From the soft-edge focused front cover photo to the series on the back cover, this is a book which shows through the words of mothers, their midwives and family members, as well as pictures, what is possible when experienced midwives have a philosophy centred in trust of women and their bodily knowledge, motivating and informing their practice. The pregnancy and birth experiences of this book happened as part of the Albany Midwifery Practice which “ran from 1997 to 2009 in Peckham, South East London, caring for an all-risk caseload of local women within the NHS. The unique model of midwifery care included continuity of carer with two named midwives and choice of place of birth. The midwives looked after over 2500 women with excellent outcomes, achieving a home birth rate of over 40% alongside a low perinatal mortality rate”.
In the ‘Forward’ legendary, USA midwife Ina May Gaskin encourages us all by saying that the amazing outcomes of this program can be replicated anywhere “the needs of birthing women are put before other concerns which often enter into maternity care policy-making and practice”. Ina May also challenges midwives, their educators and regulators by saying that the ‘true art of midwifery’ as shown in this book, is to reduce or eliminate fear of birth.
Author, midwife Becky Reed puts the contents of the book in the framework of her maternity history, midwifery career and history in the introduction; “Looking at birth”, as the birth of her first child is the first story of this tome. Her first child was a hospital birth in 1979, illustratings some of the changes in maternity practices since then. However, too many birthing women are still put in a semi-recumbent position despite evidence of the negative impacts on both mother and baby, as well asbeing contrary to the preferences and instincts of women to adopt a more appropriate, supported upright or kneeling position, as demonstrated in the other stories in this book .
Photos in the book were created as Albany midwives carried a camera as part of their birth kits, and women gave them back some of their birth photos to use as part of the 36 week “Birth Talk” for other women on the program. Subsequently many program women thought the use of photos as part of their ‘Birth Talk, “helped them to believe in themselves”. In addition, birth photos were a feature of the settings where the program’s women-led antenatal and post-natal gatherings were held, which often provoked questions and enhanced discussions at these events. Positive responses to a ‘photo story’ series of articles by Becky in ‘The Practicing Midwife’ encouraged her to create this book. Becky also felt that pictures of labour and birth need to be accompanied by their stories to give them additional meaning and educative value, which is lacking in birth photographer’s web sites and You Tube uploads. Despite the constraints of non-professional photographers (midwives or family members), limited light, tight spaces and often awkward positions of the subjects the photos show the dynamic character of natural labour for each woman. Also demonstrated in these pictures are features of physiological birth rarely seen in hospital deliveries, such as a baby born in its caul, vaginal breech birth, cords left to finish pulsating and women birthing their baby’s placenta.
Currently the majority of midwives and other maternity care practitioners qualify and practice in environments which do not promote, encourage or support physiological labour or birth, and thus such maternity professionals have not seen, nor experienced enough natural labours or births to have developed the skills and confidence to ‘manage’ woman wanting a natural labour and birth, especially outside a hospital. For example, most hospital trained midwives do not feel confident assessing progress of labour through visual and auditory signs or ‘allowing’ women to push on their own initiative as in these stories, rather they rely on disturbing the woman’s rhythm to do a vaginal examination(s). Therefore this book adds to the published research which shows us that use of inappropriate birthing spaces and practices contributes to the escalating rates of childbirth interventions, particularly for healthy women.
The stories and pictures in this book show women being cared for by midwives who encourage and support physiological birth as a normal life event in familiar, respectful and private environments; women who are trusted to make healthy choices for themselves and their babies. It shows that birth can be normal, healthy and joyous whether it happens at 36 or more than 42 weeks; whether a first or a seventh baby; a baby coming head or bottom first, or being followed by a twin. Thus this is an essential book for the reading lists of Child birth Educators, Schools of Midwifery, all Midwives and Obstetricians as well as women’s groups!
Addition: Finally an analysis of the outcomes of this program is available here and show that;
- Though more than half (57%) of all women were from minority ethnic communities; one third were single and 11.4% reported being single and unsupported.
- Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife.
- Resulting in high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding).
- Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage.
- The overall rate of caesarean section was 16%.
- The preterm birth rate was low (5%). Ninety-five percent of babies had an Apgar score of 8 or greater at 5 minutes and 6% were admitted to a neonatal unit for more than two days.
- There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities.
- There were no intrapartum intrauterine deaths.
Currently in New Zealand where more than 90% women do choose a midwife as their LMC only 3-4 % of births per annum for more than the last decade, have been at home. Meanwhile as elsewhere, rates of intervention (as below) in the labours and births of healthy women have escalated, as more and more women labour in hospitals (87% in 2014) whilst numbers who use primary units (‘birth centres’) has declined to 9% in 2014.
The NZ Ministry of Health’s definition of a Spontaneous Vagainal delivery is “any vaginal birth that does not involve Obstetric assistance or delivery’ and in 2014 did include;
- 24.4% ARM or Artificial Rupture of Membranes, from 19.0% in 2005, though the membranes protect both mother and baby in labour,
- 24% Induction of Labour or IOL; despite the risks,
- 26% Augmentation of Labour despite lack of accuracy in assessing progress of labour
- 27% Epidural despite the potential for care to raise beta-endorphin levels
- 15% Episiotomy compared to other means to protect the perineum.
These statistics means that 1 in 2 women had some form of intervention in their labours resulting in possible separation of mother and baby, especially for the 25.9% who ended their efforts with a Caesarean section . This is all despite local research which have similar outcomes as the UK Birthplace study, showing that home and birth centre births result in the healthiest outcomes for mothers and babies.
Meanwhile The Midwifery Council NZ is “The Guardian of Professional Standards” says that “The competent midwife …………………….utilises midwifery skills that facilitate the physiological processes of childbirth and balances these with the judicious use of intervention when appropriate”.