Based on a presentation by midwife and lecturer Rachel Reed. Check out her very informative website: MidwifeThinking
Birth is rarely described as easy, and in today’s culture birth is surrounded by lots of fear and feelings of danger and risk. However, for most women the safest and healthiest way to birth is a normal, vaginal birth with no unnecessary interventions. In today’s Australia though, only a minority of women birth in this safest and healthiest way.
According to Neonatal Perinatal Statistics, only 37% of women in Queensland, go into labour themselves and birth their baby without medical or surgical assistance. This matters because women rate their birth experience as important as their wedding day and we know that a woman’s experience of birth has long lasting effects on her health and on her baby’s health. The feelings we bring home from our birth experience affects our experience of parenting our new baby. Medical intervention increases the risk of post- partum depression and post- traumatic stress syndrome and we know that in general, women who birth without intervention report greater satisfaction with their experience.
There is of course no doubt that necessary caesareans and other interventions save lives, but unnecessary caesareans and interventions increase the risk for mothers and babies. With every intervention there is a risk of more intervention. This is known among health professionals as the “cascade of intervention”. Over the last ten years Australia’s caesarean rate has increased more than 52% without any evidence that this is making birth safer for women or babies, meaning we are not saving more babies or mothers by doing this. The national caesarean rate in Australia is now 31.1% with the Queensland caesarean rate at 33%. The World Health Organisation recommends a caesarean rate of about 10 – 15% and states that there are ‘no additional benefits for a rate any higher than that’. Apart from this, caesareans are very costly for our society and our health budget, compared to normal, vaginal births. So all in all, we are not seeing any benefits to women, babies or our society from this trend.
In order to understand why birth seems to be getting harder, we need to look back in history and also understand how birth works. For millions of years the majority of women have given birth successfully. Our human race depended on that. Later on science has given us the ability to study anatomy, physiology and birth, and instruments were designed to assist women when birth became abnormal and did save lots of lives. Then doctors began to compete with midwives for ‘normal’ births and the most effective way to do this, was to get birth into hospitals. The move to get all births into hospital happened under the guise of “safety”, though a large Cochrane review has later found that this was not supported by good evidence, and may have resulted in increased intervention and complications without any benefit for low risk women.
In today’s Australia, birth has become a medical event controlled by obstetricians. Most women undergo some form of medical intervention during their birth, reinforcing their own and society’s lack of confidence in women’s ability to give birth.
So what might make birth easier?
When women give birth they use the old part of their brain. The part that stands for instinctual behaviour and ‘gut’ knowing. They need an environment that allows them to use that old brain and turn off our new brain, the neocortex, which is the part of the brain that analyses, thinks and uses logic. She also needs an environment conducive to the release of a beautiful concoction of birth hormones. These particular hormones will help her birth her baby. One of the hormones in labour is called Endorphins. This hormone helps a woman cope with the pain and stress of labour by relaxing her and putting her in a spacy place also known as ‘labour land’. When a woman is in labour land she is in the old brain. The main hormone involved in birth though, is the love hormone oxytocin. Oxytocin creates contractions and thereby dilation of the cervix, so baby can be born and also makes us fall totally in love with our baby when we see him or her.
Oxytocin is inhibited by bright light, strangers, questions and fear
Fear in labour not only interferes with oxytocin release, but also reduces the blood flow to the placenta, and thereby to the baby, which can lead to foetal distress. This is what we call the fight or flight response.
Of caesareans carried out during labour: 33% = ‘failure to progress’ and 30.5% = ‘fetal distress’
Oxytocin is increased by privacy, darkness, people we know and feel safe with and touch; this makes home is an ideal oxytocin environment and we now know that a planned homebirth is as safe as a hospital birth for low risk women, despite all the obstrically induced media hype. (And for the politicians; it is also much cheaper)
We also know that women, who has midwives as their primary caregiver, has a much higher chance of a normal birth without intervention. A midwife is highly skilled in normal, natural birth and works from a woman centered belief. Obstetricians on the other hand, are highly skilled doctors, specialising in high risk pregnancy, complications and surgery. A midwife knows when birth is no longer safe and normal and will call in the obstetrician and his/her skills in dealing with complications that are outside the midwife’s scope.
But how does it work in real life? When you birth in the private system in Australia, your main care provider is always an obstetrician and although they rarely care for the woman during her labour, they do make decisions regarding her care (often via the phone). They also, in most cases, attend when the baby is emerging.
Compared to women birthing in public hospitals, women birthing in private hospitals:
• are significantly more likely to have interventions during labour
• have a 15.3% chance of forceps or vacuum birth (public 10.2%)
• have a 41.3% chance (18.2% with no labour) of having a caesarean (public 28.1%)
Another major factor which seems to increase satisfaction for women and lower the intervention rates significantly, is continuity of care. This means that a woman receives all her care from a known midwife. Women who receive continuity of care and who have continues care during labour as well:
• are less likely to be admitted to hospital during their pregnancy
• have a shorter labours • use less drugs during their labour
• have less intervention during labour
• are more likely to have a normal birth
• their babies are less likely to need resuscitation
• are more likely to be pleased with their care.
Doulas and continuity of care during labour
A doula is a trained birth support person and is ideal for providing support (emotional and physical) for women and their partners during labour and birth. She spends time with a couple getting to know them during pregnancy, helps them with issues, fears and wishes, so she knows them when labour and birth is happening. A doula is not medically trained and cannot replace a midwife, but can provide their care without the distractions a midwife may encounter, due to professional responsibilities and documenting. The benefits associated with continuous care in labour are even greater, when a Doula is part of the care.
So in summary:
A good birth environment conducive to oxytocin release and birthing from the primitive brain
Midwifery led care, so the person you deal with through your pregnancy is a midwife and only if complications arise do you see the obstetrician.
Continuity of care, care from a known midwife all the way through your pregnancy, birth and early postpartum
Support during labour from a Midwife and a trained birth doula
This makes birth easier!
But before women even become pregnant they have been socialised into perceiving birth as a risky event with medical technology and intervention as the key to reducing this risk. This picture of birth is also perpetuated in the media. Here on the Sunshine Coast we don’t have any options for birthing the easy way. Many have a medicalised birth, which reinforces the risk and danger of birth and the lack of confidence in the natural process……. they tell their birth story to other women…..
But what if all women could choose their own midwife early in pregnancy and build up a relationship of trust, had access to evidence based information about their options throughout pregnancy, felt confident in her ability to birth her baby, could choose where to birth (home, birth center or hospital), had the support of a known doula throughout her labour, had an empowering birth experience told their birth story to other women…….
How can we move towards easier birth in our community?
At the moment here on the Sunshine Coast, a group of women are fighting to get a birth center with the new hospital being built in Kawana. Please join them on Facebook http://www.facebook.com/FBCSC to see what you can do. If we don’t have the voice of the women, who are going to use these facilities we have much less power. Also the Maternity Coalition of Australia is working very hard to ensure that homebirth won’t be made illegal by 2012 as it is predicted to be. Join them on http://www.facebook.com/Maternity.Coalition?ref=ts&sk=wall.
We can’t predict how our birth journey’s will unfold. Some births need medical intervention and this is not wrong. But we can do so much more and so much better for our birthing women. Even if your birth turns high risk and needs intervention, you still deserve having a known midwife, a doula, and continuity of care. Let’s tell politicians how our birth experiences could be better and more positive, regardless of how our birth journeys unfold . Knowledge is power in this situation. Where do you want to birth?