Whose birth is it anyway?

Should caesareans be available on demand? Has the natural-birth movement gone too far? When Real Life posed these questions two weeks ago, there followed a bulging postbag, so teeming with emotion that it virtually moved on its own. What exercised readers most of all was the question of whether "natural" birth was worth all the pain, or whether, in this age of advancing technology, elective caesareans should be considered as an alternative.

Somewhat to our surprise, those who favoured technology over nature were comfortably in the majority, although both views were expressed with equal vehemence. Experiences recounted (and there was no shortage of colourful birth stories) were many and various. Call us biased if you will, but we were especially moved by hair-raising stories from those who'd seen the rough end of "natural" delivery. Comparatively few expressed any regrets about caesarean births.

What is clear from our response is that, whether because of moral pressure or disappointed expectations rising from the natural-birth movement, or good old-fashioned arrogance and prescriptiveness on the part of the medical establishment, a large number of women are not getting the births they want.

I write to tell you about two births, five years apart, one of which still produces memories I find difficult to confront and deal with.

During my first pregnancy I had no illusions about fulfilment and desire for a "birth experience". I read widely, attended antenatal and NCT classes and hoped for the event to be over as quickly and painlessly as possible - birth as a means to an end, a healthy baby, not something worthwhile in its own right.

After 16 hours of horror, my distressed baby had to have a forceps delivery as I was too exhausted to push. I was left with an internal tear, episiotomy stitches, horrendously bruised perineum, my rectum walls sagging through the anal opening and total incontinence due to nerve damage around the bladder area. I suffered a sense of humiliation, degradation and the knowledge that throughout the ordeal I had been -unable to control my own body. My mobility was non-existent for days, my bladder sensation returned after about three months, a sex life was (just) possible after eight months.

By the time I felt I could face a second pregnancy, I was determined to fight for an elective caesarean. In the event, there was no fight - a different consultant was very helpful. I had a good night's sleep, a carefully explained epidural, and a 45-minute operation. Unlike last time, the nursing staff gave me continual attention. I couldn't understand why - I felt so much better than before. For me, it was a positive birth experience.

While having every sympathy for women who advocate natural childbirth and home birth, there are many women whose bodies are simply not suited to childbirth. This has always been the case and does not relate to inappropriate medical intervention. It is only a problem if one believes procreation to be a woman's only role in life.

I am cynical as to whether these women would wax so lyrical if there was no hi-tech back-up to support them if things go dangerously wrong.

Pam Lake, Cardiff

I was more bothered about what wasn't said in your article than what was. I did not see any mention of the facts regarding the effects of medication used in epidurals on the foetal brain, nor was there any consideration given to effects of obstetric intervention on the foetus/ baby in general. In the US, the Academy of Paediatrics has not approved any of the drugs used in pregnancy and obstetrics as being safe for the foetus.

Further, there are studies which demonstrate that only a handful of the drugs used on mothers are approved for such use. Additionally, many of the hi-tech apparatus, such as ultrasound and foetal monitoring, have never been approved for use, other than in high-risk cases, by either the American FDA or the World Health Organisation. There are studies that show increased instances of learning disabilities, early motor skill retardation, many adults who will never be able to comprehend simple instruction manuals. This information has been common knowledge for at least 15 years, yet it was never mentioned. Why?

Hi-tech birth generates more income than normal birth and is more convenient for those medical professionals involved (it beats sitting with a woman through hours of labour). But what happens after that? Breast-feeding is interrupted, milk comes in late, babies are groggy and, when they do feed, they are getting the pain medication through their milk.

I truly believe that if the women who were interviewed in the article understood these and many more complications which have been documented by the American Foundation for Maternal and Child Health in New York, they might feel differently about electing an unnecessary, hi-tech procedure.

Patricia Barki, Reading

I don't know what qualifies your reporter to assert that a planned caesarean is much better for the mother than a normal delivery. Or where she gets the mistaken idea that the NCT "rule out drugs or forceps or cuts".

After delivering two babies, the first of which entailed a deep cut and low forceps, I am sure this was preferable to a caesarean, planned or not. All pain stopped the moment the baby was born, I was elated, as was everyone else in the room. I didn't notice being stitched, and the discomfort over the next few days was nothing compared to the pain and weakness described by friends following caesareans. Your reporter also missed a very important point: epidural anaesthesia is available for normal deliveries, too.

What is the point of encouraging mothers to have surgery when they could do it perfectly well themselves? Could this lead to women who wish to deliver normally being seen as time-wasters, nuisances and not worth any sympathy?

Name and address withheld

As a mother of two, I wouldn't dream of becoming pregnant if I didn't think there would be an epidural at the end of the line! As an anaesthetist, I frequently come into contact with women who consider themselves failures because they have been unable to cope with the often excruciating pain of labour, despite slavish attention to NCT methods.

The transformation of an hysterical, gibbering wreck into a rational, calm and happy woman who can enjoy and participate sensibly in the process of birth by the administration of an epidural is for me one of the most gratifying features of "hi-tech" medicine.

There's no doubt, however, that many maternity units are desolate, clinical places with brisk, overworked staff who follow years-old rules on care in labour: it is hardly surprising that many women are voting with their wombs and opting for home delivery. The answer, I believe, is a radical re-think of the environment of maternity units so that they become comfortable, welcoming, hotel-like areas with facilities allowing the whole family to participate in the experience.

If the NCT were to use their muscle to bring about this type of culture change instead of filling pregnant women with false expectations about labour, giving birth would become a much more pleasurable experience.

Dr PS Laurie, Banbury

My son was born 11 months ago by caesarean section. It was suggested by the registrar after nearly eight hours of fruitless induction. I made what I believed to be an "informed choice", but the section turned out to be a complete nightmare. It took more than 20 minutes of violent manhandling to wrestle my son out. He had to be resuscitated, I received blood transfusions and painkillers.

We were lucky; both of us recuperated quickly, bonded within two days and my son is now a normal, healthy child. I chose to have the caesarean because my waters had broken 36 hours previously and I believed it would be dangerous to wait any longer. Of course, I was told later that this would not necessarily be the case.

After the birth, I thought about what had happened and felt a need to find out more. My first step was to ask the hospital for copies of my records. But, strangely, once they had arrived and I had read them through, it all seemed pointless. Why get hung up on my bad birth experience? My baby was well and growing and needed my energy. The birth was, after all, only a transition. I know my next birth will be different anyway, in another hospital, in another country.

I think that women giving birth in the Nineties are in some kind of fashion vacuum. The Eighties were all about gaining the right to have a say in matters concerning your own pregnancy and labour. Most of the books I read were written then, and they are full of exhortations to "know your rights", "learn as much as you can", and "refuse intervention". It is all very true and useful, but it does give you a false sense of self-reliance.

In the Nineties, we have the choices our predecessors fought so hard for, but we easily forget that we can also choose to get all the help we need. Birth is a transition, and it is my belief that we need the help that technology and experts can offer in order to minimise suffering and stress. The hard part comes after the birth with the care of the newborn child.

Erika Nyman, NW9

I realise times have changed, and it seems for the better. I wish I'd had a caesarean sooner. I was three days and three nights in labour with my third child in July 1969, before they operated. By then, I was in such a state I'd have agreed to have my legs and arms amputated. As it was, they talked me into a sterilisation. I was 23. It's one of the biggest regrets of my life.

The caesarean op then was worse than childbirth, because of the aftermath, both of anaesthetic and sore wounds. There was no consumer choice then. I'd only got pregnant in the first place because my GP "popped in a coil" (unrequested) at the post-natal for my second child. Obviously the coil failed (and it cost me 10 guineas - half a week's wages, something else I wasn't told about).

Fortunately, consumerism these days involves (usually) consultation and at least some back-up if things go wrong. Things were not better in the old days. I was thrown out of bed a day after the caesarean, in agony, to see men gracefully leaping around on the moon. Every time they show that shot on TV, I can feel the pain.

Doreen Jacobs, High Barnet