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” 

The interviews in this film; of the health professionals, their caregivers and partners reveals practical and emotional reasons why they chose to birth at home rather than in a hospital, but none mention the negative impacts of the external and, or internal environment of labour, on the production of the birthing hormones; Oxytocin, Endorphins, Adrenaline/Noradrenaline and Prolactin. Nor do any of the additional maternity experts even suggest that the flow of vital substances like Oxytocin,“the shy hormone”, can be helped or hindered by environmental factors such as bright lights, noise and activities including care-giver practices or a labouring woman’s fears and behaviours. All these factors can block a labouring woman’s ability to make the essential birthing hormone cocktail and thus labour stalls in all sorts of environments but especially in unfamiliar hospitals where bright lights and noises are common along with the all hours monitoring and treatment of their ‘patients’.

The labours and births shown in this film are very similar to those which result in hospital vaginal deliveries in New Zealand, with the women mostly in positions that permit a midwife or doctor to ‘deliver’ the baby and immediately lift the baby onto their mother’s chest. This hands-on, directive style contrasts that of homebirth midwives I work with, who encourage women to birth their babies in the way that facilitates the mother’s “Fetus Ejection Reflex” and the efforts of their baby to be born. This can happen when  labour is disturbed as little as possible and the woman is confident, connected and works with her baby and body birthing instinctively as nature intends. For labour and birth to be an involuntary, instinctive process, the environment and all present during labour and birth need to protect, support and encourage the flow of birth hormones which orchestrate the ‘dance’ between mother and baby. Such natural or physiological birth is most often achieved when women, like other creatures nest, hence the better outcomes and greater satisfaction of women who birth at home compared to those who have more disturbed or managed labours and deliveries in hospital.

Not shown or discussed in this film is the natural option of gentle, spontaneous birth of the baby’s placenta, which usually results within half to an hour after the baby’s birth when this transition period is undisturbed, so the hormones flow optimally to complete the birth process. However I suspect that the women in this film had active management of this ‘stage’ including an injection of synthetic oxytocin followed by clamping and cutting of the cord before it had ceased its pulsations. Active management or placental delivery is done “to reduce bleeding” however statistics and experiences of  hands-off midwives is showing that when nature is supported and protected mothers bleed less and babies retain most of their (uterine) circulation making them optimally healthy for life outside the womb.

New Zealand women, unlike those in the USA have access to continuity of care by a midwife, and this is one of many countries in the world who have better infant and maternal mortality rates than the US. However, New Zealand birth outcomes do not support the expressed belief of Prof Eugene DeClerq “that wider use of midwifery” is the single change needed to address rising rates of caesarean section. Here in New Zealand over 90% of women have continuity of a care by midwife through pregnancy, birth and afterwards, yet from 2009 to 2014, as in previous years, there has been an increase in the rates of Caesarean section, and other interventions with no correlation with increased clinical need. For example healthy first-time mothers, with no obstetric indications, aged 20–34 years old, in labour at term (37–41 weeks) with a single baby, presenting head first, have had a decrease in spontaneous vaginal births from 2009 to 2014. In addition, the latest and previous annual MOH report shows that the vast majority (87%) of women gave birth with their midwife at a secondary or tertiary maternity facility, whilst only 3% birthed at home.  Also, half of all New Zealand women who birthed in 2014,  mostly in the care of a midwife and in a hospital, had at least one form of intervention during their labour and, or birth (24% – induction, 26% – augmented labour, 27% –  epidural, 15% – episiotomy).

The national caesarean section rate in 2014 was 27.4%, but 17.8% in 1999 when New Zealand women were first able to choose government funded maternity by the midwife of their choice. This rate was highest amongst women from the more affluent neighbourhoods who again would have a lower clinical need. Also, outcomes for women and babies varied between district health boards (DHBs) and between individual hospitals, all of which is consistent with the explanation in the “Why Not Home” film that; what practitioners experience influences their ‘world view” and what they professionally do and believe!

The women and community of New Zealand are generally unaware that local research indicates “that for women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother”. as reported by the UK Birthplace study, UK media, and supported by the Royal College of Obstetricians.

The Ministry of Health, Royal Australian and New Zealand College of Obstetricians, Midwifery Council and College of Midwives need to explore and act on last year’s research by New Zealand born and now ex-pat Dr Sarah Buckley about the evidence on innate hormonally-mediated physiologic processes in women and foetuses or newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four birth hormones.

Finally the world would  benefit from a Kiwi centred documentary which examines all the options, knowledge and issues of “Why Not Home In New Zealand?”

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.

Research reveals that there are only 2 acute conditions that might occur at homebirth in which the mother or baby may have a better outcome had they planned a hospital birth, namely: Cord prolapse and Amniotic Fluid Embolism (AFE). Although tragic, cord prolapse and AFE occur rarely at homebirth, 1/5000 and 1/500,000 respectively, when balanced with the dozens of acute emergency conditions endangering the health of mother and baby that occur at planned hospital birth caused by intervening in the birth process, the scales tip easily in favor of planned attended homebirth for low risk women.  Acute conditions caused by hospital birth are discussed here, to allow low risk women to make informed choices as to place of birth.

Go to this article to read evidence-based answers to the following questions;

Is hospital birth ever safer than homebirth for low risk women?

How do hospital perinatal (around birth) death rates compare to those of planned homebirth attended by an experienced homebirth midwife?

What accounts for the worse outcomes of low risk women in hospital compared to at home?

What acute conditions happen more often or only at hospital birth?

Why does the myth about hospital birth as safer than home birth persist?

What acute conditions or emergencies can happen at birth that are better dealt with in hospital than at home?

How common, or rare are these acute emergencies?

Also this article does not cite recent large scale studies in Holland and the UK which further support the positive outcomes for women birthing at home compared to hospital.

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 March 21st, 2013.

The pregnant Duchess of Cambridge was handed a ‘Baby on board’ badge yesterday. Photo: PA

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”.

However, the report states, for example that during 2010 in New Zealand hospitals;

• only 50.6% to 85.5% of all the healthy, first-time mothers in their local DHB had a Vaginal delivery (which may have been induced and, or augmented).
• from 4.4% to 23.5% of all the healthy, first-time mothers in their DHB had an Instrumental delivery.
• from 8.5% to 25.9% of all the healthy, first-time mothers in their DHB had a Cesarean section.
• only  16.7% to 58.3% of all the healthy, first-time mothers in any DHB had an Intact Perineum.

Thus this report shows that; “Common interventions used during (‘normal’) childbirth include: induction, epidural, episiotomy, manual removal of placenta and the management of postpartum haemorrhage”, happen to healthy, first-time mothers birthing in New Zealand hospitals, at different rates depending on who is caring for them.  This most recent MOH maternity report is NOT about the percentage of ALL women undergoing each or only one intervention in each DHB in 2010, for example cesarean delivery as suggested by the media response.

Unlike the UK there is no MOH collecting or reporting the numbers (or percentages) of women who labour and birth their babies naturally in any New Zealand maternity unit, whether they are having their first, or a subsequent baby.  Thus the Maternity Manifesto is seeking government and community support for “Labour and birth which starts, progresses and ends naturally to be the New Zealand definition of “normal birth” and the gold standard or goal for maternity services quality assessment”.

The approximately 5% of New Zealand women who currently birth at home each year, begin and end their labours naturally. This is because there is no capacity or desire for any of the aforementioned interventions to happen, or be treated at home, except for an episiotomy. However this latter possibility is not even hinted at on home birth websites, nor is it usually necessary when women birth gently and instinctively  under the influence of their birth hormones, rather than be told what to do by others.

Uninformed Maternity Media and Commentators.

The medical language and statistical format of this MOH report makes its meaning and significance unclear to many people. Thus “Jenn Hooper, spokeswoman for ‘Action to Improve Maternity’, slammed the results and review as meaningless saying  ”With cesareans, unless they are actually leading to a lot of deaths do we actually care?” . However those who know about maternity care issues and research are very concerned about the costs to individual women, babies, families and our society including the health budget, of inappropriately high and rising levels of traumatic birth events, in an otherwise healthy population.

The websites and other activities of many consumer organisations, both here and in other countries such as the UK, Australia , USA and Canada aim to reduce escalating childbirth interventions, as well as to support women and babies who have suffered through these traumas. Rising rates of Cesarean section in Australia have birthed a network of consumer organisations dedicated to addressing the misinformation around this procedure, as well as contributing to many national and state enquiries into reform of Australian maternity services. A prominent obstetrician and past President of the Australian Medical Association, has acknowledged in a national paper that the rising rates of post cesarean hysterectomies (removal of a woman’s womb) are one negative consequence of increased surgical deliveries.

Babies, families and communities also suffer when women have unexpected interventions in their births, for example studies have shown that obstetric interventions in birth increase the rates of breastfeeding failure and post-natal depression even in under-developed countries. Hospital and family resources need to be increased to meet the extra care, both phyical and emotional of women who are birth injured. These are some of the reasons why the Royal College of Obstetricians is encouraging healthy women in the UK to birth at home or in a primary birthing unit (also called a midwifery led units or birth centre).

Meanwhile, every-one in the UK and on the world-wide-web can access the rates of the aforementioned interventions for each maternity unit, each year in England, Scotland, Wales and Northern Ireland. Increasing the home birth rate is also a national goal of each country’s health service in the UK. Surely New Zealand families deserve to have a maternity service which similarly prioritises accountability and the healthiest outcomes for the majority of its population?

New Zealand families and the community also need investigative journalists to present balanced and knowledgeable analysis of their health services and its outcomes rather than sensationalist reporting or poorly informed stories which only increase the paralysing, socially created fear of childbirth that evolved with medicalised maternity care last century.

Also contrary to popular myth or mis-information, it is neither accidental nor lucky, that women who plan a home birth are more likely to have a natural birth primarily because the hormones stop the labour when a woman is disturbed, anxious (eg about getting to the hospital on time) or watched in labour. The decrease in hormonal stimulation of labour when fearful or anxious is one of many evolutionary means to ensure that a woman labours and births when she is safest and most able. Thus many women who leave home to give birth often find that their labour subsequently either stalls or stops. Yet an understanding of this physiological fact about human labour is not generally understood by most people today, including maternity carers who have limited or no experience of natural birth at home. Though many acknowledge that home is the place where labour can best progress, most fail to appreciate that to maintain effective, natural labour midwifery care should primarily promote, protect and support birth at home or in a “woman centred” environment for healthy women. Meanwhile, many women whose labours do stall on admission to hospital experience contradictory messages which precede or occur around a cascade of intervention to re-start, maintain or speed–up labour in an unfamiliar environment and an anxiety provoking situation (“but I was in a lot of pain”; “surely I am close to having baby?” etc). Often hospital environments are poorly staffed, ill-equipped or not set-up to support many alternative, ‘natural’ means to deal with stalled labours , so speeding-up labours with an oxytocin drip is common despite evidence and UK calls to restrict the use of this treatment because of life-long adverse outcomes for some babies.

In contrast, women who confidently and calmly stay labouring at home often have shorter labours and easier births than is ‘expected’ even for first babies. In my experience it all depends on whether a woman’s head, heart and body are in peaceful harmony so she can surrender or allow her body and baby to give birth. Like most other species women need to feel settled according to their own needs, to be able and ready to nest and birth. For example, I remember a woman in stop-start labour of her fifth child who needed to cry over some life changes and put the other children to bed before she went into consistent labour which was faster than my late night effort to return to her home!

Also contrary to the medical idea of stages and set time frames for labour and birth of first, or subsequent babies, some ‘early’ or ‘pre’ labour activities of women who believe/trust that ‘their bodies work’, can occur over days or weeks preceding their birth day. Similarly, home birthing women have taught me to gauge progress in labour by their behaviours and, or noises which come as a response to the movements of their emerging babies; rather than according to how many hours or minutes have passed from the start of, or in-between contractions. Such home birth experiences, when you know the woman from pregnancy teach midwives to be able to; “distinguish between a woman who is expressing her wild birthing instincts, from a woman who genuinely needs reassurance and calming.”

Michel Odent refers to labour as a time when everything should be done not to interfere with the cascade of birth hormones  which results in the easiest birth possible for both mother and baby (see previous blog). He says “The passage towards the fetus ejection reflex is inhibited by any interference with the state of privacy. It does not occur if there is a birth attendant who behaves like a “coach”, or an observer, or a helper, or a guide, or a “support person”. It can be inhibited by vaginal exams, by an eye-to-eye contact, or by the imposition of a change of environment. It does not occur if the intellect of the laboring woman is stimulated by a rational language (“Now you are at complete dilation; you must push”). It does not occur if the room is not warm enough or if there are bright lights.”

Thus the cascade of hormones flowing through an accepting, responsive woman in a supportive environment is intended by nature to “eject” or assist the exiting baby to leave its womb in a cocktail of ecstatic hormones which ensures that mother and baby are ready to ‘fall’ in love  and begin a life-long bond of child and parent. The US Childbirth Connection web site says “You and your fetus/newborn have innate abilities to start labor, labor and give birth, breastfeed, and become deeply attached to one another. The ebbing and flowing of hormones drives these well organized, finely tuned processes. It is important that you and your caregivers understand how to work with — and avoid disrupting — this inborn knowledge and drive for birth, connection, and optimal nutrition. While you don’t need to be taught how to give birth, it is fascinating to learn about the amazing capabilities of women and newborns. For example, a newborn who was not exposed to pain medications and is placed skin-to-skin on his or her mother right after birth can crawl to her breast, self-attach, and begin nursing.”

For those who wish to be more informed about the safety, benefits and practicalities of planning a home birth I recommend reading the web pages of  Dr Sarah Buckley and the Canterbury Home Birth Support group.

For whose who have had the profound experience of birthing one or morer babies in your ‘nest’ I ask you to consider sharing this good news by wearing a Home Birth Aotearoa T-shirt  during Home Birth Awareness Week 2012.

^[1] Dixon,L. et al (2012) “What evidence supports the use of free-standing midwifery led units (primary units) in New Zealand/Aotearoa?” New Zealand College of Midwives Journal 46; June 2012 p13.

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 [4] 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;

• Control over temperature
• A pleasant place to walk
• Sufficient pillows, floor mats and bean bags
• A homely, non-clinical room
• Not being overheard by others,
• A place to get snacks
• Control over the brightness of light.”

These factors are part of Bianca Lepori’s “Mind- Body-Spirit” architecture which creates birthing spaces to decrease sensory stimulations which interfere with a woman’s neuro- hormonal drivers of (natural) labour and birth, as explained in my last blog. Thus as per the diagram below Bianca’s designs aim to give each women privacy, the ability to be ‘hidden’ with beds out of the way of doors and the centre of rooms; access to water, room to walk and move in response to her baby and labour.  Other features of this supportive approach include space and supports to kneel, stretch, lean, squat or be still; surfaces which range from soft and yielding to firm and supportive as well as use of different textures, curved edges, images, colours and variations in light. Spaces which allow women to ‘hide’, control light, noise and temperature, reduce their need to think rationally which can interfere with the flow of helpful birth hormones. Similarly the availability of different surfaces and supports encourages a woman to find or adopt various, appropriate positions in response or to accommodate the baby’s efforts to be born.

From Chapter 8 of “Birth Territory and Midwifery Guardianship. Theory for practice, education and research.” by Fahy, K. Foureur, M. & Hastie, C. (2008) Elsevier’ Books for Midwives .

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Australian research into healthy birthing spaces supports all of the above and adds that: ” Labour and birth should happen as close to home as possible. Proximity to friends and support are essential for a healthy healing birthing experience and being a long way from home makes this difficult. Proximity to home can also be a spiritual thing. The familiarity of the birth space can reflect sufficient elements of home to reduce alienation and anxiety.” This statement is consistent with the vision of Waitakere women who sought a Whanua-ora inspired,  local community- managed, culturally-sensitive, birth-parenting centre which as well as the women-centred Mind-Body-Spirit birth spaces would also include:

• Family friendly post-natal rooms, with a community dinning area.
• A drop-in centre for childbearing women and their children, with breastfeeding supportive services.
• Consultation rooms for midwives, lactation consultants, doctors and complementary therapy practitioners.
• A maternity-parenting resource centre.
• Safe play areas for children – inside and out.
• Rooms for maternity and early parenting community groups to meet and host related activities.
• Art works and decorations which honour women and parenting.
• Accommodation of support services (eg catering and home help) for newly birthed women at home including those who homebirth locally.
• Flower, herb and vegetable community gardens.
• Ecologically sustainable and wheel chair accessible buildings and facilities.
• External space and a design which will support future growth both internally (eg storage areas) and externally.

The National Childbirth Trust (NCT) has developed a service to encourage and assist UK health boards to create women-centred birthing spaces, and most recently was involved in the UK Birth Place study, which concludes ; The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

When and how will New Zealand maternity facilities adopt evidence based, women-centred birth space standards?

Adrenaline and nor-adrenaline are the stress hormones of ‘flight or fight’, which give those who do extreme sports their ‘buzz’ or causes stage fright when shy people are asked to perform in public. In evolutionary terms these hormones are nature’s ‘fire escape’; the means for labouring women to leave a fearful situation, to go find a safer place to birth. However the drama, lack of trust and fear created by hospital birthing can result in the stimulation of these hormones  in many women so their labour is inhibited. For example a woman in early labour who goes to the hospital, clock watches to time her contractions or is asked questions during contractions can slow or stop her labour. Thus today many women who go to hospital are having their labours chemically started or driven with artificial oxytocin which research shows has many negative consequences with none of the benefits of natural oxytocin for mother or baby. Where-as if labour occurs and progresses naturallly with oxytocin flowing through both mother and baby, they are more relaxed and blissfully connected when they first meet, at birth.

Thus Dr Sarah Buckley says;
“A labouring woman needs to feel private, safe and undisturbed so that she can enter the altered state of consciousness that will ensure a smooth and safe orchestration of her ecstatic birth hormones. Ideal conditions for birth are similar for lovemaking or meditation”

Midwives who understand the interplay and impact of these hormones can determine how advanced, or not, a woman’s labour is with-out doing a vaginal examination!  Through the ages and across cultures many women have birthed with-out having a vaginal examination which can have negative consequences when done unnecessarily. As the baby moves down into the pelvis there are additional changes in the woman’s behaviour, then other signs as the pelvis’ opens to allow the baby out. Research is beginning to confirm this knowledge that women have known for millenia before birth was moved into hospitals.

For labour to progress naturally no-one can direct or tell the woman what to do. As much as they may want to help, all anyone else can and should do is encourage and support a woman’s efforts to connect and respond to the needs of her body, her baby so she can labour effectively. A woman labouring as her body needs will then behave more in tune with all of the labouring hormones including our body’s equivalent of morphine; beta-endorphin.

Endorphins are like heroin, a powerful naturally occurring means to relieve pain, which can similarly be addictive. For example under the influence of endorphins some sports people have gone on with their activityignoring their bodies early pain signals,  and so badly damaged their bodies through over-exertion. Like oxytocin, endorphins arise from our deep primitive brain so their flow requires that we do not use our thinking brains. Under the influence of endorphins labouring women begin to move and behave instinctively, to be in that previously mentioned ‘altered state of consciousness’ rather thrashing about in pain. However labouring in a hospital usually requires a woman to ignore outside noises, smells and other distractions, so to be able to enter and maintain an ‘altered state of consciousness’ amongst strangers and an unfamiliar, clinical environment is big ask for a woman.

For women who do access the natural peak flows of oxytocin and endorphins birth is more than bearable, with these hormones reaching high levels during late labour, birth can be pleasurable. Thus nature has provided a means to make reproducing and nurturing babies something that women want to do it again and again! Birth has evolved as a means to reproduce the best of a species, uninformed intereference is proving to be counter productive. Women need to reclaim the knowledge, control and joy of natural birth!

Peggy Vincent in Baby Catcher says;
“Women’s bodies have near perfect knowledge of childbirth; its when their brains get involved that things go wrong. When we force external rules on labouring women’s behaviour, their births may veer off track. The intrinsic intelligence of women’s bodies can be sabotaged when they are put into clinical settings, surrounded by strangers and attached to machines that limit their freedom to move. They then risk falling victim to the powerful forces of fear, loneliness doubt and distrust which all increase pain. Their hopes for a normal birth all disappear as quickly as fluid in an IV bottle.”

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.