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The Obs Pod
The Obs Pod
Episode 181 Assisted Vaginal Birth, a woman's perspective
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.
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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.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
Hello, my name's Florence. Welcome to the OBSpod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife. Maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you. Episode 181, assisted Vaginal Birth A Woman's Perspective. I have with me today a special guest, jacqueline Edwards, and Jacqueline got in touch with me after hearing my episode and perhaps a little video I did on assisted vaginal birth, and we've had a bit of an exchange, haven't we, about your experiences, good and bad, of assisted vaginal birth. So I don't know if we should start, jacqueline, with perhaps you telling us a little bit about who you are and why you got in touch with me.
Jacqueline:Yeah, that's fine. So yeah, as I say, my name is Jacqueline, I'm a mum to five children, a grandmother to one. So my two eldest sons are both grown 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 children over a couple of decades and seen different things happening during those years, but also, I think, importantly, I've had, you know, five quite different births.
Jacqueline:I would originally, you know, if I could rewind time and from day dot, I would always have planned to have a home birth. In fact I did with my first and that's consistently what I wanted. Unfortunately, I've ended up having three home birth transfers and that's. They ended up being the instrumental birth, the assisted vaginal birth. I've also had one home birth and I've had a pre-labour C-section. So I was told, technically it's not 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 home birth and the C-section, which I never thought I'd find myself saying because when I, you know, with my first before I'd ever given birth, the C-section was like the last option and it was the 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, in terms of mental health, they're the ones that have impacted me the most and had, um, a longer impact on my mental health, which is why I just feel, now that I'm finished having babies, I know what we're having anymore.
Jacqueline:I wanted to just kind of help to improve things for those coming after me and I'm not medically trained in any way, just like you know, a member of the public, a mom having babies in different ways, and I just feel like I've kind of almost like an expert in what it feels like because I've had three of them. The instrumental verse, but I wanted to share it back from the woman's point of view of how that feels, what can be positive about it and what feels negative about it. And that's one of the reasons I got in touch with you, florence, because I thought, as much as I can tell other women about it, tell other women about it. Sometimes, you know, it needs to be a bit higher up in terms of who we share it with, to enable, you know, practice to be even just slightly adjusted to make it a more positive experience for women, and that's what I'm hoping to do now with talking to you in this podcast yes, and I think you're right.
Florence:it's really valuable for us as professionals whether that's midwives or doctors listening to this or women who are going to give birth it's really important for us to understand how we make people feel and realise the implications that we may or may not see.
Florence:So as you know, I've done lots of work on women's experience of maternity care and when I talk to women, they always show me something new. There's always a blind spot. You think you're an expert in something and then someone shows you a new idea or a new aspect you haven't thought about and in preparation for today, we've exchanged a few emails and I definitely thought, oh yeah, there's, there's stuff here that's that's definitely worth talking about. So I really appreciate you getting 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 sort of long-term consequences that can have on on you.
Florence:So thank you very much for being willing to to share your experiences. You mentioned to me that you had a forceps birth, which a lot of people might see as a very negative type of birth or very interventional type of birth, and you had a ventouse birth, which people might see as a possibly less traumatic, inducing type of birth. But actually in your experience it was the reverse, that actually the forceps was better than the ventus and that some aspects of that, or a large amount of what contributed to that, was communication. Do you want to talk a little bit about those experiences?
Jacqueline:Yeah, so I've had the two, first birth and my last birth, both of them too.
Jacqueline:So the forceps was my second birth 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 an intervention rather than just having a little suction cup on top of the baby's head. And yeah, yeah, I can kind of see that. But my experience personally with the 1-2's birth, particularly the last one, it was, yeah, there were lots of aspects to it that just made it more traumatic. So I think the negatives of them were, with both my first and my last one, the pain was just excruciating. And again, you would imagine with forceps there would be more pain, but with the, I think. But neither of them were done with any pain relief. My first one, to be fair, was 28 years ago, so I've no idea what policy was then. My last one was four years ago, and I do know what the policy is because I've read all the RCOG guidelines and normally it would have been a spinal anaesthetic or, if not, a dendro block, and I didn't get either of those. And so at one point the point that always sticks in my mind when I think about the birth and when I've done so much therapy, is the part where I'm screaming out, where the doctor is attempting to attach the suction cup to my baby's head and the pain was excruciating and that just caused so much trauma and even if I have no idea how long that took, but the fact that it was so painful and knowing afterwards, unnecessarily so it just caused more trauma basically. So that was one thing, the amount of pain, that physical pain that I experienced, just not the whole consent process. It just wasn't done in a way that you would imagine any other medical procedure would be done.
Jacqueline:In terms of informed consent, now I, as I say I'm coming at this from the don't like to use patients technically not really patients are we, but the pay I'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 view and I'm sure there's so much difference to a woman being pregnant, having a discussion with an obstetrician about options and pros and cons, to a woman actually being in labour and you're trying to give this information between contractions. So I can kind of appreciate how difficult it is, but I do think that same principle of informed consent should always be there, no matter what the situation. I just feel with both of them it was almost like the doctor kind of gave me enough information to get me to consent to what he'd already decided he wanted to do. So I was given all the pros of the intervention, but without any of the cons and without really going through things like what would happen in terms of episiotomy. So I think it was just that whole process wasn't done in the way that it should be done and that really had a big impact. I mean, at the time it's difficult because you're thinking I just want the baby born, but you know it's. It carries on much longer than that and you know, when you kind of ruminate and think back to what happened, they actually know.
Jacqueline:You know neither of them were a medical emergency. It was both slow, second stage. With both of them Baby wasn't stressed. There was time. It wasn't a case not when your baby's heart's gone. You know through the floor, this baby has to come out now. I mean, even then, technically you know you're still supposed to inform consent. But I can appreciate the time in that you know it just doesn't allow it. But for me the time did allow it and you know, things like an episiotomy could have been discussed. 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.
Jacqueline:The juror would have been a much longer process, but you know, it's just little things like that. That, um, it was almost like I felt like I was collateral damage. It's like, well, let's just get the baby out, doesn't? She'll be fine. That kind of dude as in doesn't matter. If she has to go through a lot of pain, she'll, she'll live, she'll be fine and we'll get the baby. That's what I found very negative about that time allowed for things and those things that should have been done weren't done. It's almost like, well, I'm bothered, 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:yeah, yeah attitude yeah. I think so. Absolutely, pudendal block is quite quick and easy to do. I think it is something that has some skill that I think our trainee obstetricians are perhaps less experienced in pudendal block than perhaps we were when I was training, because we give spinals much more readily these days, or epidurals, but absolutely it's a relatively quick and, you know, surprisingly effective procedure actually you know I really do find it works.
Florence:So it's an injection of local anesthetic around the pudendal nerve on each side, so you have an injection each side in the vagina with some local anaesthetic and then usually some local anaesthetic into the perineum and you need to wait a little bit for it to work, but not very long, you know, maybe five minutes or so so absolutely there is no excuse for not not giving you pain relief.
Florence:I'm interested because I wonder. So we talk a lot in healthcare about bias and there's all sorts of bias, but I'm wondering whether there was a bias or an assumption. Well, you've had four babies before. You've had all these births before, with varying degrees of intervention, so I'm wondering whether that biased stuff. Because I sometimes feel that when women have had babies before, there is a little bit of a attitude of, well, she's just going to crack on and it's all going to be fine because she's done it before and I don't know if that was coming into play at all. But I'm wondering if that was part of the mindset. And you know, in terms of consent, I think you're right.
Florence:Antenatal education is really lacking in provision in terms of what maternity services provide these days. You know there's a bit and we give lots of information with QR codes and websites and etc. But I think really the time and place to have those conversations is in the pregnancy. Conversations is in the pregnancy so that when a woman's faced with a decision in the heat of the moment, she already knows what she's talking about, because she's talked about it before 36 weeks. One of the main aims of the 36 week antenatal appointment with the midwife is to have some conversations about birth preferences and birth options and what expectations that woman has and how she'd like to give birth and what pain relief and so on. So maybe it needs to be better wrapped up into that conversation, particularly if you're having your first baby, because we know an assisted vaginal birth is much more common in a first labor. You know it might be as high as one in three women having their first vaginal birth will have some form of assistance yeah, I definitely agree.
Jacqueline:Um, both of those things. Actually that, just going back to what you said originally, was there some kind of oh well, it's her fourth vaginal birth, blah, blah, even like I've got a midwife 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 last baby that I've actually got a hypertonic pelvic floor. This is the reason why I've had these difficult. Second, I have like textbook first stage labors easy, baby's, always head down, perfect position, no issues with the baby. But then I have this issue with my pelvic floor and my midwife friend was saying yeah, we always assume that once a woman's had like a couple of babies, you know she'll have this quick, easy second stage and it is. It's kind of that assumption.
Jacqueline:I think that's part of the reason why I ended up with this instrumental birth last time. So I've been pushing for an hour, baby had progressed, she'd moved down a couple of stations, but because it was my fourth vaginal birth and I've been pushing for an hour and she hadn't moved, well, you know, we'd x, this is what we'd expect. The there was that assumption as in. Well, we have to intervene now because something's not quite right, because she hasn't progressed as fast as she should have done, without actually speaking to me and saying oh well, what were your others? Do you know what?
Florence:I mean what?
Jacqueline:yeah, they'd have asked me, and I said actually, yeah, you know what? I have really long pushing stages. There's something going on. I didn't know at the time where it was. I've since found out from having um visiting pelvic physiotherapists. I'd say yeah, this is normal for me, that's fine you know, but it's.
Jacqueline:You moved a bit, that's fine, that's normal and you know it's not. So, yeah, that's. There was definitely an assumption there, and whether again, the assumption was or well, you know, she's passed a baby's passed through a vagina three times already. She won't need any pain, she'll be fine you know like I say she'll keep on, she won't feel anything.
Jacqueline:But I think those assumptions are difficult because you know, we're all different. We've all got different um pain thresholds, and it could be that the woman that they performed that intervention on yesterday last week, didn't have an epidural in place, didn't need anything, and she was absolutely fine. But I think you have to go with what the woman who is the most sensitive and has the lowest pain threshold and at least offer that, and you might say, no, I don't fancy that injection to my vagina or whatever, I'll just crack on with it, whereas 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 now going to do, do to me.
Jacqueline:So I think those assumptions yeah, it must be quite difficult as a practitioner when you've seen, like, what the norm is in inverted commas, but you're always going to have people outside and they're the ones you always have in mind every single time. What if this woman has a low pain threshold? We have to go with the assumption that you have that and if you don't, that's fantastic, yeah. So I think that that those assumptions definitely things that should be challenged every single time you have this situation.
Florence:Yes, I'm interested in what was the midwife involvement in this, because you've been pushing some time.
Florence:And then what happens is the midwife comes out and talks to the midwife in charge and says oh I need a doctor's review or whatever, and the midwife presumably had been with you for some hours and got to know you a bit, yeah, and I always think the midwife is there. You know we're coming in to maybe assist, but the midwife is still your key person and your key advocate. So I'm interested perhaps for midwives listening or student midwives listening what role the midwife played in this, if were they saying to the doctor, hang on a minute, do this, and he? He was ignoring them, or were they passive or what was happening? Well, I did find them quite passive actually.
Jacqueline:So I did trans. I say I transferred him from a home birth, this. I was like post-dates, my baby was post-dates and when my waters broke we transferred in. When my waters broke there was meconium, but she was never in distress at any point and it was just one of those cases of. I've since read that 30 percent of babies who are post-dates can have meconium or waters.
Jacqueline:Obviously at the time I didn't know this, I just thought meconium was the scary things. They said let's go. And I'm not. I'm not saying what they did was wrong. You know advising me to transfer in and I did willingly transfer in.
Jacqueline:And you know, as a plus, these the two home birth midwives, in theory should have kind of handed me over to the hospital midwives, but they stayed with me because I didn't have a support person. Long story short. So they stayed with me almost as my support people. Then obviously I had the hospital midwife and then I had the labour ward midwife coming in as well. But I did find, to be honest, even with my first one, almost once an obstetrician comes in the room, I found personally the midwives are quite passive and it's almost like they don't like to challenge the, the doctor. So, for example, with the pain relief you know I was screaming with the pain and the midwife one of the midwives from the hospital, a labour ward midwife was just saying right, you need to stop screaming, you need to calm down, listen, to listen. So it was almost like she wasn't even on my side, so it was almost like advocating. I felt she's advocating for the doctor here instead of me.
Jacqueline:And then one of the other midwives did, and I remember just saying, um, oh, but it really, really hurts. And one of the midwives said here, have some gas and air. So at that point I did have a bit of pain relief. It was gas and better than nothing. But I just thought afterwards why didn't they hand me that gas and air before the doctor started the procedure?
Jacqueline:I mean, yeah, it was the doctor's job and duty to ensure that I had pain relief in place, but given that he didn't, and given that the midwives were out there was four midwives in the room at that point not one of them thought hang on a minute, let's just see, until after I'd started screaming. So, yeah, I didn't feel as bad as I feel as angry as I feel towards the doctor, because I did feel as angry as I feel towards the doctor. So I did feel angry. I actually felt more anger towards the midwives Because they were my advocates. Yes, he failed to do his job, but so did they and their women, and at the very least, they know what even a smear feels like.
Florence:Whereas the doctor? He was male, he didn't have a clue.
Jacqueline:I'm not saying that's an excuse, but from an emotional point of view it's like hang on, there's four of you, four women, in this room. Yes, you know why. Are you passive and not kind of doing your job of being my advocate?
Jacqueline:or just saying start, just hang on, let's just give her a bit of gas. So I didn't have an epidural in place, nothing. And I was already in significant pain because I had a very quick labor, but come on very, very quickly at home. So I was already in significant pain because I had a very quick labour, but come on very, very quickly at home. So I was already in a lot of pain anyway because I didn't have time to build up all you know the endorphins and the natural pain. Then you transfer from hospital, from home to hospital. That in itself makes labour more painful because it's you know, you've got the stress, you've got the addiction. So I was in a bad situation to start with, and then it was just about to be made worse by this type of birth I was having.
Jacqueline:Once the doctor walked in the room, 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:Yeah, yes, okay, perhaps if we turn to slightly better, say a little bit about your forceps, birth and what was better about that, or how you felt the communication was better or or cared for in that situation yeah.
Jacqueline:So this was my second birth. I'd had quite a big gap I'd had nine years between my first two. I decided I'd had. I decided to pay for an independent midwife because my first birth had been so traumatic I thought I'm going to give myself the best chance. So because I had the independent midwife you know it was the one-to-one care we had lots of. So this is really good antenatal care. You know lots of long appointments for an hour or more where we go into what happened last time and you know what if you're in that situation.
Jacqueline:So we had lots of time to prepare for this eventuality and unfortunately it did happen. And what I remember one of the things I said is you know, if I do go into hospital, if I do transfer into hospital, it's because something's going wrong. At that point I want an epidural. I don't care what they're going to do to me. They're going to intervene in some way and I'm not going through any kind of birth, hospital birth with interventions, without pain relief. So I think that in itself helped because I already had a good plan, as you say, getting back to women during pregnancy, having this really good, solid plan in place. If this does happen, none of them want it to happen, because it's not a choice, is it? You're not. No woman puts on a birth plan. I want my baby pulled out by force yes exactly.
Jacqueline:It's not. It's not anything anyone's planned for. So it's like, in the eventuality of this happening, this is what I'd like, and because I'd had the bontus birth to start with, I had a good idea of what, what was going to happen, what would be done to me, how that would feel. So I said under no circumstances am I having any instruments without an epidural. And if they won't do it, then they'll have to do a c-section. That's it. There's nothing. You're not, you're not touching me without an epidural.
Jacqueline:So I had that in place. I had really good support of the midwife who transferred in with me someone I knew really well. Unfortunately, when we got there, we did have a doctor who didn't understand like why I would want an epidural. Because he's been you know he's been you've got this far and you've been pushing for hours. Why do you need it? Because of what you want to do to me now is going to be the part that's going to. I can cope with the natural pains of labor and pushing a baby out. It's all these other things you want to do to me that are going to really really hurt me In the end.
Jacqueline:You know how Hoft and Poft went out. He couldn't do anything without my consent. So he did. He did agree, he sent the anesthetist. So I think the fact that I had the epidural in place meant that I was in a very different place. I wasn't in pain, I could have a proper like adult conversation, because there's always that thing of like you're a bit infantilized, aren't you? You know you you're half naked or 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 bit like, because I had this pain relief, I could have a normal conversation, yes, which I couldn't have even between contractions. You're recovering from one. Last thing you want to do is have a full blown conversation.
Florence:Yes.
Jacqueline: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't want, I don't want an episiotomy. Can we try it without an episiotomy? And he said, well, yes, we can. And I did end up having a compete an episiotomy, because he was saying to me right, you are starting to tear, is it okay? But you know it wasn't like right, I'm going to give you an episiotomy. Okay, if I do a small episiotomy rather than just, well, you know, compared to the other two, it's like I didn't even know until the baby was born, that'd been done, you know right yeah, if you can see it's so.
Jacqueline:That's so different, isn't it? Yeah, look, you know, even saying beforehand would you like me to do episiotomy? Do you want to wait and see? Do you want to, you know, if you start to tear, you know that kind of proper adult conversation, which is what really in theory should happen. It just seemed much more respectful.
Jacqueline:As I say, yes, the things were just done to me because this is what this is how I do, things, you know, and for the episiotomy.
Jacqueline:And then me saying, for example, when the baby's head was out, I says, can you just stop, because I really want to touch my baby's head? And I mean, obviously this is'm saying in a non-emergency situation and just really lovely things like that that try to maybe honour my birth plan as much as you can in that situation. And things have been explained to me, like I remember my midwife saying you know, you wanted, like I've always wanted, delayed core clamping and a physiological third stage. She kind wanted like I've always wanted, delayed core clamping and a physiological third stage. Kind of explains me, you know we've moved off this path of normal now. So, yeah, you know, we wouldn't recommend a physiological third stage because you don't have all those lovely hormones flowing anymore. We've already intervened in the birth so we kind of like have to carry on, but it was never like we can't do this now. Yeah, it was like what do you think? Think, do you?
Jacqueline:know what I mean, and I did agree, whereas, like with the other ones, it's almost like well, now we're on this path, this is what's going to happen, this is what needs to happen, without really consulting me as a fully you know functional adult, who you know be given informed consent, so that definitely, you know.
Florence:Yeah, I think that's a really important point, being able to have that adult to adult conversation. You're right, it can end up with infantilizing so that you're you're not able to have that proper, proper conversation. So I can see that having that pain relief then gives you that chance to have that conversation and how valuable that is. I think the other thing from what you just said there that really resonated with me is respect and possibly with that acknowledgement in terms of I can think of situations where a woman has said to me beforehand I really don't want an episiotomy.
Jacqueline:And.
Florence: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 important to you. We're now in this situation where I think you really need one. You know, I can see you're starting to tear, tear, you're going to have a bad tear or whatever. I I now I know that's what you want and this isn't what you want, but I I now think we need to do this and it's kind of taking on board. We may or may not then do the episiotomy, but what I'm kind of saying is I've heard your wishes. I've really understood that this is an important thing to you, that I need to have that really separate discussion and explain why I do or don't now think that that's okay. So I think respect is a big element of it yeah, definitely, and I think it's still.
Jacqueline:It's the woman she says no, I don't want one, just go ahead exactly, yeah without banging on and on and on.
Jacqueline:So, okay, you know, yeah, make sure of that. Yes, you know, that's what you've decided, it's all noted. You know you've covered yourself, yeah, as a midwife. You know we've discussed this adamant doesn't want an episiotomy, and you know you're kind of covered then, aren't you? I mean, yeah, but definitely that that respect. And it is very hard and it's very hard to advocate for yourself and normally in like day-to-day life you can be, you know, very articulate and you can be very confident, but you know you're in a different world altogether when you're yes, very difficult.
Jacqueline:One thing that I just remembered, actually is also that made it better, and this is more from a emotional or psychological point of view. Remember the doctor saying to me and I actually picked up on this when you did your podcast saying that this is a team effort, this is, we're going to do this together. And that's exactly what the doctor said. He says I can't get this baby out on my own. You know something we're doing together. You're going to push and I don't know whether he was just saying it to inform me like you're not just going to lie down and pull the baby out and maybe it was, but from my point of view, emotionally, that just really helped because it's like it's not like I'm at the dentist having a tooth extracted and the dentist is doing all the work. You know I'm the one, yeah, we're doing it as a team. So I am pushing my baby out, my baby isn't being pulled out and even though rationally and logically afterwards you know all the people I spoke to the midwife says no, the baby can't just be pulled out. It just can't be pulled out. You have to push.
Jacqueline:At the same time, on an emotional level, sometimes it can feel like you've been very passive and you're laying the job for you, as I say, like extraction and it's not and even though, like with my last one, for example, I can tell myself over and over again that didn't happen.
Jacqueline:Sometimes it did feel like that, like I didn't really do it, whereas with that one, I think because I heard it at the time it was happening something imprinted in my brain to say like, yeah, you are pushing your baby out. So I think that even just things 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 no reason. I can't say you know what? The doctor can't do this on her own. So you know you really need to push, you're going to be pushing, or you know and, as your baby's being pushed and moving down, saying you know you're doing, you're pushing your baby out. Yeah, you are, you are doing it, you are doing. I think there's something about hearing it as it's happening, as opposed to someone telling you afterwards but you did do it yeah, yeah, it's a difference.
Jacqueline:I don't know why. There's something in your brain that, just in my, in my point, from my point of view, that's what happened. That's what happened, you know, to me, even though with the forceps birth, my baby was much higher up in the pelvis. His head needed to be rotated. You know lots of things going on at the core around his neck, which is why I ended up needing forceps and not the ventouse, because he wasn't low enough down. So in theory, with the ventouse births, 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 still feels like I did more, just possibly because of the words that that doctor yes, and you're right, I do say it's teamwork.
Florence:I say that all the time to women, um, because it genuinely is that I'm just adding a little bit, whether that's, like you say, rotating the baby's head into a better position or helping it come down, I genuinely feel that, but it's really, it's really nice to hear that that could be a really valuable thing. I'm saying, actually, and I think, even if you take away the pushing, the way the uterus is working, the way the womb is contracting, we only are pulling when the womb is contracting. You're working with the contractions, you're working with the woman's body. That's how an assistive vaginal birth works and so very much.
Florence:It is not a passive thing and I think I can see why psychologically, that is a really big point. That might help if if it's said in that moment, because it it absolutely is, um, not a passive thing, it's very much working with what's already happening and trying to expedite.
Jacqueline:It is the best word I can think of really yeah, and I think, as I say, I'm only speaking on my behalf, but I can't imagine that lots of other women feel very differently to me and I do remember with my sister.
Jacqueline:So my sister had two babies before I did. And years later she said, with a second one, again, I think she's had some. Maybe she's built the same way as I had. She's had three, two, three instrumental births, one without any instruments. And she said, with one of them I can't remember, I think it was the second saying I felt I really could have done it. I felt I was cheated. She said I felt like I was cheated 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 like running a marathon. So you've prepared for it, you've trained for it, you've imagined and you've got there and you're right and you can see the finishing line. It's right there, but all of a sudden, for some reason, you fall down and someone runs out of the crowd and they pick you up and carry and it's like you've done so much to get to where you are but, you've needed help or even not carrying you.
Jacqueline:You're limping along, you know, with your arm around them. It's, yeah, you did it, but you also had someone helping you. So it's it's a funny thing because you know, you know you did it, but it's like, but I wanted to do that last those few meters. At the end I didn't, I needed help. So anything that can mitigate that, yes, failure and inverted we talk a lot about women. You know you weren't a failure and you weren't. You were failed in this but I think to just anything that can mitigate that potential feeling of failure. You know it. Just, I just think it really helps and I do think, like saying it at the time just makes all the difference in the world, definitely. So, yeah, listening to this just takes one thing away from this is that you could just yeah, actually I remember talking to that woman and yeah, that's what it's like running a marathon just get to the end. So just, yeah, you're doing it, you're getting there.
Florence:Yeah, I mean, you're pushing your baby out yeah, no, I love that idea of a marathon and not wanting to be helped over the line. You want to do it yourself.
Jacqueline: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, but no, I want. There is that thing. If we want to be able to do things, yeah, we can see over our own bodies. And, yes, I think it all ties. It all ties into that.
Florence:Yeah that's lovely. I wanted you to mention briefly because you sent me a piece you'd written about birth trauma and how the impact it's had on you. I think the thing that struck me from what you sent me to read was the everyday life things. So if you go to a maternity unit where you've given birth and you've got birth trauma, then everyone would assume that would be triggering.
Florence:But I think the thing that really struck me was the that you could be going about doing your normal everyday life and something could trigger you that reminds you of that occasion, which perhaps we as professionals wouldn't appreciate. And the example you gave was the supermarket, and I had never thought of the fact that people in the supermarket are wearing uniforms and having fluorescent lights and some of those similarities. So I don't know if you'd be willing to share a little bit about birth trauma and what that's been like? Yeah, yeah.
Jacqueline:So as you say things like that, you, you would, you know, imagine a certain situations being in a maternity unit or even in the part of the hospital. It's so similar it's gonna could be a trigger. But every I I found this. Personally, I found the supermarket very triggering, and it was. It was the uniforms, and perhaps it was because it was the color. It was a dark blue, so it was perhaps the color of the, um, the labor wards, um, the you know the midwife I can't remember her title is a labor.
Jacqueline:Yeah, yeah, whatever the colors she had on and just the fact that there's the fluorescent lighting and it's just, it's a thought. I mean it's a form of ptsd. I wasn't officially diagnosed with ptsd, but all these are like symptoms of of ptsd being a completely different environment, nothing to do with the hospital, um, let alone, you know, maternity ward, but just having those reminders and triggering you and the I think I mentioned this. Also there was a pharmacist, so I always ended up in a till that was right opposite the pharmacy desk and I think that, in particular, triggered, triggered me, because that was a very almost clinical setting within a supermarket.
Jacqueline:And the doctor he actually did look like the doctor that assisted my baby's birth and I did end up feeling a bit sorry for him because I used to look at him and think, oh, you know, kind of like you're really annoyed and angry because you're there and triggering me. It wasn't his fault, this guy is just there doing his job. But just, you know, every day kind of things have the potential to trigger you and I don't know how to mitigate against that. Because getting back to this kind of thing of the vulnerability being in labour, even just going into a situation in hospital even when you're not in labour. I think just the fact that people wear uniforms, for example, in our culture we see uniform as an authority, don't we?
Jacqueline:so you're going there and they're almost like you're going into their territory to start with and they're wearing a uniform. So you're going there and they're almost like you're going into their territory to start with and they're wearing a uniform, so they're almost like they're in charge, and there is that power imbalance I feel. You know, even when you're just going in for, like, any kind of appointment in the hospital, but certainly when you're having a medical procedure or you're in labor, you know just just the nature of the whole fact that you're in there and you're vulnerable. Um, that power balance, imbalance is there and, as I say, I don't know how to kind of mitigate against that and that. Carrying on in everyday life, where you will come into contact with people, as I say, just in your 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.
Jacqueline:I suppose what I'd say is that if a woman needs that kind of birth, just bear in mind that it is going to be traumatic On whatever.
Jacqueline:On some level it's going to be traumatic 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 that room and that had be, you know, started to happen. But certainly, transferring in from like a low risk setting like an MLU unit or a home birth, as I did, you've already got the trauma of changing from one environment to another. That already that's, and then you add this trauma onto it. So I think everyone in the room needs to bear in mind that that woman on some level is going to be traumatized. With the best will in the world, so really to try and practice, you know, as much as you can not that you shouldn't with anyone else, but you know the empathy and the kindness and the care and the trauma-informed care really, really, really need to be in place while that's happening you know, because you don't know how that woman's going to act.
Jacqueline:She might be 100% fine with it and go and skip off and live her life, or she might be devastated, like I was and you know, feeling at points where she doesn't want to be alive anymore. So, again, you have to go with the lowest kind of denomination, as, in you know, this kind of birth has the potential to do this to a woman. So let's be kind to her, let's really care about her, because that's going to be carried with her, you know, for the rest of her life she's going to remember and it's going to be carried on into everyday life. And also what? Like you know the piece that I wrote, I did put some of the suggestions that I had from my point of view, which may not be possible, that could possibly have mitigated. I think, with, as I say, even the perfect situation. There's going to be trauma involved in that kind of birth. So what can we do to mitigate it? And for me, one of them was privacy. It's very difficult to have that kind of birth and feel you're not being watched, you're not being viewed. It's like, you know, the lights are switched on, you kind of bear with your legs wide open and what can we do to kind of, as I say, mitigate that experience for that woman?
Jacqueline:Some of the things I came up with, as I say, one of them might, may not be possible. One of them was that I understand that there needs to be bright lights in the room, but over my head do the lights have to be bright? Is that an option to not have bright lights? And I did speak to um. I did a labour ward tour recently, actually a few months ago of the hospital I gave birth and I mentioned this to the one the obstetrician that was there and she said which something I didn't think of. She said, yeah, that potentially it is. If we had lighting where we could have, you know, dim lighting in one part of the room but 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 take a few seconds to adjust. I was looking up to speak to her and where her head is, it's like it's not bright. And then I'm looking down again, it's not ideal.
Jacqueline:As I say, I don't know. That's one of the things I thought, but I'm just thinking it purely from the woman's experience. But I know that would have helped me if that had been possible, or if not. A spotlight, for example. So the room is dim. Yeah, the doctor uses a spotlight and, again, one of the things that this observation came up with was like, yes, we could have a spotlight in the ceiling, but then the women that are birthing in that room that don't need it, are looking at this light. That's kind of medicalizing the room more than it needs.
Jacqueline:So it's not. I know it's not as simple. All I can do is speak out and say this is what we've heard and for people to say, actually, in our unit, could we do that? What could we do? What could we do? Is that possible? And what would be the challenges? Because if no one says it, you're not going to think about it.
Jacqueline:Yeah, and another thing with the lighting. So my baby was born, she was absolutely fine, um, didn't need any help, she was on my chest and but again, these light, really bright lights, were kept on. And at that point, you know, could we have a spotlight because I need? I don't have any paediatry, so I need to be structured. And could you know, could we just have the lights dimmed in the room for the mum and the baby? At that point, kind of spotlight for the doctor? Yeah, to see what they're doing.
Jacqueline:And then another thing was with being viewed. Having the paediatrician and the resuscitaire was pretty much so. I was in the bed against one wall and they were on the opposite wall, but they could see everything that was on display. Yeah, and again, going back to the labour ward when I wasn't in labour was really helpful because I saw several rooms and I thought because one of the suggestions that I made that I know another unit does as standard, because I know a midwife who is married to an obstetrician and she said in my husband's unit this is standard they have the resuscitator and the pediatrician on the side, on the wall at the side, yeah, very close to the woman if they're needed, but we can't actually view you from that end of the room.
Jacqueline: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, so again, it's just maybe thinking outside the box. And then I wrote this article for aims and the lady from aims said to me one of the things I'm going to take from what you've written is I'm going to advocate for the use of screens. So again, could a screen be used so that you know? You know a screen on wheels so you can just, you can just be screened, but it can be whipped away in a second, if you know, if it's needed to, so that the only person that can view your genitals is the person that you've consented to view your genitals yeah yes, yeah, it's a bit of a free-for-all now.
Jacqueline:Bright lights on. Whoever's in the room can see you. I guess when women say things like this, you felt very exposed and vulnerable. They'll say to you oh yes, but you 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 they're?
Florence:back.
Jacqueline:You know what will this baby, you know I mean, but it's like it doesn't matter because the woman's like still exposed it's like how many times that doctor's seen other women's vaginas?
Jacqueline:he's never seen mine. Yeah, you know, I've only got one strange man standing between my legs and now I've got another one at the other end of the room staring in my direction. It's like is this 100% necessary? It's still that kind of invasion of your dignity and privacy and I imagine for women who are, you know, rape survivors or sexual assault survivors, 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 and I think the fact that I'm even 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's actually? Yeah, yeah, all these people potentially viewing her after. Yes, that it has really been thought about. Maybe it's been thought about. Um, not taking any further. So I think I just need to say it, because if I don't say it, no one's going to think yes, yes, you know. No, absolutely.
Florence:I think and I think you're right, you know, some things are practically quite difficult, some things actually, you can think, yeah, that's actually quite easy, we could easily do that and to hopefully provoke a bit of thought and hopefully some people listening to this will go away and just think, oh, in our birth, birth rooms, what could we or couldn't we do? You know, I'm thinking with the spotlight suggestion and the lights. You know I do do sometimes the cesarean with the top lights in the theatre off and just the operating light on, and the same. You could do that with an assisted birth. So it you know there are things you can do and you know you probably seen that I often say wrong is wrong even if everyone's doing it, and right is right even if no one's doing it, and so little things have to start from somewhere. So hopefully people will grasp some of this and and run with it.
Florence:Yeah, I'm just thinking so. Normally I end the podcast with the zesty bit, the kind of take-home message, and I think there's so much that you've already said that would come into that. But is there anything else that kind of comes to mind? Oh, oh, hang on. The marathon, the end of the marathon.
Jacqueline:Yeah.
Florence:Encouraging the woman and helping her understand she is a participant, she is actively birthing her baby, even if she's having some form of assistance. Would that be your zesty bit, or is there anything else you'd want to add? Yeah, I can't.
Jacqueline:Yeah, I think that would be your zesty bit, or is there anything else you'd want to add? Yeah, I can't. Yeah, I think that would be my zesty bit because, as you say, it's probably something that most people don't think about unless you experience yourself that that's how it could potentially feel for women. So I think, yeah, and everyone in that room, if the doctor doesn't say it, for whatever reason, then you know there's going to be other people in the room that can be saying it. So I think, yeah, that would be my zesty bit, to actually let the woman know she is birthing her baby with some help. And you know, I just think it makes such a difference to be saying that at the time rather than afterwards. So, yeah, I think I think that would be, as you call it, your zesty bit. If every woman having that kind of birth was hearing that at the time, then I think it would make psychologically, emotionally easier not perfect, but it would make it easier, definitely perfect thank you so so much.
Florence:I I feel that's been a really excellent conversation that I really hope will inspire people to go back and just think a little bit yeah, definitely, and I also just quickly wanted to say lastly, even though it's just me, one person, one woman, is saying this.
Jacqueline:It's almost like the women that speak out. You're almost at the tip of the iceberg. Yeah, there's also women behind me that don't speak out because they don't know whether birth could be any different, or they've just had a baby and they're exhausted, or they just want to move on. They don't want to talk about it. So I feel like I'm speaking for like 99 women who come behind me, who are not going to say, and the women who are coming after me. So it's not just I'm the only person that's experiencing it. Of course I'm not. I'm the one that's speaking out and saying how? You know how it can be. I'm not speaking every single woman 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:yes, thank you very, very much. I very much hope you found this episode of the OBS pod interesting. If you have, it'd be fantastic if you could subscribe, rate and review, on whatever platform you find, your podcasts, as well as recommending the OBS pod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalogue from clinical topics, my career and journey as an obstetrician and life in the NHS more generally. I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary.
Florence:If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at theobspod, on Twitter and Instagram, and you can email me theobspod at gmailcom. Me theobspod at gmailcom. Finally, it's very important to me to keep the OBS pod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and by chance, you do have a tiny bit to spare, you can 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.