Health

Are there still taboos around childbirth?

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Many mothers' birth plans end up in the bin, with their baby born via an emergency Caesarean or with labour induced. And in some cases, complications after delivery lead to a mother fighting for her life.

Susan Wray, professor of physiology and director of the Centre for Better Births at the University of Liverpool, says the truth is that birth plans won't work if we don't know what makes birth work - and for that we need to fund reproductive research.

Where is the work asking why pregnancies and labours go wrong?

What are the biological or inherent causes of pregnancies and births going wrong, causing disability and death.

The crucial issue is not just the woeful lack of funding available to really make inroads into the causes of these conditions, but, more worryingly, that research is not even part of the discussion and, thus, not part of any plan.

With few researchers working to tackle the root causes, it is not surprising that the public seems accustomed to stoic acceptance of poor and sometimes tragic outcomes.

In turn, this lack of scientific questioning affects funding into how we can prevent or treat adverse outcomes in pregnancy and labour.

'In the dark'

Last year, the Medical Research Council, the funder of biomedical science from the public purse, spent just 2.4% of its budget on reproductive health and child birth.

With overall success rates of less than 20%, researchers in areas that are on the fringes, such as reproductive health, are likely to find fewer supporters around the table.

A "nothing succeeds like success" mentality does not fit reproductive and childbirth research, and thus priority and fresh initiatives and research calls for funding this area need to be brought into place.

If the public funding looks slim, charitable funding rates are even lower.

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The annual report from the Association of Medical Research Charities, the body which represents medical research charities, shows that less than 1% of the money distributed is spent on reproductive research.

Why are reproductive charities such as WellBeing of Women and Action Medical Research not the recipients of huge amounts of public generosity?

I think the lack of awareness that with research we can help more women have better pregnancies and deliveries, plays a part.

It may be worth asking if there are still taboos in the public's mind around childbirth.

We are sympathetic to heart, lung or liver failure, but why not so to uterine failure? Surely in 21st Century Britain we should, by now, understand as much about the organs that start life as much as those that support it.

One thing is very clear - this lack of research funding cannot be explained by a lack of need.

Across England and Wale more than 55,000 babies were born too early in 2014. Preterm birth is common, affecting about 8% of pregnancies and is the leading cause of death in newborn babies, as well as increasing the likelihood of serious long-term health problems to surviving babies.

Yet we are largely in the dark about preventing it.

Real risk

Over 100,000 women will have births that need medical or surgical intervention.

The leading cause of emergency C-sections is that the muscle of the uterus gets tired - this is dangerous because without the muscle contracting, the baby cannot be delivered through the birth canal.

There is just one drug, which was introduced 50 years ago, that can be offered to help women suffering these labours, which are termed "failure to progress". And that one drug works only half the time.

We can neither predict which women will have these difficult labours, nor which will not respond to the drug, and need surgery.

Such labours are common, affecting one in 10 births and can be enormously traumatic for the women involved.

Many often decide against subsequent children or elect to have a C-section, with its small but nevertheless real risk.

Only awareness and more funding for research in these areas can start to make these stark figures better, and make women's birth plans less of a wish list.

Mothers will have choice only when we improve the scientific base to understand difficult pregnancies and births, and increase the chances of them being able to have the healthy birth they want for their baby.

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