Childbirth: the professional view

Fifty years ago, when the National Childbirth Trust was formed, a woman about to give birth had little or no idea what to expect. Antenatal classes were unheard of and pain relief was not commonly available.

Three senior figures involved in maternity services reflect on the main changes that have taken place.

DAME LORNA MUIRHEAD, RETIRED SENIOR MIDWIFE

Dame Lorna is now Lord Lieutenant of Liverpool

My passion has been and remains the care of labouring women which I find amazing.

In the 1960s women were dreadfully under-educated. The only things they knew were what their mothers told them. They laboured in identical wards with just a curtain between them, on their own even, without adequate pain relief.

In the 1970s - with consumerism - came the aspirations for private separate rooms to deliver in, much more pain relief. This was real choice for women.

In the 1970s men very much stayed at the top end of the bed and they had very little idea of what was going on. Now they're at the foot of the bed taking videos.

Consumers today are in the driving seat and that is probably one of the biggest things that has happened since feminist 1970, some for the better and some for the worse.

The NCT has undoubtedly been a force for good - they had an enormous impact, particularly on antenatal education

Sir John Peel has been much castigated for his report in 1970 which recommended, on the grounds of safety, that all women should deliver in hospital.

He was much castigated because it wasn't "research-based", but what statistics told Peel was that people who got in dire trouble only survived if they were in the right place with the right people and therefore, on the grounds of safety, that right place was not at home.

I believe in normal childbirth where it's possible and I also believe normal childbirth is the prerogative of the midwife, but I believe it should take place on a major labour ward because of the unpredictability of childbirth.

I have seen 14 women lose their lives in childbirth in my lifetime... now that does colour what I feel. Most of those were for things like haemorrhage and some were in hospital, but at least you can console yourself that everything was done.

The NCT has undoubtedly been a force for good - they had an enormous impact, particularly on antenatal education.

But the worst women who come to us even today come with a birth plan and a fixed idea in their head. Midwives are there to deal with things going awry. The commitment is to a lovely healthy mother and baby and the second commitment is to make that [the birth] as wonderful as possible for her.

Dame Lorna was president of the Royal College of Midwives, 1997-2004

DR GEOFFREY CHAMBERLAIN, SENIOR OBSTETRICIAN

Dr Chamberlain is writing a book on the history of obstetrics

Pain relief has changed enormously. In 1958 70% of women giving birth had no analgesia.

A woman having a baby isn't a patient. Obstetrics is a normal event, usually, and having a baby with pain relief becomes important.

An epidural is a very good pain reliever, to be with a woman in labour and see the relief she gets after about 10 or 15 minutes...

Forceps deliveries have been overtaken by the Ventouse or vacuum extraction. It seems to the woman a less invasive procedure. There's a big shout that midwives ought to be allowed to use them and it may be in the next 20 years that will come in.

I would say the presence of the husband in the labour room has been an advance

In 1955 the Caesarean section rate was about 2-3%. It increased slightly by the 1970s to 6% in 1990 it was 10%, then it roared ahead to 24% now. I don't believe that God was wrong in a quarter of deliveries.

I can see the reason for it. Many people now are not so used to difficult vaginal deliveries, breech and twins so they turn to what is an easier way [to get the baby out], but it's not easier. The mother has to recover from a major operation and I think people are whisked out of hospital far too soon afterwards.

Women stayed in 14 days when I started my own family and then it came down to 10 and now after a normal delivery, if it's in the morning, the woman will go home in the evening.

I would say the presence of the husband in the labour room has been an advance. I would say now certainly 60% or 70% of births are accompanied by husband or partner and that is very important.

He's there and not in any pain or stress or drugged and can act as a referee between midwife, doctor and the woman.

Childbirth is better from the point of view that maternal mortality is right down now in Britain to about seven per 100,000 and peri-natal mortality has gone right down. That's a major way of measuring why it is better to have a baby today.

As an emotional experience for the women it is better too and they are happier with their experience in many cases. I think the important thing is the fact women are much better educated about childbirth.

Dr Chamberlain was professor of obstetrics at St George's Hospital, Tooting in south London

GAIL WERKMEISTER, NCT PRESIDENT

Gail Werkmeister is an NCT teacher

The NCT was set up to educate women about what happened to them [in childbirth] and to help them cope with what was happening, basically, back in the 1950s.

Men weren't allowed in the room even if babies were born at home and lots of women were ignorant about birth.

Certainly we think women need somebody with them, but it doesn't have to be their partner if he isn't the right person to be there.

Women tended to go into birth in ignorance, which then became very frightening for them.

As birth moved into hospital, it became very much more medicalised and worse for women, because in the 1960s and 1970s again they were by themselves and very often given things routinely they didn't know anything about, [such as] pain relief, they were shaved, had enemas and episiotomies.

People come to classes expecting you to be a lentil-eating open-sandalled hippy

The NCT wanted to inform women about what was happening and also talk to the medical professionals, trying to get them to consider women's needs more.

Choice for women-centred care, that's the result of years and years of campaigning.

I think women have to give birth where they feel comfortable.

Women are going to have a much better birth experience if they know the midwife, they are involved in the decision-making, know about the choices.

We hope that if people get good antenatal education then they can think about these issues beforehand.

The NCT is also keen on good postnatal support for parents. Women now don't stay in hospital long and then they are out - [home] is a very lonely place to be with a new baby.

I think there's possibly a common misconception of what NCT classes are all about. People come to classes expecting you to be a lentil-eating, open-sandalled hippy - teachers like that went out in the 1960s.

Our greatest achievement? Education, spreading the word.