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I recently wrote an email to NHS Forth Valley as part of a freedom of information request, asking them to detail the birth statistics for 2022. If you want to read the email reply in its entirety I am happy to forward this on - just get in touch via the contact section of my website.

Why did I write?

I think it is so important to understand what is happening locally. We can read about induction rates and c-section rates etc in the news, but if that is not happening in our local hospital, then it doesn't affect us. I will always state, I am not anti-induction, anti-c-section, or anti-home birth. What I absolutely am against, is women not being informed so the more information I can gather and share, in my eyes, the better. Then you can choose what is right for you and your birth, what ever that may be - and that I fully support.

I was also looking for positives - is the AMU (the alongside midwifery unity) being utilised as much as it can be. What are the home birth statistics? Finally, as someone who gave birth last year, who is a part of these statistics, I wanted to know how many other women had experienced a similar experience to me. So there was definitely a personal interest invested in these results too.

Anyway, after weeks of waiting, I finally had a response! And the results are... mixed. In some cases awful! In some cases perhaps reassuring! But what I did find interesting, is I only asked for the statistics for Jan-Dec 2022, and as an added bonus, they included Jan-Mar 2023! And I have a feeling I know why they did that.... read on for more!



Place of Birth

Place of birth is really important. There have been studies done to determine where is the safest place to give birth. A HUGE study was done in the UK called the birthplace study, which I have linked if you want to read. It determined that if you are 'low risk' and this is your first baby, the safest place to give birth is in the AMU. If you are 'low risk' and this is your second baby or more, the safest place to give birth is in the AMU or at HOME. The delivery suite in the labour ward is not recommended. Now I cannot believe that so many women, 1446, 51% were classed as 'high risk' so what is happening here?

What is the difference between the Delivery Suite and the AMU?

There are 19 rooms on the labour ward in Forth Valley. 16 of the rooms are classed as 'Delivery Suites' and on the same exact corridor are 3 which are designated AMU - Alongside Midwifery Unit, 2 of these having birth pools. Watch this video to see what they look like at Forth Valley. There are many differences, from the facilities, lighting, beds and so on, but the main difference is that in the Delivery Suite, the OU, you are under doctor care, in the midwifery unit, you are under midwives care. Research such as the birth place study referenced above shows that just being under the care of doctors, you are more likely to experience interventions - they feel the need to 'fix' birth, to 'do something', and ironically by doing this - it can lead to more complications. Midwives are trained to wait, they understand how to be hands off and I personally think are absolute angels! All the midwives who supported me in my births have been incredible. But they only have 3 rooms. 3 out of 19 rooms total is 16%. 16% of all births (2825) is 452. Logically it would seem that more babies could be born in the AMU than are at present.

In addition, the home birth statistics are really disappointing. I think there are several factors affecting this - the first being fear. We don't believe it is safe. We believe hospitals are safe - and we have seen and heard lots of 'emergency' stories to believe that hospitals are the safest. I will firstly refer to the birthplace study I referenced above - if you read it you will see that the first point made is that BIRTH IS SAFE! So how sad is it that we have developed this belief that we can't trust our bodies with the most basic of natural processes and instead we have a fear that drives our decisions?

This leads me on to my second factor affecting this - our culture. We haven't heard of many women having home births, it just 'isn't done' so we don't want to be seen as different and do this for ourselves. Did you know that Scotland has the lowest home birth stats of any of the home nations in the UK? In Wales the figure is 1 in every 30 births - 3%; in England it is 1 in every 40 births - 2%, and in Scotland only 1 in 100 births are home births - 1% (stats available here). But for Forth Valley to be less than even half that at 0.39% is not great.

The Scottish Government has never set a target for home births, but its maternity agenda 'Best Start', says that women 'should be encouraged to consider home birth as an option' if they have had a previous vaginal birth without complications. I wonder what this 'encouragement' looks like and how many are given information on this?

Aside from culture, Forth Valley does not have a dedicated home birth team. Local midwives work to support home births for women who have indicated that this is their preference. But I can't help but wonder, if a home birth team would make a massive difference? In other health boards, where home birth teams have been introduced, the numbers have dramatically increased. For example in Tayside, when a pilot model home birth team was introduced, the numbers rose to 1.7%. This was then rolled out across Perth. It seems unfair that the NHS does not offer universal services that are equal across all Health Boards in Scotland.

I salute the 2 women who birthed their babies outside of medical care. There are several reasons a woman may choose to 'free birth' and it is becoming more popular. One reason is simply because the hospital will not 'allow' a water birth in their facility. For example if a woman has a risk factor such as high BMI they may say that guidelines state she cannot use the birth pool. If she really wants a water birth, there is nothing to stop her hiring a pool and birthing her baby at home. You have the right to birth your baby however and wherever you choose. Another reason for a free birth may be religious. It may be not trusting hospitals - believing hospitals are unsafe and home is safe. Or it may be that she trusts her body enough to recognise that she is capable and does not need any stranger in her home for such an intimate act. Whatever the reason - know that free birth is always an option. There is no law that states you must birth within the NHS.

Caesarean Births

The c-section rate recommended by the WHO is 10-15%. NHS Forth Valley is double or triple that at 34%. But before this becomes a witch hunt, lets break it down. The emergency c-section rate alone was 18%. So this isn't drastically higher, although it is high. And I would imagine it has something to do with the induction rate - more on that below!

The elective c-section rate is making up the rest at 14%. Whilst I am pro-choice, I do question this figure. There will obviously be cases where babies are in such a position that birthing them would be impossible, such as lying trasnverse. In addition, the placenta can also be in a position in which it blocks the cervix and again, a c-section is the best or indeed only route. The birthing person can have personal complications where a c-section again is advisable. However, I think there may be a group of women in this elective percentage where they could have birthed their babies vaginally, but didn't believe they could.

If you had a previous c-section with a first baby, it does not mean you automatically have to have one with a second. And for the women making the choice to have a c-section again - I believe it again comes down to 3 things - I'll call them the 3 C's: culture again, caution or fear again, and convenience. Culturally we believe that is just what you do if you have already had one, hardly anyone is even familiar with the term VBAC - vaginal birth after caesarean.

Women who have already had a caesarean have two main fears. The first is that the scar may rupture when trying for a vaginal birth. Whilst this is a possibility - it only occurs in 0.22% of the time, or put another way 99.88% of the time this does NOT happen! The second fear I can completely sympathise with, and that is the fear that what happened the first time may happen the second time. This is for all those women who had hoped of a natural birth, but for whatever reason, it ended in an emergency c-section. The trauma and lack of control from the first birth experience, means that taking back control by choosing that from the start second time around is easier. I think this is sad on so many levels. Sad that women are traumatised to start with, but more that I doubt they received the necessary aftercare postpartum to debrief what happened, to council them, to allow them to work through it and have the courage, faith and confidence to try again the second time.

Convenience - again I can empathise with this. Having already had one baby, having to find baby sitters to birth your second can be really tricky. There is really a 5-6 week window where you need to find people to be on 'stand-by' to look after your first child not to mention furbabies. Having an elective c-section can be far more desirable in this instance as you have a fixed date to make all your arrangements for.

Still, separate or combined, the c-section rate isn't ideal compared to WHO guidelines. It is a similar rate across the UK. In many cases we should be glad we don't stay in Cyprus, where it is 54.8%! The only European coming close to the 15% WHO threshold is Finland at 16.5%.

Induction and Interventions

This is the figure that surprised me the most and is the most outrageous! 44% is completely ridiculous! I am actually baffled as I previously reported that this was only 35.6% - that data was from Public Health Scotland from March 2021-March 2022. This data is Jan-Dec 2022, directly from the hospital. I asked how many women were induced last year and they replied 1249 - which is 44.21%.

The induction rate in 2012 was 24%. And it had hovered around the 20% mark for a long time! It has only drastically started to climb in the last ten years. Even still when a figure is this high in comparison to the national average - 33%, then there are only two things to consider. Either, there is something wrong with the women and babies in Forth Valley that we need to be induced more than those living in Edinburgh, Glasgow or anywhere else in Scotland, or, there is something wrong with the hospital that they are recommending it more than is necessary.

I think Forth Valley know this figure is out of control! And this is why I believe they sent the data for 2023 so far - because from Jan-March 2023 the rate is just 30.6%. Phew! A move in the right direction at least!

The reasons for inductions are not endless, but they are completely variable. No women is the same, no baby is the same, and there can be unique reasons where induction is indicated as the best course of action. However, and it is a big however, very often women are offered inductions, not for a unique, individualised reason, but instead they have 'qualified' due to a risk factor. Risk factors include baby measuring too big, too small, BMI, maternal age, being post due-date by 'X' number of days, gestational diabetes etc.

What it is crucial to understand it the difference between being 'at risk of' something, versus actually 'having' something. Just because you have a baby measuring 'big' and may be 'at risk of' having shoulder dystocia (where during delivery the baby's shoulder gets stuck behind the pubic bone) for example, does not mean you will have that. You may have a completely uncomplicated beautiful birth experience.

Actually, the only fact we do know is that inductions increase the liklihood of having an epidural, and having an epidural increases the liklihood of experiencing shoulder dystocia. Inductions also increase the liklihood of having an instrumental birth, and the liklihood of an induction ending in a caesarean increases the later you are induced. Dr Sara Wickham explains this really clearly in this article.

Inductions can lead to a cascade of interventions, such as forceps or ventouse, as I know all too well. My first born was born following an induction in theatre with forceps. We were in theatre as the doctor anticipated I wouldn't be able to push him out and would need a c-section. In this case it appear 112 women also experienced a similar birth to my own, with the hospital favouring forceps over ventouse. 11% assisted births is on a par with the rest of Scotland which sits between about 7-15% on average.

Why do I think the induction rate is so high? Personally, from what I have heard anecdotally through the pregnant women I work with, and the Scottish research, I think baby size is being suggested as a reason for induction frequently. But I think that as a population we are just getting bigger and birthing bigger babies - the research from Public Health Scotland supports this! So what was once a 'cut-off' for a big baby no longer should be used - or should be shifted. It is really important to know that NICE do not recommend an induction if you are measuring 'big', nor do the WHO! You can read all about that in another blog post I have written here - Is a big baby a big problem?

The statistic that I think irks me the most is augmentation. This is women who are experiencing a natural birth and labour, have not been induced and whose contractions have started naturally or whose waters have broken spontaneously. Yet, for whatever reason, their labour has not progressed quickly enough for the doctors and so augmentation in the form of a hormone drip, has been suggested to 'speed things along'. Many will tell you that 'failure to progress' is really 'failure to wait'.

28% of births were augmented - more than a quarter! So it makes me wonder - did the 806 women who chose this feel fully informed before making that choice? Did they know that the drip would make things more intense? What prompted them to make that choice and give up on the completely natural birth plan? Was it exhaustion? Impatience? Fear? Not knowing another way to speed things up naturally? Or the belief that this is 'just what you do'?

What about tearing?

This is a fear that often creeps up with clients that I teach. Many are very worried about tearing during labour. Tears are classified from a 1st degree tear, which gets called a 'graze' to a 4th degree tear. It is normal for women to experience a 1st or 2nd degree tear - a graze will heal on its own but can sting for a day or more a bit like a paper cut. A second degree tear may require a couple stitches but will again heal after 5-7 days. These are not counted by hospitals. Hospitals only count 3rd and 4th degree tears - this is where a tear extends to the anus. Hopefully it is reassuring to know that only 3.6% of women who birthed vaginally experienced this - so 96.4% of women did not have a 3rd or 4th degree tear. It is therefore unlikely to happen to you. You should also know there are ways to reduce the chances of this. Getting off your back and learning different birth positions, declining an epidural and having the freedom to move, using water or placing a hot compress on the perineum during birth can all reduce the liklihood of a serious tear.

Is a natural birth a too good to be true?

775 women, just over a quarter - 27% experienced a vaginal birth with no interventions at all. Now I asked the hospital exactly that - how many women gave birth without intervention at all, but I did not define what I meant by that, which is my mistake. So it is likely they consented to vaginal exams, possibly sweeps before or during labour, and some would argue that the presence of medical staff is in itself an intervention. So it may not have been a completely hands off birth. I am not sure whether this statistic is positive - great that these women were able to birth 'naturally', or negative - how sad that 73% of women were not? And I wonder what can be done to make this better?

What about those 2023 statistics you mentioned?

Whilst these cannot be compared like-for-like as they are only for the first three months, not a year, some things are looking more promising. The induction rate for starters! The home birth rate is also up - hopefully it can stay up! Sadly the AMU rate is down with more babies being born in the delivery suite. And of those 22 babies born in water this year - I know I supported and worked with two of those women! I think that is pretty impressive considering the data!

So what?

So what is the reason for writing all this? We can't change the facts of the past. But we can learn from them. And I suppose the takeaway message is to get informed:

  • If you are low risk - request and advocate for the AMU. If you are high risk - request it anyway! It literally can't hurt and it can be so influential for your birth experience.

  • Don't shy away from a home birth just because you don't know someone else who has had one. If you want one - go for it! They are safe and incredibly special! Let's hope Forth Valley has a home birth team in the future.

  • If you have had a caesarean before, it does not mean you need to elect to have one again - the choice is yours. Ask for information about VBAC if that is something you are interested in.

  • If you have been recommended an induction - question everything. Make sure the recommendations take your individual circumstances into consideration and remember it is also a choice. There is less chance of complications, interventions and c-sections following spontaneous labour than induction. You can always wait for labour to start naturally - there is no known case of women staying pregnant forever - your baby will arrive in their own time.

If you would like to find out more about how I can help you plan for the birth that you want, please get in touch. There are lots of ways that we can work together to prepare you for a beautiful birth.

If you found this post useful or informative, please leave me a comment or like. It would be nice to know I have helped someone :-)

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