The Dangers of Uninterpreted Birth Footage

Dear all,

 

It has always been my main critique of programmes such as One Born Every Minute that they give footage without comment, analysis or context thus rendering the information it provides at best un-useful and at worst downright misleading.  For instance watching a shoulder dystosia without some discussion about its rarity, on the fact that it’s occurrence is more likely in the semi recumbent position, and the various methods of dealing with the situation, renders the footage both distressing and misleading to watchers.

 

I remember years ago a theologian, I respect immensely contended that the Bible should not be read in public without appropriate interpretation to the listeners.  He gave the example of John 21 where after the crucifixion the disciples lock themselves in an upper room ‘for fear of the Jews’.  This passage without appropriate context and interpretation had been the justification for anti semitism and violence against Jewish people over many centuries.  However contextualised, you would realise for instance, that the disciples were Jews and Jesus was a Jew – so how could they lock the door for fear of ‘the Jews’ when this was their identity also?  This phrase is actually believed to come from the context of the writer of the Gospel some decades later, a context where Gentile Christians were being persecuted by the Jewish population in that area.   So the phrase ‘for fear of the Jews’ which has caused so much strife and suffering has little to do with the Gospel story itself and much to do with the context in which the story was written down.  “This,” said my friend Dave Bowen, “Is why the Bible should always be read with appropriate interpretation.”

 

I have come to think this same rule should apply to the sharing of birth stories and especially of the televising of birth.  Editing and comment is everything in these situations: We need to have the analysis and information to really interpret what is happening in its appropriate context.  This would mean discussion from different perspectives, disagreement and comment about the practice presented, enabling viewers and readers to get a real flavour of the variety of opinions and practices that  women can receive in their birth and the opportunities for choice there are.  It would also mean of course that practitioners would have to submit their practice to the discussion and comment of their peers in a public arena – it could be a brave practitioner and a very tactful editor who could accomplish that feat.  And yet without it women are being misled and misinformed by the ‘camera that never lies’.

 

With this in mind I came to this latest birth story to cross my desk.  As I read it, questions were raised in my mind and I thought, this is a lovely birth story but there are some real questions about the practice of the carers and the way policies are implemented and practice explained.  I felt that this birth story should not be published without some pointers and questions for further discussion. 

 

For instance:

  • Where does the 24 hour deadline for induction after waters breaking come from?  Where is the risk/benefit analysis of this policy?
  • Fantastic way to spend your early labour: on the allotment and walking the dog! Not worrying about progress or lack of it.
  • Could the midwife have avoided that devastating moment for the mother by giving her positive information that would encourage her efforts rather than dishearten? How could she have encouraged a woman making slow progress with her birth?  Is giving the information ‘1cm dilated’ as unhelpful as uninterpreted  birth footage? What about effacement? What about not giving a number but simply saying progress is being made but there is a way to go yet? What would a caring midwife say to a woman in this situation?
  • The most glaring question in this story is: if the TENS was not working and the pains were so strong – why did the mother wait so long to get in the pool? – particularly when it clearly gave so much relief?  Was she waiting for permission from the midwife? Why did she need it?

 

With these questions I hand you over to the Mother’s tale:

The arrival of Albert Oliver, 7th March 2012.

My waters broke when I woke up at 8.30am on Tuesday 6th March.  After getting in the shower I decided that they really had gone, and that I wasn’t just suffering from late pregnancy incontinence!  I rang my husband, Tony, who was already at work, and he headed home to be with me.  I also rang the delivery suite who rang the community midwife on call.  San came round at about 9.30am and confirmed my waters had gone.  She told me that I needed to ring them again when my contractions were 5 mins apart, and that should labour not begin within the next 24 hours, I was booked in for induction at 8.30am the next morning.

I spent the day with Tony and another friend, Carol.  Carol had arranged to visit that day anyway and help me rotovate my allotment. Poor Tony got roped in too.  I kept moving (light allotmenting jobs) throughout the day.  At 4pm Carol left, taking our dog with her.  Another friend called in, and we went for a walk, and had an evening meal at about 6ish.

Throughout the day I had been having contractions, and at about 7ish these became stronger and more regular.  I’d put my TENS machine on early in the day, as soon as I started feeling mild contractions. A bit after 8pm I rang the delivery suite again, as we were recording my contractions as coming every 2 to 5 mins.

Cat arrived at about 8.30pm, and after observing me, we decided that I would have an internal examination to see where we were up to.  I was really very nervous about this, as I hadn’t had any internal prodding so far in my pregnancy.  It was absolutely fine however, nowhere near as intrusive as I thought it would be.  However, the examination revealed I was only 1cm dilated at this point, and Cat commented that my contractions weren’t either consistent or long enough for me to be in established labour.

I was understandably devastated at this news (as it REALLY hurt by this point!).  Cat left, saying that I needed to call her when my contractions were every 2 minutes and lasting a full 60 seconds.   The next 2 and a half hours were not fun, and I caved in at 11.30pm and asked Tony to ring delivery suite.  Cat arrived by midnight and examined me again.  At this point I was 9cm dilated, and was incredibly relieved to hear it (as it REALLY REALLY hurt and the TENS machine by this point just didn’t seem to be cutting the mustard).

I finally got into the pool at about 12.30. We’d filled it around 6pm, so Tony needed to boil some kettles to get it back to temperature.  It felt amazing as soon as I got in, and made a massive difference to my pain management (the gas and air was making me too sick so I didn’t bother with it).  The second midwife dealt with further kettles after I got in the pool, as I didn’t want to let go of Tony’s hand.

Albert arrived at 1.39am, so I was only in the pool an hour or so.  I picked him up (with help from the midwife) and cuddled him in the pool, but had to get out to deliver the placenta (as I was bleeding).  Albert was wrapped up and given to his dad to hold, so Tony had loads of time with him immediately while the midwives dealt with my third stage.

I would recommend a pool birth to anyone, whether at home or in hospital, it made a huge difference to my labour experience – as soon as I got in the pool, the pain seemed manageable, and Albert seemed to arrive quite quickly.  We now have a perfect, happy little boy!”

A happy ending to a good birth story.  But as practitioners and as stroppy mothers and midwives, that cannot be enough – we have to ask the questions too.

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