Laws of Optimal Mammalian Birth: A treatise to de-medicalise

Birth. 

It all begins with birth. 

Mammals generally create three conditions to birth:

One - Privacy

Two - Darkness

Three - Warmth

Everything, every single one of us will ever experience began in the shared, universal experience of birth. Being birthed. What is the first thing we ever do as we arrive, the first verb/activity we engage in?

We 

c r o w n.. 

Call it woo-woo if you want: I deeply believe that birth is a majestic and magic stream of moments. 

In an earlier blogpost, I liken some of the more ‘active’ routine interventions in maternity care to violence against women and girls. Episiotomies to be exact. For some, I can imagine, this was a bit of a stretch. That’s because we are hard-wired to dread pregnancy, fear labour, totally neglect to consider postpartum and only focus on that brief moment of the baby emerging as worthy of our excitement. And, as long as ‘baby arrives safe and healthy’ everything else is deemed irrelevant. I beg to differ.

This post is an ode to broaden that singular focus. 

I have been a Doula for the arrival of 8 little humans to Earth. The word ‘doula’ stems from Ancient Greek and meant ‘female slave’. Now, it is used to describe a birth keeper. Someone who supports a Momma through her pregnancy, labour, birth and/or postpartum. Doulas aren’t medically trained – but have a deep understanding of the physiology of birth. What does physiology mean in this context? It refers to the natural biological process that is birth. The body’s innate cooperation between all systems: endocrine, cardiovascular, respiratory, hematologic, renal, gastrointestinal etc. This is subtle shift in perspective is of paramount importance. 

…because, think about it: When do we go to hospital? When something is wrong. When something is pathological and not functioning as it should. Birth however, for the vast majority of women, can be a purely physiological process: the body doing what it is supposed to do. What is BUILT to do. 

The aspect of a hospital’s treatment of birth, stripping a woman of what could possibly be one of the most formative, transcendental, empowering moments of her life that really irks me, is when these hospitals practices are not in any way rooted in evidence. Would you believe me if I told you, a scary number of maternity practices are unscientific? This is hard to fathom for someone who still believes that babies being born at home is some dark-ages digression to which we should not return and the hospital must be the prime setting. But genuinely, MOST maternity practices are not evidence-based (by this I mean scientific, rooted in research). Or, were – way back when, in the 70s and have since been disproved as necessary or beneficial to the overall health of Mum & baby.

Some classic examples of practices that have zero grounding in empirical efficacy are the following:

Vaginal Examinations: the whole concept of someone sticking their fingers inside of you to check dilation and then surmise how ‘progressed’ you are is totally outdated. Research has concluded time and time again that there is very little to be gained from routine VEs. Ironically they can act to stall labour as they are interrupting the woman from doing her thing.

Recumbent position - lying on the hospital bed: ah, hello? This prevents one of the most helpful of physics’ forces from doing its good work… GRAVITY. Also, it compresses the pelvic floor and thus ultimately restricts the birth canal. 

CTG: the scan that is offered to women to get a reading on fetal heart rate on admission has actually been proved to show an inordinate number of false positives – as high as 60%.

The ‘sweep’ or induction: this involves introducing ‘syntocin’ which is synthetic oxytocin into the woman’s system in order to speed up the whole process. ‘Oxytocin’ is sometimes called the connection hormone because it (among other things) is responsible for bonding us to others. The overall percentage of mom’s being induced hovering at around 50% of a national average this year. It should/could be expected to be 5-10%.

Why are we so obsessed with speeding up the process? Fanatical one may say. It is this very yang-driven framing of birth, a process as wild and uncontainable as the cosmos itself, as something we can tame, that pisses me off the most. Rushing something so nuanced and intelligent as the womb very methodically pushing out a creation it has been ingeniously developing for 270 days. 

The other issue that is scant understood by many people who will navigate the hospital is the package deal that these ‘interventions’ usually are. Thinking you can opt into one and then back-out of others, often isn’t the case. In the birth world this is called ‘the cascade of interventions’ as they tend to snowball. 

A classic tale:

Amy is 40+2* and is offered a sweep. 

This is the 5th time she’s been offered; they started suggesting it a week before. 

She reluctantly agrees. 

She goes home but a few hours later, feels some activity and decides to go back into hospital. 

Amy arrives to the hospital and is offered a CTG.

‘What’s it for?’ she asks. 

‘Just to check everything is ok with baby’** a nurse responds. Seems innocuous enough – so Amy agrees. 

The CTG is connected and after a while the nurse’s brow furrows, and she says ‘Mmmmm somethings a bit off there so I’m going to get you to talk to our obstetrician.’ 

Amy is transferred to a ward, where there’s lots of other people, bleeping machines, unknown healthcare practitioners and bright lights (remember what we said about the mammalian requirements for birth?). 

She waits for several hours, confused as to the previous inference by the nurse that something wasn’t quite right – and ruminating on that, rather than letting flow the strong feelings spreading across her mid-body and uterus. 

Obstetrician comes and says “I’m just going to do a vaginal examination to see how far you are progressing.”*** 

He doesn’t wait for a reply.. Or exlain the risks and benefits associated with such an intervention.

He performs it (arguably, without consent) and then shakes his head and says “It looks like your labour has stalled. Would you be open to a caesarean?...****

* meaning forty weeks, plus 2 days – so 48 hours over full-term. The hyper-fixation with ‘due dates’ is also extremely arbitrary. They are an approximation and the way in which they are treated as a silver-bullet and precise calculation creates all sorts of havoc. Let alone the falsehood itself that 40 weeks is even full-term. Birth can never be one-size fits all. Often, 2 weeks on either side is TOTALLY normal, and does not warrant intervention. 

** again, hospitals are trained to see problems. When you are trained to see problems – you will see problems. There is nothing to suggest there is anything wrong with you and your baby as you embark on your labour. People continuously suggesting otherwise is incredibly stressful – and counterproductive to the literal ‘opening’ of the body that is needed to physically release that baby into the world.

*** informed consent can never be prefaced with “I’m just going to…”. It is oxymoronic assert something as an inevitability and then claim it is a choice.

**** roughly 1 in 3 women giving birth in Ireland have caesareans at present. Sure - emergency caesareans when needed are miracles. They save lives and we should be grateful for the medico-technological advancements that have made them so widely available. That said, the World Health Organisation estimates a normal caesarean rate of between 5-10%. Why do we have 5 times that? Why are they being used routinely?

..and just like this a woman finds herself on the slippery-slope of interventions. With very little scope for even recognising the theft of her autonomy that is occuring, as many of these decisions simply weren’t presented as choices. The woman has found herself in an extremely instrumental birth, where her body doesn’t get to do what is designed to do – and she’ll never be able to know if it could have…if it was given a chance.

That obliteration of agency, combined with the distinct lack of closure can lead to birth trauma. In July of this year in Britain, the All-Party Parliamentary working group, led by Theo Clarke MP have published a report from an inquiry into birth trauma ‘Listen to Mums: Ending the Postcode Lottery on Perinatal Care’. This is an extremely welcome development and I would call for a similar interrogation to take place here in Ireland. 2022 data suggests that on our island, 18% of a cohort of 1,100 respondent new mums reported their births as traumatic. 

The sad arc of maternity care is that it did used to be woman centred. Womb-bearers caring for womb-bearers. Which kept a certain amount of lineage wisdom alive. Which allowed the medicine to be tacit feminine intuition to guide the way, stitched into the soma of those present.

It’s fair to say that the midwife as definitely been displaced, as the knowledge-broker of what birth is actually about. The rise of the ‘Doctor’ through the enactment of the 1953 Health Act, which legislated for the introduction of the 1954 Maternity and Infant Care Scheme. These benchmarks institutionalised the medical model of childbirth and hospital based, obstetric-led care in Ireland which has endured since then. This hyper-medicalisation of birth, emerging in the 1950s and continuing unabated and unchecked until now, has led to birth being: industrialised, commodified and paternalised;

Industrialised to the degree that it is de-personalised and birthing people find themselves on the production-line. A woman is not guaranteed continuity-of-care and is unlikely to be tended to by the same midwife during her labour & birth that she has been relating too during pregnancy, rather is expected to put up with whoever is on shift;

Commodified to the extent that the shackles of capitalism now strangle the birthing person’s autonomy in the trade-off for efficacy and install rigorous time-constraints against which the woman is often pitted as a ‘failure’. Most hospitals operate within a 12-hour window of how long a ‘normal’ labour lasts;

Paternalised in the manner that midwives’ heritage of witnessing births, watching them unfold in all their inglorious mess and staying silent, trusting that the Momma knows how to do this. Instead, women are asked to lie back, so the ‘Doctor’ can have a better view of the cervix, wants to jab and poke and prod their fingers around the vagina in a vain attempt to find out something that they will physically never be able to know firsthand. 

I dispute the perception that Birth is a medical event. I say that treating it within a hospital setting, more often than not, leads to it being treated as pathological, emergency or defective. In reality - it is anything but… Medicalising birth leads to Moms feeling disempowered – rather than feeling as fiercely unstoppable as they are. 

‘Matresence’, a term used to describe the transition into motherhood, coined by anthropologist Dana Raphael in the mid 70s can be indescribably challenging. So as it transpires, that feeling of being invincible - is one that is incredibly useful for it. Robbing Mommas of that feeling is a massive disservice to them.

DISCLAIMER: I don’t have any babies as of yet, but I have had the joy of witnessing births placed quite far apart on the spectrum of possibilities: from freebirth to elective caesarean. Although I do not have the voice of direct-lived experience, I have listened to those who do. Check out our book, which is a long form to this post:  Giving Birth in Ireland.