Sunday, 2 September 2012

Get Off Your Backs for a Birth Revolution!

If you gave birth recently, did you feel you had real freedom? Freedom to choose where you gave birth, who was present, what interventions took place and how you delivered your baby? Were you given access to all of the facts needed to make your choices truly informed? Who was the most powerful person in the room at the moment of birth? And did the experience leave you feeling exhilarated, disappointed, or downright traumatised?

These questions are currently being considered on behalf of all mothers as part of a global movement to ‘take back birth’ and reclaim women’s power in the birth place. ‘The freedom in a country can be measured by the freedom of birth’, states Agnes Gereb, the midwife currently imprisoned in Hungary and held up as ‘the epitome of the very worst of what’s happening in birth today’ by the makers of Freedom for Birth, a UK based film about human rights in childbirth to be globally screened on September 20th.

Over in the US, where caesarian rates are more than twice the WHO recommended 15%, and maternal mortality rates have doubled in the past 25 years, another organization - Improving Birth - are spearheading a ‘full scale birth revolution’ on Labor Day, leading ‘rallies for change’ in 100 major cities over 50 states, and demanding evidence-based care for all and the education and empowerment of birthing women.

For some, such protests might seem unnecessary. Surely, giving birth in a hospital with access to all the pain relief you might need is something women should be grateful for? No, say campaigners such as Alex Wakeford, co-founder of One World Birth, who describes how, “…birth has been stolen, by a powerful institutionalized system, that is born of fear, a system that inherently believes that birth is dangerous, and must be managed and controlled by modern technology”

Whilst a UK mother might assume that she is free, in fact, much of what happens to her in childbirth is determined, not by the limitations or otherwise of her body, but by the geographical place and historical time she gives birth. A woman delivering her baby in England in the 1950’s could expect a very different experience to a Scottish birther in the 1980’s, as the following graphs illustrate:



In the UK today as few as 20% of women are aware of the options for their place of birth, and in some geographical areas, options such as midwife led units are non-existent due to lack of funds. This in spite of the 2010 case of Ternovsky vs Hungary, in which the European Court of Human Rights ruled that every woman within Europe has the legal right to be supported in her choice of where and how she gives birth.

UK women are told that they are free to choose a home birth and that this is often the safest option, but in reality, the idea is less appealing when warned that they may have to transfer to hospital at the last minute due to a shortage of midwives. Continuity of care is also an issue: around one in three pregnant women never sees the same midwife twice in spite of government promises and nearly a fifth of women say they feel unsupported during labour and birth.

At the moment UK mothers can opt for an Independent Midwife: around £2500 buys you continuity of care, a guaranteed midwife if you want to birth at home, and – almost non-existent in the NHS - the reassurance that you will have met and made a relationship with the person who attends you at one of the most pivotal moments in your life. But you’d better be quick, because as of September 2013, Independent Midwives become illegal in the UK. 

Birth rights campaigners see this as yet another example of diminishing choices in childbirth and symptomatic of a global witch hunt against midwifery. In America, obstetricians lead the care of most pregnant women, only 1% of women get midwife led care outside of a hospital setting, and direct-entry midwives are illegal in several states: all of this in spite of sound evidence to show that midwife-led care produces better outcomes for mothers and babies.

In the UK care in birth is still largely midwife-led, but numbers are low, and the Royal College of Midwives is pressuring the government to recruit 5000 more midwives. This would undoubtedly inprove choice and help a system straining under rising birth rates. But some, including Toni Harman, Producer of Freedom for Birth, feel that this does not go far enough. “More midwives would help, but would not solve the problem of the routine Human Rights violations happening within the UK maternity system. There needs to be a complete culture shift within the obstetric community to make women the true informed decision-makers in their births.”

This ‘culture shift’ is at the core of what is demanded by those calling for a ‘birth revolution’. Campaigner Holly Lyne told me, “The way maternity services are commissioned is fundamentally flawed and the emphasis on risk assessment and fear of litigation are leading to massive amounts of costly, ineffective and traumatising intervention.” Independent Midwife Nicky Garrett added, “ I was trained to provide holistic woman-centred care and found that it was impossible to give that service within the NHS. The care for women was fragmented, paternalistic and pared to the bone, and the job satisfaction was zero.”

The importance of a positive, normal, low intervention or no intervention birth extends far beyond the individual. Women who demand better births can sometimes be accused of selfsishness, and organisations suggesting less epidurals have this week been declared anti-women. But how we birth has a huge impact on early bonding and attachment, breastfeeding, PND rates and more…which in turn has long term impact on the mental and physical health of both mother and child…which in turn affects the human race. There are plenty of ways to join the birth revolution, and it matters: true freedom in birth really could change the world.


You might also like Reflections on Freedom for Birth

6 comments:

  1. This is such an important topic. It's sad that natural birth is often viewed as taking options away from women when the over-medicalisation of birth is to blame for scaring so many women into submission. I am not satisfied with the way I birthed my daughter and though I've come to terms with it, I can't but admit that there were very real consequences in terms of bonding and my confidence as a mother. They weren't unscalable but they certainly were unnecessary. I definitely would consider an independent midwife but with a time-frame like that, it probably won't be an option. That makes me angry.

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    1. Well the IM's are currently working hard to find a way round the legality issues. Watch this space!
      And I'm sorry that happened to you. My first birth was not satisfying to me, and similarly affected my confidence. Second birth was a very healing experience and I hope the same happens to you x

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  2. I've given birth naturally to 4 children, First in hospital 2003 second and third at home and forth 2011 in hospital. On none of those occasions have I had the option or knowledge about cord cutting before the placenta and ubilical cord stopping pulsating. I think if I had the knowledge that I have now I would have waited for the cord to stop pulsating before cutting, with the exeption of my forth, who's cord had to be cut before full delivery due to it stopping her being born. My first birth was very traumatic and i had no support from my midwife at all, when my baby was born i was not told the sex, i had to ask and She was not even shown to me as soon as she was born, they cleaned her up and passed her to her father first not me. This brought on postnatal depression which i got over once i worked out what caused it. My second and third births were amazing, the midwifes were supportive and encouraging. I was relaxed and the births were very quick. My fourth birth was a planned home birth but due to waters breaking and having slow labour i had to go into hospital. The slow birth was caused by the cord being wrapped around my daughters neck twice and to add to that the cord was short so she kept bouncing up and down like on a "bungee" unfortunatly due to the prolonged water breakage she was born with phneumonia so had to spend 12 days in ICBU and SCBU (longest most painful time of my life) We as parents could have done with more support during that time but it didnt happen. I won't be having any more babies, my family is now wonderfully complete but i would advise all new mums to not be scared of telling their midwife in action what they want during labour and to stick by it unless it puts themselves and babies at risk xx

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    1. Good point and thank you for your stories. Your point about cord cutting is a good example of a question I think about often - what do we mean by informed choice? If we are not given the appropriate info it is hard to make the best decision, and we can't always rely on caregivers to be well informed either. Enjoy your wonderful family and thanks again for commenting x

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  3. I am in the US and had a home birth 6 weeks ago with my first baby. Because of the terrible insurance situation here, I didn't have any, and could not get insurance, nor could I get government aid. We paid $3000 for our midwife and home birth, and it was the best choice we could have made.
    I did a lot of research online and read books that helped shape my birth philosophy, but it was very beneficial that my midwife supported natural childbirth and encouraged informed choices. I was "overdue" by 18 days, and she would have allowed me to go to 21 if I was comfortable with it. I did the research, and believed that I was making the best choice for my baby (a smaller percentage of babies die at 42 weeks gestation than at 37, so the hype about stillbirth risk was kind of silly). I labored for 33 hours with pain in my back because the baby had her hand next to her head in the cervix. I only desired pain relief (wanted to go to the hospital) once, and I knew that I was past the point of no return (I was pushing) so I gripped my husband's hand tighter and groaned, yelled, did whatever I had to to get that baby out!
    I felt very empowered, because when I was pushing I said I wanted these certain people in the room, and all of the others were ushered out. I was relaxed because I was at home, and my husband was relaxed because he was an integral part of the birth. He caught my daughter when she came out, and cut the cord after it stopped pulsing.
    Home births are unconventional here, but I am an unconventional person, so it suited my preferences very well. I believed in my body's ability to deliver a beautiful baby, and I think that is a belief that is degraded and marginalized by the medical community. They act as if they know better than the patient, regardless of the circumstance. I found the book What To Expect When You're Expecting (a very popular book here in the US) to encourage this mindset, placing all confidence in the doctor and none in the mother.
    Anyway, I really like your blog, and appreciate the open dialogue on the subject of birth and choice. Women become outraged if someone challenges their right to abort, but often fail to stand up for what they need during a birth. I had the care I needed, and I sincerely sympathize with women who do not.

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  4. My waters broke a month early for my second child, and my planned home water birth (I'm in UK) was abandoned as my midwives advised that baby might need special care. I went to a hospital where I didn't know anyone, as my backup option of using the local birthing centre was also abandoned as baby was too early. I had no contractions for three days - but luckily I had the help of my doula and my homeopath, who kept me informed of the choices I could make about being induced, VE's, and dangers blah blah. I finally began labour and I used hypnobirthing to help with the pain - my doula helping me to stay focused. After 4 hours of intense contractions I asked to go to the labour ward, and they told me I obviously wasn't in that much pain and so I should wait. After arguing for a while I got off the bed and crawled towards the delivery room - they then got me a wheelchair to help me. They refused to let me have a water birth or even get into the tub as my waters had broken too many days ago. They kept wanting to put me on an antibiotic IV and monitor also due to baby being early and waters breaking days ago... I refused. How could I give birth naturally and freely while being wired to a machine?
    I had three VE's in total, one at admittance, one when I arrived at delivery room, and one just before baby was born. Just before baby crowned there were people knocking on my delivery room door saying that if baby didn't come soon they'd have to come in and intervene - what?! Because I'd been in there for 3 hours, refused all medication, wanted to get in a tub and was being difficult?!
    I breathed my baby out using hypnobirthing and he was perfect, 6lb2, above premmie weight, healthy and happy - despite being a month early and being inside me for three days after my waters broke! The midwife told me she'd never seen a woman who knew her body so well and that I knew exactly what I was doing. Der! It's what we're made for!
    Baby was checked every hour by staff until 6am the next day - when they announced that we were fine to go home. Had I had an antibiotic IV and baby as well, we would have had to stay in for 7 days of observations.
    I am so glad that I had my doula and that I researched all my options - having already had a baby also helped! I led my birth and it made the staff uncomfortable, they were not supportive (the midwife finally came around after about an hour) and at one point they said I was putting my baby at risk because I was refusing anti-b's and VE's. I told them that every time they came near me they were putting my baby at risk!
    I encourage all mothers-to-be to do your research and trust your instincts, you've been with your baby for 9 months or more, you know your baby and you know yourself better than anyone else. Ask for help if you need it, and refuse their 'help' if you feel it's not helpful.

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