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”.

In her “Forward, forewarned….” Kate acknowledges she has left out men, and their perspectives on these things, and that she refers to the unborn child as ‘them’ because she feels “we need gender neutral language, particularly when discussing the baby in the womb, whose person-hood can be felt before their sex can be identified.” Next comes the first of Kate’s “pick-your-own adventure moment” pages, where the reader can choose how to navigate this book according to whether they want to, in this instance on page 10; “find out how to make a baby” or not. Also through-out this book, Kate is a dispeller of fairy-tales, a realist, for example on page 29’s “pick-your-own adventure moment” she acknowledges that there are at least 6 different ways that today’s woman may have obtained sperm; not all loving nor human.  I wish I could have used this book as a guide to exploring my cycle, “fruity juices” and nature’s conspiracy to aid penetration of one ‘Lily of the valley’ smelling ovum by a single, “hyper-fast wonky swimming sperm”. Kate Evans also shows herself to be an inclusive feminist in her drawings and text, which acknowledge different racial and sexual identities, such as in the brief segment titled ‘Breeders and non-breeders’ she says we all need to respect that some women do not want children and that there are other paths including for those who are gay, straight or bi-sexual, some of whom may benefit from the practical information offered about understanding our bodies’ fertility, regardless of whether our cycles and lives are ‘regular’.

“Medicine man vs Witch doctor” on page 68, is the first example of another of Kate’s themes in this book; the critiquing of Western medicine’s limited efforts to support “our bodies’ efforts” to reproduce. In comparison, this book offers an holistic, ecologically sustainable and physiological approach to fertility and childbearing, with info-graphics on complementary therapies such as acupuncture, inclusion of varying emotional states in the “Things that go bump” chapter (p 154) to “The psycho-bitch-from-hell feeling”(p 84), as well as practicalities; like explaining how to connect with one’s ‘Butterfly kissing baby in the womb, other than through scans (page 147) to The broke mum’s budget baby list” section (p 176) . In addition, Kate’s sensitive realism shines through in her efforts to address critical matters such as partner abuse; where she acknowledges the difficulties women have in accepting or leaving a relationship which was thought to be born of ’love’, but is in-fact toxic for herself, her baby and sadly could become lethal in a culture “which romanticise arrogant emotionally unavailable men, which blame women for being victims.” Chapter 13 “Ask Aunty Katy” (p 195) is the epitome of this book’s relaxed, girl-friend style and efforts to show that many of today’s fears have in fact a good news element to them such as “There’s a reason for the anatomical proximity of anus and birth canal and, If you can get through the birth of your child without simultaneously throwing up and wetting yourself, you’re doing better than me”.

Readers outside, and possibly inside of the UK, probably need references, which indicate safe bed-sharing is supported by the UK Baby Friendly Hospital Initiative and National Institute on Clinical Evidence (NICE) as well as backed by UK and international research, attached to, or inserted into the info graphic on it (p 177).

One New Zealand reviewer of this book suggested that Chapter 15; “Crossing the sea” should be a pull out frieze for women in early labour”. As a midwife I appreciate the woman to woman encouragements and entreaties to go forth into labour and birth; “To remember your baby loves you. Close your eyes and journey in your mind to somewhere beautiful with your baby. Talk to your baby, tell them it is time to come through.” It is unique and invaluable that birth is presented as “what has happened when women have had babies since time immemorial” (p 227), usually without men and not in some-one else’s domain, so it would seem like Kate is promoting homebirth for those who only know hospital as where to be delivered. It is also vitally important that this account includes an understanding of the labour and birth hormones, as well as the factors which can enhance or limit their working, as a key ingredient in the unfolding process. It is fitting that legendary English Midwife Mary Cronk is the model for Kate’s wise-woman, knitting midwife, as Mary has helped midwives all over the world retain the knowledge to support and assist the natural birth of all babies but especially twins and breech babies. Her crone encourages the ability of Monkey Mamma’s inner, ancient mammalian brain to send out hormones which make the womb-work till the last act of procreative genius whereby the living ligatures of her womb births the placenta and stems bleeding. This chapter’s pace, content and tone are a contrast to the next; “Totally Bananas, which, though it begins a little confrontationally; “Who put men in charge of childbirth? I mean honestly, what was that about?” , it is actually an evidence based and historical review of medicalised childbirth. Thereafter follows less emotive sections on the physiological needs of labouring women, different maternity systems, women’s “Birth rights” and other birth options including a positive caesarean section (p284).  The book ends as it began with another cherubic baby, though this time in the form of another of Kate’s info-graphics; the “New centre of the Universe”. Follow this link to  a full and significant chapter; “How monkey Mama does it!”, which is Kate’s pictorial explanation of truly natural birth.

I think the disclaimer and entreaty that “this book doesn’t have all the answers, but it might inspire you to further research” would be more appropriate as part of a separate section titled ‘Further Reading”, rather than placed at the beginning of the ‘References and Index’. This is because there is a lot more information, as well as international, national and local support groups for issues addressed in this book, which readers could have been encouraged to Google. However, overall I am thankful that someone has put humour, emotions and fact in such a delightful package for women and their midwives, and I would like to see this book on the reading lists of all Childbirth Education and Midwifery courses.

Denise Hynd
Midwife

A midwife explains labour and birth from a baby’s perspective!

The knowledge about how to give birth is within every woman.

The knowledge about how to be born is within every baby.

Labour is an instinctive dance between mother and baby !

Birth is a ‘pas de deux’!

Each baby and its placenta, cord, amniotic fluid and membranes develop simultaneously following the union of the ovum (egg) and sperm. Placental function begins from implantation until the baby has moved to life outside the womb, if we allow it to complete its work.

In the womb, the placenta does the work of a heart, lungs, kidneys, endocrine and digestive system for each baby as it grows; pumping blood through baby and placenta; taking oxygen and other nutrients from the mother’s blood as well as protecting the baby from many toxic substances and excreting most growth waste by-products (some is left in the baby’s bowel; this is meconium). Placental hormones maintain the pregnancy and promote fetal development as well as initiate and maintain labour, and together with placental antibodies these hormones are vital to optimal health for the baby’s life.

Placental delivery or birth?

Delivery of the placenta or ‘Active Management of the Third Stage of Labour’ (from delivery of the baby to delivery of the placenta and membranes) involves interrupting the natural hormonal flow and pacing of this event by injecting an artificial stimulant, early clamping of the cord then positioning and prodding  the mother so another person can try to safely pull the placenta out of her. A review of recent developments of placental delivery practices shows that most if not all, lack consistency, evidence or consideration of natural methods though there is recognition of some harmful consequences of these procedures. This is particularly so in regard to clamping of the cord as explained by Midwife Rachel Read and myself in a previous blog.

On-line articles by Midwife Rachel Read and Dr Sarah Buckley explain the differences between how to support physiological birth of the placenta and fostering ‘Active Management’ or placental delivery and some of the harms and benefits of both approaches. As suggested by Rachel’s list of the factors which aid physiological placental birth, natural placental birth firstly requires that healthy women chose to birth in a supportive environment (usually not a hospital) and be attended by people who protect and promote effective flow of the labour hormones (usually an holistic homebirth midwife).

However a placenta is delivered or born, all placentae are examined for completeness and features which may impact on the health of mother and, or baby. This event should also be shared with the family as well as documented in the woman’s notes.

True ‘Afterbirth’ care choices.

Once the cord, placenta and membranes are out of the mother’s body there are other choices about their treatment other than cutting, clamping and disposal such as;

• The cord maybe tied off with a soft, bought (eg thick dental floss or a shoe-lace) or hand-made tie of either flax-string (‘muka’) or plaited threads, rather than clamped by a rigid peg.
• The cord may be burnt or ‘candled‘ to separate it from baby rather than tying or cutting it.
• ‘Lotus birth’ practices support the natural separation of placenta and cord from the baby, which can take from 3 to 5 days and encourages gentle, low levels of baby handling which can be advantage .
• Creating a placenta print is a way of remembering the unique features of your baby’s placenta as well as honouring it.
• Planting a tree over a buried placenta is enhanced by the use of a traditional and, or ecological container such as an Ipu Whenua basket.
• Placenta encapsulation or placentaphagy is one form of placenta ‘medication’ to aid recovery from lost blood and, or hormones that can impact some women even following a ‘good’ birth. Professional encapsulation costs about $NZ 250 -280 and takes 3 days. Alternatively small placenta pieces can be individually wrapped and frozen, or dried by slow cooking @ 80 degree in an oven over a week. Either way the fragments are swallowed like a tablet regularly or when needed over the first week after birth.
•  When frozen for storage before burial or other usage, a placenta needs to be clearly labelled!

Whenua

At the beginning of your world, I was part of you.
Made of the same luminous fabric, flesh of your flesh, of our father and mother’s being.
As we grew, we were separated but united.
I fed you, breathed for you, became a pathway for the flushing currents of our mother’s blood.
As you slept, I was your cradle and your guard; when you awoke I was your companion.
Together for that last day I leashed you the very limits of our linking line before
releasing you to the touch of others – lovers, yes – but surely none will hold
you as nearly, as sweetly or as softly as I did.
As our connection was severed you wept for me once, then were gone.
Carry me deep in your heart as you bury me in the soil of our home,
for I am the earth of your making.

Kate Alice 2002

The Maori name for placenta is Whenua, which also means land or environment; such a name is reflective of the placenta’s importance to Maori and in reality to all of us.

Current knowledge about the interplay of labour hormones and the factors which aid or hinder their flow, particularly that of oxytocin, reveals that a woman’s labour can start and stop for hours, or days as well as reverse. Applying this knowledge to maternity practice and antenatal preparation would see labours labelled as “Failure to Progress”  relegated to the history books, as women will have carers who promote and protect their oxytocin flow to optimise smooth and quick labour progress. Such care will also aid the simultaneous flow of other hormones, such as morphine-like endorphin which enables a woman’s body to cope with the amazing changes necessary to give birth, a process which should be outside of conscious control.

Oxytocin is a substance secreted by the pituitary gland of our deep, ancient midbrain; the same area where other basic, involuntary acts such as breathing and heart beat arise. Just as thoughts and fears can interfere with breathing, for example we can hyperventilate or breathe poorly when frightened, so thoughts and any stimulation of our conscious brain interferes with the production of oxytocin. Equally when our thoughts and fears are quiet oxytocin flows, therefore maternity carers need to resolve, not heighten any fears and concerns of pregnant women to enable them to start and progress in labour. Women and their babies would be better served by proactive care approaches like  practical dietary information and support in pregnancy rather than fear laden maternity language and regimes such as “Gestational Diabetes” testing. Almost any thoughts, particularly in first time mothers, can hinder the flow of oxytocin, because thoughts activate conscious brain activity which needs to be quiet for the shy hormone, that is oxytocin to emerge or lead!

External factors can make our hearts and breathing race, so too the flow of oxytocin is changed by things such as light which stimulates our visual perceptions to make us aware and alert, however when the light is low the darkness hormone; Melatonin also enhances the oxytocin flow. Hence many women naturally begin and progress in labour during the night. An effective flow of oxytocin is ensured when external factors such as noise, light and cold are reduced. Language is one form of communication which stimulates brain activity to hear, process and decide to respond or not, which can over-ride the hormonal directives from the primitive, mammalian parts of our brains.

Every culture, since men began to domesticate animals has made birth a social event, with the cast of expert strangers, family and friends of the last few decades possibly being the greatest. It is not coincidental that the labour of first babies in particular, is now something that takes up to half a day or more, before the need to exhort the woman to push hard to get the baby out or have it extracted. Yet oxytocin is Greek for “fast birth”, so named by the English physicist who first isolated this substance in 1905, as a pregnant cat who was given a dose then had a rapid birth. Thus fast or ‘Precipitate Labour’ which is driven by the woman’s hormones need not be ‘dangerous’ for women nor their babies as obstetric oriented or informed carers warn. However fear can negatively impact perceptions and panic poorly informed participants when they only know or learn about birth as something dire and risky. Yet an understanding of the hormones and their work shows birth as an involuntary act, one of three hormone driven processes aimed at healthy survival and perpetuation of our species. But the hormonal blueprint of labour requires that women ‘nest’ or labour in privacy so they are compelled to respond instinctively to their bodies needs, like other mammals.

When labour and birth is protected as an involuntary act, many problems such as ‘abnormal’ positions like breech resolve, twins can birth vaginally. Or several issues can be fixed in the one labour for example a first, posterior-positioned baby born ‘right way round’, after 4 hour labour in the daytime, because the mother had a shawl over her head for much of the time. Instinctive labour climaxes with an irresistible “Fetus Ejection Reflex” birth of the baby, with mother and baby bathed in hormones that will then birth the placenta, reduce bleeding and grow their positive, mutual relationships. Michel Odent in his latest book “Childbirth and the future of Homo Sapiens” has suggested that “the art of midwifery should become the art of creating the conditions for a fetus ejection reflex”.

Birth Images from Ancient Times is the first of 4 YouTube videos titled the Timeless Way created by Mother’s Advocate, which show images and explain birth practices from as far back as 20,000 years ago. This ‘herstory’ is one of communities knowing that women can give birth, because until the last 100 years or less (especially in rural communities), birth was part of everyday life and birth was women’s domain.

For generations, women who had given birth then supported others in their community during pregnancy, labour and birth. Care of childbearing women by other women was an extension or consequence of the valued role of an experienced mother or grandmother. Most of the knowledge and practices that were learnt and shared between women, across and down the generations was the basis of the practice of midwifery till birth, and midwifery training was moved to hospitals. The names each culture gave to their traditional maternity carers reflected their practices and, or esteem; ‘Midwife‘ is Old English meaning ‘with woman‘ and the French ‘Sage Femme’ translates as ‘Wise woman‘.

Women supported other women emotionally and physically to labour, birth and breastfeed usually in their homes. In some cultures there were special places for birth; such as the birthing stones for Royal Hawaiian women. The birthplaces of many famous people around the world (such as Beethoven, Thomas Edison, Margaret Thatcher, Nelson Mandela and Katherine Mansfield) are evidence of the normality of home birth. Other now historical sites, where families lived and worked such as flour mills, were also family birthplaces. The Toodyay (WA) O’Conor’s Mill  museum exhibit shows 1920′s photos of the miller and his family including a set of twins, who were born on the top floor which was accessed by a series of ladders. Girls of earlier generations, when families were bigger than today, knew birth as a normal, positive event which brought others into their homes to share the care of the mother, baby and family.

Women Side-lined.

The fourth Timeless Way video explores historical records and images about the loss of traditional midwives’ knowledge and practices as men increasingly took control of hospital-based and then state regulated maternity services, mostly in the last century. With the removal of  “mother” figures and their networks of confident supporters as well as having restrictions imposed on their ability to move  or eat in labour childbirth became increasingly less bearable, thus women accepted the offer of numbing drugs. Women’s acceptance of drugs and bed as ‘the’ place to labour unknowingly increased their lack of control, mobility aand the need for doctors to pull their babies out with forceps.

By the 1980′s the nightmare consequences of previous decades of “Twilight Sleep” labours were forgotten, so healthy women began to accept the  new technologies of fetal monitors, ultra-sounds and epidurals in labours which would previously have been safely assisted by other women and a midwife’s skill. These technologies have subsequently lessened the value and ability of midwives, and doctors to gently listen and feel to asses the welfare of a baby in the womb. Like-wise, increasing Cesarean section rates have seen a diminishing of skills and confidence to vaginally deliver breech and multiple births. These losses have recently been recognised as contributing to the outcomes of studies which incorrectly supported more surgical deliveries of these babies.

However at the same-time some midwives, particularly in the UK and Holland, continued to support home birth and had positive outcomes for women who then led pushes for more women-friendly hospital options, beginning with having a ‘supportive’ partner present, to move about in labour and even to birth in water.

Birth Today.

Unless they have been ‘educated’ to go to hospital, women in less-developed countries often still have confidence in their abilities, trusting their instincts and, or traditional practices to birth even in natural disasters such as a flood. However, the fact that this woman is doing what comes naturally is not acknowledged in media reports of these incidents, rather they are portrayed as miraculous escapes from death. Similarly, when women in first world countries birth in unusual places or situations it maybe miraculous to “freakish” but never that women’s bodies and babies do know how to birth by themselves. Even when those present in unplanned deliveries follow their instincts rather than medical advice and have a safe outcome, there is no questioning by the media about any medical interferences in otherwise healthy pregnancies. An example of this is the  reporting of a father who unraveled his baby’s cord from around its neck instead of clamping and cutting it as directed by phone emergency services.

Today most European women are healthier than those in previous centuries, but trust in their ability to grow and birth a baby (second smallest circle of risk) has been replaced by fear and misunderstandings about how to help themselves through these processes. This fear is spreading around the world along with the adoption of technology oriented maternity services and its unquestioned support by mass media. Statistically women are more at risk of death due to obesity (maroon circle) or a traffic accident (green circle of risk) however  there is no community or individual fear about getting in a car, even when pregnant. Rather, fear of birth or “Tocophobia” is a modern epidemic such that the word ‘abnormal’ has been dropped from some explanations of its meaning. Thus many people now believe that “Childbirth is dangerous“, not a wonderous, evolved means to grow healthy individuals as experienced by home birth families and their midwives. Meanwhile science has shown that belief affects our health in many ways, including blocking our ability to birth or even to become pregnant.

Many pregnant women hear only scary birth stories these days, and the MOH admits that in NZ hospitals: “Common procedures used during childbirth include: induction, epidural, episiotomy, manual removal of the placenta, and the management of postpartum haemorrhage . ……….. Nationally, there were 33 hysterectomies related to childbirth in 2007.”  Such a reality suggests that many midwives do not know how to promote, protect or support natural birth in a hospital, because most NZ women have the same midwife’s care in labor as through-out their pregnancy and post-natal period. Despite the New Zealand College of Midwives Consensus statement that: “Women who are experiencing normal pregnancies should be offered the option and encouraged to give birth in primary maternity facilities or at home. The evidence clearly demonstrates that women who receive effective antenatal care and are assessed to be at low risk for complications, will give birth to healthy babies and need fewer interventions if they are supported to give birth in a primary maternity unit or at home.” many NZ midwives do not offer the option of home birth (or primary unit) care to women.

Midwives, the MOH and media need to publicise the growing numbers of studies which show home birth to be as safe as hospital birth, and a more satisfactory outcome for mothers and families. A successful home birth is about helping the woman and her family to labour and birth instinctively. The benefits and means to access labour hormones and active birth should be part of midwifery and DHB maternity information as well as influencing the layouts and decoration of maternity environments. Informed public debate around Home Birth, the consequences and means to counter increasing rates of childbirth intervention needs to be a topic in NZ media.

Perhaps the lessons of David Attenborough to respect and support the natural birthing instincts and needs of animals can be transfered to the care of labouring women, as we seem to be re-learning the value and ability of women to nurture their newborns. Reflecting on the above matters or attending a Home Birth Aotearoa support group and, or discussing any concerns with an experienced home birth midwife will help Kiwi  couples to regain this trust? Women have shown me that those who make a heart and body connection with their baby in pregnancy then work with, or allow that knowledge and trust to guide them through labour to birth instinctively and powerfully.

PS Here is a song  to go with this blog called Full Circle by Judy Small, the video was done by Homebirth Australia as part of their ongoing campaign for Australian governments to equally fund a woman’s choice of care by a midwife to birth at home!

(see also Song to Nicola Roxon and Homebirth)

Due to its significance for Maori, most New Zealanders have learnt to respect the placenta once it is delivered, still most babies here, as elsewhere, are having their cord cut before its vital work has finished. Yet Maori acknowledge that ‘the place where one’s umbilical cord was severed is ….a place of special importance for each person…………their place of first emergence into the world, of first maturation and foundation.’  This cultural perception is consistent with the physiological reasons why the cord should be left to finish its work. Similarly those who practice Lotus birth or leave the cord and placenta to separate naturally, do it for a variety of reasons which acknowledge the united origin, life and history of baby, cord  and placenta.

What is lost with early cord cutting?
While the cord is pulsating both it, and the placenta are functioning organs. Thus, when the cord is clamped and, or cut prior to its natural shut down of these structures, both mother and baby miss out on good things intended for each of them. When not interrupted, a complex interplay of the final birth events aids the baby’s first breaths, shuts down the cord, separates and expels  the placenta from the womb and minimises bleeding. Typically, the cord continues to pulsate for up to 5 minutes after the baby’s birth, returning blood to the baby’s circulation including its lungs this increases the internal pressures squeezing fluid out of the lungs, thus helping the baby’s first breaths. The first breathing efforts of the baby also draw more blood into the lungs, again changing the internal pressure ranges which help close the heart openings which were part of the feotal (baby in the womb) circulation.

A woman who births her placenta, rather than has her placenta delivered or pulled-out, after a vaginal birth is using her body as it is intended; she and her baby are utilising the final surges of birth hormones to not only complete the birth but also to begin their new life together in the healthiest state possible. For example New Zealand midwifery data and other sources are beginning to refute the claim that ‘Active Management of the Third Stage’ reduces the risk of haemorrhage. Other studies are exploring negative impacts of the drugs used in this intervention which has over-ridden natural birthing of the placenta, with-out any evidence of benefit to mother or baby.

It is hard to know when clamping and cutting of a pulsating cord started, though the ancient Greek philosopher Aristotle warned against early tying of cords, as did Erasmus Darwin in 1801. There are many different types of cord ties or clamps these days, each with their own accessories for application, removal or both. However no manufactured versions have the natural antibacterial and softness of the traditional Maori flax tie or muka, nor the love connection of a mother’s handmade creation.

In 2009 the UK Royal College of Obstetricians and Gynaecologists said that “Immediate cord clamping became routine practice without rigorous evaluation. There is now a body of evidence suggesting that immediate, rather than deferred, clamping may be harmful for both term and preterm births.”  Professor of Obstetrics Nicholas Fogelson explores the impact of premature cord clamping and answers concerns about things like the impact of gravity on the uncut cord, in 3 YouTube videos. The primary risk for a baby of having its cord cut before it has stopped pulsating is the loss of up to one third or more of its blood supply along with vital blood-borne nutrients needed for its outside the womb life. Thus Prof Fogelson likens cord clamping to the old practice of blood letting; the original ‘iatrogenic’ or doctor caused injury, for if adults lost this much of their blood they may need a transfusion to cope!.

Because the return of cord and placental blood to the newly born baby helps the initial expansion of their lungs, cutting of this life line can be linked to subsequent traumas for baby and mother involved in resuscitation and, or separation in a nursery for observation or treatment of an exsanguinated baby. Studies have also found the loss of blood volume and associated nutrients from cord clamping places premature babies at increased risk of intra-cerebral (inside the brain) bleeding and infections. Cutting a cord which is around the baby’s neck before it has been born, risks not only the highest possible depletion of the baby’s future blood supplies, but the cutting of its oxygen supply line means there is a high risk of brain damage if immediate delivery is not possible. As information is now widely available on the web about alternative techniques and the related physiology maternity carers need to stop searching for, cutting and fearing ‘nuchal‘ (around the neck) cords thereby acting on the ethical¹ and practical implications of this non-evidence based practice.

A UK Obstetrician has developed a new baby resuscitation trolley to encourage hospital staff to leave the cord intact, however home-birthers have long known that along with an intact life-line, the mothers chest and voice are vital components for reviving stunned babies. We need to go back to the ancient medical motto of “First do no harm” and keep our hands off the cord till it has finished its life saving work.

Studies into the impact of not doing immediate cord clamping and cutting are showing that this common practice denies babies their biological needs and means to reach their full developmental potential! The UK National Institute of Clinical Excellence have recently moved  to recommend delayed cord clamping of at least i minute following an online  campaign by a British midwife, it is past time that all babies were no longer robbed of their optimal circulation that nature intends them to start life with!

1. Hutchon, D.J.R. “Immediate or early cord clamping vs delayed cord clamping“  Journal of Obstetrics & Gynaecology November 2012; 32: 724- 729

Labouring and birthing on a bed is not how birth is intended or should be.Women labouring on their backs, or sitting on a bed to birth is one of many non-physiological or inappropriate hospital maternity practices the Royal College of Midwives is trying to stop in the UK.

Past president of the International Federation of Obstetricians and Gynecologists (FIGO); Roberto Caldeyro-Barcia  stated in 1975 that “Except for being hanged by the feet, the supine position is the worst conceivable position for labour and delivery”.

The possible consequences of labouring and birthing on a bed include;

1)      Reducing the room for the baby to exit by up to one-third, as the tailbone is forced forward, this also increases the pain and length of labour as well as the difficulty to deliver the baby.

2)       Stretching of mainly, or only the perennial tissues (area between vagina and anus), rather than pressure being evenly exerted on all of the pelvic floor, makes perennial tearing more likely. Also the pelvic floor’s contribution to the natural feedback loop or drive of the ‘Fetus Ejection Reflex’ ( nature’s means to birth the baby) is not as effective as when upright.

3)      Being less than upright results in various degrees of major blood vessel compression which causes decreased fetal circulation (blood supply to the baby) and increases maternal blood pressure, both of which can lower oxygen supply to the baby resulting in decelerations of the fetal heart rate (fetal distress).

4)     Weaker, less frequent, and more irregular contractions as pressure on the cervix is less (impeding nature’s feedback mechanism) so l pushing is harder as increased force is needed to work against gravity than when upright.

5)       Venous thrombosis (clots) or nerve compression from the pressure of the leg supports, when the legs are put into stirrups, also increases the need for episiotomy or risk of tears because of excessive stretching of only the perennial tissue and uneven tension on the pelvic floor.

All of the above increase the risk of instrumental (vacuum or forceps) delivery or a caesarean section to get the baby out, all
of which have their own short and long term risks of harm to both mother and baby!

Many studies asking women about their preferences have shown that being upright compared to lying down results in less pain during labour and pushing, less backache, shorter and more effective efforts to birth the baby with less trauma to the mother and the baby is born in a better condition.
The only problem appears to be for those who want to catch the baby, they need to be flexible!

‘Mother’s Advocate’ has published a 6 part series; ‘Healthy Birth Practices’ on You Tube, as well as 4 episodes of their ‘Timeless Way’. The latter explores how most of our ancestors, regardless of their culture, would have birthed in a supported upright position until the most recent generation had hospital deliveries or attempted to birth in a ro0m dominated by a (hospital) bed.

“Get up, stand up: stand up for your rights!” ― Bob Marley

This series also shows the need behind the UK’s ‘One midwife, One woman’ movement, Campaign for Normal Birth and government targets to increase homebirth. Whilst most New Zealand women can and do access a midwife as their Lead Maternity Carer, many go to a secondary or tertiary hospital to labour and birth. Thus several annual MOH reports state; “Common interventions used during (‘normal’) childbirth include: induction,epidural,episiotomy,manual removal of placenta and the management of postpartum haemorrhage.” Yet New Zealand has no government targets about normal birth, nor campaigns to lower growing intervention rates. Rather national inactivity around this issue suggests a lack of concern about the costs of childbirth interventions for the women, babies, families or communities of New Zealand?

Meanwhile the UK Campaign for Normal Birth aims to get women birthing off beds plus UK midwives to apply ‘10 Top Tips’ to support ‘normal birth practices’. However, as UK Midwife Sheena Byrom quotes Michel Odent saying “The best environment I know for an easy birth is when there is nobody around the woman in labour but an experienced midwife or doula – an experienced mother figure who is there, and who can remain silent. Silence is a basic need for a woman in labour. Privacy is another basic need.”

The science which birthing women need is that which accesses their natural labour and birth hormones. ‘Gentle Birth, Gentle Mothering’ and ‘Orgasmic Birth’ as their titles suggest are 2 books that explain the benefits of these hormones as well as ways to access them.

The Venus of Willendorf created about 24,000 BC, honours women’s birthing abilities, though human birth had been successfully happening long before even this date. Birth in hospital started as desperate charity housing of homeless, medieval  women and resulted in the death of far more that the more usual homebirthing, till antisepsis then antibiotics were widely introduced in the mid 20th century. Homebirth continued as the place of most births until post WW2. The social standing and power of new medical doctors led suffragettes to support the building of women’s hospitals and wealthy women began their gender’s submission of their labouring bodies to the rituals, directions and unproved knowledge of obstetricians, again from just before mid last century. To maintain their livelihoods midwives followed the women to work in hospitals, and then to become a ‘profession’ they accepted hospital based training, taking on the experiences and practices of fearful rather than respectful birthing. Though some women and midwives maintained the homebirth fires which are now being flamed by more recent scientific knowledge of the birthing hormones, which confirms the ancient experiences and substantiates emerging midwifery studies of woman-centred, undisturbed labour and birth.

Overall, ‘One Born every Minute’ reflects growing evidence about the inappropriateness of hospital as the place of birth for the healthy majority compared to the safety of homebirth[1] and why women have higher levels of satisfaction with their experiences in ‘home-like’ environments rather than hospitals[2].

Signs around New Zealand suggest that vets and sheep-farmers understand that what happens around birth has life-long implications for the nurturing relationship between a mother and her child. New Zealand needs  programs to promote, support and protect natural birthing, which can benefit us all as new generations then start life bathed-in and primed by optimal levels of oxytocin. Becoming a supporter and promoting the Maternity Manifesto which seeks government support of ‘Normal birth and Alternatives to Hospital Birth’ is one way of  creating more woman-centred birth options for all New Zealanders.