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Last week, the television presenter Kirstie Allsopp criticised the National Childbirth Trust (NCT), claiming it was "politicised" and "dogmatic", and that its classes didn't always prepare prospective mothers for the possibility of a caesarean section. Raising her views on Twitter, many women responded with similar feelings – and many others defended the charity. She discusses the issues with childbirth activist Sheila Kitzinger. Emine Saner listens in.
Kirstie Allsopp: Two years ago I was talking to someone who'd had a C-section, and she was saying she felt guilty. I asked her what she had learned about C-sections in her NCT class and she said they just gave her a leaflet. I raised a question on Twitter, saying "anyone doing NCT classes? What prep do you get for C-sections?" I got tweets back saying they had done operation theatre role play, but I got other tweets saying they didn't do any, or they did a bit but it was described as a "worst-case scenario". I received a letter from the NCT that said: "do we teach what women would like to be the outcome, or do we teach what could be the outcome?" Two years later [ie last week], Belinda Phipps [the NCT's chief executive] was on the radio. I was irritated because I thought, she has this platform, she's the spokesperson for this important organisation, and she could have addressed some important issues – so I sent a frivolous, petulant tweet, but what was extraordinary were the replies I got. People told me about classes where they had been informed that a C-section was a terrible thing, that they wouldn't be able to breastfeed, that they wouldn't be able to bond with their babies, and I realised there are women out there who feel having a caesarean was their fault. Something is going wrong – and not just in NCT lessons – in what we are telling women about childbirth, so they end up feeling this profound guilt and sense of loss if they don't have a vaginal birth.
Sheila Kitzinger: I can't speak on behalf of the NCT, although I was involved with them for many years. I run my own organisation called Birth Crisis and women, and men, ring me to discuss what they are left with after birth – how they're suffering from post-traumatic stress. Experiencing a birth when there was intervention of one kind or another – especially something like a high- forceps delivery or a C-section – it's about finding the courage and strength to use it constructively, and that's a very hard message, which women often find difficult to receive. When I introduced birth plans to this country in the early 1980s, I thought it was very important that we think ahead to all the things that might happen in childbirth, because when we embark on birth, it's a bit like planning a picnic in the English weather – you cannot know if it will pour with rain – and it's ridiculous to embark on it without thinking: "What if? What would be my priorities?"
KA: I had a C-section and thought "lucky me!" Nobody thinks a back-to-back 11lb 11oz baby should have come out the right way, so I never had that sense of failure. It's only now, when I look at the comments on this blog I posted, that I realise I'm privileged in not feeling guilty. I didn't have any classes, and I trusted the midwives implicitly, so I never had those worries about control or planning, and I didn't feel as if anything had been taken away.
SK: I'm glad you had superb care, but there are many women who don't. Recently a woman said to me that she had told her obstetrician she would like to give birth vaginally if possible, and he said: "Are you a doctor? Well, it's none of your business then."
KA: What is lacking is people saying, "different women feel different levels of pain. You do not know until you are engaged in it how it will take you." Some of the most neurotic people have these extraordinary births, and then other people who are calm and stoical in every way are panicked by the pain.
SK: Stoical is an unfortunate approach to birth. Imagine making love and feeling you have to put on a performance. This is how birth is sometimes treated, as if you have to show that you can do it; exhibit what you've learned in antenatal classes. This is hardly conducive to having an experience that is personal and intimate. Birth has become very goal-oriented.
KA: I spoke to friends after my son was born, and with some it was "poor you, if you'd had more support it would have been possible [to have a vaginal birth]". Others have heard the same things: if you'd held out against the cascade of intervention, if you'd been braver … There's a similar attitude with breastfeeding. Of course, breast is best, but nature is not perfect and the mantra of "work harder at it and it will come good, and if it doesn't then it's because you didn't try hard enough" is impacting on women in the most appalling ways. I look at a body of work like yours and I see so much good that has been done but I wonder now if, in the work that you and others are doing to campaign for choice and empowerment, are there some women who are being caught in the crossfire?
SK: Yes, and moreover, looking back at the failures and successes, I wonder if we've made any progress at all.
KA: One of the ideas that upsets me is that when couples go to classes, they're taught this phrase the "cascade of intervention" and asked what the partner feels about what the mum has "done" to the baby. If they are being told these things are bad for the baby, then if these things do happen, he could be blaming her.
SK: And she could be blaming him for having stood aside and let them do things to her. It's not surprising you get stresses in the relationship between the couple. In childbirth, we can't predict exactly how it will be. You can't produce a template and say "this is how it is and I'm all prepared for it, and if it doesn't come off like this I'm an utter failure and I've been cheated". The awful thing is when a woman feels so isolated that she's ashamed to tell anyone else, and feels a terrible inner anger that is directed against herself.
KA: A friend of mine went to a class and was looking forward to her "show and tell" after the birth – she rang up and told [the class leader] she had had a caesarean, and she was never invited back. It's that kind of thing – the woman who joins a group, makes friends with other women and then is rejected because somehow there is this idea that if you talk about C-sections, if you talk about bottle feeding, it is somehow propagating it.
SK: I absolutely agree with what you're saying, and we need to address it. The idea that nature is always best, we need to question it.
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