Propaganda

At work I steer clear of birth underwater. I disapprove, but disapprove even more at obstetricians interfering in normal birth. If asked, I give advice in the normal way but, despite practising obstetrics for almost 40 years, I’ve never witnessed one in real life.

Some enthusiasts think that if people like me did, we might be converted. Recently on Twitter, Milli Hill, a journalist hoping just that, invited a few male obstetricians to watch this waterbirth video (click here).

My reply that “birth videos aren’t my thing”, was a clumsy attempt to forestall an argument, but it and a couple of other similarly lukewarm responses seemed to have the opposite effect.

Discussion about water and home birth got conflated, obstetricians were accused of defensiveness, the patriarchy came up, someone shared an emotional blog about a stillbirth at home, and someone else talked of throwing a grenade into the birth debate.

Poor Milli was both disturbed at our original refusal to emote, and shocked at the reaction to our refusal. I lay low.

But the central issues seemed to be lost in the debate, so as the dust settles, let me try and explain.

Why birth videos in general are “not my thing”

I’ve no issues with home birth, but still don’t watch dry land home birth videos. Hospital dramas and documentaries leave me cold. It’s not a control thing. It’s not the patriarchy. I rejoice when any woman gives birth safely without help. But caring for birthing women is my job. And for every birth attendant that means worry. We’re paid to appear calm and professional on the surface, but we’re also paid to check, anticipate and plan for trouble. I’d go so far as to say that if birth attendants don’t find their job a bit stressful they’re doing it wrong.

I don’t just mean clinical worries about things like cord prolapse and abruption.  Of course we worry about those things. But we should, and usually do, worry about everything else as well.  A good home midwife, calming the partner of a woman in transition as dawn comes up after a long labour, also remembers that the rush hour traffic will make transfer slower if needed. A good obstetrician, encouraging a woman to persevere with an attempt at a vaginal birth after Caesarean, also remembers the twins next door, and that the night registrar has called in sick and the locum is new. Others may view birth videos with pleasure but to me they’re a busman’s holiday.

But why couldn’t I have faked it for Milli? Said: “How lovely!” and moved on. That’s because it was birth underwater.

Why waterbirth videos in particular

I have a visceral dislike of birth underwater. It’s a risky, almost evidence-free experiment with no underlying rationale (click here). Perhaps I’m over-reacting, but it’s one of the few things that makes me crosser than Brexit!

And the video is propaganda. Not just the editing, soft music and beautiful photography, although there’s plenty of that. But the implication that a difficult first birth has been converted to a beautiful second one by being at home, in the pool, with family, friends and first child in attendance.

We aren’t told much about the first birth but it seems reasonable to assume that it had ended via the vaginal route. Second births in such cases are almost invariably easy. Yes the midwives were wonderful, home was a perfectly reasonable place to have the baby, and it was correct to not interfere, but the baby would have come just as easily on dry land, with no risk of water aspiration, intoxication or water-related infection.

I’m sorry Milli

If I’d been quicker witted, I’d have watched the video and made an intelligent comment on the calm, efficient and discreet way the midwives went about their safety-critical duties – monitoring the water temperature, auscultating the fetal heart, checking for bleeding while the mother bonded, and that the clamp was correctly placed before the father cut the cord. See, I did watch it! All that impressed me a lot. I am delighted that such skilful midwives looked after her.

But I have to be honest. I didn’t enjoy it. I don’t think birth underwater is wise. And this sort of video isn’t going to convert me.

Jim Thornton