December = party season. And in 2018, for me, a wedding and a 40th birthday augmented the usual shenanigans. It means I’ve spent a good amount of time slightly boozily explaining what a doula is, and that hypnobirthing is more than just snake oil and optimism. I’ve learnt a quick way to dispel the preconception that I’m a well-meaning loony, is to dial up the oxytocin, baby, and talk about how important bedrooms, boobs and sex are to pregnancy and birth. It’s an attention grabber, alright.
Sometimes, though, I’m challenged. And when those challenges come, they can be pretty hard;
“What right do you have to talk to pregnant women when you don’t have any medical training or clinical experience?”
“Birth is just horrendous, why are you setting women up to have an unrealistic experience?”
“If I had not had medical assistance during my birth, I or my baby would have died. Birth shouldbe managed in a medical environment.”
And frankly, I agree with them. There’s no dressing it up. Some labours are very long. Some labours are very painful. Some babies become distressed. Sometimes birth does become a medical matter. More than all of these things, though, I share with them the principle that women should not suffer in birth.
We are lucky to live in a country where science & technology identifies obstetric issues when they are present (usually), where analgesia is readily available, and where speciality trained medics are on hand to assist in emergencies. And all for free! This is something I will never stop being grateful for. And I will neverquestion, judge or undermine any woman’s informed choices.
My job is to support women as they make their own informed decisions about birth. Most of us know vanishingly little about it until we’re physically working towards it. And what with trying to get pregnant and the Two-Week-Wait, that leaves us with only about 37 weeks to gather the information, opinion and insight we need to overcome our preconceptions and form our own risk/benefit analyses.
To do that, women need more than the solid facts about how bodies work and why. They need to get to grips with the relative merits and risks of the options available, and the complex realities of how people, location, emotions and hormones can affect the process of birth. Most of all, though, women need to understand that they have the right to be respected and heard.
I know that sounds like a pretty low bar, but I can tell you from experience that when women talk about birth trauma, they very rarely talk about pain (the thing we’re conditioned to fear), they talk about being ignored, persuaded, coerced or belittled. And, sadly, I can tell you that those stories are all too frequent to be anomalies.
So here’s why I won’t talk generically about how ‘bad’ inductions, epidurals or any other intervention is; because sometimes they are necessary to alleviate suffering, and more, because to get drawn into a discussion about their relative merits is a distraction from the real issues real women face in childbirth.
This is what I DO want to talk about.
I want to see a change in spending policy, so that women are offered the practical education, time, support and space they need to create the births they want.
I want a change in attitude, so that women, their knowledge, instincts & beliefs are heard, trusted and considered alongsideany real medical risk factors
I want pregnancy care plans to be focused on how women can be supported towards a birth that is right for them.
Stack it up like that, and there is no longer any tension between ‘normal’, ‘natural’, ‘assisted’ and ‘intervention’. The narrative is no longer about how the baby exits the body, but on how caregivers engage with labouring women, and how flexibly they can support the individuals. We can start to alleviate the overpowering responsibility placed on women at their most vulnerable, and begin to think about how the NHS can better support over-worked, under-paid, under-valued midwives.
Suddenly, then, I don’t need to have an opinion about whether inductions, epidurals or assisted deliveries are a ‘good’ thing or a ‘bad’ thing. I can just care about whether women know what their options are and are able to access them.
Suddenly, then, it’s simply informed women, making informed decisions, supported by midwives, doulas, obstetricians and anaesthetists. Simple.