‘Balanced information on the risk and the benefits’

On the face of it, the Birth Trauma Association should be an organisation with which I indentify. As a doula and antenatal teacher who often flirts with the idea of midwifery training, I abhor the idea of woman being traumatised by their experience of birth, particularly if (as I fear is the case frequently) this trauma could be avoidable.

Unfortunately, though, a common call from the BTA in order to remove birth trauma is ‘epidurals for all’, as if pain and trauma are two sides of the same coin. A quote I read in May’s issue of The Practising Midwife worries me: BTA’s press officer is quoted as saying ‘good, balanced information should be provided [in antenatal classes]… not horror stories and not pie in the sky stories; balanced information on the risks and benefits of pain relief.’

These are my italics, and I’ll tell you why.

When I talk about pain relief in labour, be it with doula clients antenatally, during labour, or in a variety of antenatal classes, I am sometimes accused of being biased. Of being against epidurals or pethidine. Of suggesting that the only way to give birth is the natural way. And this is just not the case.

But can you really have balanced information on the risks and benefits when, in the vast majority of cases, the risks vastly outweigh the benefits?

To offer balanced information, for every five risks of pethidine, surely I should be suggesting to my clients five benefits of pethidine? Each time I talk about one of the dangers of an epidural, I should ‘balance’ it with one of its advantages? Then I would be balanced and the BTA would applaud me. My clients would leave without fearing labour, I would no longer be accused of being biased, and all would be well.

Until my clients were in labour. Afterwards the parents whose pethidine-sleepy baby failed to breastfeed would ask me why I didn’t tell her about this. From her rubber-ring vantage point after the huge episiotomy and epidural-induced forceps, women would curse me, while wincing. And the lucky women who escaped the side effects of these powerful analgesics would sit smugly, wondering why the woman who had a waterbirth ‘put herself through all that pain’.

Because whether the BTA like it or not, there are a whole lot more risks than benefits to the strongest forms of pain relief available in labour, and if I tell it like it is to pregnant couples, then I am not offering balanced information. I can’t, because like it or not, the evidence base is not balanced. It would be like offering to teenagers the pros and cons of smoking. Or, if you prefer something a little less emotive, the pros and cons of eating five portions of fruit and veg a day, or exercising for 20 minutes three times a week, or driving at over 70mph on the motorway – or whatever other public health issue you plan to pick out of the air.

And what about this idea of ‘not horror stories and not pie-in-the-sky stories’. One woman’s horror story is another woman’s wanting to know all the facts. One woman’s pie in the sky awakens another to the possibilities of uplifting birth. These issues are subjective, must be tackled sensitively and require a delicate and tactful level of reflective practice within antenatal education be it one-to-one, or in classes, delivered in an antenatal class setting or at a midwife appointment.

The skill then lies with my presenting the evidence in a way that it doesn’t look like it’s my bias: so that people don’t leave with a sense that they have made an inferior choice. Both as a doula and as an antenatal teacher I have had plenty of clients who have chosen to have epidurals or use pethidine in labour, and I have seen the modern medical miracle first hand of transformation that an epidural can bring about.  But I have also witnessed the ancient natural miracle of a normal birth, with all the exulted, victorious joy that accompanies it – and the triumph that a mother carries with her in her first months of motherhood when she tastes that firsthand.

So actually the skill isn’t just in my presentation of this: it should be in the media’s presentation of this more broadly. It is, at the very least, naïve to suggest that satisfaction with one’s birth can be reduced to understanding a tick-box with a balanced number of pros and cons, regardless of what subject we are weighing up. (It could be pain relief, place of birth, method of birth, method of onset of labour: when to go to hospital: you chose.) It is simplistic to suggest that such a huge issue should be addressed for the first time during an antenatal class which takes place in the second, or more likely, third trimester of pregnancy. In fact these kinds of issues crop up in the media every single week, and the bias veers almost always away from the normal and towards the interventionist. And it is missing the point to suggest that birth trauma could be reduced one iota by such a tick-box approach in an antenatal class, any more than deaths by lung cancer could be reduced by secondary-school age children doing projects on ‘balanced information on the risks and benefits’ of smoking.

So come on, Birth Trauma Association. Yes, of course there will be women whose trauma would have been lessened by the administration of timely epidural. But the reasons that women are traumatised by birth lie at a far deeper level – both institutional and societal – than can be found in the controlled drugs cupboard in the labour ward, unlocked by the rescuer in green scrubs.


~ by Kedi Simpson on May 25, 2011.

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