By Dr. Lorin Lakasing, author of “Delivering the truth: Why NHS maternity care is broken and how we can fix it together”
For those wanting to start a family, a positive pregnancy test should be welcome news, but for many of today’s mothers-to-be the numerous controversies that surround pregnancy, childbirth and motherhood can cause confusion, apprehension, anxiety and unease. Partners (and parents) have an important role to play in helping mothers navigate these uncertainties and maintain a balanced view of the journey ahead.
When pregnancy meets the Internet
Mothers of mums-to-be may be able to offer useful insights. For example, previous generations relied on midwives or charitable organisations for advice and support, whereas these days many people look for information online, where parents can easily be led down unhelpful rabbit holes.
Many of today’s mothers will align themselves with so-called “natural” birthing philosophies that promise a perfect birthing experience, while others—troubled by anecdotal accounts of labours that have “gone wrong”—request delivery by elective Caesarean section. The “natural birth” group frequently overlook data suggesting that transfer rates for mothers labouring at home or in a birth centre are over 40% in most units. Those opting for an elective Caesarean section often underestimate the post-operative recovery time needed.
Google is not always your friend.
Technology can shift our choices
Many dilemmas faced by mothers and families today relate to use of technology and the interventions that inevitably come with a high-tech model of care. Take, for example, ultrasound examination of the fetus. Everyone is delighted to “see” the fetus, “hear” the heartbeat or have the gender of the baby revealed, but few are prepared for the conversations that might follow if all is not well.
Even if the antenatal course proceeds uneventfully, labour can present another set of tech-related problems. It is widely recognised that continuous electronic fetal heart rate monitoring in labour increases the chance of interventions such as instrumental vaginal delivery or Caesarean section, so some mothers will opt for intermittent monitoring instead, but then be surprised if their babies are born with low oxygen levels and need admission to the Special Care Baby Unit despite signing up to a model of care where the fetus is effectively unmonitored for much of the time.
Most clinical guidelines and protocols allow significant latitude in interpretation, aimed at avoiding so-called ‘unnecessary’ intervention. But is this approach really feasible?
Rethinking risk
Historical maternal mortality and stillbirth data make for sombre reading and reflect the stark realities of what “natural” or un-intervened pregnancy and birth was like in the pre-tech era. Society accepted that many mothers and infants died and that good outcomes were little more than good fortune. But as laboratory facilities, screening programs and better imaging techniques were developed, expectations rose. Today poor outcomes are perceived as something that can be mitigated and society has become increasingly intolerant of failure.
Indeed, the modern-day maternity service is expected to investigate, explain and compensate for any imperfect outcome. The historical quest—merely to survive pregnancy—is now taken for granted and modern narratives focus primarily on the pregnancy and birthing experience. This presents mothers and families with the greatest controversy of all – how to square this zero-tolerance approach with the belief that pregnancy and childbirth are essentially physiological processes where most interventions are at best unnecessary and at worst can cause harm.
When expectations and reality collide
We know from inquiries focusing on the accounts of harmed and bereaved parents that many parents will claim their baby could have been saved by earlier admission, more monitoring, more tests, more scans or earlier delivery. The low-tech, hands-off approach that mothers were encouraged to believe in prior to the tragic outcome is rarely put under the spotlight.
The focus now becomes the quality of care provided by frontline staff who are often vilified for their failings even though many feel unable to challenge inappropriate choices for fear of accusations of not listening, overruling or coercion.
In the current climate there is a huge disconnect between what mothers and families expect of the service and what it is set up to provide. Recent data suggests that 4–5% of mothers are left traumatised by their birthing experience and typically the blame is laid at the feet of frontline staff although clearly other factors play their part. It is interesting to consider why previous generations, whose clinical outcomes were objectively worse, did not report such high levels of subjective dissatisfaction. And whilst the service could unquestionably do better, perhaps another dimension to this debate is whether mothers and families have realistic and achievable expectations.
Supporting mothers
For fathers and partners, being prepared for uncertainty is one of the most useful things they can do. Partners are in a unique position to provide both practical support and emotional encouragement.
Practical support starts with planning ahead. Think about the financial impact of becoming a family, take advice on maternity and paternity leave and pay (which can differ widely), avoid the marketing and advertising traps surrounding pregnancy and childbirth, and organise care for older children. Helping with housework and managing the flow of visitors after the baby comes home can also make a significant difference.
Emotional support does not necessarily mean always agreeing with the mother. Pregnancy information obtained from the internet or social media can be of very poor quality and, in some cases, result in choices that can cause harm. If a woman is becoming unnecessarily preoccupied with particular notions, especially around birthing practices, it is reasonable to encourage her to take a step back and explore other sources of information, notably healthcare professionals who can provide more realistic and personally tailored advice.
This is particularly important because circumstances can change. A birth plan or preferred approach to care may have seemed entirely reasonable during pregnancy but become less appropriate as labour develops or new information becomes available. A supportive partner can help ensure that questions are asked, information is understood and concerns are communicated clearly. If something does go wrong, an engaged partner may also be better placed to help their partner understand what is happening and ensure that her concerns are heard.
That does not mean attempting to second-guess clinical decisions. It means being informed enough to ask questions, understand the answers and support a partner when difficult decisions need to be made. Knowing what options were discussed beforehand can also help when circumstances change and reconsidering decisions is required.
Finally, partners should recognise that this is a major change for them too. Unlike mothers, they will not have had months of constant physical awareness of what is about to come. Sometimes it can feel as if they have been catapulted onto a new planet. When time allows, it is therefore important to maintain connections with friends and hobbies and to avoid resentment growing. Partners can take turns in ring-fencing some ‘me-time’ and, where childcare and finances permit, go out for dinner together and challenge themselves to talk about something other than the baby.
Pregnancy and childbirth inevitably involve uncertainty, difficult choices and sometimes outcomes that nobody wanted. Maternity services undoubtedly need to address their shortcomings, but families also need realistic expectations of what healthcare professionals can provide. For fathers/partners, being informed, supportive and prepared to advocate for their partner may be one of the most valuable contributions they can make.
ABOUT THE AUTHOR
Dr. Lorin Lakasing is an NHS consultant in obstetrics and fetal medicine. She draws on her 30 years of clinical experience in maternity care to give an insider’s view of the current worrying situation and its development, and suggests how we might move towards the safe, effective NHS maternity service that everyone deserves. Her latest book, “Delivering the truth: Why NHS maternity care is broken and how we can fix it together” is about the stories behind the headlines, revealing the reasons why major stakeholders in this vital service have inadvertently been encouraged to pursue different agendas, and how that has made effective, collaborative working towards optimal clinical outcomes almost impossible.
Web: https://lorinlakasing.com/publications.html
Amazon: https://amzn.eu/d/g1dX9rh
