Birthing a better story
source: Positive News, February 2017
As a journalist covering solutions, Danielle Batist understood the power of positive news to inspire and empower. But when she fell pregnant, she was shocked by the overdose of drama surrounding birth stories. A year on, she feels it is time to redress the balance.
“You’re not ill, you’re just pregnant”, was the usual response of any of my Dutch friends and relatives when I broke them the news. Everyone in my family was born at home and no one bat an eyelid when I said I’d try to take a natural approach to birth too. But in the UK, where we live, things were different. Not drawn to drama, I had nonetheless encountered almost exclusively shocking and sensational stories about childbirth. From mum forums to red tops and pub conversations (“My cousin’s auntie’s neighbour gave birth in a shopping mall”); it seemed like no one had a ‘normal’ birth, even though I wasn’t entirely sure what that was.
At pregnancy yoga and National Childbirth Trust classes, people often half-jokingly referred to the hugely popular TV show One Born Every Minute and how it made them nervous about what was ahead. I decided to watch it to get a picture of what birth was like in Britain. Even though I know how TV formats and edits work, all the screaming and panic and bright lights didn’t put me at ease, and neither did it calm the nerves of my partner! It turned out we weren’t alone in our worries: a few months into my pregnancy, a ‘fear free childbirth’ campaigner launched a petition to urge the show’s producers at Channel 4 to present a more realistic picture of birth.
By the time my maternity leave came around, I found myself desperately Googling “positive birth stories” and thankfully realised platforms are starting to appear. Somerset-based mum of three Milli Hill founded the Positive Birth Movement four years ago, after she spent her first pregnancy ‘terrified’ by the negative narrative surrounding birth. At the same time, she was frustrated by the lack of empowerment among other women she talked to. When her baby was overdue, she chose not to have an induction until 42 weeks and 3 days to give nature time to do its thing. “Whenever I told people that, they would always say: ‘Really? I didn’t know they let you do that!’ That used to really annoy me; why are women made to feel that the choice isn’t in their hands?”
The movement, despite being mocked online by some for addressing ‘first world problems’, rapidly gained global momentum. It now has over 400 real life groups who regularly meet around the UK, as well as 36 other countries including the US, Brazil, Indonesia, Turkey, Uganda, South Africa, Morocco and Poland. Hill, alongside midwives, obstetricians and doulas (birth ‘mentors’) running the groups, stresses that a positive birth does not have to be ‘natural’ or ‘drug free’ – it simply has to be informed from a place of positivity as opposed to fear and misinformation.
Leah Neuhauser, who delivered her baby son via emergency caesarean, testifies to this view. She moved from the US to the UK mid-pregnancy and found support at Positive Birth Movement meetings. “My image of birth in the States is very clinical. Not once was I told I had any choice in the manner of which my son was born. I was not given the option of a water birth versus hospital bed, or the option to delay cord clamping etcetera. It is our baby, our birth experience; shouldn’t we have the right to choose? The meetings gave me a safe environment to talk about things they do not tell you in the books and things your friends may not tell you. I felt much more at ease knowing I had choices.”
Positive birth principles are even applied to caesareans on a clinical level. In July, a video of a baby effectively delivering itself after the incision was made was watched 2.5 million times. NHS obstetrics consultant Andy Simms, who performed the operation in Nottingham University Hospital, said he filmed the procedure to spread awareness to colleagues: “The idea of a gentle caesarean has been around for about eight years and is starting to take off around the country. It is about creating a soft environment, and making the birth less clinical. And it doesn’t require any more resource of staff than a regular caesarean – it just adds a few more minutes to the operation.” He dismissed the criticism that promoting gentle caesareans will encourage women to request delivery by caesarean when there is no good indication: “I don’t think it will do that – I think people who have the option of a natural birth will usually go for that. But for those who need a surgical delivery, it definitely softens the experience.”
Human rights in birth
Other organisations, like Birth Rights in the UK, aim to improve women’s experience of pregnancy and childbirth through human rights like dignity, autonomy, privacy and equality. In their 2013 study called ‘Dignity in Childbirth’ the majority of respondents said that birth changed how they felt about themselves. Of women who had a spontaneous vaginal delivery, 22 percent felt the impact was negative. For instrumental and c-section deliveries, the figures rose to 77 and 73 percent respectively. Hill believes there is a ‘quiet revolution’ occurring and welcomes the mind shift that is taking place: “We’re talking about human rights here; we’re not talking about whether somebody wants whale music and tea lights. It is about the way women are treated and the fundamental effect that has on the rest of their lives.”
Cultural and societal attitudes need changing, but existing mothers themselves are not always ready to embrace a different mind-set, says Hill. “For many women, there is a lot of sadness and pain around their birth experiences. A soon as you start talking about improving birth, you’re asking some people to think: it could have been different for me. That is a really hard feeling to have. So some people say: ‘no, it couldn’t have been, and all that mattered was the healthy baby’. Saying that your own experience matters too can be seen as somehow selfish, because of that constantly repeated phrase. Of course a healthy baby is what we all want, but that should be the baseline of our expectations, not the pinnacle.”
At the same time, problems are exacerbated by the fact that many midwives feel they cannot deliver the best care. The Royal College of Midwives raised alarm bells in October 2016 as it fears a “midwife exodus”. In a report called ‘Why Midwives Leave’ – it surveyed over two-thousand midwives who quote their excessive workload and staff shortages as reasons for dissatisfaction and leaving the profession.
There are glimmers of hope, however, even within the NHS. When I told my nearest hospital I wanted a home birth, they transferred me to their ‘caseloading team’: a small group of NHS community midwives who support women wanting to give birth at home within the area. It was a postcode lottery and I just happened to be lucky that such a brilliant team was available to me. My midwife Emily Stockton came to our house for all my check-ups and introduced me and my partner to her colleagues in person, so we knew whoever would be on call.
It was her colleague Vicky Guilor who attended my labour, in the middle of the night during Easter Weekend. She was calm, she was supportive and she let me ‘get on with it’, just as I had hoped for. My other half was fully involved and helped with anything from fetching drinks to timing contractions and filling the pool. Together with the second midwife who is routinely called in for the final part of labour, they helped me deliver a healthy baby girl. After they made sure we were comfortably settled, they stopped by to check on us every day for the next ten days.
Realising the benefits but also the limitations of their NHS work, Guilor and Stockton set up The Group, an antenatal class for parents who don’t have access to caseloading midwives. “We have a lot of time to spend with our women, getting to know them and their families and surrounding them with positive messages. But we know that the majority of women do not have this opportunity. We started The Group so that more couples can have the chance to talk frankly with midwives and feel supported, confident and in control of their own, unique birth experience. No two paths are the same.”
The necessity of a trusted relationship
The NHS commissioned a National Maternity Review last year, which highlights the lack of continuity of care. Soon after, a report released by Green Templeton College and King’s College London presented evidence to show how women and babies benefit from maternity care provided by a single midwife, or a small group of midwives whom they get to know throughout pregnancy, labour and the early weeks of motherhood. Since then, the NHS in England announced that all pregnant women will soon be given a personal maternity care budget of at least £3000 to pick and choose their own NHS care, whether they choose to give birth in a midwife-run unit, a hospital or at home.
How to have a labour of love
Midwife Vicky Guilor: “Birth is unlike any event you have ever experienced before and it can shape how you feel about yourself, your body and your ability to be a great parent. Not only can a negative experience effect you emotionally but fear of labour and birth can have a physical effect. For a labour to progress the love hormone oxytocin needs to be produced. This hormone is only released when women feel safe, calm, relaxed and loved. Fear, stress and anxiety stimulate adrenalin and cortisol which then blocks oxytocin and natural pain relieving endorphins. In turn a labour can slow down and become more painful. That is why it is so important to get your head in the game. Teach and prepare yourself to let go of fears and inhibitions, give in to your body and let nature take its course. This may not guarantee a straightforward birth, but it will guarantee a positive one.”
A useful guide to birth statistics
UK Consumer watchdog Which has developed a helpful ‘Birth Choice’ tool which includes data comparison to give future parents an indication of the type experience they may have. For example, looking at the percentage of women who have had a water birth in a labour ward gives you a sense of how experienced the midwives there might be in delivering babies in water.