The Ministry of Maternity Truth was patting itself on the back this week.
According to a report in the The Independent, University Hospital’s Bristol NHS Trust was brought to book for issuing dangerous advice to women, ‘on helping themselves to a normal birth.’
To the paper’s consternation, the advice included “stay at home as long as you can” and “you’re less likely to need medical interventions in the form of drugs to speed up your labour, or to help you give birth when you go to hospital.” The leaflet added that mothers should “try to avoid an epidural” and “have a home birth”. It also advised them to “avoid having your labour induced unless there’s a good reason for it”.
Who exactly discovered the ‘disinformation’ isn’t specified. But in full support of the criticism, The Independent was quick to cork the errant maternity tips by phoning the Trust to question them about it. Following the call, the hospital’s ‘outdated’ childbirth advice was deleted from its website.
The distortions in this piece are dizzying. Yet how compelling it sounds. Especially with the conflating but very unexplained connection that’s made between physiological birth and the maternity care scandals of Morecombe Bay and Shrewbury and Telford Hospital Trusts. It silences debate. It closes thinking down. But thinking is exactly what we need to do.
First of all, birth for low risk women is very safe. This isn’t opinion. It’s not wimmin-wash. It’s ordinary biology. What evidence shows.
Examine the Birthplace study, look to the World Health Organisation, call the Royal College of Obstetricians. Find a consultant and ask them yourself: ‘Is birth dangerous by default? Is labour likely to harm me and my baby?’ They will say no.
For forty years, and decades before that, repeated studies have reached a consistent conclusion and clear clinical consensus: for a healthy woman with a well grown baby, the physiological process of labour comes with very little risk.
In an uncomplicated pregnancy, birth is generally so safe and certain by nature that last year’s meta-analysis by McMaster University (data from 21 studies since 1990 comparing 500,000 intended home and 500,000 intended hospital birth outcomes in eight countries) confirmed that ‘low risk pregnant women who intend to give birth at home have no increased chance of the baby's perinatal or neonatal death compared to other low risk women who intend to give birth in a hospital.’
The key here is low-risk – that is the clincher. But according to the World Health Organisation, 70-80% of women world wide will be. Further, here in the UK, all pregnant women receive free, high quality, antenatal assessment from trained midwives and sonographers to confirm whether they and their baby are in good, labour-equipped health - or otherwise, and offered fitting care accordingly.
Which brings us back to the question of the Bristol Trust’s advice – guidance the article says is informed by ‘dangerous ideology’ and an irresponsible ‘natural birth’ agenda.
Really? Given birth is ‘generally very safe’ (NICE); given the advice was directed at women whose labour was starting at home, meaning their pregnancies were unlikely to be complex or under consultant care, isn’t the advice on how to help labour actually reasonable and appropriate – if anything consonant with the World Health Organisation’s latest research-based guideline on intrapartum care? :
‘Whilst much is known about the clinical management of labour and childbirth, less attention is paid to what, beyond clinical interventions, needs to be done to make women feel safe, comfortable and positive about the experience. The growing knowledge on how to initiate, accelerate, terminate, regulate, or monitor the physiological process of labour and childbirth has led to an increasing medicalization of the process. It is now being understood that this approach may undermine a woman’s own capability in giving birth and could negatively impact her experience of what should normally be a positive, life-changing experience.’
Women are being misled by a natural birth agenda is the claim. But isn’t it the other way around? The cultural establishment seems to throw out any old opinion it fancies to frame the national maternity story, despite the facts being a google-click away, and institutions everywhere come to heel. But isn’t that a bit creepy? A little gaslight-ish even. How and why was it wrong for the Trust to advise “avoid having your labour induced unless there’s a good reason for it” for example? Do they mean women should be induced for no reason?
Research and evidence confirm that interventions like epidural and induction, just are more likely to create unnecessary complications in birth; that birth at home just is a very appropriate choice for women with uncomplicated pregnancies; and staying at home until labour is strong and established, the early phase of birth that doesn’t routinely require close monitoring, is standard policy. If the point when a mother heads for hospital was so clinical or critical a decision that she wasn’t in a position herself to judge, why aren’t ambulances sent as standard to every labouring woman in the land?
And what about choice in all this? Although many in the media are of the opinion that women are cornered by scheming midwives into wanting a natural birth, the NHS National Maternity Review of 2016, Better Births confirmed that a whopping seventy five per cent of women say that they would like to give birth without medical intervention.
Some will absolutely require planned obstretic care. And a proportion more will require care unexpectedly. But by and large, the majority of us continue to feel that keeping birth as low-tech and on physiological track as possible is probably a good thing given it offers the highest chance of mother and baby being in good shape.
That is why, despite the age of the safe Caesarean, women still want to give birth vaginally in huge numbers; it’s why it’s a Trust’s duty of care to support women to that end.
As uncomfortable and unsure as our society seems to be with the idea, pregnancy is not a condition. Birth is not an illness. The human body has the hardware to grow a baby spontaneously, and a concomitant ability to get the baby out. Yet still the stories flow, inaccurate, hysterical, exaggerating the dangers of birth and the female body’s incompetence when faced with it.
What if there were similar stories in the press about men, constant and overplayed warnings about malfunctioning male physiology? ‘NHS Trust criticised for encouraging natural morning erections without the assistance of metal instruments. Men warned of the dangers of their testes exploding should they ejaculate unattended?
It seems like new truths can be planted like seeds these days, folk panics cultivated out of nowhere.
But I’m not worried. Because parents’ instincts are drawn like magnets to facts.
Last week, a father with a face full of fear said to me:
'Birth is chaotic, it's messy. It’s distressing and its dangerous ….of COURSE we need to be in hospital.‘
'Have you been at a birth?' I asked? And he stopped short. Shook his head.
'So where did you get those ideas?’ I asked.
Two hours, a packet of biscuits and a proper biology lesson later, he was planning where to put up the pool.