All this push for 'normal birth' - why I keep pushing.

 Photo credit and copyright: Claire Riding. Midwife Lynda Drummond 

Photo credit and copyright: Claire Riding. Midwife Lynda Drummond 

Guest blog post by Australian student midwife @MegHitchick

“All this push for ‘normal birth’ – what’s the point? Women and babies used to die all the time in childbirth, so who cares if we have high rates of intervention? What does it matter which way we give birth, as long as the baby is healthy?”

As a consumer of the media, I see this - or some variation on this theme - so often. In a somewhat sinister twist, I occasionally see this one:

“Midwives endanger lives with their stubborn insistence on pushing for normal birth.”

I’m a third year student midwife, and a birth addict. In October last year, I attended the International Normal Labour and Birth Conference in Sydney, Australia. Seeing so many esteemed, brilliant and passionate people assemble to protect and promote normal birth was somewhat overwhelming, and possibly even more so was trying to keep up with it all on social media! Thousands upon thousands of tweets, Facebook posts and #normalbirth16 hashtags flooded the web, drawing many comments from people near and far. During one session, as I scrolled through my Twitter feed, one heartfelt comment stood out to me among the many. I won’t quote it directly, but in essence it said this:

“Great. Way to go making all us mums who had to have Caesarians or other help to give birth feel like crap. All this ‘normal birth’ stuff does is make a competition out of motherhood. I’m healthy, my baby is alive and that’s all that matters. So shut up with the ‘normal birth’ trumpet.”

In that moment, my heart broke. Not just a little bit, either - a big, frustrated ‘snap’.

It broke for this amazing, tough, proud mother who has come out the other side of birth feeling like a fighter, a survivor, and who hears the message of ‘failure’ in the normal birth movement.

It broke for all the women who feel that they are constantly judged for a choice that their bodies made for them.

It broke for mothers who did the best things for themselves and their babies - the best they could in the time and the place where they faced birth, and with the people and facilities that they were surrounded by - and who still feel that they need to justify themselves for it. They’re angry. And I’m angry for them. I’m angry alongside them.

Because the move to protect normal birth is not, and has never been, about trying to conscript women into accepting less intervention, less Caesarian section, less pain relief in birth. The purpose of such advocacy is never about blaming women for their choices and experiences. The point of the exercise is NOT to make mothers feel like failures if their birth did not meet the ‘optimum’ recommendations. Birth is not, and should never be, a competitive sport.

Advocating for normal birth is NOT about holding women accountable.

Advocating for normal birth IS about holding birth workers accountable.

The purpose of the movement towards more normal birth is to hold professionals, doctors, midwives and policy makers responsible for the way in which they provide care for women and their families through pregnancy and birth. It is to challenge systems that create the conditions under which so many women’s bodily processes and births are chosen for them.

And women should never, ever be given the ridiculous idea that in birthing, they were somehow not good enough, not strong enough, not natural enough. Instead, we must take great care to ensure that women hear the message right: it is up to us birth workers to be the best we can be, so that we don’t cause you harm or disrupt birth unnecessarily under the banner of ‘keeping you safe’.

It is entirely on the shoulders of midwives, doctors, policy makers and governments, to use the most recent evidence we have to give the best care: evidence that shows that continuous care by a known midwife improves outcomes (Sandall, et al, 2016) and increases maternal satisfaction (Forster, et al, 2016). Evidence that shows that continuous electronic monitoring in low-risk labour doesn't change how often we lose babies, but it changes how often we perform c-sections (Alfirevic, Devane & Gyte, 2006). Evidence that flies in the face of a whole lot of policy, procedure and propaganda.

So don’t be fooled - advocating normal birth is not some crazy, midwife-led agenda to keep obstetricians out of work and see women suffer through difficult labour without pain relief (although that’s what some outspoken critics might have you believe). It’s true that many of the most articulate advocates for normal birth are midwives, but are midwives really that vicious?

What possible motivation could a midwife have, for wanting to see less unnecessary intervention in birth? It's not like midwives are naive to the things that can go wrong - they see it often. They are trained to recognise impending problems, and to refer as necessary. Chances are, in a low risk pregnancy, it will be a midwife who first detects a possible pregnancy complication - and they DO recognise them. It would be a fair bet to say that a midwife has seen pregnancy, labour and birth unravel into disaster more often than the average person walking down the street. So by seeking to reduce interventions, can we infer that midwives harbour some secret desire to see these adverse events more often?!

Anyone who has stumbled upon a midwife shaking silently in the tea room over a near miss would know otherwise. Anyone who has seen a midwife arrive home from a shift where the unthinkable has happened, would know otherwise. Nobody wishes these things to happen - especially not midwives.

Midwives do not benefit financially from less intervention. Less use of 'technology' during labour creates more work for the midwife, not less. Midwives who provide the gold standard of midwifery care - continuous care with a known midwife throughout pregnancy, labour and birth - experience considerable disruption to their personal and social lives. So why should midwives care? There is nothing in it for them, not personally, anyway. The motivation is purely a deep conviction that pregnancy, birth and mothering are profound life events that can be source of incredible empowerment, when women are upheld in the centre of them. This conviction brings with it the determination to ensure that women do not only 'survive' their experience, they 'thrive' through it. 

That’s why I’m determined to continue to advocate for normal birth. Not because I think birth intervention is the sign of a ‘failed woman’. Not because I want women to feel ‘crap’ about the way in which they have given birth. But because I never want to see our systems of care undervalue and underrate the incredible intuition of a woman birthing in a supported, protected and empowered space. The process and power of normal, uninterrupted birth must be the focus of curiosity and deep respect for all birth workers. Only when this is true, can women be confident that their birth experiences represent the optimum for themselves and their babies. And then my heart won’t be broken anymore.


Meg Hitchick is an exceptionally talented student midwife at Western Sydney University. Meg has written a beautiful piece about eye contact and the importance of communication for The Practising Midwife, which is available here for you to read

I met Meg last year at the International Normal Labour and Birth Conference in Sydney. Meg wrote and performed an incredibly revealing 'skit' about the choices (or lack of) women have to negotiate during childbirth.  I recorded it LIVE via Facebook, and after making it publicly accessible, the video went viral. The performance has been replicated by others in England (with permission), and midwifery leaders are using it as part of a training tool. You can watch a recording of the skit below...please leave your comments.

References

Forster, D. A., McLachlan, H. L., Davey, M., Biro, M. A., Farrell, T., Gold, L., Flood, M., Shafiei, T. and Waldenstrom, U. (2016). Continuity of care by a primary midwife (caseload midwifery) increases womens satisfaction with antenatal, intrapartum and postpartum care: Results from the COSMOS randomised controlled trial. BMC Pregnancy and Childbirth, 16 doi:http://dx.doi.org.ezproxy.uws.edu.au/10.1186/s12884-016-0798-y

Sandall J., Soltani H., Gates S., Shennan, A. & Devane, D. 2016. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5

Alfirevic, Z., Devane, D. & Gyte, G. 2006. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane database of systematic reviews(3): CD006066.