I don’t watch many real birth programmes on TV mainly because they upset me so much and make me angry. The ones I have seen mainly show women on a bed – with no apparent reason for being there; and it’s all bright lights, interruptions and being told what to do and then is it any surprise that each labouring woman struggles and needs assistance.
Labour and birth can be bloody tough – there’s pain, there’s endurance and there needs to be the right mindset/preparation, knowledge and support for the unpredictability and the amazing intensity.
Women’s needs vary so much in labour but as a mother, as a doula and as a seasoned antenatal teacher I do know what can make a difference: being listened to; being asked what you need; being treated with kindness, compassion and professionalism; a gentle birth environment so you are encouraged to move and respond to the needs of your body and your baby with active birth equipment and birth pools; softer lighting and quiet; medical staff who are part of your team, not your superior; good, clear communication so you feel safe and so you know more about your options; respect of your choices and your needs.
As a doula I have mainly worked alongside the most brilliant midwives who have done all of the above, they have been outstanding and they will make a difference to each woman they work with. But I have also experienced midwives who have been challenged by my presence as a doula; who have used coercive language; who have been resistant to changes in the birth room to make it more comfortable and usable; who have very much focused on the bed as the place to labour.
As an antenatal teacher one of my roles is to provide ongoing support outside of the classes for women who are faced with options that they don’t understand or feel they have any choice over – this happens a lot around membrane sweeps and induction.
As a mother of three I have mainly experienced outstanding midwives who have supported and cared and looked after me and my needs brilliantly but there was a stark difference between the homebirths with my first two babies and the hospital birth with my third. At home it was calmer and darker, I could wander and lean as I needed to, the midwives worked around me and didn’t get in my way. In hospital, my midwife was pretty wonderful and she supported me to be and to move as I needed to but I was more aware of protocol – 2 or 3 doctors just came in and spoke to me mid-contraction, I was given a timescale to birth within and I was told to get on the bed. My midwife encouraged me to ignore all of that.
I was criticised for birthing standing up by a doctor who happened to be in the room.
Having been an antenatal teacher for about 18 years now, the issues remain largely the same for labouring women – and I remain frustrated by the lack of informed choice, the narrowing of options and the lack of person-centred care that can exist within maternity wards. For me, it comes back to birth preparation – have knowledge, be prepared to be assertive and to put yourself at the centre of your care by asking questions, knowing more about your options and saying what you need.
I work with a lot of second-time parents who are way more feisty because they know more about what they are dealing with and want more of a say in their care and their options because they may have felt unheard first time around.
Don’t get me wrong, interventions have their place, they can be necessary and they can be life-saving but I don’t want them to be the norm, I don’t want them to be the go-to when pregnancy, labour, birth isn’t quite as straight-forward as someone else’s. Discussion, options and care go a long way to personalising labour & birth when interventions are clearly needed or when flexibility and a step-by-step approach could be more effective.
There are some fantastic midwives, doctors and maternity units in this country, with positive examples of best practice – we’re just not seeing this on our TV screens so the expectant parents who are watching it are prepared for this as their normal, to be disempowered and to expect birth to be unmanageable. There is still a way to go to have a maternity system that looks after and supports women and their babies better, to balance safety with wellbeing.
Janine – a specialist in pregnancy, birth and early parenting