From the moment you get a positive pregnancy test, your mind begins racing. These early hours and days are spent trying to organise where you will have your baby and with whom. Irish parenting forums are a testament to this, every new birth club board sees a flurry of activity in the early days of recently pregnant mums 2b. Some are trying to book in to the hospital, midwife, or consultant of their choice. Others are seeking recommendations or inside knowledge of a specific hospital, or consultant, or midwife.

This urgent activity in early pregnancy is a sign that we women understand the importance of having control over who we choose to provide care to us over our maternity care journey. When we take ownership of our needs and care options for pregnancy and birth, we are more likely to have a healthy positive birth experience. How we feel about our care options is important. How we feel about our chosen health care provider is important. How we feel about our experience of pregnancy and birth is important.

What women said . . .

“I contacted the midwife I wanted to book in with before I even tried to get pregnant. Just to introduce myself and get an idea of when she was available. I planned our ttc around her dates. I couldn’t risk losing out on her care due to my due date falling into her holiday time. The moment I got a positive pregnancy test I rang her. She knew about my pregnancy before my husband did. I saw on Rollercoaster only a day later women with similar due dates couldn’t get a midwife as they were already fully booked out.”

And:

“I’m luckier than most in that I have 2 units I can choose from. I chose the one slightly further away as they have a midwife led unit and I didn’t want consultant led care.”

And:

“It was important to me that I had continuity of care so I decided to go private with a consultant. My first baby I did not find my consultant great but overall I like the concept of private care so on my second I had a different consultant and it was a different experience. I really loved that experience and I felt very supported. Once I had this relationship, it was important to me that I have him for the rest of my pregnancies but I knew how quick he booked out, the good ones always do! I found it very stressful in the early days trying to book in with my Obs. My biggest fear would be he was booked out. It never happened, but it was always a source of great fear and stress for me!”

Women are reclaiming birth in Ireland. Everyday AIMSI sees new examples of this. Being proactive in their choices of hospital, care option, health care provider. Hiring a house in order to be in the catchment for DOMINO homebirth, asking for a new health care professional in labour, changing hospitals, challenging policy – women are becoming more proactive in their approach of navigating the system in order to ensure that they get the most out of their maternity care and have a healthy positive birth experience. But for some, the idea of the ‘birth experience’ is still a source of difficulty. This article seeks to dispel the myth that the birth experience doesn’t matter, otherwise known as ‘all that matters is a healthy baby’ and to challenge the Naysayers who peddle it.

What makes a ‘birth experience’?

To dispel the myth of the ‘birth experience’ we need to break this term down and look at the single ingredients which make up the overall experience. The Naysayers have been working very hard to create a negative image for the birth experience. But the reality is that your birth experience is as individual as you are, and is based on many different aspects of your feelings, care, and events during your pregnancy, birth, and post-birth period.

How you are treated during your pregnancy, birth, and after the birth of your baby.
How your baby is treated.
How you feel about your care.
How you were spoken to.
Was your care provider supportive?
Were you treated with dignity and respect?
Were you in unnessessary pain or distress?
Were your rights upheld?
Were your mental and emotional well-being considered?
Was your physical health considered?
Were you consulted?
Were alternatives suggested?
Did you have time to talk to your care provider about what your vision of birth entailed?
Were you encouraged to share your birth preferences with your care provider?
Did your care provider give you all of the information necessary to make informed decisions about your pregnancy, labour and birth?

All these aspects and more make up your “birth experience” and your experience matters!

In some circles, the term ‘Birth Experience’ has been manipulated to mean something that its not. In these circles, there is an insistance that women place too much emphasis on the “experience” of birth. These Naysayers think women who desire a positive birth experience are to be looked down upon. Selfish. Stupid. Spoiled.

The Naysayers will tell you that your rights, your body, your mind, and your experience are of no value; that the birth experience does not matter. That what happens to you in pregnancy, labour, birth does not matter. That as a woman, a mother – YOU do not matter.

The Naysayers are very clever. They sell their message in such a way that you might just second guess yourself. They tell us we are selfish, risky, putting experience over outcome, that we have unrealistic expectations. They sell worthlessness as a virtue, telling us “all that matters is a healthy baby” and “I didn’t care if they cut off both my legs so long as my baby was OK”. Making us wonder…

“Am I selfish for wanting a positive birth experience?”

What women say, and what the Naysayers would have you believe, are two very different things.

All That Matters is a Healthy Mother AND Baby.

We’ve all heard the saying ‘all that matters is a healthy baby’. Think about this for a moment. In a Western, developed nation in Europe, such as Ireland, with good ante-natal care, nutrition, disease control, hygiene, are our standards so low that the only expectation – the only measurment of success we have for childbirth – is a living and healthy baby?

EVERY woman wants a healthy baby.

To date, AIMSI has never had contact with a woman who did not prioritise the health of her baby when making birth choices. However, women also want to be healthy themselves and recognise that not all birth choices, nor all maternity units or individual health care providers, are created equal when it comes to minimising routine interventions which may have adverse affects on the health of mothers AND babies.

There are some amazing midwives and doctors in the Irish maternity system who actively go outside of policy in their individual practice in order to provide women with informed choice, evidence based, and woman-centred care. They are to be applauded!! However, the Irish system overall is largely based on expert obstetric opinion, not evidence based practice. This is unacceptable, but, not highly unusual in practice unfortunately. In fact, one study showed that only one third of the recommendations put forth by the American College of Obstetricians and Gynaecologists in its practice bulletins are based on good and consistent scientific evidence.

“By medicalising birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman’s state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what ‘non-medicalised’ birth is. The entire modern obstetric and neonatological literature is essentially based on observations of ‘medicalised’ birth.” – World Health Organization “Having a Baby in Europe”

For women, it is not a case of prioritising the health of herself over her baby, nor a selfish desire for an idealistic ‘perfect’ birth. Its about looking at all the information and balancing the risks and benefits in order to make the best, most informed decision she can, in order to have a healthy and positive birth for them both.

What the women say. . .

“I hate seeing this term. Its so dismissive! I take great care looking after my health, especially in pregnancy. This doesn’t stop in birth…the choices I make in birth are to try to make sure my baby AND ME are healthy at the end of it all. What good am I to my baby otherwise? And when I mean healthy, I mean mentally and physically healthy. Not enough emphasis is put on how we feel after a birth.”

“my baby is first priority and is delivered safely into the world but not forgetting I am there too.”

“I love my baby and I love myself. I also love my husband and kids, who need me to be me after birth, not a broken shell. I had a birth with a ton of intervention and there was never anything wrong with my baby but more that my body wasn’t performing as they thought it should. That was not a happy nor a healthy time for me, or my baby. I lost the first year of his life as it took me that long to recover. Next baby was different, next baby I was more informed and made choices. I emerged from that birth a whole person, body and soul”

Women Have Unrealistic Expectations

This is one that we hear alot from Naysayers, and sadly, this one often generates from health care professionals and maternity units. The reality is, telling women they have “Unrealistic Expectations” is a cop out for failing to provide women with individualised, evidence based, women-centred care. What our health care professionals should ask themselves is not do women have unrealistic expectations in birth – BUT – why do women seek to birth outside of the standards of practice on offer?

“Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalised birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized.” Marsden Wagner, MD, WHO

There are times when medical issues arise and intervention is required. Dr. Amali Lokugamage, an obsetrician in the UK, has spoken about the importance of maintaining aspects of normal birth during these occasions saying, “In case of emergencies and induction: rescue as many elements of physiological birth as possible” , and also, “let’s humanise high risk status”.

We can be much kinder.

What is ‘evidence based’ practice?

Evidence based practice means that the way your maternity care is provided is based on high-quality research studies – which look at if a practice is safe, harmful, or appears to have no increase either way – combined with clinical expertise, and the desires of the person seeking care, in order to provide the best care possible. Evidence based practice means that the procedures your health care team are providing have been studied carefully and that the results have been reviewed and published. Studies are ranked in terms of the quality. Only the best possible evidence should be used when in practice.

“Avoid basing decisions on untested but strongly held beliefs, what you have done in the past, or on uncritical “benchmarking” of what winners do.” -J. Pfeffer, Top 5 EBMgt Tips.

In Irish maternity care, much of the way we provide care to women is not based on evidence. In fact, a lot of the routine policies in Irish maternity units have been shown to do more harm than good and can increase the chances that you or your baby will have problems. Routine policy also means that as women, our needs, personal history and circumstances, and desires are often not taken into account for some care options and we may find ourselves restricted, not based on evidence, but by a blanket policy to exclude women in certain circumstances.

Over the next 42 weeks, we will be exploring many of these un-evidenced practices and the myths that surround them.

What women said. . .

“as a low risk healthy woman my only choice for care was public obstetric led or private obstetric led. Sure, a midwife attends me in labour but the policy is governed by obstetric practice, not midwife led or normal birth. There isn’t even a bath in the hospital here. I feel so angry when I see the choices on offer other places”

“my first choice would be a MLU, but no MLU here so homebirth is next choice but there is only 1 midwife in my area and she books up quick”

“Well I had one consultant led delivery. Staff were excellent. Baby was number one priority. I however felt dissected, bottom and top ends, when it came to the delivery. 2nd and 3rd labours were mid wife led. Staff amazing. I and my husband felt totally involved and a sense of wholesomeness. I am grateful I could experience the MLU service.”

“I booked into my local unit as a public patient in the hope of flying under the radar and avoiding routine interventions. I find some policies they are willing to over-look, but others they are very fond of, regardless of risk and evidence. I had quite a battle against the CTG and while I finally managed intermittent monitoring, it was not without a fight. How they love their machines!”

“I was shocked to be scheduled for a Caesarean as it was discovered my placenta was too low for a vaginal birth. It was important to me to maintain some evidence based practice and birth preferences into my Caesarean. The consultant agreed to delayed cord cutting and immediate skin to skin. I was also told I could keep my baby in recovery. It helped knowing that I still had some control over points that were important to me.”

AIMS Ireland also asked women: What matters to you in childbirth?
** Warning: not an ‘unrealistic expectation’ in sight**

“Was: that my baby be born breathing (she was very ill)  Is: due 2nd July and would like VBAC and to be listened to and not hear section mentioned to me unless of course I simply have no choice.”

“After giving birth to my first son and feeling like I had no control over it, when I had my second 12 years later I really wanted to feel it was me doing it and not following direction. Really wanted no pain relief/epi offered – if I asked for it fine, but not have it given unless asked. Managed it with my now 20 month old darling son and feel so much better about that birth.”

“For them not to assume i know stuff and explain everything. Also that no one tries to push decisions onto to me when in pain. Finally that they come to me to tell me what is happening rather than for me to go find a midwife to tell me about my care”

“Consideration for my safety as well as baby’s (which should be as a matter of course anyway), respect and dignity, informed choice and consent around birthing methods and care provided”

“Empathy”

“Being listened to by medical staff”

“Being treated as a whole person.”

“I just want to be treated as an individual not a number and for my care to be based on normal birth unless there is a medical reason why this is not possible. I am not saying ‘no intervention’ just if intervention is recommended its intervention for a reason “

Respecting women’s rights and dignity during birth matters

The Naysayers lament that emphasis on informed choice and birth preferences is scaremongering or only serve a specific agenda. The reality is that birthing autonomy and a positive birth experience are closely linked.

Written birth preferences aren’t just a wish list – they stack the odds in favour of mums receiving individualised care rather than production line care, policy led care, and more importantly evidence based care.

While many women have preferences for their needs in birth – the where and how they birth – they also expect to be involved in the decision process of what happens to their body. Women expect to be respected in their choices and informed of changes directly. Women expect to be spoken to with respect and be treated with dignity. Women expect consent to be obtained for tests, interventions, procedures. Failures in any of the above can greatly impact a woman’s experience and well-being, and, not only matter, but are violations of women’s rights.

“Women’s strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers.” – Annie Kennedy & Penny Simkin

What women say. . .

“Why are we so afraid of women being informed in pregnancy? What are we afraid of? Speaks volumes.”

“Being informed and making informed decisions about the care of you and your baby is the key to a positive birth birth experience”

“At one point during my labour the midwives were talking about me over me about what to do. I turned to them and said “I am in the room you know”!”

“I had a brilliant birth experience on my third baby. First was a section for breech, second I was pushed into a VBAC and had complications. On my third I knew I wanted another section and went in early making my case. Obs agreed to the section and a few other aspects that were important to me (husband had skin to skin with baby, etc). It made such a difference being in control and listened to.”

Changing our beliefs – silencing the Naysayers

“When you change the way you view birth, the way you birth will change.” ~Marie Mongan, Hypnobirthing

For many of us, the Naysayers have got into our head. We believe that birth is something which happens to us, as a passenger, rather than being an active participant in our birthing experiences. At 42 weeks, we want to change the way we look at birth in Ireland.

We can do better.
Better in the care we provide.
Better in the care we expect.
We need to reclaim our birth experiences and silence the Naysayers.
We need to believe, truly believe with confidence that our experience in birth matters.

We deserve a healthy and positive birth experience. Our babies deserve a healthy and positive birth experience.

Women need to take ownership of the choices we make and we need to speak out when the system does not provide us with the care we need and deserve.

It is happening. Women are reclaiming birth in Ireland and health care providers are responding. The evidence based, woman-centred, positive healthy care that is already happening in Ireland. We celebrate by sharing our positive stories to support and encourage more health care professionals to provide this type of care and to show women how good things can be – to seek it out – to demand it! Together, we can silence the Naysayers, and reclaim the birth experience for healthier mothers and babies.

Read more about your options in birth choices here

References:

Scientific evidence underlying the American College of Obstetricians and Gynecologists’ practice bulletins.: http://www.ncbi.nlm.nih.gov/pubmed/21826038

Fish can’t see water: the need to humanize birth. Marsden Wagner: http://www.ncbi.nlm.nih.gov/pubmed/11742640