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.
I totally agree with all Linda’s comments here (disclosure – we are colleagues, but I speak here as another mother). Although my experience with a group affiliated with the NCT was 18 years ago, I heard much the same ideological bias. It was one reason I ended up giving birth as an elderly primigravida under conditions that were in retrospect entirely unsuitable – we were lucky it came out well. The same bias distorted the breastfeeding support (or lack of it) I subsequently got from coaches attached to the same group. Yet that said, I too found that the group itself was vital, especially as mine operated outside the UK, serving expatriate English-speaking parents who face extra difficulties. A more thorough emphasis on evidence-based medicine and less anti-establishment ideology (except of course where that is warranted by the evidence!) might well fix these problems with an otherwise much-needed organisation.
Even though it’s fifteen years since I first gave birth, I still harbour a grudge towards the NCT and the way they made me feel. I had a planned c-section due to a medical condition, my mother died two weeks after my daughter was born (one week after I left hospital) and not surprisingly, I struggled to breastfeed. I turned to the NCT for help but was met with insistence that I try harder to feed my baby and instructions to speak to my health visitor about my recovery. In other words – I was shunned. I ended up with post-natal depression and was put on suicide watch by the health visitors who were absolutely brilliant and carried on being brilliant when I had my other children. I didn’t make friends with any new parents because of this situation and trying to arrange the funeral/sort out personal effects etc. I needed a charity like the National Childbirth Trust to reach out and support me unconditionally but they didn’t. Thank god for the NHS post natal care.
This exactly describes my own experience of the NCT, we were taught to view doctors as the enemy, and although interventions were covered we were lead to believe they only happened if you gave in to the doctors or were afraid, causing your body shut down the labour process. I was made to feel like a failure for ending up with an emergency c-section. However the friends I made were invaluable and much of the official NCT information seems more balanced. The organisation needs to tackle the issue of teachers presenting personal beliefs as facts to women at a very vulnerable time and acknowledge the damage that can be done by this. The trauma of my daughters birth was made far worse by my teachers response and has had a long lasting effect on me.
Hi. I attended hypnobirthing classes and I don’t think what we learned was ridiculous at all. Yes, we banished fear by addressing any fears we had by learning the facts about childbirth – yes, the facts! I saw videos of women giving birth using hypnobirthing techniques and yes, they did do it as simply as sheep and cows. I had intended to have a water birth but this didn’t happen for us as I had gone 2 weeks overdue although I did go into labour spontaneously. In fact, I raced through the first stage of labour (something hypnobirthing helps with because you focus on breathing and visualisation and of course you’ve banished fear too). I had gas and air during labour and that was it re: pain relief. Towards the end of labour, however, my contractions went off and I ended up with an emergency spinal block and forceps. Did I feel guilty because I had to have medical intervention? No! Why? Hypnobirthing! I learned that whatever course the birth took was OK because the birth is about me and baby working together and if help is needed then so be it. So, if hypnobirthing isn’t for you, Linda, then that’s fine, but don’t knock it for others who might be a little more open to alternative ways of birthing.
an interesting article – thank you.
You may be interested to have a look at our evidence-based pregnancy site
The Doctor and Daughter’s Guide to Pregnancy
http://Www.doctoranddaughter.co.uk
I totally agree with this article. I was a very young first time mother and in hindsight somewhat vulnerable to blindly believing everything I was told in NCT classes. The leadership MUST ensure all teachers are on the same page as the organisation, because in some cases new mothers are entirely reliant on the advice they give. This means they MUST give responsible, balanced and evidenced based guidance. Motherhood and feelings of guilt go hand in hand for most women anyway. Let’s empower new mums with consistent and accurate advice – not petrify them with subjective opinion and impossibly high expectations of birth and early motherhood.
Hi Linda – I couldn’t agree more with you and Kirstie. I went to an NCT class before I had my 1st child 5 years ago and really didn’t find it helpful at all. My husband and I attended a 3 day intensive course hoping to make friends & learn more about what was about to happen to us when our baby arrived. What we came away with was nothing like that. The people we were with were all terrified and the NCT class seemed to add fuel to their terror. They were all very pro-natural birth & anti-medical intervention, whereas I was pretty much clueless. What we’d hoped to find out was practical, useful information on birth and what we needed to do with our newborn baby (a beginners how to guide) – what we got was a very “whimsical” tale of the beauty of natural birth & how pain was all in your mind. Honestly I left with no more idea on what was likely to happen to me than when I arrived. A complete waste of time and money.
When my baby didn’t arrive on his due date (new years eve 2007), my next 5 days were spent waiting & wondering what might be … then on Jan 5th I headed into hospital for a quick pre-eclampsia check & my next 2 days went in a bit of a blur. My baby was an “unstable lie” so I was firstly going to have a csection, then he moved so I was induced (it didn’t work after 48 hours of trying) so on 7th Jan I had an emergency csection and my little boy arrived. Nothing practical about my situation had ever been mentioned in the NCT class & I felt completely lost.
Then the hospital breastfeeding “police” gave me an impossibly hard time, I was a brand new mum & NCT had never covered anything barring breast feeding to me. My baby would/could not breastfeed – numerous midwives tried & failed. I kept getting more & more stressed. My Grandma had died on the day my son was born. I was in a really tough place and made to feel like a complete failure because my little boy wouldn’t feed. I spent the next 6 hellish weeks expressing milk, because ALL the information I’d had from the NCT & NHS told me bottle feeding was wrong. As a new mum, the pressure & the stress
was terrifying. I knew nothing and after getting into such a state I made the decision to move to bottle feeding but I constantly was made to feel like a rubbish mum for this by “authorities” on the subject. There was no information on bottle feeding, or formula or how to feed my baby – I had no idea, it was the worst guilt I have ever felt.
I was a new mum and felt totally excluded because of the bottle feeding. Experience has taught me how wrong this was but at the time it was terrifying. I went to the NCT thinking they would be like an experienced “best friend” who would give me the help & guidance I so desperately needed. That was not what I got. I got ideology, a vision of a “perfect” birth & a weird version of a “cult” reality.
2 years later I went on to have my next child, experience had taught me a lot. She breastfed straight away no worries even though I had a bottle & formula in my hospital bag with me just in case (in fact she was the opposite & refused to be bottle fed for 6 months). I would have expected the NCT to provide me with this type of knowledge. Babies are all different, what works for one may or may not work for another. It’s your decision, women need to feel confident & empowered when they have their first child. My NCT experience did nothing for me. I didn’t feel included, I felt like a failure because my birth/baby didn’t do what they said he should. He has grown up wonderfully, bottle feeding him hasn’t hampered his development and I know now that was the right decision for me. Happy Mummy = Happy Baby. The end.
The impression I have of the NCT recently is that it has had to respond to the huge amount of criticism it’s received (whether at the end of news articles, on sites such as Mumsnet or elsewhere), and ensure that its public message is one of support and choice for ALL women — and not concentrated on the importance of natural or ‘normal’ birth (or breastfeeding for that matter) for as many women as possible. But while I welcome this change in attitude, my concern lies in how genuine the organisation’s assurances really are. Here’s why:
1) In 2010, in the midst of lengthy and ongoing correspondence between myself and the NCT, I was requesting its help to support my campaign for support for women who request a cesarean, and I supplied some of the same evidence I submitted to the NICE caesarean guideline development group.
I was told in no uncertain terms that I would not be receiving its support. Instead, the NCT maintained that maternal request (MR) would likely increase rates of maternal and infant mortality and morbidity, and compared it to someone demanding a hip replacement with no medical need.
Of course in the following year, NICE published its updated CS guidance recommending that a MR should be supported within the NHS — a recommendation that could never have been made had there been insufficient evidence to support its comparable safety and cost (with a planned vaginal delivery). To my knowledge, there was no public outcry from the NCT that NICE had made a dangerous or unethical mistake and on the contrary, it seemed to support the guidance.
2) In August 2012, there were was an outcry following the publication of a collaborative document from RCOG, the RCM and the NCT, which contained guidance on the importance of increasing ‘normal birth’ birth, even if it leads to more ventouse or forceps deliveries (i.e. no epidurals, no cesareans, and defined health outcomes that are NOT considered a gold standard to pursue in many doctors’ and women’s view).
Information on its contents was criticised by a number of maternity charities, organisations and medical professionals:
http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%20release%20final.pdf
Further, responses (in comments) from news reports of this story were overwhelmingly AGAINST the document’s recommendations:
http://cesareandebate.blogspot.co.uk/2012/09/media-response-to-news-of-guidance-for.html
And two separate Mumsnet threads expressed overall anger:
http://cesareandebate.blogspot.co.uk/2012/08/mumsnet-users-express-anger-at.html
But yet… although initially removed from RCOG’s website, the document was later reinstated.
****
My point is that the content of the NCT’s antenatal classes may be the least of women’s worries. Obviously, it should be of a high quality and presented in a balanced way, but what’s far more important is what happens in the labour wards throughout this country and in hospital antenatal consultations where decisions are being made about each woman’s birth plan.
This is because you can attend the most informative and balanced antenatal class in the world, but if your request for an epidural or cesarean is ultimately denied (for example), or your pregnancy or labour are allowed to continue for a longer time than you feel comfortable with, or believe to be safe (e.g. late gestation or prolonged labour with warning signs of potential problems), then this will ultimately have a far greater impact on your birth experience and satisfaction.
We need to make sure that the NCT is speaking up for ALL women and ALL choices ‘outside’ the antenatal classroom too – i.e. when it comes to influencing maternity policy and strategies, hospital targets and political decision-making. Currently, the NCT is relied on far too heavily by the government (and organisations such as the RCOG and RCM) as being the ‘representative voice’ of women in this country, and there clearly needs to be far greater communication with the many smaller charities and organisations whose members provide them with equally legitimate (and sometimes different) information about what women want from their maternity care.
Thank you so much for initiating this discussion.
Pauline Hull
Co-author, Choosing Cesarean, A Natural Birth Plan
Pauline. Thanks for these comments. You raise some very interesting points that I’d never really considered before.
While I agree that with hundreds of classes going on all the time there will inevitably be some variations in quality, I don’t agree with the overall idea that a few anecdotes makes data on this. More than that though, as a former volunteer with an NCT branch (who had a section and didn’t breastfeed either) it is extremely frustrating to see high profile mums repeatedly go to the press attacking a charity (she did this a couple of years ago) who has clearly no intention of wanting to address the problem or engage with them. You make good points, sadly Allsop just appears to have a grudge and risks pouring that negativity over an otherwise sensible discussion.
After my NCT course, I was very much under the assumption that natural childbirth was very important and that you should minimise medical intervention if at all possible. For example, I was told that you should tweak your nipples to boost oxytocin levels rather than use the artificial form which would make contractions worse than the natural way. This extended my birth experience and looking back – I don’t think was sound advice.
Luckily, my cousin who is a Midwife told me to be as flexible as possible, so I did trust in the Doctors and follow their advice. However, my mistake regarding the oxytocin caused me to run out of energy, as well as end up having many intervention treatments to get my baby out.
I agree with what you say about the materials being informative and more helpful, but some of the teachers are very way out in their assertions. Sometimes these ideas stick and this isn’t a good thing necessarily.
NCT do need to address some of the criticisms voiced against them. I know once friend who didn’t even mention c-sections for the fear of being condemned during their course. I know another friend who asked for c-sections to be covered and felt like they had said the wrong thing.
When you’re a mum for the first time, you are impressionable and it’s worrying that NCT hold such influential courses these days whilst the NHS equivalent ones have dwindled. You can make friends at NCT, but don’t think everything you are told is correct and they should follow a more friendlier viewpoint.
On a final note, many of my friends who were unable to breastfeed felt like a failure after these classes and also, subject to HV visits. Life is too short and babies have not read the same text books that these people have!
I couldn’t agree with Linda’s and Sharon’s comments more. A balanced view. NCT does an enormous amount of good, but always struck me as too idealogical (an insistence on “good pain” and I found an implicit belief that you’ve failed in some way if you have a C section).
Our facilitator was very nice and it was good to meet other expectant parents, but having a complicated pregnancy I didn’t really feel that they catered for me. When my son was born with a serious medical condition that didn’t fit the pattern either, I didn’t feel the support was there either – it was like I didn’t fit the model and therefore it was a bit like I didn’t exist.
Kirsty Allsop may be controversial in her comments, but I think this reflects how quite a few people feel about the “holy grail” of the NCT.
Having volunteered for the NCT since my sone was 3months old I am proud to say I support this great charity. I don’t know about the classes as I didn’t have them and wish my midwife had told me about them. But their Bumps and Babies group in my local town was a life line. We have also started one for Young parents and it has just had its first birthday. As a branch we are very proud of what we have achieved in our local are and are trying every day to help more parents through a very tough life change. Our members are breast feeders, bottle feeders c-section deliveries to waterbirths. We support informed choice and I know that is what I have had since I found the NCT. We try very hard to send a message of friendship and equaliy and we work hard at a healthy relationship with the local health workers and midwives in our area. I personally am training to help other mums who have PND as I did and who have suffered Miscarriage. We do so much more than classes, weening courses, baby first aid, parenting classes etc etc.
I had a c-section and went to the NHS class. one mum there knew she was having a c-section and the midwife refused to cover it, that was only 2 years ago.
In the last 5 years the NHS and NCT courses have updated and cover lots more. I know our class teachers have a huge section on all kind of delivery options.
I am proud of the chairty I support and I know we do great work. Like anything we work tirelessly to make sure all parents have a positive experienc and we welcome feedback and do our best to accommodate everyone.
Dear Linda,
When will your bumpology ebook be available in North America? I can’t wait to read it but want the e version! Amazon.co.uk won’t let me buy it as I’m not in the UK. As a medical doctor I am so excited to read a book that has been thoroughly researched and is not a load of biased rhetoric!
Cheers
J
It is being published in the US, hopefully later this year, though we don’t yet have a firm publication date. Thanks so much for your interest!
Hi, I’m a Hypnobirth practitioner, and I would just like to say I never tell woman they will have a pain free birth, but I do say that by using the techniques I teach you can achieve a more comfortable birth experience and I also say that birth can be unpredictable but educate woman on there choices, risks and benefits of interventions/procedures. I never say doctors are the enemy, unfortunately they are in a system which requires them to tick boxes and meet demands both resourcefully and economically. We do unfortunately live in a society of fear mongering and worries of being accountable/sued if something goes awry. Thus everyone is grouped in the same box and risk is assessed on a just in case manner even if risk is minuscule. At the end of the day, like most things in life it comes down to time and money.
I did NCT in summer 2014 and I’m sad to say nothing appears to have changed. Breastfeeding wasn’t a choice it was the only valid option. We weren’t allowed to be taught how to make up a bottle or discuss bottle feeding practicalities (what you would need etc.). I felt a huge pressure to NEVER bottle feed. Personally I did breastfeed so if I felt that pressure how must the bottle feeding mums have felt. There was no advice on any complications that might happen such as prolonged latent stage, failure to progress, feotal distress. I thought I was prepared as I had attended these classes but I realised during labour that a lot of the important stuff had been missed and by then it was too late.