antenatal classes,  birth,  nct

on birth

I have been following the recent debate regarding birth, antenatal classes and the NCT [National Childbirth Trust] with interest, as I am keen for women to support each other rather than reinforce their own decisions by vilifying all other points of view. I am also keen for the language used surrounding birth to be positive and accepting rather than used to wound and guilt. For what it’s worth, here’s my take.

Before I start, full disclosure.

(a) We didn’t partake in any NCT classes, for the following reasons:

. I object to there being a(n apparent) monopoly on antenatal classes.

. I found the cost of the classes to be off putting (as we fall in the ditch between earning enough to not warrant a discount but not wanting to prioritise close to £300 on top of all the other costs of a baby).

. Reviews and recommendations from all and sundry that I spoke to and read of spoke only of the positive of having a ready made group of friends, which we felt unnecessary to us.

. Unstructured learning did not appeal. I also was wary of being in a group of people where the majority wished to focus on something which I did not, as I understand this to be the way that the teaching is focused.

. Unwilling to risk that the particular teacher we may have been assigned was heavily pro “natural” or “straightforward” birth (which I object to, and object to those terms) and/or breastfeeding.

(b) Pip’s birth followed active & second stage of labour of about 17/18 hours which commenced in the birthing centre and following close to 4 hours of actual pushing ended with an assisted, venteuse delivery (including pitocin, epidural and episiotomy) during which I hemorrhaged half a litre of blood and culminated in a hospital stay of four days.

I have followed Kirstie Allsopp’s twitter feed, blog post following the discussion and the blog of the discussion which started this particular debate (an appearance on radio 4) as well a rather less interesting Daily Mail article and some rather dull comments on the same. I also read one or two blog posts from NCT teachers (I will update links if I can remember what else I read).

First, I feel strongly that all birth should be regarded as positive regardless of specifics. I find it extremely trying that the word ‘failure’ is used in any context. I also find it saddening that the words ‘assistance’, ‘intervention’ and ‘epidural’ (amongst others) are used in a way which suggests that if they are to come into play this is in some way a negative. (e.g. ‘intervention spiral’, ‘statistically more likely to end up with an epidural…’ etc). Whilst we are at it, I also find the use of the phrase a “natural” birth to be problematic, as it somehow suggests that there is an ‘unnatural’, ergo wrong, alternative. I also feel that the statistics bandied around by NCT teachers and supporters of the same are inflammatory (e.g. that in “95% of cases a straightforward birth is possible” {apparently} whilst stating elsewhere that nationally 1 in 4 births are by caesarian section.) It appears that ‘they’ are suggesting that almost all of those caesarian sections are unnecessary.

Secondly, I feel saddened that there is an overriding suggestion that birth is something women can control. Further, that there is a school of thought that straightforward birth for those who want it is possible (including the unspoken juxtaposition that those births which are not straightforward must either have not wanted it enough or been weak and consented to interventions which precluded a straightforward birth). [And I quote “As an NCT Teacher, I promote straightforward birth for those who want it, not straightforward birth at any cost”]

I can see why people turn to the NCT for information. As I wrote previously, I found the NHS antenatal classes to be sorely lacking. For (particularly first time) parents, pregnancy, birth and caring for a small baby can be a huge unknown and time of fear and uncertainty. The word “labour” in itself suggests hard work at the very least and there can be no mother who faces birth without realising that the process is likely to be painful. Beyond that, no experience is identical. And yet, somehow, we end up comparing and competing and any process of comparison and competition ends with winners and losers. And ‘we’ have somehow come to the conclusion collectively that there are ‘better’ and ‘worse’ births. All compounded by the oft repeated comment that guilt is personal and self afflicted and only we are responsible for this.

I find it a shame though, that for those who do turn to the NCT for information, there seems to be a great deal of people who found that the teaching they received was biased towards a perception that there can be a ‘better’ birth outcome and that they can personally can control that. It seems that the NCT could do to address this perception rather than continuing to be more and more dogmatic. (or threatening legal action).

Furthermore, I personally find the suggestion that there is an opinion that I should have made a birth plan, in advance, when I was “thinking rationally” so that “when I wasn’t thinking logically” whilst in labour, I didn’t make decisions that the rational me wouldn’t have agreed with, to be objectionable. The supposition that both there was an objective truth in advance (which I would suggest was actually a subjective viewpoint) and that should somehow take preference to a reaction to circumstances as they actually happen, seems totally illogical to me.

In the event, Pip simply wouldn’t progress down the birth canal, despite near on four hours of pushing, fully dilated, first  in a birthing pool and then simply in the room, using gas and air (which is where part one of my birth story ends. sorry about the spoiler). Despite the midwife asking me whether I really wanted to be one of the 38% transferred to the labour ward, we decided that the best decision based on the circumstances and facts at the time (prolonged pushing could cause the baby to become distressed, and exhausted from standing and squatting for hours) was to transfer to doctor led care. I can clearly remember telling myself that the only reason to carry on pushing in the same fashion was to tell people that I done it that way, and that my ego was not as important as my baby’s safety. I won’t lie though, I did feel that in some way I had failed and I spent the next part of the labour in tears. My exhaustion led to being offered an epidural and after discussing the merits we opted to take this option. This did not diminish my feeling of the contractions, only the pain of them, and I felt far more present than I did at any point in the previous 12 hours. The short story version ends with Pip’s heart rate dropping and being told that she needed delivering immediately. Being neither a doctor nor someone who wished to put my baby’s health at risk, I consented to an episiotomy and venteuse delivery and I pushed out Pip. Would we have made different decisions in the same circumstances had we made an arbitrary list of ideals in a classroom a month earlier? I hardly think so. But I could see that I might have felt differently about the decisions we did make had we written that so called logically decided list.

(And this is only about birth. I haven’t even mentioned feeding the baby and support regarding post natal depression, which are two other oft quoted criticisms of the NCT. In fact, despite it’s tag line as the UK’s largest charity for parents, and enjoying an apparent monopoly on advice provision outside of the NHS, it states “The NCT as an organisation does not promote or advocate on issues relating to formula feeding” (although it does then include a list of links to other sites).  How, when so many mothers bottle feed for one reason or another can such an organisation abandon those people?)

So what is the answer? I wish I knew. *I* think , unsurprisingly, perhaps we need a new solution. Unbiased providers of antenatal classes where there is a specific structured course where all attendees are taught the same thing about all the possible scenarios of birth, with no particular emphasis placed on any of them as better or more desirable? However, as my husband posits, am I actually just trying to solve a problem which doesn’t need solving?


  • ArielGraphy

    I’m following this debate as well. We are in the thick of it and while we are scheduled to take an NCT class, we are taking it with a very large grain of salt. We’re planning a home birth, but only because I have panic attacks when I enter hospitals and that won’t be helpful, I’m sure. We’re also only a 5 minute drive from the hospital should it all go pear-shaped.
    There is so much to be said on the issue, but I have to agree that any language that calls any birth experience a failure is complete bullsh*t.

  • Sz

    Rach, I am amazed. Not having children, and not even really considering it at the moment, I tend to steer clear of this type of debate, as I feel I have no personal insight to add. But I am utterly astounded that women feel judged about the way in which they bring a baby into the world. I strongly feel, and I hope I continue to feel – particularly if/when I have children, that growing a baby and bringing it into the world as a healthy human being is utterly awe-inspiring, no matter how the baby is delivered. I genuinely can’t understand why people care how a baby is delivered, as long as it’s healthy. Mothers go through enough grief from their kids (I know – I’m a teacher!) through the rest of their lives – it would be nice if you didn’t have to beat yourself up about decisions right from the beginning!

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