A Guest Blog from Hannah Horne
Birth matters to all of us. It is the moment where a Mother gets to meet her precious, tiny baby. Birth is an event a Mother has most certainly spent months, if not years, dreaming about. Wondering what her baby will look like; whether the baby has hair; who in the family the baby takes after. She will get to hold her baby for the first time and count its tiny fingers and tiny toes. Birth matters to each and every one of us. When a baby is born, so is a Mother, a Father and a brand new family. Whether we have children or not birth matters to us all, because we have all been born and these first moments of life are unique and precious.
Birth is a major life changing event and deserves our respect. Over the last 17 years I have witnessed births in all contexts, first as a Student Midwife, then as a Midwife. I have seen birth as a birth partner/friend, and as a Mother myself. I have seen low risk birth, pool birth, birth shadowed by obstetric or medical illness, breech birth, operative birth, multiple birth, home birth, and birth in the car park! Every birth is unique and special. New life is precious, therefore so is birth. I have spent my career working with women to listen to their wishes and fears and encouraging them to achieve their best birth possible.
Many women mentally prepare for their ideal birth and have a birth plan detailing their wishes of how they would like their birth to be. However, labour and birth cannot always be planned. There have been many births I have witnessed that have gone totally to ‘plan’ and many others where we have had to modify ‘plans’ to accommodate safe care yet a achieve a positive birth experience. A woman wishing for an epidural may have a rapid birth without pain relief, whereas another may be planning a low risk birth only to have the experience overshadowed by a medical or obstetric complication. In these instances women can find it difficult to process how things haven’t gone to plan. I have countless times sat with women crying and broken because they are feeling a sense of failure in not achieving the birth they planned. Often when complications during labour and birth occur the birth experience can be overtaken with fear and negative emotions. Birth trauma is frighteningly common, ranging from 25 to 35 percent (PATTCh.org, 2016 ). As is perinatal mental health illness, including anxiety and depression, affecting 10 to 20 percent of women (Bauer et al, 2014).
Birth preparation largely focuses on the practical preparations for motherhood; get the nursery ready; getting the necessary equipment and clothes; what pram/car seat/changing bag have you got? Antenatal classes focus on labour and birth; how to cope; types of pain relief; types of birth and developing a ‘Birth Plan’. There can be a focus on keeping birth ‘low risk’ and aiming for a normal birth being the ‘gold standard’ of all births.
I am all for encouraging ‘normal’ birth and throughout my career have encouraged and supported women to achieve this, but in a country where the Caesarean Section rate is approximately 25 percent and the instrumental birth rate is approximately 12 percent (NCT, 2015) it is unfair to perpetuate the myth that all birth is low risk and magical. Women are being set up to fail. Pregnancy and birth complications happen. It is how health professionals and society manage, or react to them, in order to empower women that is the important task.
In the antenatal period it would be more beneficial for women to have time to discuss their feelings and fears around birth and motherhood. There needs to be a shift away from the practicalities and women need to be encouraged to address their emotions. ‘Birth Plans’ need to become ‘Birth Preparations and Preferences.’ What would you like your birth to be like? What would you like to happen when your birth doesn’t go to plan? How can the midwives and professionals assist you in achieving your birth aims even when a transfer to theatre is required?
I have always aimed to ‘normalise’ birth in all contexts; in ‘high risk’ birth women can be assisted to mobilise where possible and the use of hypnobirthing techniques can be encouraged to maintain a sense of calm even in an emergency situation. In working alongside midwifery, obstetric and anaesthetic colleagues policies and protocols have been developed to allow flexibility in high risk settings; high risk pool birth; telemetry (wireless) continuous fetal heart monitoring; increasing skin to skin rates in obstetric theatre settings.
Every day there are midwives and birth supporters encouraging and supporting women to achieve their best birth possible. There are also strong leaders within the Midwifery and Birth arena who are challenging current routine practices to increase positive birth experiences for women. Jenny Clarke blogs promoting skin to skin and midwifery (jennythem.wordpress.com). Sheena Byrom writes about kindness, compassion and respect creating positive birth experiences in her book ‘The Roar Behind the Silence’ and Milli Hill has founded the Positive Birth Movement which challenges ‘the epidemic of negativity and fear that surrounds modern birth.’
If conversations around birth change, we can allow perceptions to shift, we can reduce the statistics of women feeling like their bodies have failed them by not having the perfect birth whilst building Maternity Services which are responsive to women’s needs. Women can view birth in a positive light and be encouraged to prepare for birth, covering various possible outcomes but also be emotionally prepared for the unexpected.
Women can become birth warriors; if they birth without intervention they should be celebrated for their bravery, but if they require obstetric support undergoing what could possibly be painful and frightening procedures in order for their baby to be birthed safely, this bravery too should be celebrated and viewed positively. If women are assisted in preparing for the emotional upheaval of labour, birth and new motherhood then riding the roller coaster of emotions that will inevitably happen won’t be as shocking or traumatic. Birth matters, after a positive birth a positive mother can be born.
Hannah is a married mum of 2 boys and has been a midwife to many over the last 14 years. Currently she is a Perinatal Mental Health Specialist Midwife. Her passions are supporting motherhood, midwifery, yoga and chocolate!! You can follow Hannah on Instagram.
Simpkin, P. (2016) Birth Trauma: Definition and Statistics. http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics/ (Accessed 15/09/16)
RCPSYCH (2016) Postnatal Depression
http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/postnataldepression.aspx (Accessed 15/09/16)
Bauer, A., Parsonage,M., Knapp, M., Iemmi, V. and Adelaja, B. (2014). The costs of perinatal mental health. http://everyonesbusiness.org.uk/wp-content/uploads/2014/12/Embargoed-20th-Oct-Final-Economic-Report-costs-of-perinatal-mental-health-problems.pdf (Accessed 15/09/16)
NCT (2015) Maternity Statistics –England
https://www.nct.org.uk/professional/research/maternity%20statistics/maternity-statistics-england (Accessed 15/09/15)