It's another long one; sorry...
Here's another one of those episodic things of post it now whilst it's actually relevant, and strangely enough it's related to one of the previous ones. I am accepting that I am not a doctor, or a scientific researcher or anyone special in the way of learning or teaching about neurodiversity, so I could be wrong about this, but here we go.
I had a bit of a rant recently in reaction to the way that Streeting announced the enquiry into ND conditions and possible over-diagnosis, particularly in recent years. I would point out again that whilst it didn't say it was particularly in connection with the increased number of women being diagnosed, the timing of this enquiry is awfully suspect, because it comes at a time when the understanding of ADHD, autism and the like in women is developing, becoming better publicised and therefore more women are putting themselves forward for diagnosis. In recent days, the statistics on methods of birth have also been published and there has been judgemental outcry at the results particularly because there is. a stat that is being pulled out as being particularly of note and that is the rate of C-sections is higher than the rate of vaginal births, for the first time, and apparently that really upsets a lot of people.
Overall, the stats say that over 45% of births were from C-sections and around 44 to 45% from spontaneous vaginal birth. If you can do maths you might be as confused as I was with that, wondering where else or how else you might get them out, but it's because instrumental delivery (forceps or Vantouse) accounts for around 10-11% of births. Now, as headline figures these seem to be useful in seeing the trends of changes in births over the years, but aside from that, unless there is additional data, beside of it, this doesn't tell you a damn thing about WHY the rate of C-section has gone up, but that doesn't make a good story, so you get rags like the Daily Mail that include buzz words and phrases like 'too posh to push' because it riles people up, and what do riled up people of this day and age do? We react, we comment, we share, we add our own remix and commentary or whatever. Unfortunately, some people do this and share the article which is the source of their rage, and whilst I understand the desire to do that, because there is nothing better than sharing your anger at something when there is something to be genuinely angry about, but it is worth pointing out that the writers and editors of the Daily Mail know exactly what they're doing and whilst the mortality of their actions is questionable, sadly they are not stupid; if they were, they wouldn't do what they do so well as to still be in business when print media has been spluttering along with it's death rattle noise for the last two decades or more. (I do know there is an irony in saying this as a blog writer; I really do.) Interacting with posts and articles. produced by the Daily Mail makes them money. You can be as morally correct as you want to be, but even hate reactions on Facebook, comments where you disbarage them, their writers and their readers just adds to the algorythm thinking something is interesting (because it is) and showing it to more people and sharing it puts it in front of more people's eyes which is good for them because of things like advertising. Honestly, I don't know if their writers actually BELIEVE half of what they write, but if it makes you angry, it makes them money. Some people try and get around it by posting a screenshot of the article, and it works better than sharing a link or similar, but sadly it does mean people may search it to go and read additional sections or to interact with it themselves, however positively or negatively, and so even indirectly it can generate them some traffic. For what it's worth, I'm not just ragging on them for what they're saying about mother's whilst I'm literally pregnant with my son; I have a longstanding hatred of the putrid rot that they circulate from when they decided to pass comment about the suicide of a friend of mine, and honestly, I get mad at myself now for how much I let their words hurt me, but there it is.
Are we too posh to push? Who knows? Has anyone done any quality research, or done a deep dive into the data? Is it recorded as a simple 'this is the method by which the baby eventually came out' or is there an action log which records what each patient went through? I'm not saying you have to suffer for your C because there are many women who a C section works better for. There are all sorts of traumas concerning genitals that mean it's better to be booked in, sliced, stitched and presented with your little bundle (no, I'm not so naive as to think it's that easy, because it's not) or there are medical conditions which necessitate it. Socially, there are women who feel that what happens with them and their friends and their peers is you get booked in, you go in to the hospital in a timely fashion and you are home in a predictable time because everything is planned, everything is scheduled and organised and that's that. And who is to say that that is wrong? Equally there are women that have had a C section previously who would love to have a VBAC (Vaginal Birth After C) and for whatever reason, can't. There are many who have laboured, at home or in a birth centre or in the hospital, for hours or days, and labour has stalled, medications aren't working, or whatever has happened has happened and they have to come to what can be a heartbreaking decision to have a C section, for their own good, for the good of their baby, for the sake of infection prevention, because they're exhausted, because something about their anatomy isn't quite working, because the baby is in distress, or a lot of other reasons as well; are they being lumped in with this idea of being too posh to push? Because even if you accept the fact that it's right to demonise people for being too posh to push (it isn't, but let's pretend for a moment we're all assholes and it is) how is it right to lumber those women who have pushed and pushed and pushed through pain and suffering and tearing and all sorts, into a category of "too posh to push"? How is that not insulting in the highest degree?
I would also like to point out that big babies are getting bigger. Someone told me 8 pounds was a normal sized baby when I was actually pregnant and I wanted to drop to my knees and pray for the survival of my vagina, because that sounds like trying to push a bowling ball out. When we're talking about "big babies" we're talking 10 or more pounds... You can pine for the good old days when women lay back and thought of England to get the baby in there in the first place, and then had to just bare down and push on because the alternative was either not available or not widely so, but they and their little five and six pound infants make some of these stodgy babes look like giants. Do we need to talk about or look into why babies are being born bigger? Maybe, but then you also need to back off of the women who deliver them if the idea of that passing through their pelvis is more than they can bare. Perhaps it's a problem with general fitness, not for the size of the baby, but the strength, meaning the actual physical strength and muscles of a women. We're becoming more and more reliable on cars as a mode of transport instead of our own two legs, so maybe muscles that would previously have been stronger are less cut out for the strains and stresses of labour, but to me that is again a different question than being too posh to push.
I started this blog mentioning about neurodiversity, and it may not be something where the connection matters, but there is a high correlation between neurodiversity and hypermobility, which in turn then contributes to a higher than average instance or probability of pelvic girdle pain. Whilst some may say PGP is just a bit of tummy pain towards the end of your pregnancy, I can assure you, it's not. From personal experience, it's really not. It's an exceptionally limiting condition and it's something which can - I found out unfortunately - get progressively worse. I struggled with getting onto and off of the sofa, I struggled getting up and down the stairs, I struggled getting in and out of bed, and I was regularly up five or six times a night in need of a pee, so it's not like it was practical or possible to just wake my partner every time I needed to pee, because he still had to get up and go to work even when I was able to be signed off because the only thing I could focus on was the pain. As a result of that, I was offered an induction, because I got to the stage where the way I was walking was just not amusing anymore and in terms of the quality of life I had, it was awful and it could have gone on for a number of weeks like that. Higher levels of inductions though - if there are higher levels... it's not something I saw in the data but it's not something I took an overly in depth look for - mean higher levels of C section and instrumental delivery, because a certain number of inductions end up in each one. Is that being looked into? Is that being accounted for? Is patient choice being respected? (It sounds like it is by the doctors and the midwives in maternity, but there is a distinct lack of respect from the press and potentially the public.)
In terms of facilities, staffing and many other things, as a country we are failing. The number of services which are poorly rated is horrendous and doesn't reflect on the work done by the incredibly kind and caring staff who just want to do their best, but are overworked, underpaid, sometimes potentially undertrained and generally taking the brunt of it when things are not going to plan. Like everywhere in the NHS, funding is being focused in some areas and not others, because it's not an unlimited pot, and things like infant feeding teams are seeing a rise in the number of people successfully breastfeeding in most timescales (and it is beneficial even in the shortest timescales) and the success of skin to skin contact in the early hours of babies lives, which encourages a number of good outcomes for both mother and baby. Alongside that, they're dealing with things like an increase in the number of overwhelmed parents and an increase in shaken baby syndrome in certain areas, and the necessary learning for parents in those areas to try and prevent that rise from continuing or being replicated elsewhere. I guess my biggest concern with this data is, and this is who cares, and why do they care, because if it's not for the right reasons - aka, looking into why, carefully examining if there's a problem and how to address that problem or problems etc instead of just demonising women for choosing to give birth in a way that feels safe and comfortable for them - then I kind of don't want to hear it. Especially because, whilst we happen to be on the subject, C sections are hard, and C section recovery can be brutal, and these women are having to return home with a newborn, a scar and, if they're lucky, someone at home for two weeks to help them out, but we all know that the financial strain on people is currently ever increasing so it's hard to judge anyone who decided they simply could not afford to take paternity leave. In that position, a woman can be left at home, alone, with a baby, and even in the situation where this is her first and only child, there are tasks she will need to do for that child that she shouldn't be doing yet because she is recovering from a major operation that is often treated like child's play. We need to do better for fathers or second parents or whatever you want to call them, but that also then means doing better by mothers, birthing people, again, whatever. If people need to use that as a reason, so be it. Not everyone can bounce back in two weeks or less. Not everyone is physically or mentally ready to take on the task of being solely responsible for themselves and another tiny little life who can't ask for what they need, can't tell you what's wrong and cries as their best way to communicate. Life is hard at the moment, finances are stretched, it is a hard time of year to be feeling the pinch, too, and sometimes it feels like everything is just piled on at the point that you're having a baby and if your only reaction to that is "having a baby was your choice" then honestly, you don't realise how f***ed the economy will be if people don't start having babies, because there is already not enough of them.
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