Tuesday, 13 May 2014

The case for 'natural' births

It is easy to see why so many would be sympathetic towards the guidelines recommending that healthy women should give birth in midwife-led units. Eschewing invasive and technical medical procedures and language, mothers-to-be can hope for a more natural, less clinical experience; an altogether more holistic – an even more spiritual – experience.

But seeing the new advice from the National Institute for Health and Care Excellence (NICE) brought back worrying memories and sent a shiver down my spine. While I am sure these midwife-led centres provide wonderful locations for thousands of mothers to give birth, from my own experience, I fear mothers are unduly pressured, by midwives, their peers and society itself to take what may not be the safest - or, even, the most relaxing, and least uncomfortable - option.

NICE’s latest guidelines say that women expecting a ‘straightforward’ pregnancy should be encouraged to give birth in a midwife-led unit rather than a traditional labour ward, filled with doctors and nurses. The study – featuring 65,000 births – found that such units were just as safe as doctor-led units in low-risk deliveries. 

Inevitably, I can only approach this from personal experience. Before my wife was due to give birth, we dutifully made our way to several meetings preparing us for the big day. They were all led by midwives and quickly my wife started mapping out as natural a birth as possible. A detailed birth plan was created featuring aromatherapy, massage and birthing balls; a water birth was mentioned. I even have vague memories of a conversation about what albums to put on an iPad to provide the whole experience with a suitable soundtrack.

The midwife-led unit we were due to use boasts, on its website, that the ‘rooms are less like clinical hospital rooms, instead decorated and furnished in a more “home-from-home” style’. The only pain relief on offer was to be gas and air. This was no place for epidurals. The way in which the whole experience was described, repeatedly, was undeniably persuasive; inevitably, it was a birth we would all wish for.

When the moment came, however – despite having been predicted a straightforward birth – our as-yet unborn baby started to have an irregular heartbeat. Our anxieties were fuelled by having experienced a family tragedy, under similar circumstances, just a couple of years earlier; any chance for a natural birth ended very quickly. My wife was attached to a monitor to track the baby’s heartbeat, which fell dramatically with each contraction. Tests were repeatedly, and unsuccessfully, carried out to see if there had been any brain damage, but ultimately our, mercifully healthy, daughter was born via a caesarean section. It turned out the umbilical cord was wrapped twice around her neck and any further efforts for a natural birth – which we could have insisted upon – may have proved disastrous.

The extent of the problem with the umbilical cord was never fully identified until the actual birth and it would be unfair to blame the midwife-led unit for failing to identify this problem. But, during the months of preparation, the whole process of childbirth had almost become sanitised and made straightforward by the midwives' descriptions of what they could provide. There was no space for brutal and complicated realities.

As it turned out, the doctor-led, traditional labour ward, was next door to the midwife-led unit so, in our case; there was no troublesome journey between them. It is vital that such proximity is maintained in all cases for when inevitable complications arise.

All of this is not to say we were not well treated by midwives. We had the same midwife with us consistently for about 12 hours, reassuring and helping us, as various doctors and consultants busied themselves with trying to work out what to do. And, the day after the birth, another spent more than an hour and half with us giving us invaluable advice on breastfeeding.

But, we do have to question why hospital births are promoted as, somehow, less 'empowering' than a 'natural' birth, and even anti-feminist. It has been many years since the hospital environment has been dominated by men and it seems strangely old-fashioned to imply that effective pain-killing and efficient medical intervention somehow represent the loss of maternal control and the exercise of masculine authority. Pain relief is somehow presented as a kind of admission of failure, a betrayal of the sisterhood.

And we only have to look at Victorian cemeteries to see what happened to enormous numbers of young, healthy women and their babies, when they were safely at home, trying to give birth.

The urge to provide choice of births is laudable, though one wonders how much cheaper midwife-led units are than doctor-led ones. Child birth must be guided by safety and not cost. And before any choice can be made, prospective parents must be fully informed of what midwife-led units can and, crucially, cannot offer.


It seems I am not the only one with such concerns. Here are a couple of reactions I have had:

A recent mother said:

'I was told be a midwife that all these natural birthing centres that have been popping up in NHS hospitals was much more money motivated. Apparently, the NHS gets a set amount of money for a woman in labour and this amount is reduced depending on the intervention so financially it is in their best interest to encourage as little intervention as possible and get women to go into these birth centres.

And a father of two said:

'I believe money is very much part of it. As soon as drugs are involved eg epidural then a doctor is required, the mother has to be more closely monitored in the earlier stages etc. Our experience with [our daughter] was about being pressured not to switch from the midwife area to the doctor area once we were there. [My wife] wanted an epidural and was offered aromatherapy! She was also made to feel guilty for wanting pain relieving drugs. Not very sisterly at all. [With our next child] we made sure we went straight to the doctor side of the ward and had a much better experience.'

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