As a health editor, Eve Simmons interviewed scores of mothers about their traumatic birth stories over the years
Reality TV star Louise Thompson, who has spoken about her own traumatic childbirth experience. Pictured with her son Leo
Here are eight things every pregnant woman should know to avoid a traumatic delivery, by veteran health editor EVE SIMMONS
- A woman can choose to have a C-section if she asks for one – and there’s no shame in doing so.
Reality star Louise Thompson recently revealed that her request for a caesarean was refused by hospital staff. Instead, she endured a 24-hour labour in which she contracted a life-threatening infection, tore her womb and lost three-and-a-half litres of blood.
Hospitals prefer women not to have a C-section because there are more risks of giving birth this way compared to a vaginal delivery.
However, much of this research is based on women who have more than one child – once you have a C-section, future vaginal births are not recommended due to the risk of haemorrhage.
Some hospitals may refuse a C-section if there is inadequate staff or operating theatres.
If this is the case, they have to refer you to a hospital that will.
‘If you are determined to have a C-section and it is safe to do so, keep pushing until you get one,’ says childbirth safety campaigner, Catherine Roy.
- 2) Don’t believe everything you read on Instagram – or hear in an antenatal class
I’ve debunked several myths about pre and post-natal health over the years. Many of them first circulated on Instagram, while others were rooted in something said in an antenatal class.
They include the fable that ‘natural’ births (free from pain relief) are better for the baby, or that labouring on your back is best.
I’ve heard tragic cases in which babies have died because the mother has ignored doctors’ advice to be induced – following the instructions of a non-medical birth coach she found on Instagram.
‘Stay away from social media,’ urges Catherine Roy. ‘And remember that antenatal teachers are not medically qualified.’
Campaigner Catherine Roy urges expecting mothers to ‘stay away from social media’
- 3) You can go to another hospital – even at the very last minute
I’ve heard countless stories of women who hurry to hospital when their labour begins, only to be told by nurses to go home.
Some women may prefer to avoid the hospital until they absolutely must be admitted. But, if not, experts say you can turn up at another one.
‘Legally, hospitals can’t turn you down if you are in labour,’ says Catherine Roy. ‘Technically, you can go wherever you want.’
However, according to Dr Pat O’Brien, a consultant in obstetrics and gynaecology at University College London, it is preferable to stick to the hospital that’s expecting you.
‘It is best to be somewhere that has your scans, blood and other detailed information, to minimize the risk they’ll miss something important,’ he says.
Dr O’Brien says you must get to the nearest hospital as quickly as possible if you suspect your baby is no longer moving, you are bleeding, have a fever or your pain is severe and constant.
- 4) If your waters break, move quickly
Most women will go into labour within about 12 hours of their waters breaking, and give birth within 48 hours.
The waters ‘breaking’ means the amniotic sac has broken and is no longer protecting you and the baby from infections, which can lead to deadly sepsis.
NHS guidance suggests visiting a hospital within 24 hours of your waters breaking, so you can be closely monitored for signs of infection.
‘If you haven’t entered labour naturally within a day, the hospital may suggest inducing you,’ says Dr O’Brien.
- 5) If you’re 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’s expecting 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 on the ward, which is often an obstetrician.
‘And if you see a junior doctor, ask to speak to a more senior one,’ says Dr O’Brien. If it’s a midwife-led centre, you could ask to speak with the manager of the ward or the most senior nurse.
Demanding a rough timeline of what is supposed to happen next will help you notice if the labour isn’t going according to plan.
- 6) You shouldn’t be pushing for hours on end
Doctors used to encourage women to push for as long as possible before turning to interventions like forceps or a caesarean.
The logic was that it was better for a woman to give birth vaginally than to subject them to a major operation.
However, experts have since discovered the life-ruining toll of prolonged pushing – namely nerve damage, tissue tears and muscle destruction that can leave a woman with permanent disabilities.
At least a third of women experience tearing that requires stitches, and up to one in 12 have the most extreme tear that extends from the v****a to the back passage.
The amount of time actively spent pushing should be kept to around one hour to reduce the risk of injury, experts say
Dr O’Brien says the amount of time spent actively pushing should be kept to around one 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 if it appears to be moving down the birth canal.’
He adds that, these days, suction cups should be used more often than forceps to help coax the baby out.
‘When the contraction comes, the doctor uses the cup to pull the baby gently from below, guiding it into the right position.’
But if you’d rather use no device and move straight to a C-section, that’s your prerogative.
- Don’t forget to move
The lithotomy position, or frog’s legs as it’s often called, is the stance that most women are advised to take when pushing.
But after a while this position can put pressure on the sciatic and femoral nerves in your pelvis and hips, potentially damaging them and even causing partial paralysis.
If you’ve had an epidural, it may be difficult to move your legs, so ask someone to straighten your legs every so often.
While there are no firm guidelines in the UK, US recommendations suggest that women are moved every 30 minutes to an hour to protect the nerves.
- Epidurals are safe – but there is an alternative
A cross-party report into birth trauma published last month concluded that women who have babies in UK hospitals are ‘mocked’, ‘shouted at’ and subjected to medical interventions they didn’t consent to
The risk of suffering paralysis after an epidural is rare, but 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 a blood vessel, or you’ve 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, anaesthesiologist and former president of the Ontario Medical Association in Canada.
A far more common, yet less serious, complication is a ‘post-dural puncture headache’. This feels like a terrible migraine that starts within a week of the epidural in around one in 100 cases. It happens when the fluid that protects the spine and the brain leaks out of a puncture hole and affects the delicate balance of liquid that surrounds the brain.
Some go away on their own. But always seek medical help as soon as possible as, if untreated, there is a risk of bleeding around the brain.
While the pain-relieving benefits of epidurals far outweigh the risks, if you don’t want one, there is an alternative.
Last year, health chiefs approved remifentanil for labour pains. This potent pain relief is administered via a vein in the arm and allows you to retain more movement.
It wears off quickly, meaning it requires top-ups, and you will need regular monitoring because the drug can cause a drop in oxygen levels – which is presumably why many hospitals don’t regularly offer it.
