'Don't tell women how to give birth'

VIEWPOINT Cathy Warwick General Secretary, Royal College of Midwives

Debate rages over how babies should be born

How a woman gives birth provokes strong views, with impassioned arguments for normal births, and for Caesareans.

But in this week's Scrubbing Up health column, Cathy Warwick of the RCM says the most important thing is for women to be able to choose.

The use of technology in birth - such as the development of epidurals for pain relief and Caesarean sections - has long been a cauldron into which divisive and conflicting issues and opinions have been poured.

This is particularly relevant at the moment.

A recent UK study which looked at how and why women chose the birth they did found mothers-to-be preferred to keep an open mind and, as their pregnancy progressed, became increasingly confident in the advice they received from health professionals.

They tended to be more open-minded regarding choice of type of birth at the end of pregnancy.

It seems important to remember that since the 1970s, there has always been a vocal and active lobby against home birth.

Thirty years ago it was virtually impossible to have one in this country, and women and many midwives and doctors have fought actively and hard to challenge this and give women choice.

Women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it Read your comments

When the National Institute for health and Clinical Excellence (NICE) was considering guidance on giving birth in the NHS, the large number of midwives who sent in comments were only too aware of how the home birth option was once again nearly lost.

They had to challenge the appropriateness and interpretation of the evidence being considered on the safety of place of birth.

There is a fundamental question needing to be asked here; why do some doctors and midwives devalue the choice of home birth, despite the lack of evidence against it?

The continued polemic around it also remains uncomfortable.

'Macho bullying?'

It has been suggested that many midwives see childbirth as an essential "rite of passage".

The implication is that this is an illogical position in a technological age.

We know however that childbirth is a life-changing experience for all women however it happens, and midwives' and women's groups have worked hard to support the joy of this from every viewpoint.

Water births are increasingly popular

We also know that women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it.

The charge that there is a "macho bullying group" directing women towards a less interventionist birth is simply not based on evidence.

What there are though, are midwives fighting for real and informed choice for women.

Labelling midwives and women as members of two groups - either "pro" or "anti" technology - is also not helpful.

Women often change their views on birth during pregnancy, and there are many factors that influence that change.

Bottom line

What we do know is what women want at all times, is good and unbiased information from the health professionals caring for them, so that they can make the appropriate choice about how technology can help them.

One high-profile obstetrician recently relating the birth experience to the advances in agriculture, transport and energy production reminded us alarmingly of the language previously used in the "active management of labour", when women's bodies were viewed as machines that were frequently "inefficient" and in need of acceleration.

It has seemed that the health professionals that care for women today had largely moved on from this strange and controlling discourse, and it's disappointing this may not be the case.

The bottom line here is that what women want is to be able to make a real choice, for the health service to offer them that choice, and for that choice to be based on having all the information needed to make an informed decision.

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We asked you for your views. Please find a selection of your comments below.

The biggest problems I have had surrounding the choice of where to give birth is that the consultant I have seen has acted as though there isn't a choice and told me that I had to have a hospital birth without explaining why. I'm fed up with being patronised - at my last meeting I was told that I did not need to know what my blood test results were and that it would all be dealt with by the consultants. Surely I have a right to know what is going on after all it is my body.
Vicky, Suffolk

My first child was born six weeks ago. The labour process was a nightmare - 20 hours of active labour, with very little help or encouragement from the midwives in the midwife-led unit where we started. They just kept measuring heart rates and interrogating us about the intervals between contractions, telling us after a few hours of active labour, "If you are going to deliver naturally, it really should happen within the next 2-3 hours"; and then after ten hours of active labour, "If the birth was going to happen naturally, it would have happened by now." They tried to make it sound as though we had choices, although they kept misleading us about their intentions and it was obvious they were railroading us in a particular direction. They gave us the impression my wife's body had failed at the birthing process, and that intervention was required with drugs that would speed up the contractions. Finally we got transferred to the delivery suite (medicalised unit) after several painful procedures from unsympathetic midwives. Fortunately the midwives there were more professional - they explained the options clearly, gave us choices and then tried their best to help us. After 20 hours of active labour, with the contractions slowing down, my wife just needed helpful advice and encouragement from some midwives who knew what they were doing. No injections. No hormones. No drugs. She just needed talking through the process, to be told what to expect and where to push.
Matthew Slyman, Huddersfield, England

In NZ it is becoming increasingly difficult to get a doctor to do a birth. There are almost none left willing to do it for reasons mostly surrounding pay. Midwives and birthing clinics are almost the only option unless a woman can afford a private hospital and make arrangements months in advance. Personally I don't want a home birth with a midwife who doesn't have a medical degree. My mother tried it and I almost didn't get here. I will demand and nice, shinny, sterile, hospital room with a doctor and every gizmo modern medicine has ever come up with. I've had plenty of 'rights of passage' in my life so far and I can think of very few that have made me a better person in the long run.
J. Garcia, Auckland, New Zealand

I gave birth to my second child at home nearly 13 years ago. As we were living in Cornwall at the time, the thought of travelling to Truro was horrendous, especially as I was fairly certain that I would have a quick delivery. This proved to be the case. The midwives, Victoria and Naomi, were fantastic and I could not have asked for a better service from them. There was no pressure as to where I delivered my baby, and the choice was mine. Compared to the hospital birth I had first time around I would choose a home birth every time. I appreciate that this is not everyone's preference, but women must be given all options, in an objective manner, giving them to opportunity to choose the most appropriate birth for them and their baby.
Helen Rogers, Matlock UK

I would have to say that with both my pregnancies and births I met midwives who refused to listen to me and who decided that what I wanted didn't matter. I think it is the luck of the draw. During my 2nd labour a midwife told me I couldn't have an epidural as she didn't believe in them and when I asked for pethidine she gave me valium. I didn't complain because after she went off shift I got the epidural and then ended up having an emergency C section.
Grace, Middlesbrough Cleveland

I gave birth to my second son at home 46 years ago. It seemed absolutely right that he should be born in the same bed in which he was conceived. It was so relaxed and easy, I had the undivided attention of the midwife. It was not common in those days to allow husbands to be present at the birth. The midwife dispatched my husband downstairs to boil water as the crucial moment arrived, and as he was busy with this task, she told me that he was looking rather green, and that she would not be able to cope with two patients! By the time he returned, the baby was born and that boiled water was never used or needed. Oh happy days!!
Nina Sansome, Ashford Kent

I gave birth thrice in the US, always with midwives participating and obstetricians and anaesthesiologists for backup. All three deliveries had significant complications. I was enormously grateful for the epidurals. Before I actually gave birth myself, I breezily imagined "only home births without drugs are actually the best way." Well, I stand corrected by Mother Nature. The most important thing, I believe on the strength of my own experience, is of course for Fathers to be present for the birth; also, for total support for breast feeding. I consider home birth to be far too risky knowing what I know now. Each of my pregnancies was trouble-free, indeed highly enjoyable... It was only during actual labour that both my life and the lives of my children were actually at risk. Hospitals can provide an effective, home-like environment; doctors can receive sensitivity training. But the security of a fully equipped medical centre cannot be matched by any household. Sisterhood is wonderful; my last birth, with a woman OB-GYN was by far the best experience. But safety must come first, and a perfectly healthy baby is more important than proving a point!
Maria Amadei Ashot, London, UK (currently visiting California)

My daughters arrived in two very different ways: Initially my 1st started with seven hours of active pacing and panting with no pain relief. I was at Poole Maternity Hospital and when she became very distressed an epidural was chosen and 1.5 hours later I managed to give birth without any further medical intervention. My second baby came within less than two hours on my living room floor: with ambulance team and midwife that I had never met before. We all talked/worked together and some gas and air was provided by the ambulance team and lots of encouragement from the midwife plus her expert sewing skills after the event! Neither births followed a "plan" and PND followed the 2nd birth. However, remaining realistic, listening to both myself and professionals and taking the babies health/positions as priority meant that my children arrived safely. Being in control was never an issue and each case is different, however I could not of asked for better help having both of my babies. Giving birth is nature and not a rite of passage - parents to be need to be realistic and positive.
Celia Hodgson, Dorset UK

I wholly agree with Cathy Warwick's article - especially that the language of these 'high-profile obstetricians' makes labouring women feel like passive patients. In my pregnancy notes, one page reads: 'If women are to fed during labour, the food must be....' followed by research into the best foods during labour. That passive wording suggests passive helplessness, like your caregiver is going to open the door at a certain point in your labour and throw some food in at you! Sounds like a zoo and the labouring woman is no more than an animal!
Mrs A Wood, Hitchin, Hertfordshire

Why does everyone think that all women WANT a home birth? the idea of going through such an emotionally testing time in my own home horrifies me. What if it wasn't the "beautiful" experience I'd hoped for? I'd be reminded of it every time I stepped into the room in which it happened. I have had two children, both in hospital and I wouldn't have wanted to be anywhere else - I wanted the reassurance of a team of trained professionals just outside the room. The first birth was quite trying, but at least I never have to go into that room again.
Caroline, Maidenhead