A Normal Birth - you're making life very difficult for us My Dear!

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Women have always wanted to be listened to around the subject of pregnancy , birth and in the postnatal period. This is probably the most sensitive and life changing event they will encounter and should be heralded as such , but the medical model has invariably been there in the background and can be perceived in many ways to contest and control.

Clearly, it is comparatively rare nowadays for serious complications to arise in the period of childbirth and women are hopefully healthier now than ever before, better informed and more autonomous. However , the promotion of both dignity and choice is a conflicting area even in the age of the enlightened 2000s.

Post-War Babies

In the UK before the start of the National Health Service in 1948, most babies were born at home. My four sisters and I were part of those home birth statistics in the decades following that , but by the mid 1970s there was a shift towards hospital deliveries and the medicalization of birth. In fact by 1975 home births were around 5% and have dropped lower than that since.

Student Midwife Days

By the time I had commenced my midwifery training in the late 70s new technology such as routine ultrasound scans and epidural anaesthesia were de rigueur. I remember commenting to my mother that the rows of silent women attached to tubes and monitors, were more akin to those having major surgery, not undergoing childbirth. I recollect controversially saying to the ward sister that I would have my babies at home (and I subsequently did ,with one child )and she reprimanded me for being "dangerous and irresponsible", reflecting the paternalistic attitude of the time.

Suddenly induction and acceleration of labour , rupturing of membranes and episiotomy were treated as normal procedures. Not only that, but women had to undergo the undignified process of shaving and green soap enema routine at the start of their labours, to add to the fear and trepidation of their entering the unfamiliar hospital environment.

Maternity pressure groups started to emerge from this wave of modern intervention. Wendy Savage, an obstetrician in London in 1977 believed in minimal surgical procedures and asserted that pregnancy should be treated as normal until found to be otherwise. She was a very controversial figure in a previously male dominated field and was struck off for a while when she came under scrutiny for her practise. For many women she was a heroine and an advocate for what they felt to be their right.

Brighton and Saudi Experience

In the 80s the National Childbirth Trust took up the mantle more forcefully and became vocal about the rising rate of unnecessary inductions and Caesarian sections. I worked in Brighton , England then, known for its alternative lifestyles, and many women were requesting non invasive births and appearing with ready- made birth plans. Suddenly it was getting away from the "Do as you are told and don't make a fuss " attitude of the 50s to the development of choice.

I went to work as a Midwife in Saudi Arabia around that period, where I was honoured to have the experience of witnessing more normal births than I had ever encountered. Here women often arrived at the hospital in advanced labour, gave birth naturally and without effort and were sitting five minutes later eating dates and chatting happily. Some babies never even made the reception area but were born cosily nestled in their Mama's clothing or on the back seat of a not so happy Father's car!

Later when I had gone through the pain of labour myself , with copious amounts of gas and air , I reflected on these women and felt a huge surge of respect.

In the early 1990s,when my children were born, significant changes occured around a woman's choice of how and where to give birth. Discussions were still raging between those who advocated minimal intervention and more relaxed birth environments and those who wanted modern techniques and the reassurance that large main hospitals as opposed to birth centres, were the safest places to be.

Back to Here and Now

Today, with the UK's rising birth rate and limited resources, key areas that have to be maintained in maternity services are the difficult combination of empowering women, maintaining safety and pursuing cost effectiveness. Controversial moves to make larger centres of birth may not however meet mothers' needs. Low risk pregnancies are seen too frequently in high risk units and those with high risk pregnancies find it difficult to get priority consultations as a result.

Women generally feel that the quality of their relationships with medical professionals are the most important aspect of their care, rather than the actual place of birth, but often the number of midwives are below recommended levels and subsequently can't provide the ideal 1:1 attention. This is something that would have been a given in those days of the 1940s, when the village midwife came whizzing round on her bike in the middle of the night, but financially and on a human level, this is no longer sustainable.

So in conclusion, in these days of a potential UK maternity crisis with limited resources, women are consistently most likely to be satisfied with their care if good interpersonal relationships are maintained, above all else. It is hoped that Government and hospital policies are being adopted to promote this in practice. In the meantime are we still causing problems to the NHS by requesting a normal birth?

Julia Youll, Dubai, United Arab Emirates