May 17, 2025 • 50 mins
Trigger warning: This episode discusses birth trauma.
When a birth doesn't go as planned and requires intervention, how does it feel from the woman's perspective? Jacqueline Edwards, mother of five, shares her powerful firsthand experiences of both traumatic and positive assisted vaginal births, challenging healthcare professionals to see beyond the clinical procedure.
Through our conversation, Jacqueline offers a rare glimpse into the psychological impact of instrumental deliveries. She describes her experiences with both forceps and ventouse deliveries, revealing how communication, respect, and pain relief dramatically affected her perception of each birth. Surprisingly, her forceps delivery – often considered the more invasive intervention – proved less traumatic than her ventouse births due to better communication and adequate pain management.
The emotional weight of assisted birth emerges through Jacqueline's moving marathon analogy: "You've prepared for it, trained for it, you can see the finishing line... but all of a sudden, for some reason, you fall down and someone runs out of the crowd and picks you up and carries you." This powerful comparison highlights the sense of incompleteness many women feel when intervention becomes necessary, despite having done most of the work themselves.
What shines through is how small, seemingly insignificant actions from healthcare providers can transform a potentially traumatic experience. When an obstetrician told Jacqueline "I can't get this baby out on my own. This is something we're doing together," it fundamentally shifted her perception from passive recipient to active participant. These simple words acknowledged her essential role in bringing her baby into the world.
Jacqueline also shares practical suggestions for improving care during instrumental deliveries – from better lighting arrangements to privacy screens – alongside powerful insights into how birth trauma can manifest in unexpected everyday situations, like trips to the supermarket. Her testimony stands as both a call for change and a roadmap for more compassionate, woman-centered care during assisted births.
Whether you're a healthcare professional seeking to improve practice, an expectant parent preparing for birth possibilities, or someone processing their own birth experience, this episode offers invaluable perspective on centering women's dignity and agency during one of life's mo
Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Florence (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
Episode 181, assisted VaginalBirth A Woman's Perspective.
(01:00):
I have with me today a specialguest, jacqueline Edwards, and
Jacqueline got in touch with meafter hearing my episode and
perhaps a little video I did onassisted vaginal birth, and
we've had a bit of an exchange,haven't we, about your
experiences, good and bad, ofassisted vaginal birth.
(01:22):
So I don't know if we shouldstart, jacqueline, with perhaps
you telling us a little bitabout who you are and why you
got in touch with me.
Jacqueline (01:32):
Yeah, that's fine.
So yeah, as I say, my name isJacqueline, I'm a mum to five
children, a grandmother to one.
So my two eldest sons are bothgrown up now and I have my three
daughters still living at home.
My eldest son is 28.
My youngest daughter is four.
So, yeah, I've had my childrenover a couple of decades and
(01:57):
seen different things happeningduring those years, but also, I
think, importantly, I've had,you know, five quite different
births.
I would originally, you know, ifI could rewind time and from
day dot, I would always haveplanned to have a home birth.
In fact I did with my first andthat's consistently what I
wanted.
Unfortunately, I've ended uphaving three home birth
transfers and that's.
They ended up being theinstrumental birth, the assisted
(02:18):
vaginal birth.
I've also had one home birthand I've had a pre-labour
C-section.
So I was told, technically it'snot an elective section, but I
wasn't in Labour and I'd say,out of all of them, the two most
positive ones were the homebirth and the C-section, which I
never thought I'd find myselfsaying because when I, you know,
with my first before I'd evergiven birth, the C-section was
(02:41):
like the last option and it wasthe most like disastrous kind of
birth I could have imagined,but it ended up being very
positive and empowering for me,um, whereas the assisted vaginal
births less so and I'd say, interms of mental health, they're
the ones that have impacted methe most and had, um, a longer
impact on my mental health,which is why I just feel, now
(03:04):
that I'm finished having babies,I know what we're having
anymore.
I wanted to just kind of help toimprove things for those coming
after me and I'm not medicallytrained in any way, just like
you know, a member of the public, a mom having babies in
different ways, and I just feellike I've kind of almost like an
expert in what it feels likebecause I've had three of them.
(03:25):
The instrumental verse, but Iwanted to share it back from the
woman's point of view of howthat feels, what can be positive
about it and what feelsnegative about it.
And that's one of the reasons Igot in touch with you, florence
, because I thought, as much asI can tell other women about it,
tell other women about it.
(03:47):
Sometimes, you know, it needsto be a bit higher up in terms
of who we share it with, toenable, you know, practice to be
even just slightly adjusted tomake it a more positive
experience for women, and that'swhat I'm hoping to do now with
talking to you in this podcastyes, and I think you're right.
Florence (04:02):
it's really valuable for us as professionals whether
that's midwives or doctorslistening to this or women who
are going to give birth it'sreally important for us to
understand how we make peoplefeel and realise the
implications that we may or maynot see.
So as you know, I've done lotsof work on women's experience of
(04:26):
maternity care and when I talkto women, they always show me
something new.
There's always a blind spot.
You think you're an expert insomething and then someone shows
you a new idea or a new aspectyou haven't thought about and in
preparation for today, we'veexchanged a few emails and I
definitely thought, oh yeah,there's, there's stuff here
(04:48):
that's that's definitely worthtalking about.
So I really appreciate yougetting in touch and and having
this conversation with me,because I know it's not easy
necessarily to re-go through,particularly when things are are
less good yeah and and the sortof long-term consequences that
(05:08):
can have on on you.
So thank you very much for beingwilling to to share your
experiences.
You mentioned to me that youhad a forceps birth, which a lot
of people might see as a verynegative type of birth or very
(05:31):
interventional type of birth,and you had a ventouse birth,
which people might see as apossibly less traumatic,
inducing type of birth.
But actually in your experienceit was the reverse, that
actually the forceps was betterthan the ventus and that some
(05:54):
aspects of that, or a largeamount of what contributed to
that, was communication.
Do you want to talk a littlebit about those experiences?
Jacqueline (06:05):
Yeah, so I've had the two, first birth and my last
birth, both of them too.
So the forceps was my secondbirth and, as you say, from the
outside it kind of seems well,forceps, you know, it's kind of
potentially caused more damage.
It seems more it's more of anintervention rather than just
having a little suction cup ontop of the baby's head.
And yeah, yeah, I can kind ofsee that.
But my experience personallywith the 1-2's birth,
(06:28):
particularly the last one, itwas, yeah, there were lots of
aspects to it that just made itmore traumatic.
So I think the negatives ofthem were, with both my first
and my last one, the pain wasjust excruciating.
And again, you would imaginewith forceps there would be more
pain, but with the, I think.
But neither of them were donewith any pain relief.
My first one, to be fair, was28 years ago, so I've no idea
(06:51):
what policy was then.
My last one was four years ago,and I do know what the policy
is because I've read all theRCOG guidelines and normally it
would have been a spinalanaesthetic or, if not, a dendro
block, and I didn't get eitherof those.
And so at one point the pointthat always sticks in my mind
when I think about the birth andwhen I've done so much therapy,
(07:11):
is the part where I'm screamingout, where the doctor is
attempting to attach the suctioncup to my baby's head and the
pain was excruciating and thatjust caused so much trauma and
even if I have no idea how longthat took, but the fact that it
was so painful and knowingafterwards, unnecessarily so it
just caused more traumabasically.
(07:33):
So that was one thing, theamount of pain, that physical
pain that I experienced, justnot the whole consent process.
It just wasn't done in a waythat you would imagine any other
medical procedure would be done.
In terms of informed consent,now I, as I say I'm coming at
this from the don't like to usepatients technically not really
(07:55):
patients are we, but the payI'll use that term anyway a
patient's point of view and it's, I'm sure it's very different
from a doctor's point of viewand I'm sure there's so much
difference to a woman beingpregnant, having a discussion
with an obstetrician aboutoptions and pros and cons, to a
woman actually being in labourand you're trying to give this
information between contractions.
(08:16):
So I can kind of appreciate howdifficult it is, but I do think
that same principle of informedconsent should always be there,
no matter what the situation.
I just feel with both of themit was almost like the doctor
kind of gave me enoughinformation to get me to consent
to what he'd already decided hewanted to do.
So I was given all the pros ofthe intervention, but without
(08:40):
any of the cons and withoutreally going through things like
what would happen in terms ofepisiotomy.
So I think it was just thatwhole process wasn't done in the
way that it should be done andthat really had a big impact.
I mean, at the time it'sdifficult because you're
thinking I just want the babyborn, but you know it's.
It carries on much longer thanthat and you know, when you kind
(09:02):
of ruminate and think back towhat happened, they actually
know.
You know neither of them were amedical emergency.
It was both slow, second stage.
With both of them Baby wasn'tstressed.
There was time.
It wasn't a case not when yourbaby's heart's gone.
You know through the floor,this baby has to come out now.
I mean, even then, technicallyyou know you're still supposed
(09:22):
to inform consent.
But I can appreciate the timein that you know it just doesn't
allow it.
But for me the time did allowit and you know, things like an
episiotomy could have beendiscussed.
There was time to put you know,to administer a pedendal block.
As far as I'm aware, it's quite, you know, quick,
straightforward.
The juror would have been a muchlonger process, but you know,
(09:45):
it's just little things likethat.
That, um, it was almost like Ifelt like I was collateral
damage.
It's like, well, let's just getthe baby out, doesn't?
She'll be fine.
That kind of dude as in doesn'tmatter.
If she has to go through a lotof pain, she'll, she'll live,
she'll be fine and we'll get thebaby.
That's what I found verynegative about that time allowed
for things and those thingsthat should have been done
weren't done.
(10:05):
It's almost like, well, I'mbothered, or I don't care, or do
you know what I mean?
I don't know what was going on,but from my point of view it's
like just can't be bothered,should be fine you know what I
mean?
Florence (10:14):
yeah, yeah attitude yeah.
I think so.
Absolutely, pudendal block isquite quick and easy to do.
I think it is something thathas some skill that I think our
trainee obstetricians areperhaps less experienced in
(10:36):
pudendal block than perhaps wewere when I was training,
because we give spinals muchmore readily these days, or
epidurals, but absolutely it's arelatively quick and, you know,
surprisingly effectiveprocedure actually you know I
really do find it works.
(10:57):
So it's an injection of localanesthetic around the pudendal
nerve on each side, so you havean injection each side in the
vagina with some localanaesthetic and then usually
some local anaesthetic into theperineum and you need to wait a
little bit for it to work, butnot very long, you know, maybe
five minutes or so so absolutelythere is no excuse for not not
(11:21):
giving you pain relief.
I'm interested because I wonder.
So we talk a lot in healthcareabout bias and there's all sorts
of bias, but I'm wonderingwhether there was a bias or an
assumption.
Well, you've had four babiesbefore.
You've had all these birthsbefore, with varying degrees of
(11:44):
intervention, so I'm wonderingwhether that biased stuff.
Because I sometimes feel thatwhen women have had babies
before, there is a little bit ofa attitude of, well, she's just
going to crack on and it's allgoing to be fine because she's
(12:07):
done it before and I don't knowif that was coming into play at
all.
But I'm wondering if that waspart of the mindset.
And you know, in terms ofconsent, I think you're right.
Antenatal education is reallylacking in provision in terms of
what maternity services providethese days.
(12:29):
You know there's a bit and wegive lots of information with QR
codes and websites and etc.
But I think really the time andplace to have those
conversations is in thepregnancy.
Conversations is in thepregnancy so that when a woman's
faced with a decision in theheat of the moment, she already
(12:50):
knows what she's talking about,because she's talked about it
before 36 weeks.
One of the main aims of the 36week antenatal appointment with
the midwife is to have someconversations about birth
preferences and birth optionsand what expectations that woman
has and how she'd like to givebirth and what pain relief and
(13:13):
so on.
So maybe it needs to be betterwrapped up into that
conversation, particularly ifyou're having your first baby,
because we know an assistedvaginal birth is much more
common in a first labor.
You know it might be as high asone in three women having their
first vaginal birth will havesome form of assistance yeah, I
(13:36):
definitely agree.
Jacqueline (13:37):
Um, both of those things.
Actually that, just going backto what you said originally, was
there some kind of oh well,it's her fourth vaginal birth,
blah, blah, even like I've got amidwife friend and she said the
same thing midwives, you know.
I won't go into all the details, but I found out I didn't find
out until after I had my lastbaby that I've actually got a
hypertonic pelvic floor.
This is the reason why I've hadthese difficult.
(13:57):
Second, I have like textbookfirst stage labors easy, baby's,
always head down, perfectposition, no issues with the
baby.
But then I have this issue withmy pelvic floor and my midwife
friend was saying yeah, wealways assume that once a
woman's had like a couple ofbabies, you know she'll have
this quick, easy second stageand it is.
It's kind of that assumption.
I think that's part of thereason why I ended up with this
(14:20):
instrumental birth last time.
So I've been pushing for anhour, baby had progressed, she'd
moved down a couple of stations, but because it was my fourth
vaginal birth and I've beenpushing for an hour and she
hadn't moved, well, you know,we'd x, this is what we'd expect
.
The there was that assumptionas in.
Well, we have to intervene nowbecause something's not quite
right, because she hasn'tprogressed as fast as she should
have done, without actuallyspeaking to me and saying oh
(14:42):
well, what were your others?
Do you know what?
Florence (14:44):
I mean what?
Jacqueline (14:44):
yeah, they'd have asked me, and I said actually,
yeah, you know what?
I have really long pushingstages.
There's something going on.
I didn't know at the time whereit was.
I've since found out fromhaving um visiting pelvic
physiotherapists.
I'd say yeah, this is normalfor me, that's fine you know,
but it's.
You moved a bit, that's fine,that's normal and you know it's
not.
So, yeah, that's.
There was definitely anassumption there, and whether
(15:06):
again, the assumption was orwell, you know, she's passed a
baby's passed through a vaginathree times already.
She won't need any pain, she'llbe fine you know like I say
she'll keep on, she won't feelanything.
But I think those assumptionsare difficult because you know,
we're all different.
We've all got different um painthresholds, and it could be
that the woman that theyperformed that intervention on
yesterday last week, didn't havean epidural in place, didn't
(15:28):
need anything, and she wasabsolutely fine.
But I think you have to go withwhat the woman who is the most
sensitive and has the lowestpain threshold and at least
offer that, and you might say,no, I don't fancy that injection
to my vagina or whatever, I'lljust crack on with it, whereas
(15:48):
another woman will be like, yeah, actually, you know, when I go
to the dentist I need, like,maximum pain relief.
Give me the map.
Yeah, this thing you're nowgoing to do, do to me.
So I think those assumptionsyeah, it must be quite difficult
as a practitioner when you'veseen, like, what the norm is in
inverted commas, but you'realways going to have people
outside and they're the ones youalways have in mind every
single time.
What if this woman has a lowpain threshold?
We have to go with theassumption that you have that
(16:11):
and if you don't, that'sfantastic, yeah.
So I think that that thoseassumptions definitely things
that should be challenged everysingle time you have this
situation.
Florence (16:21):
Yes, I'm interested in what was the midwife
involvement in this, becauseyou've been pushing some time.
And then what happens is themidwife comes out and talks to
the midwife in charge and saysoh I need a doctor's review or
whatever, and the midwifepresumably had been with you for
(16:45):
some hours and got to know youa bit, yeah, and I always think
the midwife is there.
You know we're coming in tomaybe assist, but the midwife is
still your key person and yourkey advocate.
So I'm interested perhaps formidwives listening or student
(17:05):
midwives listening what role themidwife played in this, if were
they saying to the doctor, hangon a minute, do this, and he?
He was ignoring them, or werethey passive or what was
happening?
Well, I did find them quitepassive actually.
Jacqueline (17:21):
So I did trans.
I say I transferred him from ahome birth, this.
I was like post-dates, my babywas post-dates and when my
waters broke we transferred in.
When my waters broke there wasmeconium, but she was never in
distress at any point and it wasjust one of those cases of.
I've since read that 30 percentof babies who are post-dates
can have meconium or waters.
(17:42):
Obviously at the time I didn'tknow this, I just thought
meconium was the scary things.
They said let's go.
And I'm not.
I'm not saying what they didwas wrong.
You know advising me totransfer in and I did willingly
transfer in.
And you know, as a plus, thesethe two home birth midwives, in
theory should have kind ofhanded me over to the hospital
midwives, but they stayed withme because I didn't have a
support person.
(18:02):
Long story short.
So they stayed with me almostas my support people.
Then obviously I had thehospital midwife and then I had
the labour ward midwife comingin as well.
But I did find, to be honest,even with my first one, almost
once an obstetrician comes inthe room, I found personally the
midwives are quite passive andit's almost like they don't like
to challenge the, the doctor.
(18:24):
So, for example, with the painrelief you know I was screaming
with the pain and the midwifeone of the midwives from the
hospital, a labour ward midwifewas just saying right, you need
to stop screaming, you need tocalm down, listen, to listen.
So it was almost like shewasn't even on my side, so it
was almost like advocating.
I felt she's advocating for thedoctor here instead of me.
(18:45):
And then one of the othermidwives did, and I remember
just saying, um, oh, but itreally, really hurts.
And one of the midwives saidhere, have some gas and air.
So at that point I did have abit of pain relief.
It was gas and better thannothing.
But I just thought afterwardswhy didn't they hand me that gas
and air before the doctorstarted the procedure?
I mean, yeah, it was thedoctor's job and duty to ensure
(19:06):
that I had pain relief in place,but given that he didn't, and
given that the midwives were outthere was four midwives in the
room at that point not one ofthem thought hang on a minute,
let's just see, until after I'dstarted screaming.
So, yeah, I didn't feel as badas I feel as angry as I feel
towards the doctor, because Idid feel as angry as I feel
towards the doctor.
So I did feel angry.
I actually felt more angertowards the midwives Because
(19:29):
they were my advocates.
Yes, he failed to do his job,but so did they and their women,
and at the very least, theyknow what even a smear feels
like.
Florence (19:38):
Whereas the doctor?
He was male, he didn't have aclue.
Jacqueline (19:40):
I'm not saying that's an excuse, but from an
emotional point of view it'slike hang on, there's four of
you, four women, in this room.
Yes, you know why.
Are you passive and not kind ofdoing your job of being my
advocate?
or just saying start, just hangon, let's just give her a bit of
gas.
So I didn't have an epidural inplace, nothing.
And I was already insignificant pain because I had a
(20:02):
very quick labor, but come onvery, very quickly at home.
So I was already in significantpain because I had a very quick
labour, but come on very, veryquickly at home.
So I was already in a lot ofpain anyway because I didn't
have time to build up all youknow the endorphins and the
natural pain.
Then you transfer from hospital, from home to hospital.
That in itself makes labourmore painful because it's you
know, you've got the stress,you've got the addiction.
So I was in a bad situation tostart with, and then it was just
(20:23):
about to be made worse by thistype of birth I was having.
Once the doctor walked in theroom, it's almost like, right,
this is their territory now,yeah, and they're going to kind
of take over.
That's how it felt for my.
Florence (20:35):
Yeah, yes, okay, perhaps if we turn to slightly
better, say a little bit aboutyour forceps, birth and what was
better about that, or how youfelt the communication was
better or or cared for in thatsituation yeah.
Jacqueline (20:57):
So this was my second birth.
I'd had quite a big gap I'd hadnine years between my first two
.
I decided I'd had.
I decided to pay for anindependent midwife because my
first birth had been sotraumatic I thought I'm going to
give myself the best chance.
So because I had theindependent midwife you know it
was the one-to-one care we hadlots of.
So this is really goodantenatal care.
(21:19):
You know lots of longappointments for an hour or more
where we go into what happenedlast time and you know what if
you're in that situation.
So we had lots of time toprepare for this eventuality and
unfortunately it did happen.
And what I remember one of thethings I said is you know, if I
do go into hospital, if I dotransfer into hospital, it's
because something's going wrong.
At that point I want anepidural.
(21:40):
I don't care what they're goingto do to me.
They're going to intervene insome way and I'm not going
through any kind of birth,hospital birth with
interventions, without painrelief.
So I think that in itselfhelped because I already had a
good plan, as you say, gettingback to women during pregnancy,
having this really good, solidplan in place.
If this does happen, none ofthem want it to happen, because
(22:03):
it's not a choice, is it?
You're not.
No woman puts on a birth plan.
I want my baby pulled out byforce yes exactly.
It's not.
It's not anything anyone'splanned for.
So it's like, in theeventuality of this happening,
this is what I'd like, andbecause I'd had the bontus birth
to start with, I had a goodidea of what, what was going to
happen, what would be done to me, how that would feel.
So I said under nocircumstances am I having any
(22:25):
instruments without an epidural.
And if they won't do it, thenthey'll have to do a c-section.
That's it.
There's nothing.
You're not, you're not touchingme without an epidural.
So I had that in place.
I had really good support ofthe midwife who transferred in
with me someone I knew reallywell.
Unfortunately, when we gotthere, we did have a doctor who
didn't understand like why Iwould want an epidural.
(22:45):
Because he's been you know he'sbeen you've got this far and
you've been pushing for hours.
Why do you need it?
Because of what you want to doto me now is going to be the
part that's going to.
I can cope with the naturalpains of labor and pushing a
baby out.
It's all these other things youwant to do to me that are going
to really really hurt me In theend.
You know how Hoft and Poft wentout.
He couldn't do anything withoutmy consent.
(23:11):
So he did.
He did agree, he sent theanesthetist.
So I think the fact that I hadthe epidural in place meant that
I was in a very different place.
I wasn't in pain, I could havea proper like adult conversation
, because there's always thatthing of like you're a bit
infantilized, aren't you?
You know you you're half nakedor you've got a nightie on,
you're in a hospital setting,you're in pain, you're very
vulnerable.
So I felt like a little bitlike, because I had this pain
(23:31):
relief, I could have a normalconversation, yes, which I
couldn't have even betweencontractions.
You're recovering from one.
Last thing you want to do ishave a full blown conversation.
Florence (23:40):
Yes.
Jacqueline (23:42):
So that definitely having proper pain relief in
place made sense, made it easier, and because of that we could
have a proper full conversation,like I said.
For example, you know, I don'twant, I don't want an episiotomy
.
Can we try it without anepisiotomy?
And he said, well, yes, we can.
And I did end up having acompete an episiotomy, because
he was saying to me right, youare starting to tear, is it okay
(24:04):
?
But you know it wasn't likeright, I'm going to give you an
episiotomy.
Okay, if I do a smallepisiotomy rather than just,
well, you know, compared to theother two, it's like I didn't
even know until the baby wasborn, that'd been done, you know
right yeah, if you can see it'sso.
That's so different, isn't it?
Yeah, look, you know, evensaying beforehand would you like
me to do episiotomy?
Do you want to wait and see?
(24:24):
Do you want to, you know, ifyou start to tear, you know that
kind of proper adultconversation, which is what
really in theory should happen.
It just seemed much morerespectful.
As I say, yes, the things werejust done to me because this is
what this is how I do, things,you know, and for the episiotomy
.
And then me saying, for example,when the baby's head was out, I
(24:44):
says, can you just stop,because I really want to touch
my baby's head?
And I mean, obviously this is'msaying in a non-emergency
situation and just really lovelythings like that that try to
maybe honour my birth plan asmuch as you can in that
situation.
And things have been explainedto me, like I remember my
midwife saying you know, youwanted, like I've always wanted,
(25:06):
delayed core clamping and aphysiological third stage.
She kind wanted like I'vealways wanted, delayed core
clamping and a physiologicalthird stage.
Kind of explains me, you knowwe've moved off this path of
normal now.
So, yeah, you know, we wouldn'trecommend a physiological third
stage because you don't haveall those lovely hormones
flowing anymore.
We've already intervened in thebirth so we kind of like have
to carry on, but it was neverlike we can't do this now.
Yeah, it was like what do youthink?
(25:28):
Think, do you?
know what I mean, and I didagree, whereas, like with the
other ones, it's almost likewell, now we're on this path,
this is what's going to happen,this is what needs to happen,
without really consulting me asa fully you know functional
adult, who you know be giveninformed consent, so that
definitely, you know.
Florence (25:52):
Yeah, I think that's a really important point, being
able to have that adult to adultconversation.
You're right, it can end upwith infantilizing so that
you're you're not able to havethat proper, proper conversation
.
So I can see that having thatpain relief then gives you that
chance to have that conversationand how valuable that is.
(26:14):
I think the other thing fromwhat you just said there that
really resonated with me isrespect and possibly with that
acknowledgement in terms of Ican think of situations where a
woman has said to me beforehandI really don't want an
episiotomy.
Jacqueline (26:33):
And.
Florence (26:35):
I said to her I know you really don't want an
episiotomy.
I know you know I've heard that.
I know that's really importantto you.
We're now in this situationwhere I think you really need
one.
You know, I can see you'restarting to tear, tear, you're
going to have a bad tear orwhatever.
I I now I know that's what youwant and this isn't what you
(26:58):
want, but I I now think we needto do this and it's kind of
taking on board.
We may or may not then do theepisiotomy, but what I'm kind of
saying is I've heard yourwishes.
I've really understood thatthis is an important thing to
you, that I need to have thatreally separate discussion and
(27:22):
explain why I do or don't nowthink that that's okay.
So I think respect is a bigelement of it yeah, definitely,
and I think it's still.
Jacqueline (27:32):
It's the woman she says no, I don't want one, just
go ahead exactly, yeah withoutbanging on and on and on.
So, okay, you know, yeah, makesure of that.
Yes, you know, that's whatyou've decided, it's all noted.
You know you've coveredyourself, yeah, as a midwife.
You know we've discussed thisadamant doesn't want an
episiotomy, and you know you'rekind of covered then, aren't you
?
I mean, yeah, but definitelythat that respect.
(27:55):
And it is very hard and it'svery hard to advocate for
yourself and normally in likeday-to-day life you can be, you
know, very articulate and youcan be very confident, but you
know you're in a different worldaltogether when you're yes,
very difficult.
One thing that I just remembered, actually is also that made it
better, and this is more from aemotional or psychological point
(28:18):
of view.
Remember the doctor saying tome and I actually picked up on
this when you did your podcastsaying that this is a team
effort, this is, we're going todo this together.
And that's exactly what thedoctor said.
He says I can't get this babyout on my own.
You know something we're doingtogether.
You're going to push and Idon't know whether he was just
saying it to inform me likeyou're not just going to lie
down and pull the baby out andmaybe it was, but from my point
(28:39):
of view, emotionally, that justreally helped because it's like
it's not like I'm at the dentisthaving a tooth extracted and
the dentist is doing all thework.
You know I'm the one, yeah,we're doing it as a team.
So I am pushing my baby out, mybaby isn't being pulled out and
even though rationally andlogically afterwards you know
all the people I spoke to themidwife says no, the baby can't
(28:59):
just be pulled out.
It just can't be pulled out.
You have to push.
At the same time, on anemotional level, sometimes it
can feel like you've been verypassive and you're laying the
job for you, as I say, likeextraction and it's not and even
though, like with my last one,for example, I can tell myself
over and over again that didn'thappen.
Sometimes it did feel like that,like I didn't really do it,
(29:22):
whereas with that one, I thinkbecause I heard it at the time
it was happening somethingimprinted in my brain to say
like, yeah, you are pushing yourbaby out.
So I think that even justthings like that, like the
doctors, like you say you,that's what you say and if, like
any midwives listen to this,the doctor doesn't say that, the
midwife can say that there's noreason.
(29:43):
I can't say you know what?
The doctor can't do this on herown.
So you know you really need topush, you're going to be pushing
, or you know and, as yourbaby's being pushed and moving
down, saying you know you'redoing, you're pushing your baby
out.
Yeah, you are, you are doing it, you are doing.
I think there's something abouthearing it as it's happening,
as opposed to someone tellingyou afterwards but you did do it
(30:03):
yeah, yeah, it's a difference.
I don't know why.
There's something in your brainthat, just in my, in my point,
from my point of view, that'swhat happened.
That's what happened, you know,to me, even though with the
forceps birth, my baby was muchhigher up in the pelvis.
His head needed to be rotated.
You know lots of things goingon at the core around his neck,
(30:24):
which is why I ended up needingforceps and not the ventouse,
because he wasn't low enoughdown.
So in theory, with the ventousebirths, I did a lot more of the
pushing on my own, or quite,you know, close to being born,
compared to the forces.
But the force response stillfeels like I did more, just
possibly because of the wordsthat that doctor yes, and you're
right, I do say it's teamwork.
Florence (30:46):
I say that all the time to women, um, because it
genuinely is that I'm justadding a little bit, whether
that's, like you say, rotatingthe baby's head into a better
position or helping it come down, I genuinely feel that, but
it's really, it's really nice tohear that that could be a
(31:09):
really valuable thing.
I'm saying, actually, and Ithink, even if you take away the
pushing, the way the uterus isworking, the way the womb is
contracting, we only are pullingwhen the womb is contracting.
(31:29):
You're working with thecontractions, you're working
with the woman's body.
That's how an assistive vaginalbirth works and so very much.
It is not a passive thing and Ithink I can see why
psychologically, that is areally big point.
That might help if if it's saidin that moment, because it it
(31:52):
absolutely is, um, not a passivething, it's very much working
with what's already happeningand trying to expedite.
Jacqueline (32:02):
It is the best word I can think of really yeah, and
I think, as I say, I'm onlyspeaking on my behalf, but I
can't imagine that lots of otherwomen feel very differently to
me and I do remember with mysister.
So my sister had two babiesbefore I did.
And years later she said, witha second one, again, I think
she's had some.
Maybe she's built the same wayas I had.
She's had three, two, threeinstrumental births, one without
(32:25):
any instruments.
And she said, with one of themI can't remember, I think it was
the second saying I felt Ireally could have done it.
I felt I was cheated.
She said I felt like I wascheated out of that birth and I
hadn't given birth at this point, so I didn't know what she
meant.
Looking back now I 100%understand it and, to use an
analogy, how I feel it's likerunning a marathon.
So you've prepared for it,you've trained for it, you've
(32:47):
imagined and you've got thereand you're right and you can see
the finishing line.
It's right there, but all of asudden, for some reason, you
fall down and someone runs outof the crowd and they pick you
up and carry and it's likeyou've done so much to get to
where you are but, you've neededhelp or even not carrying you.
You're limping along, you know,with your arm around them.
It's, yeah, you did it, but youalso had someone helping you.
So it's it's a funny thingbecause you know, you know you
(33:12):
did it, but it's like, but Iwanted to do that last those few
meters.
At the end I didn't, I neededhelp.
So anything that can mitigatethat, yes, failure and inverted
we talk a lot about women.
You know you weren't a failureand you weren't.
You were failed in this but Ithink to just anything that can
mitigate that potential feelingof failure.
You know it.
Just, I just think it reallyhelps and I do think, like
(33:34):
saying it at the time just makesall the difference in the world
, definitely.
So, yeah, listening to thisjust takes one thing away from
this is that you could just yeah, actually I remember talking to
that woman and yeah, that'swhat it's like running a
marathon just get to the end.
So just, yeah, you're doing it,you're getting there.
Florence (33:53):
Yeah, I mean, you're pushing your baby out yeah, no,
I love that idea of a marathonand not wanting to be helped
over the line.
You want to do it yourself.
Jacqueline (34:03):
That's a really good way of thinking about it
actually yeah, it's like kids,isn't it, when they say, no, I
want to do it.
You know, getting direct young.
Yeah, yeah, I'll help them, butno, I want.
There is that thing.
If we want to be able to dothings, yeah, we can see over
our own bodies.
And, yes, I think it all ties.
It all ties into that.
Florence (34:22):
Yeah that's lovely.
I wanted you to mention brieflybecause you sent me a piece
you'd written about birth traumaand how the impact it's had on
you.
I think the thing that struckme from what you sent me to read
(34:42):
was the everyday life things.
So if you go to a maternityunit where you've given birth
and you've got birth trauma,then everyone would assume that
would be triggering.
But I think the thing thatreally struck me was the that
you could be going about doingyour normal everyday life and
(35:07):
something could trigger you thatreminds you of that occasion,
which perhaps we asprofessionals wouldn't
appreciate.
And the example you gave wasthe supermarket, and I had never
thought of the fact that peoplein the supermarket are wearing
uniforms and having fluorescentlights and some of those
(35:27):
similarities.
So I don't know if you'd bewilling to share a little bit
about birth trauma and whatthat's been like?
Yeah, yeah.
Jacqueline (35:39):
So as you say things like that, you, you would, you
know, imagine a certainsituations being in a maternity
unit or even in the part of thehospital.
It's so similar it's gonnacould be a trigger.
But every I I found this.
Personally, I found thesupermarket very triggering, and
it was.
It was the uniforms, andperhaps it was because it was
the color.
It was a dark blue, so it wasperhaps the color of the, um,
(36:01):
the labor wards, um, the youknow the midwife I can't
remember her title is a labor.
Yeah, yeah, whatever the colorsshe had on and just the fact
that there's the fluorescentlighting and it's just, it's a
thought.
I mean it's a form of ptsd.
I wasn't officially diagnosedwith ptsd, but all these are
like symptoms of of ptsd being acompletely different
(36:21):
environment, nothing to do withthe hospital, um, let alone, you
know, maternity ward, but justhaving those reminders and
triggering you and the I think Imentioned this.
Also there was a pharmacist, soI always ended up in a till
that was right opposite thepharmacy desk and I think that,
in particular, triggered,triggered me, because that was a
very almost clinical settingwithin a supermarket.
(36:43):
And the doctor he actually didlook like the doctor that
assisted my baby's birth and Idid end up feeling a bit sorry
for him because I used to lookat him and think, oh, you know,
kind of like you're reallyannoyed and angry because you're
there and triggering me.
It wasn't his fault, this guyis just there doing his job.
But just, you know, every daykind of things have the
potential to trigger you and Idon't know how to mitigate
(37:06):
against that.
Because getting back to thiskind of thing of the
vulnerability being in labour,even just going into a situation
in hospital even when you'renot in labour.
I think just the fact thatpeople wear uniforms, for
example, in our culture we seeuniform as an authority, don't
we?
so you're going there andthey're almost like you're going
into their territory to startwith and they're wearing a
uniform.
So you're going there andthey're almost like you're going
(37:26):
into their territory to startwith and they're wearing a
uniform, so they're almost likethey're in charge, and there is
that power imbalance I feel.
You know, even when you're justgoing in for, like, any kind of
appointment in the hospital,but certainly when you're having
a medical procedure or you'rein labor, you know just just the
nature of the whole fact thatyou're in there and you're
vulnerable.
Um, that power balance,imbalance is there and, as I say
(37:50):
, I don't know how to kind ofmitigate against that and that.
Carrying on in everyday life,where you will come into contact
with people, as I say, just inyour supermarket, and you know
you can avoid it to a degree,you could, you know, shop online
, but the fact that it's there,it's, it's very difficult.
So I think I don't know.
I suppose what I'd say is thatif a woman needs that kind of
(38:13):
birth, just bear in mind that itis going to be traumatic On
whatever.
On some level it's going to betraumatic for her because it was
never the plan, no one planned.
So it's.
Even if you were in hospital,you transferred, or even if
you'd started laboring in thatroom and that had be, you know,
started to happen.
But certainly, transferring infrom like a low risk setting
(38:33):
like an MLU unit or a home birth, as I did, you've already got
the trauma of changing from oneenvironment to another.
That already that's, and thenyou add this trauma onto it.
So I think everyone in the roomneeds to bear in mind that that
woman on some level is going tobe traumatized.
With the best will in the world, so really to try and practice,
you know, as much as you cannot that you shouldn't with
(38:55):
anyone else, but you know theempathy and the kindness and the
care and the trauma-informedcare really, really, really need
to be in place while that'shappening you know, because you
don't know how that woman'sgoing to act.
She might be 100% fine with itand go and skip off and live her
life, or she might bedevastated, like I was and you
know, feeling at points whereshe doesn't want to be alive
(39:17):
anymore.
So, again, you have to go withthe lowest kind of denomination,
as, in you know, this kind ofbirth has the potential to do
this to a woman.
So let's be kind to her, let'sreally care about her, because
that's going to be carried withher, you know, for the rest of
her life she's going to rememberand it's going to be carried on
into everyday life.
And also what?
Like you know the piece that Iwrote, I did put some of the
(39:39):
suggestions that I had from mypoint of view, which may not be
possible, that could possiblyhave mitigated.
I think, with, as I say, eventhe perfect situation.
There's going to be traumainvolved in that kind of birth.
So what can we do to mitigateit?
And for me, one of them wasprivacy.
It's very difficult to havethat kind of birth and feel
(40:00):
you're not being watched, you'renot being viewed.
It's like, you know, the lightsare switched on, you kind of
bear with your legs wide openand what can we do to kind of,
as I say, mitigate thatexperience for that woman?
Some of the things I came upwith, as I say, one of them
might, may not be possible.
One of them was that Iunderstand that there needs to
(40:20):
be bright lights in the room,but over my head do the lights
have to be bright?
Is that an option to not havebright lights?
And I did speak to um.
I did a labour ward tourrecently, actually a few months
ago of the hospital I gave birthand I mentioned this to the one
the obstetrician that was thereand she said which something I
didn't think of.
She said, yeah, thatpotentially it is.
(40:41):
If we had lighting where wecould have, you know, dim
lighting in one part of the roombut bright lights in the other,
then yes, that could happen.
She said, from my point of view, what I find is that, going
from light to dark, my eyes takea few seconds to adjust.
I was looking up to speak toher and where her head is, it's
like it's not bright.
(41:02):
And then I'm looking down again, it's not ideal.
As I say, I don't know.
That's one of the things Ithought, but I'm just thinking
it purely from the woman'sexperience.
But I know that would havehelped me if that had been
possible, or if not.
A spotlight, for example.
So the room is dim.
Yeah, the doctor uses aspotlight and, again, one of the
things that this observationcame up with was like, yes, we
(41:24):
could have a spotlight in theceiling, but then the women that
are birthing in that room thatdon't need it, are looking at
this light.
That's kind of medicalizing theroom more than it needs.
So it's not.
I know it's not as simple.
All I can do is speak out andsay this is what we've heard and
for people to say, actually, inour unit, could we do that?
What could we do?
What could we do?
(41:47):
Is that possible?
And what would be thechallenges?
Because if no one says it,you're not going to think about
it.
Yeah, and another thing with thelighting.
So my baby was born, she wasabsolutely fine, um, didn't need
any help, she was on my chestand but again, these light,
really bright lights, were kepton.
And at that point, you know,could we have a spotlight
because I need?
I don't have any paediatry, soI need to be structured.
And could you know, could wejust have the lights dimmed in
(42:07):
the room for the mum and thebaby?
At that point, kind ofspotlight for the doctor?
Yeah, to see what they're doing.
And then another thing was withbeing viewed.
Having the paediatrician andthe resuscitaire was pretty much
so.
I was in the bed against onewall and they were on the
opposite wall, but they couldsee everything that was on
display.
Yeah, and again, going back tothe labour ward when I wasn't in
(42:30):
labour was really helpfulbecause I saw several rooms and
I thought because one of thesuggestions that I made that I
know another unit does asstandard, because I know a
midwife who is married to anobstetrician and she said in my
husband's unit this is standardthey have the resuscitator and
the pediatrician on the side, onthe wall at the side, yeah,
very close to the woman ifthey're needed, but we can't
(42:50):
actually view you from that endof the room.
And again, it'll depend on the,on the unit, because when I went
back to my hospital, some rooms, yes, you could have done that,
but others it was so small,it's like I know this the only
place we can put them, yeah, soagain, it's just maybe thinking
outside the box.
And then I wrote this articlefor aims and the lady from aims
(43:10):
said to me one of the things I'mgoing to take from what you've
written is I'm going to advocatefor the use of screens.
So again, could a screen beused so that you know?
You know a screen on wheels soyou can just, you can just be
screened, but it can be whippedaway in a second, if you know,
if it's needed to, so that theonly person that can view your
genitals is the person thatyou've consented to view your
(43:30):
genitals yeah yes, yeah, it's abit of a free-for-all now.
Bright lights on.
Whoever's in the room can seeyou.
I guess when women say thingslike this, you felt very exposed
and vulnerable.
They'll say to you oh yes, butyou know, they see this all the
time.
It's nothing and looking at you, that pediatrician might be
looking over, thinking right,what am I going to do when
(43:51):
they're?
Florence (43:51):
back.
Jacqueline (43:51):
You know what will this baby, you know I mean, but
it's like it doesn't matterbecause the woman's like still
exposed it's like how many timesthat doctor's seen other
women's vaginas?
he's never seen mine.
Yeah, you know, I've only gotone strange man standing between
my legs and now I've gotanother one at the other end of
the room staring in my direction.
It's like is this 100%necessary?
(44:11):
It's still that kind ofinvasion of your dignity and
privacy and I imagine for womenwho are, you know, rape
survivors or sexual assaultsurvivors, that would be pretty
harrowing.
That would be pretty harrowing.
That, yeah, pretty.
It's not nice for any of us,but added in that extra trauma
(44:33):
and I think the fact that I'meven having to say this speaks a
lot, doesn't it?
Yeah, I'm having to say hang on, guys, have you ever, ever
thought what that woman'sactually?
Yeah, yeah, all these peoplepotentially viewing her after.
Yes, that it has really beenthought about.
Maybe it's been thought about.
Um, not taking any further.
(44:54):
So I think I just need to sayit, because if I don't say it,
no one's going to think yes, yes, you know.
No, absolutely.
Florence (45:03):
I think and I think you're right, you know, some
things are practically quitedifficult, some things actually,
you can think, yeah, that'sactually quite easy, we could
easily do that and to hopefullyprovoke a bit of thought and
hopefully some people listeningto this will go away and just
think, oh, in our birth, birthrooms, what could we or couldn't
(45:27):
we do?
You know, I'm thinking with thespotlight suggestion and the
lights.
You know I do do sometimes thecesarean with the top lights in
the theatre off and just theoperating light on, and the same
.
You could do that with anassisted birth.
So it you know there are thingsyou can do and you know you
(45:50):
probably seen that I often saywrong is wrong even if
everyone's doing it, and rightis right even if no one's doing
it, and so little things have tostart from somewhere.
So hopefully people will graspsome of this and and run with it
.
Yeah, I'm just thinking so.
(46:10):
Normally I end the podcast withthe zesty bit, the kind of
take-home message, and I thinkthere's so much that you've
already said that would comeinto that.
But is there anything else thatkind of comes to mind?
Oh, oh, hang on.
The marathon, the end of themarathon.
Jacqueline (46:29):
Yeah.
Florence (46:30):
Encouraging the woman and helping her understand she
is a participant, she isactively birthing her baby, even
if she's having some form ofassistance.
Would that be your zesty bit,or is there anything else you'd
want to add?
Yeah, I can't.
Jacqueline (46:46):
Yeah, I think that would be your zesty bit, or is
there anything else you'd wantto add?
Yeah, I can't.
Yeah, I think that would be myzesty bit because, as you say,
it's probably something thatmost people don't think about
unless you experience yourselfthat that's how it could
potentially feel for women.
So I think, yeah, and everyonein that room, if the doctor
doesn't say it, for whateverreason, then you know there's
going to be other people in theroom that can be saying it.
So I think, yeah, that would bemy zesty bit, to actually let
(47:06):
the woman know she is birthingher baby with some help.
And you know, I just think itmakes such a difference to be
saying that at the time ratherthan afterwards.
So, yeah, I think I think thatwould be, as you call it, your
zesty bit.
If every woman having that kindof birth was hearing that at
the time, then I think it wouldmake psychologically,
(47:27):
emotionally easier not perfect,but it would make it easier,
definitely perfect thank you soso much.
Florence (47:38):
I I feel that's been a really excellent conversation
that I really hope will inspirepeople to go back and just think
a little bit yeah, definitely,and I also just quickly wanted
to say lastly, even though it'sjust me, one person, one woman,
is saying this.
Jacqueline (47:56):
It's almost like the women that speak out.
You're almost at the tip of theiceberg.
Yeah, there's also women behindme that don't speak out because
they don't know whether birthcould be any different, or
they've just had a baby andthey're exhausted, or they just
want to move on.
They don't want to talk aboutit.
So I feel like I'm speaking forlike 99 women who come behind
me, who are not going to say,and the women who are coming
after me.
(48:17):
So it's not just I'm the onlyperson that's experiencing it.
Of course I'm not.
I'm the one that's speaking outand saying how?
You know how it can be.
I'm not speaking every singlewoman that's had this type of
birth, but this is how it can be, and it probably is for a lot
of women, as well.
Florence (48:32):
yes, thank you very, very much.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review, on whatever platformyou find, your podcasts, as well
(48:53):
as recommending the OBS pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalogue
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
(49:16):
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
(49:40):
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
episodes, you can find me attheobspod, on Twitter and
Instagram, and you can email metheobspod at gmailcom.
(50:06):
Me theobspod at gmailcom.
Finally, it's very important tome to keep the OBS pod free and
accessible to as many people aspossible, but it does cost me a
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and by chance, you do
(50:28):
have a tiny bit to spare, youcan now contribute to keep the
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contribute, you now can.
Thank you for listening.
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
Episode 181, assisted VaginalBirth A Woman's Perspective.
(01:00):
I have with me today a specialguest, jacqueline Edwards, and
Jacqueline got in touch with meafter hearing my episode and
perhaps a little video I did onassisted vaginal birth, and
we've had a bit of an exchange,haven't we, about your
experiences, good and bad, ofassisted vaginal birth.
(01:22):
So I don't know if we shouldstart, jacqueline, with perhaps
you telling us a little bitabout who you are and why you
got in touch with me.
Jacqueline (01:32):
Yeah, that's fine.
So yeah, as I say, my name isJacqueline, I'm a mum to five
children, a grandmother to one.
So my two eldest sons are bothgrown up now and I have my three
daughters still living at home.
My eldest son is 28.
My youngest daughter is four.
So, yeah, I've had my childrenover a couple of decades and
(01:57):
seen different things happeningduring those years, but also, I
think, importantly, I've had,you know, five quite different
births.
I would originally, you know, ifI could rewind time and from
day dot, I would always haveplanned to have a home birth.
In fact I did with my first andthat's consistently what I
wanted.
Unfortunately, I've ended uphaving three home birth
transfers and that's.
They ended up being theinstrumental birth, the assisted
(02:18):
vaginal birth.
I've also had one home birthand I've had a pre-labour
C-section.
So I was told, technically it'snot an elective section, but I
wasn't in Labour and I'd say,out of all of them, the two most
positive ones were the homebirth and the C-section, which I
never thought I'd find myselfsaying because when I, you know,
with my first before I'd evergiven birth, the C-section was
(02:41):
like the last option and it wasthe most like disastrous kind of
birth I could have imagined,but it ended up being very
positive and empowering for me,um, whereas the assisted vaginal
births less so and I'd say, interms of mental health, they're
the ones that have impacted methe most and had, um, a longer
impact on my mental health,which is why I just feel, now
(03:04):
that I'm finished having babies,I know what we're having
anymore.
I wanted to just kind of help toimprove things for those coming
after me and I'm not medicallytrained in any way, just like
you know, a member of the public, a mom having babies in
different ways, and I just feellike I've kind of almost like an
expert in what it feels likebecause I've had three of them.
(03:25):
The instrumental verse, but Iwanted to share it back from the
woman's point of view of howthat feels, what can be positive
about it and what feelsnegative about it.
And that's one of the reasons Igot in touch with you, florence
, because I thought, as much asI can tell other women about it,
tell other women about it.
(03:47):
Sometimes, you know, it needsto be a bit higher up in terms
of who we share it with, toenable, you know, practice to be
even just slightly adjusted tomake it a more positive
experience for women, and that'swhat I'm hoping to do now with
talking to you in this podcastyes, and I think you're right.
Florence (04:02):
it's really valuable for us as professionals whether
that's midwives or doctorslistening to this or women who
are going to give birth it'sreally important for us to
understand how we make peoplefeel and realise the
implications that we may or maynot see.
So as you know, I've done lotsof work on women's experience of
(04:26):
maternity care and when I talkto women, they always show me
something new.
There's always a blind spot.
You think you're an expert insomething and then someone shows
you a new idea or a new aspectyou haven't thought about and in
preparation for today, we'veexchanged a few emails and I
definitely thought, oh yeah,there's, there's stuff here
(04:48):
that's that's definitely worthtalking about.
So I really appreciate yougetting in touch and and having
this conversation with me,because I know it's not easy
necessarily to re-go through,particularly when things are are
less good yeah and and the sortof long-term consequences that
(05:08):
can have on on you.
So thank you very much for beingwilling to to share your
experiences.
You mentioned to me that youhad a forceps birth, which a lot
of people might see as a verynegative type of birth or very
(05:31):
interventional type of birth,and you had a ventouse birth,
which people might see as apossibly less traumatic,
inducing type of birth.
But actually in your experienceit was the reverse, that
actually the forceps was betterthan the ventus and that some
(05:54):
aspects of that, or a largeamount of what contributed to
that, was communication.
Do you want to talk a littlebit about those experiences?
Jacqueline (06:05):
Yeah, so I've had the two, first birth and my last
birth, both of them too.
So the forceps was my secondbirth and, as you say, from the
outside it kind of seems well,forceps, you know, it's kind of
potentially caused more damage.
It seems more it's more of anintervention rather than just
having a little suction cup ontop of the baby's head.
And yeah, yeah, I can kind ofsee that.
But my experience personallywith the 1-2's birth,
(06:28):
particularly the last one, itwas, yeah, there were lots of
aspects to it that just made itmore traumatic.
So I think the negatives ofthem were, with both my first
and my last one, the pain wasjust excruciating.
And again, you would imaginewith forceps there would be more
pain, but with the, I think.
But neither of them were donewith any pain relief.
My first one, to be fair, was28 years ago, so I've no idea
(06:51):
what policy was then.
My last one was four years ago,and I do know what the policy
is because I've read all theRCOG guidelines and normally it
would have been a spinalanaesthetic or, if not, a dendro
block, and I didn't get eitherof those.
And so at one point the pointthat always sticks in my mind
when I think about the birth andwhen I've done so much therapy,
(07:11):
is the part where I'm screamingout, where the doctor is
attempting to attach the suctioncup to my baby's head and the
pain was excruciating and thatjust caused so much trauma and
even if I have no idea how longthat took, but the fact that it
was so painful and knowingafterwards, unnecessarily so it
just caused more traumabasically.
(07:33):
So that was one thing, theamount of pain, that physical
pain that I experienced, justnot the whole consent process.
It just wasn't done in a waythat you would imagine any other
medical procedure would be done.
In terms of informed consent,now I, as I say I'm coming at
this from the don't like to usepatients technically not really
(07:55):
patients are we, but the payI'll use that term anyway a
patient's point of view and it's, I'm sure it's very different
from a doctor's point of viewand I'm sure there's so much
difference to a woman beingpregnant, having a discussion
with an obstetrician aboutoptions and pros and cons, to a
woman actually being in labourand you're trying to give this
information between contractions.
(08:16):
So I can kind of appreciate howdifficult it is, but I do think
that same principle of informedconsent should always be there,
no matter what the situation.
I just feel with both of themit was almost like the doctor
kind of gave me enoughinformation to get me to consent
to what he'd already decided hewanted to do.
So I was given all the pros ofthe intervention, but without
(08:40):
any of the cons and withoutreally going through things like
what would happen in terms ofepisiotomy.
So I think it was just thatwhole process wasn't done in the
way that it should be done andthat really had a big impact.
I mean, at the time it'sdifficult because you're
thinking I just want the babyborn, but you know it's.
It carries on much longer thanthat and you know, when you kind
(09:02):
of ruminate and think back towhat happened, they actually
know.
You know neither of them were amedical emergency.
It was both slow, second stage.
With both of them Baby wasn'tstressed.
There was time.
It wasn't a case not when yourbaby's heart's gone.
You know through the floor,this baby has to come out now.
I mean, even then, technicallyyou know you're still supposed
(09:22):
to inform consent.
But I can appreciate the timein that you know it just doesn't
allow it.
But for me the time did allowit and you know, things like an
episiotomy could have beendiscussed.
There was time to put you know,to administer a pedendal block.
As far as I'm aware, it's quite, you know, quick,
straightforward.
The juror would have been a muchlonger process, but you know,
(09:45):
it's just little things likethat.
That, um, it was almost like Ifelt like I was collateral
damage.
It's like, well, let's just getthe baby out, doesn't?
She'll be fine.
That kind of dude as in doesn'tmatter.
If she has to go through a lotof pain, she'll, she'll live,
she'll be fine and we'll get thebaby.
That's what I found verynegative about that time allowed
for things and those thingsthat should have been done
weren't done.
(10:05):
It's almost like, well, I'mbothered, or I don't care, or do
you know what I mean?
I don't know what was going on,but from my point of view it's
like just can't be bothered,should be fine you know what I
mean?
Florence (10:14):
yeah, yeah attitude yeah.
I think so.
Absolutely, pudendal block isquite quick and easy to do.
I think it is something thathas some skill that I think our
trainee obstetricians areperhaps less experienced in
(10:36):
pudendal block than perhaps wewere when I was training,
because we give spinals muchmore readily these days, or
epidurals, but absolutely it's arelatively quick and, you know,
surprisingly effectiveprocedure actually you know I
really do find it works.
(10:57):
So it's an injection of localanesthetic around the pudendal
nerve on each side, so you havean injection each side in the
vagina with some localanaesthetic and then usually
some local anaesthetic into theperineum and you need to wait a
little bit for it to work, butnot very long, you know, maybe
five minutes or so so absolutelythere is no excuse for not not
(11:21):
giving you pain relief.
I'm interested because I wonder.
So we talk a lot in healthcareabout bias and there's all sorts
of bias, but I'm wonderingwhether there was a bias or an
assumption.
Well, you've had four babiesbefore.
You've had all these birthsbefore, with varying degrees of
(11:44):
intervention, so I'm wonderingwhether that biased stuff.
Because I sometimes feel thatwhen women have had babies
before, there is a little bit ofa attitude of, well, she's just
going to crack on and it's allgoing to be fine because she's
(12:07):
done it before and I don't knowif that was coming into play at
all.
But I'm wondering if that waspart of the mindset.
And you know, in terms ofconsent, I think you're right.
Antenatal education is reallylacking in provision in terms of
what maternity services providethese days.
(12:29):
You know there's a bit and wegive lots of information with QR
codes and websites and etc.
But I think really the time andplace to have those
conversations is in thepregnancy.
Conversations is in thepregnancy so that when a woman's
faced with a decision in theheat of the moment, she already
(12:50):
knows what she's talking about,because she's talked about it
before 36 weeks.
One of the main aims of the 36week antenatal appointment with
the midwife is to have someconversations about birth
preferences and birth optionsand what expectations that woman
has and how she'd like to givebirth and what pain relief and
(13:13):
so on.
So maybe it needs to be betterwrapped up into that
conversation, particularly ifyou're having your first baby,
because we know an assistedvaginal birth is much more
common in a first labor.
You know it might be as high asone in three women having their
first vaginal birth will havesome form of assistance yeah, I
(13:36):
definitely agree.
Jacqueline (13:37):
Um, both of those things.
Actually that, just going backto what you said originally, was
there some kind of oh well,it's her fourth vaginal birth,
blah, blah, even like I've got amidwife friend and she said the
same thing midwives, you know.
I won't go into all the details, but I found out I didn't find
out until after I had my lastbaby that I've actually got a
hypertonic pelvic floor.
This is the reason why I've hadthese difficult.
(13:57):
Second, I have like textbookfirst stage labors easy, baby's,
always head down, perfectposition, no issues with the
baby.
But then I have this issue withmy pelvic floor and my midwife
friend was saying yeah, wealways assume that once a
woman's had like a couple ofbabies, you know she'll have
this quick, easy second stageand it is.
It's kind of that assumption.
I think that's part of thereason why I ended up with this
(14:20):
instrumental birth last time.
So I've been pushing for anhour, baby had progressed, she'd
moved down a couple of stations, but because it was my fourth
vaginal birth and I've beenpushing for an hour and she
hadn't moved, well, you know,we'd x, this is what we'd expect
.
The there was that assumptionas in.
Well, we have to intervene nowbecause something's not quite
right, because she hasn'tprogressed as fast as she should
have done, without actuallyspeaking to me and saying oh
(14:42):
well, what were your others?
Do you know what?
Florence (14:44):
I mean what?
Jacqueline (14:44):
yeah, they'd have asked me, and I said actually,
yeah, you know what?
I have really long pushingstages.
There's something going on.
I didn't know at the time whereit was.
I've since found out fromhaving um visiting pelvic
physiotherapists.
I'd say yeah, this is normalfor me, that's fine you know,
but it's.
You moved a bit, that's fine,that's normal and you know it's
not.
So, yeah, that's.
There was definitely anassumption there, and whether
(15:06):
again, the assumption was orwell, you know, she's passed a
baby's passed through a vaginathree times already.
She won't need any pain, she'llbe fine you know like I say
she'll keep on, she won't feelanything.
But I think those assumptionsare difficult because you know,
we're all different.
We've all got different um painthresholds, and it could be
that the woman that theyperformed that intervention on
yesterday last week, didn't havean epidural in place, didn't
(15:28):
need anything, and she wasabsolutely fine.
But I think you have to go withwhat the woman who is the most
sensitive and has the lowestpain threshold and at least
offer that, and you might say,no, I don't fancy that injection
to my vagina or whatever, I'lljust crack on with it, whereas
(15:48):
another woman will be like, yeah, actually, you know, when I go
to the dentist I need, like,maximum pain relief.
Give me the map.
Yeah, this thing you're nowgoing to do, do to me.
So I think those assumptionsyeah, it must be quite difficult
as a practitioner when you'veseen, like, what the norm is in
inverted commas, but you'realways going to have people
outside and they're the ones youalways have in mind every
single time.
What if this woman has a lowpain threshold?
We have to go with theassumption that you have that
(16:11):
and if you don't, that'sfantastic, yeah.
So I think that that thoseassumptions definitely things
that should be challenged everysingle time you have this
situation.
Florence (16:21):
Yes, I'm interested in what was the midwife
involvement in this, becauseyou've been pushing some time.
And then what happens is themidwife comes out and talks to
the midwife in charge and saysoh I need a doctor's review or
whatever, and the midwifepresumably had been with you for
(16:45):
some hours and got to know youa bit, yeah, and I always think
the midwife is there.
You know we're coming in tomaybe assist, but the midwife is
still your key person and yourkey advocate.
So I'm interested perhaps formidwives listening or student
(17:05):
midwives listening what role themidwife played in this, if were
they saying to the doctor, hangon a minute, do this, and he?
He was ignoring them, or werethey passive or what was
happening?
Well, I did find them quitepassive actually.
Jacqueline (17:21):
So I did trans.
I say I transferred him from ahome birth, this.
I was like post-dates, my babywas post-dates and when my
waters broke we transferred in.
When my waters broke there wasmeconium, but she was never in
distress at any point and it wasjust one of those cases of.
I've since read that 30 percentof babies who are post-dates
can have meconium or waters.
(17:42):
Obviously at the time I didn'tknow this, I just thought
meconium was the scary things.
They said let's go.
And I'm not.
I'm not saying what they didwas wrong.
You know advising me totransfer in and I did willingly
transfer in.
And you know, as a plus, thesethe two home birth midwives, in
theory should have kind ofhanded me over to the hospital
midwives, but they stayed withme because I didn't have a
support person.
(18:02):
Long story short.
So they stayed with me almostas my support people.
Then obviously I had thehospital midwife and then I had
the labour ward midwife comingin as well.
But I did find, to be honest,even with my first one, almost
once an obstetrician comes inthe room, I found personally the
midwives are quite passive andit's almost like they don't like
to challenge the, the doctor.
(18:24):
So, for example, with the painrelief you know I was screaming
with the pain and the midwifeone of the midwives from the
hospital, a labour ward midwifewas just saying right, you need
to stop screaming, you need tocalm down, listen, to listen.
So it was almost like shewasn't even on my side, so it
was almost like advocating.
I felt she's advocating for thedoctor here instead of me.
(18:45):
And then one of the othermidwives did, and I remember
just saying, um, oh, but itreally, really hurts.
And one of the midwives saidhere, have some gas and air.
So at that point I did have abit of pain relief.
It was gas and better thannothing.
But I just thought afterwardswhy didn't they hand me that gas
and air before the doctorstarted the procedure?
I mean, yeah, it was thedoctor's job and duty to ensure
(19:06):
that I had pain relief in place,but given that he didn't, and
given that the midwives were outthere was four midwives in the
room at that point not one ofthem thought hang on a minute,
let's just see, until after I'dstarted screaming.
So, yeah, I didn't feel as badas I feel as angry as I feel
towards the doctor, because Idid feel as angry as I feel
towards the doctor.
So I did feel angry.
I actually felt more angertowards the midwives Because
(19:29):
they were my advocates.
Yes, he failed to do his job,but so did they and their women,
and at the very least, theyknow what even a smear feels
like.
Florence (19:38):
Whereas the doctor?
He was male, he didn't have aclue.
Jacqueline (19:40):
I'm not saying that's an excuse, but from an
emotional point of view it'slike hang on, there's four of
you, four women, in this room.
Yes, you know why.
Are you passive and not kind ofdoing your job of being my
advocate?
or just saying start, just hangon, let's just give her a bit of
gas.
So I didn't have an epidural inplace, nothing.
And I was already insignificant pain because I had a
(20:02):
very quick labor, but come onvery, very quickly at home.
So I was already in significantpain because I had a very quick
labour, but come on very, veryquickly at home.
So I was already in a lot ofpain anyway because I didn't
have time to build up all youknow the endorphins and the
natural pain.
Then you transfer from hospital, from home to hospital.
That in itself makes labourmore painful because it's you
know, you've got the stress,you've got the addiction.
So I was in a bad situation tostart with, and then it was just
(20:23):
about to be made worse by thistype of birth I was having.
Once the doctor walked in theroom, it's almost like, right,
this is their territory now,yeah, and they're going to kind
of take over.
That's how it felt for my.
Florence (20:35):
Yeah, yes, okay, perhaps if we turn to slightly
better, say a little bit aboutyour forceps, birth and what was
better about that, or how youfelt the communication was
better or or cared for in thatsituation yeah.
Jacqueline (20:57):
So this was my second birth.
I'd had quite a big gap I'd hadnine years between my first two
.
I decided I'd had.
I decided to pay for anindependent midwife because my
first birth had been sotraumatic I thought I'm going to
give myself the best chance.
So because I had theindependent midwife you know it
was the one-to-one care we hadlots of.
So this is really goodantenatal care.
(21:19):
You know lots of longappointments for an hour or more
where we go into what happenedlast time and you know what if
you're in that situation.
So we had lots of time toprepare for this eventuality and
unfortunately it did happen.
And what I remember one of thethings I said is you know, if I
do go into hospital, if I dotransfer into hospital, it's
because something's going wrong.
At that point I want anepidural.
(21:40):
I don't care what they're goingto do to me.
They're going to intervene insome way and I'm not going
through any kind of birth,hospital birth with
interventions, without painrelief.
So I think that in itselfhelped because I already had a
good plan, as you say, gettingback to women during pregnancy,
having this really good, solidplan in place.
If this does happen, none ofthem want it to happen, because
(22:03):
it's not a choice, is it?
You're not.
No woman puts on a birth plan.
I want my baby pulled out byforce yes exactly.
It's not.
It's not anything anyone'splanned for.
So it's like, in theeventuality of this happening,
this is what I'd like, andbecause I'd had the bontus birth
to start with, I had a goodidea of what, what was going to
happen, what would be done to me, how that would feel.
So I said under nocircumstances am I having any
(22:25):
instruments without an epidural.
And if they won't do it, thenthey'll have to do a c-section.
That's it.
There's nothing.
You're not, you're not touchingme without an epidural.
So I had that in place.
I had really good support ofthe midwife who transferred in
with me someone I knew reallywell.
Unfortunately, when we gotthere, we did have a doctor who
didn't understand like why Iwould want an epidural.
(22:45):
Because he's been you know he'sbeen you've got this far and
you've been pushing for hours.
Why do you need it?
Because of what you want to doto me now is going to be the
part that's going to.
I can cope with the naturalpains of labor and pushing a
baby out.
It's all these other things youwant to do to me that are going
to really really hurt me In theend.
You know how Hoft and Poft wentout.
He couldn't do anything withoutmy consent.
(23:11):
So he did.
He did agree, he sent theanesthetist.
So I think the fact that I hadthe epidural in place meant that
I was in a very different place.
I wasn't in pain, I could havea proper like adult conversation
, because there's always thatthing of like you're a bit
infantilized, aren't you?
You know you you're half nakedor you've got a nightie on,
you're in a hospital setting,you're in pain, you're very
vulnerable.
So I felt like a little bitlike, because I had this pain
(23:31):
relief, I could have a normalconversation, yes, which I
couldn't have even betweencontractions.
You're recovering from one.
Last thing you want to do ishave a full blown conversation.
Florence (23:40):
Yes.
Jacqueline (23:42):
So that definitely having proper pain relief in
place made sense, made it easier, and because of that we could
have a proper full conversation,like I said.
For example, you know, I don'twant, I don't want an episiotomy
.
Can we try it without anepisiotomy?
And he said, well, yes, we can.
And I did end up having acompete an episiotomy, because
he was saying to me right, youare starting to tear, is it okay
(24:04):
?
But you know it wasn't likeright, I'm going to give you an
episiotomy.
Okay, if I do a smallepisiotomy rather than just,
well, you know, compared to theother two, it's like I didn't
even know until the baby wasborn, that'd been done, you know
right yeah, if you can see it'sso.
That's so different, isn't it?
Yeah, look, you know, evensaying beforehand would you like
me to do episiotomy?
Do you want to wait and see?
(24:24):
Do you want to, you know, ifyou start to tear, you know that
kind of proper adultconversation, which is what
really in theory should happen.
It just seemed much morerespectful.
As I say, yes, the things werejust done to me because this is
what this is how I do, things,you know, and for the episiotomy
.
And then me saying, for example,when the baby's head was out, I
(24:44):
says, can you just stop,because I really want to touch
my baby's head?
And I mean, obviously this is'msaying in a non-emergency
situation and just really lovelythings like that that try to
maybe honour my birth plan asmuch as you can in that
situation.
And things have been explainedto me, like I remember my
midwife saying you know, youwanted, like I've always wanted,
(25:06):
delayed core clamping and aphysiological third stage.
She kind wanted like I'vealways wanted, delayed core
clamping and a physiologicalthird stage.
Kind of explains me, you knowwe've moved off this path of
normal now.
So, yeah, you know, we wouldn'trecommend a physiological third
stage because you don't haveall those lovely hormones
flowing anymore.
We've already intervened in thebirth so we kind of like have
to carry on, but it was neverlike we can't do this now.
Yeah, it was like what do youthink?
(25:28):
Think, do you?
know what I mean, and I didagree, whereas, like with the
other ones, it's almost likewell, now we're on this path,
this is what's going to happen,this is what needs to happen,
without really consulting me asa fully you know functional
adult, who you know be giveninformed consent, so that
definitely, you know.
Florence (25:52):
Yeah, I think that's a really important point, being
able to have that adult to adultconversation.
You're right, it can end upwith infantilizing so that
you're you're not able to havethat proper, proper conversation
.
So I can see that having thatpain relief then gives you that
chance to have that conversationand how valuable that is.
(26:14):
I think the other thing fromwhat you just said there that
really resonated with me isrespect and possibly with that
acknowledgement in terms of Ican think of situations where a
woman has said to me beforehandI really don't want an
episiotomy.
Jacqueline (26:33):
And.
Florence (26:35):
I said to her I know you really don't want an
episiotomy.
I know you know I've heard that.
I know that's really importantto you.
We're now in this situationwhere I think you really need
one.
You know, I can see you'restarting to tear, tear, you're
going to have a bad tear orwhatever.
I I now I know that's what youwant and this isn't what you
(26:58):
want, but I I now think we needto do this and it's kind of
taking on board.
We may or may not then do theepisiotomy, but what I'm kind of
saying is I've heard yourwishes.
I've really understood thatthis is an important thing to
you, that I need to have thatreally separate discussion and
(27:22):
explain why I do or don't nowthink that that's okay.
So I think respect is a bigelement of it yeah, definitely,
and I think it's still.
Jacqueline (27:32):
It's the woman she says no, I don't want one, just
go ahead exactly, yeah withoutbanging on and on and on.
So, okay, you know, yeah, makesure of that.
Yes, you know, that's whatyou've decided, it's all noted.
You know you've coveredyourself, yeah, as a midwife.
You know we've discussed thisadamant doesn't want an
episiotomy, and you know you'rekind of covered then, aren't you
?
I mean, yeah, but definitelythat that respect.
(27:55):
And it is very hard and it'svery hard to advocate for
yourself and normally in likeday-to-day life you can be, you
know, very articulate and youcan be very confident, but you
know you're in a different worldaltogether when you're yes,
very difficult.
One thing that I just remembered, actually is also that made it
better, and this is more from aemotional or psychological point
(28:18):
of view.
Remember the doctor saying tome and I actually picked up on
this when you did your podcastsaying that this is a team
effort, this is, we're going todo this together.
And that's exactly what thedoctor said.
He says I can't get this babyout on my own.
You know something we're doingtogether.
You're going to push and Idon't know whether he was just
saying it to inform me likeyou're not just going to lie
down and pull the baby out andmaybe it was, but from my point
(28:39):
of view, emotionally, that justreally helped because it's like
it's not like I'm at the dentisthaving a tooth extracted and
the dentist is doing all thework.
You know I'm the one, yeah,we're doing it as a team.
So I am pushing my baby out, mybaby isn't being pulled out and
even though rationally andlogically afterwards you know
all the people I spoke to themidwife says no, the baby can't
(28:59):
just be pulled out.
It just can't be pulled out.
You have to push.
At the same time, on anemotional level, sometimes it
can feel like you've been verypassive and you're laying the
job for you, as I say, likeextraction and it's not and even
though, like with my last one,for example, I can tell myself
over and over again that didn'thappen.
Sometimes it did feel like that,like I didn't really do it,
(29:22):
whereas with that one, I thinkbecause I heard it at the time
it was happening somethingimprinted in my brain to say
like, yeah, you are pushing yourbaby out.
So I think that even justthings like that, like the
doctors, like you say you,that's what you say and if, like
any midwives listen to this,the doctor doesn't say that, the
midwife can say that there's noreason.
(29:43):
I can't say you know what?
The doctor can't do this on herown.
So you know you really need topush, you're going to be pushing
, or you know and, as yourbaby's being pushed and moving
down, saying you know you'redoing, you're pushing your baby
out.
Yeah, you are, you are doing it, you are doing.
I think there's something abouthearing it as it's happening,
as opposed to someone tellingyou afterwards but you did do it
(30:03):
yeah, yeah, it's a difference.
I don't know why.
There's something in your brainthat, just in my, in my point,
from my point of view, that'swhat happened.
That's what happened, you know,to me, even though with the
forceps birth, my baby was muchhigher up in the pelvis.
His head needed to be rotated.
You know lots of things goingon at the core around his neck,
(30:24):
which is why I ended up needingforceps and not the ventouse,
because he wasn't low enoughdown.
So in theory, with the ventousebirths, I did a lot more of the
pushing on my own, or quite,you know, close to being born,
compared to the forces.
But the force response stillfeels like I did more, just
possibly because of the wordsthat that doctor yes, and you're
right, I do say it's teamwork.
Florence (30:46):
I say that all the time to women, um, because it
genuinely is that I'm justadding a little bit, whether
that's, like you say, rotatingthe baby's head into a better
position or helping it come down, I genuinely feel that, but
it's really, it's really nice tohear that that could be a
(31:09):
really valuable thing.
I'm saying, actually, and Ithink, even if you take away the
pushing, the way the uterus isworking, the way the womb is
contracting, we only are pullingwhen the womb is contracting.
(31:29):
You're working with thecontractions, you're working
with the woman's body.
That's how an assistive vaginalbirth works and so very much.
It is not a passive thing and Ithink I can see why
psychologically, that is areally big point.
That might help if if it's saidin that moment, because it it
(31:52):
absolutely is, um, not a passivething, it's very much working
with what's already happeningand trying to expedite.
Jacqueline (32:02):
It is the best word I can think of really yeah, and
I think, as I say, I'm onlyspeaking on my behalf, but I
can't imagine that lots of otherwomen feel very differently to
me and I do remember with mysister.
So my sister had two babiesbefore I did.
And years later she said, witha second one, again, I think
she's had some.
Maybe she's built the same wayas I had.
She's had three, two, threeinstrumental births, one without
(32:25):
any instruments.
And she said, with one of themI can't remember, I think it was
the second saying I felt Ireally could have done it.
I felt I was cheated.
She said I felt like I wascheated out of that birth and I
hadn't given birth at this point, so I didn't know what she
meant.
Looking back now I 100%understand it and, to use an
analogy, how I feel it's likerunning a marathon.
So you've prepared for it,you've trained for it, you've
(32:47):
imagined and you've got thereand you're right and you can see
the finishing line.
It's right there, but all of asudden, for some reason, you
fall down and someone runs outof the crowd and they pick you
up and carry and it's likeyou've done so much to get to
where you are but, you've neededhelp or even not carrying you.
You're limping along, you know,with your arm around them.
It's, yeah, you did it, but youalso had someone helping you.
So it's it's a funny thingbecause you know, you know you
(33:12):
did it, but it's like, but Iwanted to do that last those few
meters.
At the end I didn't, I neededhelp.
So anything that can mitigatethat, yes, failure and inverted
we talk a lot about women.
You know you weren't a failureand you weren't.
You were failed in this but Ithink to just anything that can
mitigate that potential feelingof failure.
You know it.
Just, I just think it reallyhelps and I do think, like
(33:34):
saying it at the time just makesall the difference in the world
, definitely.
So, yeah, listening to thisjust takes one thing away from
this is that you could just yeah, actually I remember talking to
that woman and yeah, that'swhat it's like running a
marathon just get to the end.
So just, yeah, you're doing it,you're getting there.
Florence (33:53):
Yeah, I mean, you're pushing your baby out yeah, no,
I love that idea of a marathonand not wanting to be helped
over the line.
You want to do it yourself.
Jacqueline (34:03):
That's a really good way of thinking about it
actually yeah, it's like kids,isn't it, when they say, no, I
want to do it.
You know, getting direct young.
Yeah, yeah, I'll help them, butno, I want.
There is that thing.
If we want to be able to dothings, yeah, we can see over
our own bodies.
And, yes, I think it all ties.
It all ties into that.
Florence (34:22):
Yeah that's lovely.
I wanted you to mention brieflybecause you sent me a piece
you'd written about birth traumaand how the impact it's had on
you.
I think the thing that struckme from what you sent me to read
(34:42):
was the everyday life things.
So if you go to a maternityunit where you've given birth
and you've got birth trauma,then everyone would assume that
would be triggering.
But I think the thing thatreally struck me was the that
you could be going about doingyour normal everyday life and
(35:07):
something could trigger you thatreminds you of that occasion,
which perhaps we asprofessionals wouldn't
appreciate.
And the example you gave wasthe supermarket, and I had never
thought of the fact that peoplein the supermarket are wearing
uniforms and having fluorescentlights and some of those
(35:27):
similarities.
So I don't know if you'd bewilling to share a little bit
about birth trauma and whatthat's been like?
Yeah, yeah.
Jacqueline (35:39):
So as you say things like that, you, you would, you
know, imagine a certainsituations being in a maternity
unit or even in the part of thehospital.
It's so similar it's gonnacould be a trigger.
But every I I found this.
Personally, I found thesupermarket very triggering, and
it was.
It was the uniforms, andperhaps it was because it was
the color.
It was a dark blue, so it wasperhaps the color of the, um,
(36:01):
the labor wards, um, the youknow the midwife I can't
remember her title is a labor.
Yeah, yeah, whatever the colorsshe had on and just the fact
that there's the fluorescentlighting and it's just, it's a
thought.
I mean it's a form of ptsd.
I wasn't officially diagnosedwith ptsd, but all these are
like symptoms of of ptsd being acompletely different
(36:21):
environment, nothing to do withthe hospital, um, let alone, you
know, maternity ward, but justhaving those reminders and
triggering you and the I think Imentioned this.
Also there was a pharmacist, soI always ended up in a till
that was right opposite thepharmacy desk and I think that,
in particular, triggered,triggered me, because that was a
very almost clinical settingwithin a supermarket.
(36:43):
And the doctor he actually didlook like the doctor that
assisted my baby's birth and Idid end up feeling a bit sorry
for him because I used to lookat him and think, oh, you know,
kind of like you're reallyannoyed and angry because you're
there and triggering me.
It wasn't his fault, this guyis just there doing his job.
But just, you know, every daykind of things have the
potential to trigger you and Idon't know how to mitigate
(37:06):
against that.
Because getting back to thiskind of thing of the
vulnerability being in labour,even just going into a situation
in hospital even when you'renot in labour.
I think just the fact thatpeople wear uniforms, for
example, in our culture we seeuniform as an authority, don't
we?
so you're going there andthey're almost like you're going
into their territory to startwith and they're wearing a
uniform.
So you're going there andthey're almost like you're going
(37:26):
into their territory to startwith and they're wearing a
uniform, so they're almost likethey're in charge, and there is
that power imbalance I feel.
You know, even when you're justgoing in for, like, any kind of
appointment in the hospital,but certainly when you're having
a medical procedure or you'rein labor, you know just just the
nature of the whole fact thatyou're in there and you're
vulnerable.
Um, that power balance,imbalance is there and, as I say
(37:50):
, I don't know how to kind ofmitigate against that and that.
Carrying on in everyday life,where you will come into contact
with people, as I say, just inyour supermarket, and you know
you can avoid it to a degree,you could, you know, shop online
, but the fact that it's there,it's, it's very difficult.
So I think I don't know.
I suppose what I'd say is thatif a woman needs that kind of
(38:13):
birth, just bear in mind that itis going to be traumatic On
whatever.
On some level it's going to betraumatic for her because it was
never the plan, no one planned.
So it's.
Even if you were in hospital,you transferred, or even if
you'd started laboring in thatroom and that had be, you know,
started to happen.
But certainly, transferring infrom like a low risk setting
(38:33):
like an MLU unit or a home birth, as I did, you've already got
the trauma of changing from oneenvironment to another.
That already that's, and thenyou add this trauma onto it.
So I think everyone in the roomneeds to bear in mind that that
woman on some level is going tobe traumatized.
With the best will in the world, so really to try and practice,
you know, as much as you cannot that you shouldn't with
(38:55):
anyone else, but you know theempathy and the kindness and the
care and the trauma-informedcare really, really, really need
to be in place while that'shappening you know, because you
don't know how that woman'sgoing to act.
She might be 100% fine with itand go and skip off and live her
life, or she might bedevastated, like I was and you
know, feeling at points whereshe doesn't want to be alive
(39:17):
anymore.
So, again, you have to go withthe lowest kind of denomination,
as, in you know, this kind ofbirth has the potential to do
this to a woman.
So let's be kind to her, let'sreally care about her, because
that's going to be carried withher, you know, for the rest of
her life she's going to rememberand it's going to be carried on
into everyday life.
And also what?
Like you know the piece that Iwrote, I did put some of the
(39:39):
suggestions that I had from mypoint of view, which may not be
possible, that could possiblyhave mitigated.
I think, with, as I say, eventhe perfect situation.
There's going to be traumainvolved in that kind of birth.
So what can we do to mitigateit?
And for me, one of them wasprivacy.
It's very difficult to havethat kind of birth and feel
(40:00):
you're not being watched, you'renot being viewed.
It's like, you know, the lightsare switched on, you kind of
bear with your legs wide openand what can we do to kind of,
as I say, mitigate thatexperience for that woman?
Some of the things I came upwith, as I say, one of them
might, may not be possible.
One of them was that Iunderstand that there needs to
(40:20):
be bright lights in the room,but over my head do the lights
have to be bright?
Is that an option to not havebright lights?
And I did speak to um.
I did a labour ward tourrecently, actually a few months
ago of the hospital I gave birthand I mentioned this to the one
the obstetrician that was thereand she said which something I
didn't think of.
She said, yeah, thatpotentially it is.
(40:41):
If we had lighting where wecould have, you know, dim
lighting in one part of the roombut bright lights in the other,
then yes, that could happen.
She said, from my point of view, what I find is that, going
from light to dark, my eyes takea few seconds to adjust.
I was looking up to speak toher and where her head is, it's
like it's not bright.
(41:02):
And then I'm looking down again, it's not ideal.
As I say, I don't know.
That's one of the things Ithought, but I'm just thinking
it purely from the woman'sexperience.
But I know that would havehelped me if that had been
possible, or if not.
A spotlight, for example.
So the room is dim.
Yeah, the doctor uses aspotlight and, again, one of the
things that this observationcame up with was like, yes, we
(41:24):
could have a spotlight in theceiling, but then the women that
are birthing in that room thatdon't need it, are looking at
this light.
That's kind of medicalizing theroom more than it needs.
So it's not.
I know it's not as simple.
All I can do is speak out andsay this is what we've heard and
for people to say, actually, inour unit, could we do that?
What could we do?
What could we do?
(41:47):
Is that possible?
And what would be thechallenges?
Because if no one says it,you're not going to think about
it.
Yeah, and another thing with thelighting.
So my baby was born, she wasabsolutely fine, um, didn't need
any help, she was on my chestand but again, these light,
really bright lights, were kepton.
And at that point, you know,could we have a spotlight
because I need?
I don't have any paediatry, soI need to be structured.
And could you know, could wejust have the lights dimmed in
(42:07):
the room for the mum and thebaby?
At that point, kind ofspotlight for the doctor?
Yeah, to see what they're doing.
And then another thing was withbeing viewed.
Having the paediatrician andthe resuscitaire was pretty much
so.
I was in the bed against onewall and they were on the
opposite wall, but they couldsee everything that was on
display.
Yeah, and again, going back tothe labour ward when I wasn't in
(42:30):
labour was really helpfulbecause I saw several rooms and
I thought because one of thesuggestions that I made that I
know another unit does asstandard, because I know a
midwife who is married to anobstetrician and she said in my
husband's unit this is standardthey have the resuscitator and
the pediatrician on the side, onthe wall at the side, yeah,
very close to the woman ifthey're needed, but we can't
(42:50):
actually view you from that endof the room.
And again, it'll depend on the,on the unit, because when I went
back to my hospital, some rooms, yes, you could have done that,
but others it was so small,it's like I know this the only
place we can put them, yeah, soagain, it's just maybe thinking
outside the box.
And then I wrote this articlefor aims and the lady from aims
(43:10):
said to me one of the things I'mgoing to take from what you've
written is I'm going to advocatefor the use of screens.
So again, could a screen beused so that you know?
You know a screen on wheels soyou can just, you can just be
screened, but it can be whippedaway in a second, if you know,
if it's needed to, so that theonly person that can view your
genitals is the person thatyou've consented to view your
(43:30):
genitals yeah yes, yeah, it's abit of a free-for-all now.
Bright lights on.
Whoever's in the room can seeyou.
I guess when women say thingslike this, you felt very exposed
and vulnerable.
They'll say to you oh yes, butyou know, they see this all the
time.
It's nothing and looking at you, that pediatrician might be
looking over, thinking right,what am I going to do when
(43:51):
they're?
Florence (43:51):
back.
Jacqueline (43:51):
You know what will this baby, you know I mean, but
it's like it doesn't matterbecause the woman's like still
exposed it's like how many timesthat doctor's seen other
women's vaginas?
he's never seen mine.
Yeah, you know, I've only gotone strange man standing between
my legs and now I've gotanother one at the other end of
the room staring in my direction.
It's like is this 100%necessary?
(44:11):
It's still that kind ofinvasion of your dignity and
privacy and I imagine for womenwho are, you know, rape
survivors or sexual assaultsurvivors, that would be pretty
harrowing.
That would be pretty harrowing.
That, yeah, pretty.
It's not nice for any of us,but added in that extra trauma
(44:33):
and I think the fact that I'meven having to say this speaks a
lot, doesn't it?
Yeah, I'm having to say hang on, guys, have you ever, ever
thought what that woman'sactually?
Yeah, yeah, all these peoplepotentially viewing her after.
Yes, that it has really beenthought about.
Maybe it's been thought about.
Um, not taking any further.
(44:54):
So I think I just need to sayit, because if I don't say it,
no one's going to think yes, yes, you know.
No, absolutely.
Florence (45:03):
I think and I think you're right, you know, some
things are practically quitedifficult, some things actually,
you can think, yeah, that'sactually quite easy, we could
easily do that and to hopefullyprovoke a bit of thought and
hopefully some people listeningto this will go away and just
think, oh, in our birth, birthrooms, what could we or couldn't
(45:27):
we do?
You know, I'm thinking with thespotlight suggestion and the
lights.
You know I do do sometimes thecesarean with the top lights in
the theatre off and just theoperating light on, and the same
.
You could do that with anassisted birth.
So it you know there are thingsyou can do and you know you
(45:50):
probably seen that I often saywrong is wrong even if
everyone's doing it, and rightis right even if no one's doing
it, and so little things have tostart from somewhere.
So hopefully people will graspsome of this and and run with it
.
Yeah, I'm just thinking so.
(46:10):
Normally I end the podcast withthe zesty bit, the kind of
take-home message, and I thinkthere's so much that you've
already said that would comeinto that.
But is there anything else thatkind of comes to mind?
Oh, oh, hang on.
The marathon, the end of themarathon.
Jacqueline (46:29):
Yeah.
Florence (46:30):
Encouraging the woman and helping her understand she
is a participant, she isactively birthing her baby, even
if she's having some form ofassistance.
Would that be your zesty bit,or is there anything else you'd
want to add?
Yeah, I can't.
Jacqueline (46:46):
Yeah, I think that would be your zesty bit, or is
there anything else you'd wantto add?
Yeah, I can't.
Yeah, I think that would be myzesty bit because, as you say,
it's probably something thatmost people don't think about
unless you experience yourselfthat that's how it could
potentially feel for women.
So I think, yeah, and everyonein that room, if the doctor
doesn't say it, for whateverreason, then you know there's
going to be other people in theroom that can be saying it.
So I think, yeah, that would bemy zesty bit, to actually let
(47:06):
the woman know she is birthingher baby with some help.
And you know, I just think itmakes such a difference to be
saying that at the time ratherthan afterwards.
So, yeah, I think I think thatwould be, as you call it, your
zesty bit.
If every woman having that kindof birth was hearing that at
the time, then I think it wouldmake psychologically,
(47:27):
emotionally easier not perfect,but it would make it easier,
definitely perfect thank you soso much.
Florence (47:38):
I I feel that's been a really excellent conversation
that I really hope will inspirepeople to go back and just think
a little bit yeah, definitely,and I also just quickly wanted
to say lastly, even though it'sjust me, one person, one woman,
is saying this.
Jacqueline (47:56):
It's almost like the women that speak out.
You're almost at the tip of theiceberg.
Yeah, there's also women behindme that don't speak out because
they don't know whether birthcould be any different, or
they've just had a baby andthey're exhausted, or they just
want to move on.
They don't want to talk aboutit.
So I feel like I'm speaking forlike 99 women who come behind
me, who are not going to say,and the women who are coming
after me.
(48:17):
So it's not just I'm the onlyperson that's experiencing it.
Of course I'm not.
I'm the one that's speaking outand saying how?
You know how it can be.
I'm not speaking every singlewoman that's had this type of
birth, but this is how it can be, and it probably is for a lot
of women, as well.
Florence (48:32):
yes, thank you very, very much.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review, on whatever platformyou find, your podcasts, as well
(48:53):
as recommending the OBS pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalogue
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
(49:16):
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
(49:40):
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
episodes, you can find me attheobspod, on Twitter and
Instagram, and you can email metheobspod at gmailcom.
(50:06):
Me theobspod at gmailcom.
Finally, it's very important tome to keep the OBS pod free and
accessible to as many people aspossible, but it does cost me a
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and by chance, you do
(50:28):
have a tiny bit to spare, youcan now contribute to keep the
podcast going and keep it free,via my link, to buy me a coffee,
don't feel under any obligation, but if you'd like to
contribute, you now can.
Thank you for listening.
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