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Women were left on blood-stained sheets without painkillers. Babies were born with cerebral palsy because warning signs were ignored. Some left with lifelong injuries because staff refused to perform a Caesarean section.
These are just some of the heartbreaking birth stories reported over the past year, as the UK’s growing maternity care crisis has come to light.
A cross-party report on birth trauma published last month concluded that women who have babies in UK hospitals are “mocked at”, “screamed at” and subjected to interventions to which they do not consent.
As a health editor, I’ve interviewed dozens of mothers about their traumatic birth stories over the years. I’ve also quizzed leading maternal health experts on how to have the safest birth possible.
I’ve compiled this information, along with advice from campaigners and doctors, to bring you eight essential tips for giving birth in British hospitals today.
I can’t guarantee that nothing will go wrong, but at least you’ll feel better prepared to face the experience.
As health editor, Eve Simmons interviewed dozens of mothers about their traumatic birth stories over the years.
A cross-party report on birth trauma published last month concluded that women having babies in UK hospitals are “teased”, “screamed at” and subjected to medical interventions for which they did not consent.
There is no such thing as “too fancy to press”
According to official UK guidelines, a woman can choose to have a caesarean section if she requests it, and there is nothing wrong with doing so.
Reality TV star Louise Thompson recently revealed that hospital staff rejected her request for a C-section. In her place, she had to endure a 24-hour labor in which she contracted a life-threatening infection, tore her uterus and lost three and a half liters of blood.
Hospitals prefer that women not have a cesarean section because there are more risks of giving birth this way compared to a vaginal birth.
However, much of this research is based on women who have more than one child: once a cesarean section is performed, future vaginal births are not recommended due to the risk of bleeding.
Some hospitals may refuse a cesarean section if they do not have adequate staff or operating rooms.
If this is the case, they have to refer you to a hospital that will do this.
“If you’re determined to have a C-section and it’s safe to do so, keep pushing until you get it,” says safe birth activist Catherine Roy.
Don’t believe everything you read on Instagram or hear in a prenatal class
Over the years I have debunked a number of myths about prenatal and postnatal health. Many of them first circulated on Instagram, while others originated from something said in a prenatal class.
They include the fable that “natural” births (without pain relief) are better for the baby, or that it is best to give birth face up.
I have heard of tragic cases where babies have died because the mother ignored doctors’ advice to be induced, following the instructions of a non-medical birth coach she found on Instagram.
“Don’t use social media,” urges Catherine Roy. “And remember that prenatal care teachers have no medical training.”
Activist Catherine Roy urges pregnant women to ‘stay off social media’
You can go to another hospital, even at the last minute
I have heard countless stories of women rushing to the hospital when labor begins and being told by nurses to go home.
Some women may prefer to avoid the hospital until it is absolutely necessary to admit them. But if not, experts say you can apply elsewhere.
“Legally, hospitals can’t turn you away if you’re in labor,” says Catherine Roy. “Technically, you can go wherever you want.”
However, according to Dr Pat O’Brien, consultant in obstetrics and gynaecology at University College London, it is preferable to stay in the hospital where you are due to give birth.
“It’s best to be somewhere where they have your scans, blood and other detailed information, to minimize the risk of them missing something important,” she says.
Dr. O’Brien says you should get to the nearest hospital as quickly as possible if you suspect your baby is no longer moving, is bleeding, has a fever, or is in severe, constant pain.
If your water breaks, move quickly
Most women go into labor about 12 hours after their water breaks and give birth within 48 hours.
Your waters “break” means that your amniotic sac has ruptured and no longer protects you or your baby from infection, which can lead to life-threatening sepsis.
NHS advice suggests visiting a hospital within 24 hours of your waters breaking, so you can be closely monitored for signs of infection.
“If labor hasn’t started naturally within a day, the hospital may suggest you induce labor,” says Dr. O’Brien.
If you are not happy, ask for the manager.
In many of the cases heard in the cross-party review, life-threatening problems were the result of women’s complaints not being listened to.
Consultant Dr Pat O’Brien recommends attending the hospital that is waiting for you.
So how do you get medical professionals to pay attention if you think something is wrong?
Catherine Roy and Dr. O’Brien recommend asking to speak to the most senior person in the room, who is usually an obstetrician.
“And if you see a younger doctor, ask to speak to a more experienced one,” says Dr. O’Brien. If it is a midwife-led centre, you can ask to speak to the ward manager or more senior nurse.
Demanding a rough timeline of what is supposed to happen next will help you notice if the birth is not going as planned.
You shouldn’t push for hours on end.
Doctors used to encourage women to push for as long as possible before resorting to interventions such as forceps or a Caesarean section.
The logic was that it was better for a woman to give birth vaginally than to undergo major surgery.
However, experts have since discovered the life-ruining cost of prolonged pushing: nerve damage, tissue tears and muscle destruction that can leave a woman with permanent disabilities.
At least a third of women experience tears that require stitches, and up to one in 12 have the more extreme tear that extends from the vagina to the anus.
According to experts, the time spent actively pushing should be kept to about an hour to reduce the risk of injury.
Dr. O’Brien says the amount of time spent actively pushing should be kept to about an hour, although there are no hard and fast rules.
“It depends on a number of factors, such as how tired the mother is, the position of the baby, whether the baby is in distress and whether the baby appears to be moving through the birth canal.”
She adds that suction cups should be used more often than forceps to help deliver a baby these days.
“When the contraction comes, the doctor uses the cup to gently pull the baby from below and guide it into the correct position.”
But if you prefer not to use any device and go straight to a C-section, that is your prerogative.
Don’t forget to move
The lithotomy position, or frog legs as it is often called, is the position most women are recommended to adopt when pushing.
But after a while, this position can put pressure on the sciatic and femoral nerves in the pelvis and hips, potentially damaging them and even causing partial paralysis.
If you have had an epidural, it may be difficult to move your legs, so ask someone to stretch them from time to time.
While there are no firm guidelines in the UK, US recommendations suggest women should be moved every 30 minutes to an hour to protect nerves.
Epidural is safe, but there is an alternative
Reality TV star Louise Thompson has opened up about her own traumatic birth experience.
The risk of paralysis after an epidural is rare, but is often discussed.
Some studies suggest the risk is as low as one in 141,000, and this usually happens because the needle has hit a nerve or blood vessel, or you have contracted an infection in the wound.
“In my 15 years of administering epidurals, I have never seen a case of paralysis, and neither have any of my colleagues,” says Dr. Nadia Alam, an anesthesiologist and past president of the Ontario Medical Association in Canada.
A much more common, although less serious, complication is “post-dural puncture headache.” This feels like a terrible migraine that starts a week after the epidural in about one in 100 cases. It occurs when fluid that protects the spine and brain leaks through a puncture hole and affects the delicate balance of fluid surrounding the brain.
Some go away on their own, but you should always seek medical help as soon as possible as there is a risk of bleeding around the brain if left untreated.
While the benefits of an epidural for pain relief far outweigh the risks, if you don’t want it, there is an alternative.
Last year, health officials approved remifentanil for labor pain. This powerful pain reliever is administered intravenously into the arm and allows greater movement to be maintained.
It wears off quickly, so it needs to be administered regularly and regular monitoring will be necessary because the medication can cause a drop in oxygen levels, which is probably why many hospitals do not offer it regularly.
