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”.
“Why not Home?:The surprising birth choices for doctors and nurses” is a new and beautifully produced US documentary exploring the experiences of several family nurse practitioners, obstetrically trained doctors and midwives who choose to deliver (as they call birth) their babies at home, rather than in a hospital. This film reviews the history of birth moving from home to hospital in the USA, the rising and internationally high US caesarean section rates and 2 sets of research about the safety of home birth compared to hospital delivery; all of which are some of the reasons behind these US health professionals asking “Why Not Home”. Continue reading
Since the beginning of hospital birth, research supporting its use for low risk women has been lacking. The last 15 years has produced 17 studies all supporting attended planned homebirth as safer for low risk women. Continue reading
Duchess of Cambridge, open your eyes to the home birth revolution
A seldom written fact is that the Queen had all four of her children at home. Ahead of a new ITV documentary this evening, Home Delivery, Beverley Turner, a strong advocate of such births, hopes Kate Middleton is tuned in.
Daily Telegraph, London 21 Mar 2013
At 9pm tonight, I hope Katherine and William Wales will be tucked up in their crested onesies, dipping chocolate brownies in their Earl Grey and watching ITV, because in the documentary Home Delivery, they will see something so rarely glimpsed that it should have been narrated by David Attenborough: human birth as a perfectly normal, rather jolly occasion, overseen by a brassy midwife in the cosy surrounds of family homes. It is a timely antidote to Channel Four’s terrifying One Born Every Minute.
I defy any woman – including Kate – not to wonder, how we’ve managed to muck up maternity services so badly, that only two per cent of British women now have such a safe, cheap and empowering birth. The type that, as Davina McCall once said of her three home births, “knocked spots off any drug I’ve ever taken. When those babies popped out, I wanted to stand naked on the highest mountain and roar with pride. I could do it again and again and again”.
Reports about the latest release of the Ministry of Health’s ‘Maternity Clinical Indicators’ suggest that either; reporters and some consumer organisations do not understand the origins and meaning of these ‘indicators’, or they have no concern for the welfare of healthy, first-time mothers and their babies?
The various rates of different childbirth interventions reported last month by the MOH, including Cesarean section rates, are the outcomes ONLY for women who are ‘standard primipara’; that is they are healthy, first-time mothers “aged between 20 and 34 years at the time of birth in a hospital or birthing unit”, whose birth of a single, head first baby at term followed a pregnancy with no “recorded obstetric complications that are indications for specific obstetric intervention.” The healthy circumstances of these women means they are amongst the most likely individuals who should have had a normal or natural labour and birth. Or as this report says, this group should have had “low intervention and complication rates ………… consistent across hospitals”. Continue reading
The 2 year UK Place of Birth study showed that for healthy women a planned home birth was most likely to result in a natural birth, compared to labouring in an obstetric or midwifery led (primary) unit. Whereas healthy women labouring in an obstetric maternity unit more often had their labours sped–up (called ‘augmentation of labour’) and needed an epidural for pain relief, both of which contribute to labours ending with either an instrumental or surgical delivery. These findings are the same for birth outcomes in New Zealand  where most women have continuity of care through-out each pregnancy, labour and the first 6 weeks after birth by the same midwife, which is rare in the UK. When NZ women labour in a secondary or tertiary hospital, up to one-third of healthy women may have their babies delivered by either forceps, vacuum or surgery. Where-as those who labour at home in either country, are the women most likely to have a natural vaginal birth compared to those who labour in a midwifery led (primary) birth unit or a hospital. Continue reading
Despite, research from New Zealand, UK and other countries, which shows that for healthy pregnant women homebirth with an experienced midwife, is safer that labouring in an obstetric hospital, an increasing majority of New Zealand women are delivered in a secondary or tertiary hospital (over 85% in 2011).
The Royal College of Midwives Practice Guidelines state that “Hospital is an alienating environment for most women, in which institutionalised routines and lack of privacy can contribute to feelings of loss of control, and increased anxiety brought on through loss of control can interfere with the normal effective physiology of labour” and that “control, or lack of it, was important to the women’s experience of labour and their subsequent emotional well being.”
New Zealand women and many midwives seem unaware that local [1,2, 3] and international  evidence shows that the place of birth not only has an important effect on interventions but that women report higher satisfaction with their experiences in “home‐like” environments, with the following features;
The hormone, or messenger-chemical in our bodies, which is meant to start and continue labour, to birth a baby and placenta is called oxytocin; oxytocin is the hormone of ‘love’, human connection and altruism (‘forgetting oneself’). Oxytocin is needed, and present during love-making and breastfeeding as well as when we hug, touch or share any pleasant activity with another. This hormone, like others is made and released by a deep primitive, unthinking part of our brain, which is also where our breathing, heart-beat and temperature control; all life sustaining efforts of our bodies arise. Continue reading
Perhaps the UK series; ‘One Born Every Minute’ shows examples of why a Royal College of Obstetricians and Gynaecologists (RCOG) Expert Advisory Group said; “Too much care is provided within secondary and tertiary settings. Too many babies are born in the traditional ‘hospital’ setting. We need to drive this care back into the community with the appropriate provision of facilities and professionals with appropriate skills.” Continue reading