Works Cited

A.M. Jukic, D. B. (2013, October 13). Length of human pregnancy and contributers to its natural variation. Retrieved from ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777570/

ABC Law Centers. (n.d.). Pitocin Induction and Birth Injury. Retrieved from abclawcenters.com: https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-medication-errors/pitocin-and-oxytocin/

Americanpregnancy. (2017, Month 24). Epidural Anasthesia. Retrieved from americanpregnancy.org: http://americanpregnancy.org/labor-and-birth/epidural/

AsianScientist. (2012, March 12). Unnecessary Induction of Labor Linked to Birth Complications Study. Retrieved from asianscientist.com: https://www.asianscientist.com/2012/04/health/inducing-labor-in-pregnant-women-linked-to-birth-complications-2012/

Briggs, H. (2016, December 7). Caesarean births ‘affecting human evolution’. Retrieved from bbc.co.uk: http://www.bbc.co.uk/news/amp/science-environment-38210837

Buckley, S. (2016, February 10). Epidurals: Real Risks for Mother and Baby. Retrieved from birthinternational.com: https://birthinternational.com/article/birth/epidurals-real-risks-for-mother-and-baby/

Campbell, D. (2009, July 10). It’s good for women to suffer the pain of a natural birth, says medical chief. Retrieved from theguardian.com: https://www.theguardian.com/lifeandstyle/2009/jul/12/pregnancy-pain-natural-birth-yoga

Davis, A. (2013, May 30). Choice, policy and practice in maternity care since 1948. Retrieved from historyandpolicy.org: http://www.historyandpolicy.org/policy-papers/papers/choice-policy-and-practice-in-maternity-care-since-1948

Dodd, R. M. (2011). Short and Long-term Outcomes after Cesarean Section. Retrieved from http://www.medscape.com: https://www.medscape.com/viewarticle/739458_2

Eugene R. Declercq, C. S. (2014, Winter). Major Survey Findings of Listening to Mothers: Pregnancy and Birth. Retrieved from ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894594/

Goodtoknow. (2015, October 29). One Born Every Minute terrifying new mums. Retrieved from goodtoknow.co.uk: http://www.goodtoknow.co.uk/family/544547/one-born-every-minute-terrifying-new-mums

Griffiths, C. (2017, September 10). GIRL ABOUT TOWN: Call the midwife! Duchess of Cambridge is keen on a home birth for her third baby. Retrieved from dailymail.co.uk: http://www.dailymail.co.uk/tvshowbiz/article-4868988/GIRL-TOWN-Kate-keen-home-birth.html

Hill, M. (2015, November 9). Love Birth? You probably hate One Born Every minute. Retrieved from activebirthcentre.com: http://activebirthcentre.com/birth-2/one-born-every-minute-milli-hill/

Johanson, R. (2002). Has the medicalisation of childbirth gone too far? NCBI, 892–895.

Kirkham, M. (1999). The culture of midwifery in the National Health Service in England. PubMed, 732-739.

Kirkup, D. B. (2015). The Report of the Morcambe Bay Investigation. London: The Stationary Office.

Luce, A. (2016). “Is it realistic?” the portrayal of pregnancy and childbirth in the media. BMC.

NCT. (2014, March). Maternity Statistics-England. Retrieved from nct.org.uk: https://www.nct.org.uk/professional/research/maternity%20statistics/maternity-statistics-england

NetMums. (2011, April 1). People wanting to scare me with their pregnancy and birthing stories. Retrieved from netmums.com: https://www.netmums.com/coffeehouse/pregnancy-64/pregnancy-stories-863/557973-people-wanting-scare-me-their-pregnancy-birthing-stories.html

NHS. (2016, November 9). Hospital Maternity Activity 2015-16. Retrieved from digital.nhs.uk: http://digital.nhs.uk/catalogue/PUB22384

Pasha-Robinson, L. (2017, September 7). Billion pound clinical negligence bills ‘threatening NHS finances’. Retrieved from Independent.co.uk: http://www.independent.co.uk/news/uk/home-news/nhs-clinical-negligence-bills-finances-budget-healthcare-trusts-doctors-a7934546.html

PubMed Health. (2012, July 19). Pregnancy and birth: Epidurals and painkillers for labor pain relief. Retrieved from www,ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072751/

Rushing, J. N. (2011, June). Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis. Retrieved from ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

Sciencedaily. (2015, June 22). Molecular mechanisms within fetal lungs initiate labor. Retrieved from http://www.sciencedaily.com: https://www.sciencedaily.com/releases/2015/06/150622162023.htm

Smith, G. C. (2001, July 1). Use of time to event analysis to estimate the normal duration of human pregnancy. Retrieved from academic.oup.com: https://academic.oup.com/humrep/article/16/7/1497/693431/Use-of-time-to-event-analysis-to-estimate-the

Stoll, K. (2014). Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. MidwiferyJournal, 220-226.

Thielking, M. (2015, December 1). Sky-high C-section rates in the US don’t translate to better birth outcomes. Retrieved from http://www.statnews.com: https://www.statnews.com/2015/12/01/cesarean-section-childbirth/

UCLAN. (2016, March). Interventions in Normal Labour and Birth. Retrieved from rcm.org.uk: https://www.rcm.org.uk/sites/default/files/Labour%20Interventions%20Report%20A4%2020pp%202016_3.pdf

Walsh, D. (2009, June 18). Pain and Epidural Use in Normal Childbirth. Retrieved from http://www.rcm.org.uk: https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/pain-and-epidural-use-in-normal-childbirth

WHO. (2015, April). WHO statement on ceasarean section rates. Retrieved from http://www.who.int: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

 

Reflections

Some things I think I did particularly well were:

šMost of my sources are from recent medical journals and therefore have a high level of peer review

šI did my own primary research, with an effort to make my survey as reliable as possible

šI’ve used a mix of quantitative and qualitative data to get a well rounded view of the subject

Some things I could improve on are:

šThe countries I mainly looked at was the UK & the US This isn’t reflective of European cultures, like Sweden which has the lowest rate of intervention.

šSince I am an advocate of natural birth, doing this project alone may have made it susceptible to bias

šMy survey may not have made it very far outside of my own social circle

šTime management

Conclusions

In conclusion, although it is a complex issue, my research has definitely found that childbirth has become over-medicalised, both in medical practise, and in society’s perceptions of childbirth. Some people would take no issue with this- after all in developed countries, we have a maternal mortality rate almost 18 times smaller than in undeveloped countries. (Johanson, 2002) Therefore, it could be claimed that this is the lesser of two evils, and a level of medicalisation is necessary to maintain the safety of women. This is true; it is important that we have the resources to keep women safe in emergencies and the ability to check on mother and baby throughout pregnancy. However, all the evidence points to an increase in unnecessary intervention, which as I have highlighted, can lead to more maternal health problems than it possible prevents. This over-medicalisation is important as a health issue, because of all the potential risks and costs of unnecessary intervention. However, it is also important as a feminist issue, as we have developed a culture where women’s bodies and processes are rarely spoken about and are feared. Empowering women means educating them about these fears, bringing the truth into the light and encouraging trust and solidarity between women.

Ideally, pregnancy and childbirth should be community based. Girls and women should grow up seeing childbirth as a natural, everyday event and support each other through this time, to reduce the culture of fear surrounding pregnancy. Continuity of care is essential so women can build a strong, trusting relationship with their midwife. I believe this would lead to an increase of trust for women in their own bodies, and in their midwives, which would cause a decrease in this psychological dependence on medical technology.

Having the resources for medical intervention is absolutely essential for when things do go wrong, but ultimately, a woman’s most important resource is her own body. It’s time to bring back our faith as a culture in women.

Other Explanations for Increase in Medicalisation

Some may argue the healthcare system is responsible for an increase in unnecessary intervention; in 2016 the NHS faced a £1.6 billion cost in clinical negligence lawsuits. (Pasha-Robinson, 2017) Arguably, this could put considerable pressure on obstetricians and midwives to compensate for this by utilising as much medical procedures as possible, especially since litigation relates to obstetrics 70% of the time. (Johanson, 2002) The Morcambe Bay report was published in 2015, which exposed clinical negligence of midwives which led to several deaths, and implied that these deaths could have been avoided if midwives weren’t trying to ‘pursue natural birth at any cost’. (Kirkup, 2015) A natural response to these tragic events would be to compensate by intervening more, at the slightest hint that something may be wrong. Sadly, the actions of a few dominant midwives in the Morcambe Bay trust may have damaged the reputation of natural birth and midwives for years to come.

Unfortunately, in the UK at least, we do live in a culture of blame, and in a society where very few babies die, this means that fingers are often pointed at midwives when something goes wrong. In fact, a study indicates that such is the environment within the NHS that midwives themselves blame themselves, experiencing a lot of guilt and shame along with a high pressure to conform with other midwives. (Kirkham, 1999) This environment where midwives experience so much pressure, and feel very much in the public eye cannot lead to positive, supportive relationships between mothers and their midwives, or midwives with their peers. As a result, this may lead to high levels of anxiety in both the midwife and the mother, therefore leading to an increase in medical intervention.

Effect of the Media on Fear and Medicalisation

 

There have been several studies linking a fear of childbirth to further medical intervention. For instance, a study on fear of birth in young Canadians found that participants who reported being most fearful of birth were most favourable towards intervention such as C-section or epidural. Not only this, but participants who reported their perceptions of childbirth to have been shaped by the media had generally higher scores of fears about childbirth. (Stoll, 2014) This suggests that the media absolutely does influence how Westerners perceive childbirth, and it’s very plausible to say this could lead to an increase in medical intervention. Interestingly, the study also included Asian participants, who were much more likely to have high fear of childbirth, indicating that medicalisation and fear isn’t just a Western phenomenon.

These results have a more serious implication when looked at in other studies which suggest that a majority of women use the media as a dominant way to learn about childbirth. Luce et al found that many women do look to television to perhaps fill a cultural void, but as I have observed, these television shows often sensationalise and medicalise birth. This is problematic because as Luce writes, ‘As women turn to television to learn how others feel and cope with childbirth, birth is no longer a natural experience that women own, rather generations of women have never seen a real-life birth before they themselves experience it. This makes the absence of low-risk, undramatic, or ‘uneventful’ childbirth even more worrying’. (Luce, 2016) Despite happening every day, childbirth is not an everyday part of most people’s lives, and as a result can be seen as a scary event since it is unknown. If a majority of women are learning from television, they are receiving a biased, sensationalised view of childbirth and the fear arising from this has been linked to women wanting more medical intervention in birth. Again, the question is raised of if women truly have an informed choice when so much of the media around them is implying they should hand over their control to doctors.

Luce’s study proposes that to fix this, ‘midwives need to be more involved with TV programmers to improve the representation of midwifery and maternity in the media’. This could theoretically help non-eventful, low risk natural births become an everyday part of women’s lives again, just as it was before the medicalisation of childbirth, when women would support each other through birth. More realistically, midwives could also consider the fact that most women do use television as a form of education, and counterbalance this by asking women their fears, and dispelling them. Some trusts have even introduced midwives trained specifically for helping women with bad fears of childbirth, or tokophobia. Ina May Gaskin in her book Spiritual Midwifery takes the approach of sharing women’s positive birth stories, in which women share from their own perspective the wonderment of bringing another life into the world. Even in the stories where things go wrong, for instance a breech birth, the emphasis is less on the scary or painful parts of birth, but instead the parts of childbirth that made it worth it. As a society, it is important for women to share their positive birth stories, for the media to show positive birth and for birth to be seen as a natural, everyday event, so that women can reclaim birth for our own.

Cutting Out

Some things need to be cut out from my original plan, as the essay has gone in a different direction than anticipated.

Firstly, I won’t be writing about foetal heart monitoring anymore, as I feel I’ve covered the most important and common medical interventions. I also won’t be doing the interviews, as I think the survey is enough independent research to cover personal responses to childbirth.

Instead of this, I’ll be looking more in detail to how perceptions of childbirth link to an increase in fear of childbirth and medicalisation. This is a topic that came up in both my study on epidurals, and also when I studied One Born Every Minute. I’ve established that childbirth is becoming increasingly medicalised; therefore it is important to look at why.

Epidurals

Epidurals are a widely used method of pain relief in the West, with over 50% of American mothers opting for one, with more women requesting one than for any other form of pain relief. (Americanpregnancy, 2017) Like the other medical procedures I’ve looked at, epidural rates are also increasing; in fact they doubled from 1989 to 2008 in the UK, going from 17% to 33%. (Walsh, 2009). This isn’t surprising given the effectiveness in pain relief- only 1 in 100 women require additional pain relief after an epidural, compared to 28 out of 100 women when other pain relief options are used (PubMed Health, 2012).

However, there is considerable opposition to the widespread use of epidurals, both from midwives and members of the natural birth movement, as many argue that epidurals lead to a ‘snowball effect’, as epidurals can lead to further intervention being necessary. Dr Sarah Buckley describes this as a ‘cascade of intervention’ and says that epidural often leads to women having a slower labour, caused by the epidurals effect on the pelvic floor muscles, which can reduce a first time mother’s chance of a natural birth to less than 50%. The slowing of the pelvic floor muscles not only leads to a slower labour but puts a baby more at risk of dystocia (where the baby is ‘wedged’ in an awkward position), and this leads to an increased risk of the use of forceps, or a caesarean section. The use of forceps often means that an episiotomy is necessary, where the perineum is cut to make more room. This then requires stitches, which can take up to 4 weeks to heal. (Buckley, 2016). All this increased intervention can leave a mother feeling powerless, and can take away from the joy of childbirth, as well as increasing risks when caesarean births and episiotomies are involved.

Despite this, a key value of our NHS is patient choice. It is understandable why a woman would choose to forgo the pain of labour when we have the technology available to do so. If this choice is informed- the mother is aware of all the risks- women absolutely should be able to take this option. However, it is questionable how much of this is a choice given the high levels of scrutiny women face for their birth decisions- for example there was a lot of controversy in the tabloids about Kate Middleton considering a home birth; for example, the Daily Mail said ‘the Duke and Duchess decided not to take the risk last time. A similar request with the third baby would be more acceptable’, implying that home birth is not only risky, but also an ‘unacceptable’ choice in the eyes of the public (Griffiths, 2017). Can women truly make a free choice when they are under scrutiny? To add to this, even if women are receiving all the information from their midwife, the onslaught of misinformation and scaremongering from the media in the west may counteract this. In an article about epidurals, the Guardian describes the ‘agony of childbirth’ in its opening paragraph (Campbell, 2009). In online forums many women also complain about only hearing negative birth stories from the women around them, contributing to a fear of pain and of childbirth. (NetMums, 2011). Although none of this means that women should have the choice of epidural taken away from them, it does raise the issue that many women cannot make an informed, non-biased choice. Western society perceives birth as dangerous, painful, and an event to be medicalised, a statement which is backed up by my survey, and countless women who are terrified of this natural process.

Itinerary Adjustment

Since I’ve started a new job, my goals for the essay haven’t been manageable. By now I’m supposed to have written 1000 words on labour inductions and C-sections and 1000 words on the media and my survey. I have managed to do this, meaning I am about half way through the essay. However, I am meant to have done an interview, 1000 words on fetal heart monitoring and epidurals, and another 500 words on perceptions of childbirth by the 7th December. Therefore, I’m going to have to rethink my itinerary and finish my first draft by the end of the Christmas holidays (January 4th) rather than by Christmas Day.

7/12/17: 500 words on epidurals

14/12/17: 500 words on fetal heart monitoring

21/12/17: Interview & 500 words about

28/12/17:  700-1000 words on the link between media and medicalisation

4/1/18: Proofreading, introduction, conclusion and bibliography

Analysis of One Born Every Minute, Series 9 Episode 5

I’ve chosen this show because several women I’ve spoken to said they used it to prepare for labour. Some argue that it’s an educational show that depicts many variations of birth; others argue that it sensationalises birth and may terrify mothers-to-be. I’ll be analysing the episode to give my own perspective on the show, and also looking at various audience responses online.

Judging from this episode, I’d argue that the program definitely sensationalises birth; it picks up on the most dramatic and exciting births, which therefore portrays a narrow viewpoint. The title sequence is needlessly dramatic, with women screaming, tense music, midwives running and even the sound of sirens. Already the show reinforces the idea that childbirth is dangerous. There’s a lot of emphasis on the pain the women feel; for instance there are many close up shots of Kirsty as she moans in pain, allowing the audience to empathise with her. All the women are shown screaming in the later stages of labour, and tense music emphasises the ‘risk’ and drama of the situation. There’s also a complication for Kirsty, in which she is raced to the operating theatre, with midwives shouting, dramatic music that connotes danger and doctors speaking in an authoritative tone. Kirsty is shown to have no control whatsoever of what’s going on, and this is a key fear for many women that makes them what inductions or epidural: control. I’d argue that shows like this reinforce stereotypes about birth: that it is unbearably painful, risky and controlled by medical professionals, and this could absolutely lead to a rise in more medicalised births.

Milli Hill, founder of the positive birth movement, agrees: “Frankly it shocks me that the whole nation is continually bombarded with images of these outdated practices of birth. The films that generally appear in the programme reveal no comprehension of the need of women to move freely. Neither is it in any way understood that birth is a hormonal process calling for deep privacy and very discreet and minimal presence of other people.” (Hill, 2015). Birth is an underrepresented topic in the media, but the way it is represented in shows like this may not be progressive.

However, in online forums there is evidence that many women found the show helpful. Gillian Anderson said “I’ve had 3 births and the programme gives great insite into what may happen. I had no idea when I was first pregnant what it would be like” and Stoney1979 said “my daughter had her first child 4months after i delivered her youngest brother. if it wasnt for this program and seeing my pregnancy issues first hand she wouldnt of had a clue what to expect or how different labours are for every pregnancy”   (Goodtoknow, 2015). This shows there is a variety of responses to the show; it would be reductionist to say it is fully harmful, or fully helpful for birth. I wouldn’t argue that the show should be banned, as some people do, but there is certainly a gap in the media for representations of positive natural birth, and this is bound to take a toll.

Second Survey Results

I have made two surveys to investigate Western perceptions of childbirth. The first one had some issues in how it was written, as there were some ambiguous questions which confused my participants- for example, ‘There is no non-medical reason why a woman should refuse pain relief during labour. Do you agree?’ was very confusing as it contained a double negative. To improve this in my second survey, I changed the statement to ‘Women should accept pain relief during childbirth’ which is less ambiguous. Another problem was that the scales all went the same way; any ‘strongly agree’ answer indicated a more pro-medical person. This will have made my survey vulnerable to acquiescence bias, which I changed in the second survey, in which I asked questions in different ways. In the first survey I only collected quantitative data, but in the second I have both quantitative and qualitative data, allowing for a more rounded look at the issues. The only problem I have been unable to fix is that my respondents are mainly from the UK, which is a biased sample. However, there are respondents from the USA and Norway. Bearing this in mind, I would argue that my survey is a reliable source of information given that I have made every effort to eliminate bias and confounding variables.

Overwhelmingly, my survey has supporting evidence my theory that this culture has a fear of natural childbirth. The majority of respondents indicated that childbirth should happen in a hospital, with an average 60% agreement rate for this statement, whereas only 43% agreed that medical intervention should be avoided where possible. 64% agreed that women should always accept pain relief during labour, indicating a strong pro-medical attitude in our society. My open questions provided interesting results. For the question ‘Would you be afraid to give birth and why?’ some respondents said no, but the majority said yes. Reasons for this fear included ‘the amount of pain involved’, ‘the risk of tearing your vagina’, ‘it’s still dangerous’ and ‘afraid of losing the baby, or dying in childbirth’. Most respondents mentioned risk, which indicates that many people still consider childbirth to be frightening and dangerous. This is reinforced by the answers to my next question- ‘Do you feel childbirth is dangerous? Why?’ Many responses indicated the idea that childbirth is inherently risky: ‘even today people die or end up with permanent injury- most dangerous thing I’ve ever done’, and ‘yes as there are so many things that can go wrong’. Some respondents indicated that it is not dangerous anymore due to medical help: ‘no as there are always fully trained medical professionals if anything goes wrong’. Even this answer implies that childbirth is dangerous, if not in the presence of doctors. My final open question was ‘Is the Western medical model of childbirth superior to cultures that value home birth? Why?’ This produced very mixed responses. Most respondents said the Western model is safer: ‘I think both mother and baby are more likely to survive’, for example. Although some questioned the Western model, as one person said ‘the mother should feel comfortable wherever she gives birth’, the majority of answers show that people feel a medical model is the best model for childbirth.

Therefore, my survey has shown that people, at least in the UK, do tend to think of childbirth as dangerous, and a procedure that should be managed by medical professionals. Now, I’m interested in looking at where these perceptions may have come from, by analysing how childbirth is portrayed in the media.