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Women's Choices in Birth and Pregnancy.

Posted on 25 February 2012
Women's Choices in Birth and Pregnancy.

Women’s choices in pregnancy and birth

Pregnant women in Britain today have choice about many aspects of their pregnancy and birth. This is fantastic, and is reflected in the statutory code of conduct of The Nursing and Midwifery Council. This code, which all midwives in Britain are bound by, includes the following directions to midwives:

  • You must ensure that you gain consent before you begin any treatment or care
  • You must respect and support people's rights to accept or decline treatment and care
  • You must uphold people's rights to be fully involved in decisions about their care

The National Institute for Clinical Excellence (NICE)’s 2007 Antenatal care Guidelines goes even further, by stating that women should be explicitly made aware that they have the option of accepting or refusing ALL treatments and tests offered to them.

  • As a midwife, I firmly believe that all pregnant women should be aware of this.
  • As a woman, I firmly believe that all pregnant women should be aware of this.

That each and every choice is YOURS to make.

Afterall, no one cares more about your baby and yourself than you, and pregnancy is not an illness. And birth is not a trauma. The female body is, by definition, capable of giving birth. Birth is an incredible thing that, given the chance, the majority of women can experience as a positive.

  • So why are positive birth stories still less common than negative one?
  • And how can we expect pregnant women to be able to make all these choices, when most first time mums have never been pregnant before, and feel nervous about ‘simple’ things such as changing a nappy or feeding a baby!

I believe that a great place to start is by examining the very questions that pregnant women and their partners are likely to be asked nowadays.

Anyone who’s read any book about pregnancy and birth, or talked to a midwife or care provider,  or considered making a birth plan, will know some of these questions.

Often they come in the form of ‘closed’ questions. A closed question is a question which has a particular number of possible answers. Common examples from midwifery include:
Where would you like to have your baby? How do you plan to feed your baby?  Are you happy to have the injection? (a phrase commonly used by some midwives to offer women ‘choice’ regarding the third stage of labour).

I find it strange and confusing that such questions are so commonly used in healthcare settings, because it is widely known that:
a) Closed questions are not effective at finding out someone’s true opinion or wishes
b) Closed questions often involve assumptions about how much the listener knows about the subject
c) When asked to someone who doesn’t have already know a great deal about the subject, closed questions do not assist people in making informed choices

The other kind of questions are open questions, which have no limited set of responses. They have a vast potential of answers – and are much better at actually finding out what people think and want... and feel. Examples of open questions are:
How do you feel about being pregnant? What hopes do you have for the birth? What kind of support do you find helpful?

I suggest that the most appropriate way to think about choices in pregnancy and childbirth is not to start by asking – or answering – closed questions, but to start with these bigger, open questions.
The beauty about this approach is that the answers you give to the bigger questions actually help to work out what are the most appropriate answers for you to the more detailed closed questions.

Thus, instead of asking ‘Where do you plan to have your baby?’, I suggest a more appropriate question is ‘What kind of birth would you like to have?’.
Instead of the question, ‘Does your partner plan to be there at the birth?’, again, I suggest a more appropriate question is ‘What kind of birth would you like to have?’, also ‘What kind of situations do you feel safe in?’  and  ‘In what kind of environment do you feel your partner gives you really great support?’. .  As birth preparation author Pam England wrote:  “Asking your husband to be your sole guide through labour is like asking him to lead the way on a climb of Mount Everest. He may be smart and trustworthy, you may love him, but in the Himalayas you’d both be a lot better off with a Sherpa!”

You may well need to go and learn about what options there are, and the differences that the different options involve, so then you can make a truly informed choice.  I also think a very important question is this - What do we know about what helps and hinders women when giving birth?

In fact, I think this is the most important and helpful question a pregnant woman can ask.  So let’ start with this question.
What do we know about what helps and hinders women when giving birth?

Well, we know this. Birth is a hormonally-regulated process. That means that understanding the roles that the different birth hormones play, and what factors and conditions assist and hinder their production, can help us to understand birth, and what we can do to make birth a positive experience.  As far as we know, the hormone with the greatest potential to assist birth is oxytocin. Oxytocin acts on a woman’s uterus, causing it to contract effectively. It also works on a woman’s emotions, helping her feel calm, focused and soft. It has a vital role in helping a woman feel capable of letting go enough to allow her baby to pass through her birth canal and into the world. 

Oxytocin is also the hormone of the female orgasm.  Sometimes called ‘the love hormone’, it is produced in greatest quantities when we feel safe, when we are surrounded by people we love and trust deeply, when we are able to let go and open up. We produce it when we are in skin to skin contact with loved ones, which is partly why having uninterrupted skin to skin contact for at least an hour after birth is so important. Following a completely unmedicated birth, in the hour following birth a woman’s body is capable of producing oxytocin at levels far above those at any other moment of her life.

It is also sometimes called ‘the shy hormone’, as its production is hindered in any setting in which a woman feels shy, fearful, nervous or not entirely at ease,  or in situations where people are asking you questions which require you to use your logical, thinking brain. It does flow well in contexts where you feel safe, relaxed, happy, warm, snuggly, cosy and calm.
So, instead of asking yourself the question ‘Where do I want to have my baby?’ I suggest you ask yourself this question:
 ‘Where do i most feel safe, relaxed, happy, warm, snuggly, cosy, in control and calm?’ and take it from there.

There is no other question I know of that will assist you more in working out what set up will work best for your birth, as oxytocin really is the driver behind the birth process. There are certainly other relevant questions to ask yourself when pregnant, and not all of them involve the birth itself. Some will involve what support and care are available to you during your pregnancy, and what you yourself would most benefit from.

From my understanding of the role of oxytocin in birth, I personally believe that women benefit enormously from being able to build up a relationship of trust with their midwife, and that the midwife who cares for a woman during pregnancy must also be the midwife attending the birth.  That’s why I choose to work as an independent midwife: where I live, it’s the only way that I can give women the kind of care that I believe to be most beneficial for them and their babies.

In the meantime, I suggest that pregnant couples and women considering pregnancy give time and consideration to finding out the following:
What can I do prior to and during my pregnancy to increase my chances of a healthy pregnancy, birth and postnatal period?

There are certain exercises, foods and herbs that can make a massive difference to a woman’s health and ability to birth her baby – are you doing these? How can you find out about these? (There are some free exercise podcasts on my website, which might serve as a starter).
What services exist in my area enabling me to have skilled people I know and trust present at my birth?

(By ‘skilled people’ I mean people who not only know you well, but are also experts in facilitating the natural process of birth – whilst I wholeheartedly support the presence of fathers at births, my experiences of attending births has led me to believe there is a real need for other support people that the woman knows well and trusts who are knowledgeable and skilled at assisting at births)

Is my midwife able to advise me on such things? If not, who can?

There are so many people, organisations and services now who are out there to help. As a starter, you can look at the links page on my website for some ideas for the different resources out there.

Thanks for reading, and I wish you all the very best on this amazing journey, and in finding the people and ways to surround you with help and support so that you can have the best experience possible for you.  Don’t let what happened to a really good friend of mine happen to you:

‘We went into hospital and the midwife was absolutely lovely. She was so helpful and calm. And then the shift changed and we got a different midwife, and the first thing she said when she walked in the room was ‘When will you be wanting your epidural?’. I didn’t want an epidural; I was doing fine. But after two hours of her going on and on about it, I opted for an epidural. My partner wanted to ask if there was a different midwife available, but we knew it was busy that night, and we didn’t feel confident in asking for a different midwife: what if they’d said no, and then we’d have been stuck with someone we’d complained about?’

There is so much you can do to retain control over this, one of the most important processes in your life. I really encourage you to go out there and find out what you can about how to best support  positive birth experiences. Your baby and yourself are too important to leave to luck.

Feel free to get in touch any time – it’s what I’m here for!

Best,  Julie

www.northernmidwifery.co.uk or 07957 993370 

facebook page: Northern Midwifery
 

1 comment

Independent Midwives Commented on 07 Dec 2012

Booking an independent midwife would give you the best chance of homebirth and give baby more time to turn as you may be able to go further overdue than your local hospital policy allows.

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