Yesterday, I accidentally opened the floodgates to a mass outpouring of criticism of the National Childbirth Trust (NCT), when I appeared on Radio 4’s Today programme describing my experiences of NCT classes. With me, was the NCT’s chief executive Belinda Phipps, who defended the organisation.
Almost immediately, TV presenter Kirstie Allsopp tweeted: ‘Turn to BBC Radio 4 for talk of a book about all the absurd myths surrounding pregnancy & birth. More NCT b******* as usual though. Lots of people have good NCT experiences, but many don’t. This is a very politicised, dogmatic and in my experience, scary organisation.’
Allsopp’s comments prompted a flurry of Tweets from ex-NCT class attendees, some positive, but many negative, ultimately resulting in a story in the Daily Mail.
Sadly Today only gave us three minutes on air, but I had a much longer chat with Phipps beforehand and I thought people might be interested to hear what she said to me.
When I was pregnant with my first daughter, I attended NCT classes, like so many pregnant women do, with the primary goal of making some new friends. I also expected to get accurate, impartial advice about birth and the choices available to me.
I’ll admit that I was completely ignorant about what birth might entail. Obviously I’d heard that it was painful, but I’d also attended hypnobirthing classes where I’d been told that women could give birth as easily as sheep or cows if only they banished fear (yes, I realise this sounds ridiculous now ).
Upon hearing that I’d been doing hypnobirthing, my NCT teacher suggested I consider a home birth, which I declined. Instead, I planned to go to a midwife-led home-from-home centre in London, because that sounded rather cosy.
In our NCT classes, we learned about the various drug options available to us – in fact we had to go off and research them for ourselves, then present back to the class. But our teacher also seemed to make her own thoughts on pain relief clear, when several weeks into the course, we started hearing this phrase: “a spiral of medical intervention”.
Through a series of role-plays, we learned that if we requested an epidural (which involves inserting a big needle into your spine) to numb the pain, we’d end up flat on our backs, strapped up to an array of monitors and machines that go beep. Not only would this quash any hopes of a beautiful water-birth, we’d be more likely to need a c-section or a birth involving forceps which might make us tear. This was terrifying. Not only am I afraid of needles, I was terrified of tearing, and our teacher had also told us that a c-section would make breastfeeding difficult; would make it hard to bond with our babies; and would take weeks to recover from.
The overriding impression I was left with was that birth is something women can control, that doctors aren’t to be trusted, and that if I did end up requesting an epidural or needing a c-section I would have failed in some way.
Reading many of the comments that Allsopps’ Tweet provoked, I know I’m not alone in this. In a previous blog, I also described research suggesting that women who go into labour wanting a natural birth and end up having an epidural often feel profoundly disappointed and guilty.
When I was researching my book, Bumpology, I revisited many of the things I’d heard about the risks associated with c-sections, induction and epidurals and discovered that many were overblown, based on flaky scientific research, or untrue.
When I put all of this to Belinda Phipps, she largely agreed, and pointed out that the NCT’s website has a whole section devoted to evidence-based guidelines, which I have read (and occasionally even reference in my book) . They are clear and well researched. The point is I didn’t know about these when I was pregnant, and our NCT teacher certainly never told us about them (Phipps says a few of these guidelines are now handed out in classes for parents to read at their leisure).
I wonder how there can be such a disconnection between what the NCT as an organisation says, and what some of its teachers preach. I’ve even come across an NCT document which advises teachers on the kind of messages they should convey. They include telling women:
“Do what you can to minimise complications developing, but do not feel personally responsible for achieving the ‘perfect birth’. Childbirth is unpredictable and often does not go according to a mother’s wishes. Prepare yourself for the kind of birth you would like and for possible deviations from your ideal.”
Phipps’ defence is that although all NCT teachers have to sit a diploma and are periodically checked, they are only human and they have their own beliefs. Fine, but if they are teaching under the NCT’s name, perhaps the NCT should keep them on a tighter rein.
There are also things about “natural” birth that my NCT teacher didn’t tell me, but I wish she had:
- That tearing during a “natural” birth is extremely common (85% of women tear and more than a third need stitches); that it’s not that bad, but that you really must take care of the wound and watch for any signs of infection (swelling, heat, discharge) and INSIST on seeing a doctor if you suspect one.
- That you may get so constipated after a natural birth that the lining of your bottom may tear, so you need to drink, drink, drink!
- That a lot of women get stuck in the early stages of labour – sometimes for days – and that it is excruciating and exhausting. And that an epidural can bring enormous relief and even speed up labour in these circumstances.
- That although 36% of women anticipate suffering extreme pain during labour, 65% report experiencing it
Phipps rightly pointed out that there is a lot to cram into the 16 or so hours of tuition that you get on an NCT course. But it wouldn’t take much to tell parents about some of these realities – even hand them a brown paper envelope “to be opened once you have your baby”, advising women on the first difficult days after birth.
Phipps also told me that parents can always call their teacher between classes if they have any extra questions – but how can expectant parents really know what they should be asking?
Finally, Phipps says that women can complain if they feel unhappy about what an NCT teacher has told them, and that she will act upon it. But if you don’t realise that what your NCT teacher has told you may be distorted or unbalanced, how can you know to complain? Also, calling the NCT is possibly the last thing you feel like doing when you’ve just given birth. You have enough on your plate.
On balance, the NCT does a huge amount of good, and without them I never would have met some of my closest friends. But they shouldn’t ignore those who feel let down – or that they have let themselves down – as a result of what their NCT teacher has said. It’s time for the NCT to listen to the criticisms of, not only famous mums like Kirstie Allsopp, but to the hundreds of parents who have responded to her comments with horror stories of their own. Its leadership must take action to ensure that the NCT’s central, evidence-based message isn’t diluted by the personal beliefs of teachers, which are at odds with the best-available scientific research.