As a Consultant Midwife my job description tasks me with promoting and supporting normal birth. Well how hard can that be? Women have been giving birth since time began and the size of the global population suggests very successfully. Women have been supporting each other through childbirth for centuries. The first known usage of the word midwife was in the 14th Century and originates from old English for mid (with) and wif (woman).
The World Health Organisation (WHO), International Confederation of Midwives (ICM), International Federation of Gynaecology and Obstetrics (FIGO), Royal College of Midwives (RCM) and the Nursing and Midwifery Council (NMC) all agree that pregnancy and childbirth is a normal physiological process and life event and that midwives have a unique role to play in promoting and supporting normal birth.
So I find myself asking why is it in the 21st Century we require a specific midwifery role to promote and support normal birth – is that not what a midwife does?
Women have always been anxiousand/or fearful of labour and childbirth which is normal and healthy. However, in 2000 Hofberg and Brockington first identified a condition known as tokophobia (a morbid fear of pregnancy and/or childbirth). This condition has led to an increase in the number of women requesting elective caesarean section. Women no longer support each other in childbirth and are not directly experiencing the process. Women now get information from TV and social media sites which tend to focus on the dramatic and emergency situations. In addition sadly some women are so traumatised by their first birth that they simply cannot face the process again.
The medicalisation of childbirth saw doctors take over from the traditional female birth attendant and women were no longer “with woman” whilst they gave birth but doctors (generally male) were “delivering” women. Control was taken away from women and how a woman was to be delivered was quite prescriptive – generally on her back with legs in lithotomy. Some medical advances were extremely positive with the advent of antibiotics seeing a reduction in deaths from puerperal fever and oxytocic drugs preventing deaths from post partum haemorrhage. However despite the many advances we still cannot find a better way to give birth than nature in that any of the interventions we use all have potentially harmful side effects.
With medicalisation comes litigation and the perceived risk that someone will sue can lead to fear amongst health professionals and defensive practice which generally means more intervention.
It is therefore my job to work with midwives and our obstetric colleagues to have confidence and trust in the women we care for to achieve a normal birth and crucially to identify when that is not going to be the safest option and advise and support her accordingly. The emphasis is on achieving the best birth experience and not necessarily about the type of birth.
We need to work together to reduce the fear. It has been demonstrated in many ways that fear can be toxic – from its ability to alter the labour process and outcome to the culmination of fear across a whole organisation resulting in harm to patients.
Midwives do have a unique role in that they are with women through hours of labour and are privileged to be present at the birth. If we are hard to negotiate with it is because we are advocating for and protecting women against unnecessary interventions. I aim to ensure that midwives are truly person centred in their approach to labour and birth and women tell us what their hopes and aspirations are for their baby’s birth. It is the midwives job to do everything she can to help achieve those aspirations.
I was sad about the nature of the announcement of Prince George’s birth. “Her Royal Highness The Duchess of Cambridge was safely delivered of a son at 4.24pm today”. So who gets the credit for “delivering” the Prince– the Queen’s Gynaecologist! This young woman gave birth – it was she who laboured for hours and felt all the pain, followed by the joy of greeting her new son.
So any women reading this and considering having a baby I would urge you to take back control of your birth – the midwives are ready to support you. You will give birth to your baby (however that may be) and we can leave deliveries to the pizza guy.
The midwives in Dumfries and Galloway are mounting a campaign to encourage women to take back control and have the best birth they can. Look out for the MPower event on 24th May 2014.
Karen King is a Consultant Midwife in NHS Dumfries and Galloway