(Head of Policy Research at the National Childbirth Trust)
Response to 'Give Me Hospital Birth Any Day'
Published in the Independent, 30 August 1999, and reprinted here with the author's permission.
Marina Baker (Deliver me from hospitals, 26 August) demonstrated that women who choose a home birth or question the need for a caesarean are not at all airheads who 'want to dance in the meadows with daisies in their hair' (Give me hospital birth any day, 26 August) but normal people who want to weigh up the pros and cons of different ways of giving birth and decide what's right for them and their baby. The trouble is that where you live and who you go to see when you're pregnant, is as likely to determine the choices you're offered as your health and the details of your pregnancy. This is not just an accident of geography, it is the result of different beliefs about birth.
The 'midwifery model' is based on the belief that childbirth is a normal physiological process, for which women's bodies are well designed. Midwives and doctors educated within this framework believe it is important for women to feel confident about their bodies and their ability to give birth. They believe the environment and the things done to women can help labour go smoothly or interrupt the flow.
The 'medical model' is based on the belief that evolution has done childbearing women no favours - the human brain is now big and our pelvises are narrow - and birth is only normal in retrospect. Doctors and midwives who have been educated in this frame of reference tend to relate to pregnant women as cases with the potential for complications, which must be managed to avoid disaster.
We're all influenced to some extent by these beliefs. Alibhai Brown demonstrates which mast her flag is nailed to: 'childbirth is a difficult and dangerous process and we need all the help we can get.' Baker is equally clear, 'If you're uptight, which is often the case in hospital, it slows down your contractions. At home you're more relaxed which really does mean less pain and a faster labour.'
We need the best of both approaches. We should protect and promote normal labour through a greater understanding of the midwifery model and embrace evidence-based medical care when it is needed. Differences in beliefs and their consequences should be actively debated to help us achieve the right balance in the UK. On the face of it women appear to have more choice in childbirth but official statistics show that fewer and fewer women are defined as normal throughout their maternity care. Just 25 years ago, only one in twenty women had their baby by caesarean, now one in six women do, despite improved health and smaller families. Is this really necessary or is our fear of complications producing a different kind of disaster ?
27 August 1999
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