery with mine. I would encourage any woman to dispense with the heroics and the theatrics and prioritise safety and comfort with out the risk of PTSD and post natal.depression which seems to be a result of many of these unnecessary childbirth battles.
I couldn’t agree more with this. There is an unsettling and bizarre masochism that accompanies the natural birth movement. Feminists took over from the misogynist birth experience of the past to box women into a very narrow, and often life threatening worldview of bringing new life to the planet. In the past young men met their death on the battlefield and young women in the process of giving birth. Not everyone met their fate this way but large numbers did. Women are the absolute worst offenders when it comes to pushing a guilt ridden diatribe around birth, nursing and infant care. Two planned sections for me and two very healthy 4000 gram boys. Only my female friends saw my experience as some sort of defeat.
We all have different experiences. I found the interventions in my birthing processes deeply upsetting and disempowering. But maybe the bottom line is whether we have come to expect technological support as a human right, and therefore to demand it and rely on it – which means we lose our autonomy and touch with our natural bodies. It’s the path to transhumanism. I’d quite like to see Mary Harrington respond to this article!
I can say conclusively that without a c-section I would have had a seriously poor outcome. Do you get your teeth pulled without anesthetic? We never used to. Is it trans human to rely on that technology or common sense? There’s a massive gap between pain reduction and saving a women’s life and having surrogates and external wombs. I believe you misunderstand Mary’s vision of transhumanism and your view further demonstrates this sort of malign derision towards women for needing medical intervention to birth. Not everyone does, but for those who do, we are eternally grateful.
I would not like to try to speak for the great Ms. Harrington and it would be valuable to hear from her directly on the topic but her published writing does speak of the very difficult time she had during the birthing process. It sounds as though her and perhaps her babies health were at great risk during and for a time afterward…. So one should not presume she would have issue with good and necessary medical support…
I accept a lot of maternity care is poor and of course it does happen that staff fail to intervene when they should. I’m sorry to hear the writer had such a bad experience but I can’t accept the argument that there is a cult of natural birth when intervention rates are the highest they have ever been. Less than half of women have a spontaneous labour with more than half either planned C-section or induced and of these spontaneous labours many will then have in labour caesarian or instrumental delivery not to mention other interventions. Very few women have a “natural” birth. I’m speaking as a woman who has had interventions herself so I have no axe to grind here.
Basically, at every level, the NHS is ideological, marxian to the core, and utterly shite.
Seriously, folks, the Left is going to kill us all with their civilization-eating nonsense if we don’t stop them. This piece is just today’s example.
Totally. Thank god we’ve had a Tory government running things for years and the NHS, and everything else, is going wonderfully. We should all give daily thanks to the intellectual and political colossi this has given us. Boris Johnson, Matt Hancock and Liz Truss, to name but three.
All good leaders. Unfortunately British politics seems to be full of flowers who see themselves as leaders. Not a good situation to be in when everyone has a dagger, for “ceremonial purposes” only.
The Government doesn’t run the NHS, NHS England runs the NHS. Ministers can do very little to influence how it operates, other than to accede, or not, to demands for more money.
Another disaster courtesy of Blair’s “arm’s length bodies”.
Thank you. This needs repeating again and again until it finally sinks in with the public at large. The government funds the NHS. The NHS managers manage it (with varying degrees of success). Bad managers need to be fired. But you never see it happening in the public sector.
To be fair to the managers, they are in a situation in which the lack the power they need to manage effectively. They are pretty toothless, and the medical profession is very powerful.
I honestly think it’s the wrong model. It makes users the weakest stakeholder in the whole system, by taking their money from them, handing it over to the provider, then leaving them to try and get a service with no bargaining power.
David, this is sarcasm, right? I certainly hope so!
It’s not just a fantasy that natural birth can be beautiful, peaceful, bonding…I had three home births and one hospital birth. The home births were beautiful, the hospital birth full of strange people, noises and smells, my baby whisked off and cleaned up before cuddles.
Yes – but we shouldn’t extrapolate from that to everyone’s experience. I was present at all three of mine, and they were all like that. And I do think a positive attitude can help. But it can still be a very tough experience.
Another good “cultural archaeology” piece, tracing current practices to the ideas, and intellectual turning points of the past. There was a time when medicine generally, and it’s relation to maternity in particular, was seen as patriarchal, oppressive and deliberately robbing women of agency. The “medicalisation” of pregnancy.
As a side note, feminism in France was very different, following both Cartesianism and existentialism in seeing nature itself as oppressive – especially to women. Older French feminists are still very critical of what they call “naturalism”.
Isn’t it complementary therapies? Or was the use of complimentary a little joke about care being “free at the point of delivery”?
“… a picture is being painted in the NHS of a custom-made journey of self-discovery that allows women to realise their true biological and spiritual potential.”
Oy.
She sounds…dissatisfied?
When the government holds the purse strings, all sense in budgeting goes out the window. Yet again, women and children are the ones being deemed expendable.
I the worst outcomes, with the worst medical neglect, is there not a case for charging those medical staff responsible with manslaughter through negligence?
Of a piece with the Left’s ongoing assault on Western standards of civilization. They do not have the right to drag us along in their attempted cultural suicide.
All four of my children were born at home, two in the UK in the 1990s with NHS midwives, and 2 in the USA, with an independent, private midwife. The private experience was slightly better, as it was with just one midwife (with support at birth time) while the UK experience was with a team, some of whom we were compatible with and some not. It was a bit hit-and-miss, but the births both went well enough. My wife was in labour for a full 52 hours with our first son, and yet being at home she was allowed to take her time, and birth naturally. In hospital they’d probably have rushed it or performed a cesarian as they would have needed the bed. My two daughters, born in the USA were both born in birthing tubs, a gentle and calm process. In all four cases we knew that if the birth started to look difficult the hospital was close by. I am a big advocate of natural, home birth. It doesn’t work though if it is a cost-saving tactic by an overworked and underpaid NHS. The problem is not natural childbirth (remember, unnatural, doctor-assisted/drug-assisted birth in the UK is only been around 80 years or so) it is a broad, and ever-dwindling misunderstanding of the natural process of childbirth, and the stress and even guilt the mother is made to feel in hospital (and now NHS home) births. Natural birth isn’t a “cult”. I’d say it is actually hospital birth—where drugs and even stirrups are frequently used, and a mother is little more than a cog or component in the ‘birth machine’—that is the cult. And the sooner we can collectively be de-hypnotised from this cult the better for society—and every mother and child therein.