Wednesday, July 29, 2009

'Don't tell women how to give birth' !

Cathy Warwick
Cathy Warwick
General Secretary, Royal College of Midwives

Newborn baby
Debate rages over how babies should be born

How a woman gives birth provokes strong views, with impassioned arguments for normal births, and for Caesareans.

But in this week's Scrubbing Up health column, Cathy Warwick of the RCM says the most important thing is for women to be able to choose.

The use of technology in birth - such as the development of epidurals for pain relief and Caesarean sections - has long been a cauldron into which divisive and conflicting issues and opinions have been poured.

This is particularly relevant at the moment.

A recent UK study which looked at how and why women chose the birth they did found mothers-to-be preferred to keep an open mind and, as their pregnancy progressed, became increasingly confident in the advice they received from health professionals.

They tended to be more open-minded regarding choice of type of birth at the end of pregnancy.

It seems important to remember that since the 1970s, there has always been a vocal and active lobby against home birth.

Thirty years ago it was virtually impossible to have one in this country, and women and many midwives and doctors have fought actively and hard to challenge this and give women choice.

Women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it

When the National Institute for health and Clinical Excellence (NICE) was considering guidance on giving birth in the NHS, the large number of midwives who sent in comments were only too aware of how the home birth option was once again nearly lost.

They had to challenge the appropriateness and interpretation of the evidence being considered on the safety of place of birth.

There is a fundamental question needing to be asked here; why do some doctors and midwives devalue the choice of home birth, despite the lack of evidence against it?

The continued polemic around it also remains uncomfortable.

It has been suggested that many midwives see childbirth as an essential "rite of passage".

The implication is that this is an illogical position in a technological age.

We know however that childbirth is a life-changing experience for all women however it happens, and midwives' and women's groups have worked hard to support the joy of this from every viewpoint.

Water birth
Water births are increasingly popular

We also know that women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it.

The charge that there is a "macho bullying group" directing women towards a less interventionist birth is simply not based on evidence.

What there are though, are midwives fighting for real and informed choice for women.

Labelling midwives and women as members of two groups - either "pro" or "anti" technology - is also not helpful.

Women often change their views on birth during pregnancy, and there are many factors that influence that change.

What we do know is what women want at all times, is good and unbiased information from the health professionals caring for them, so that they can make the appropriate choice about how technology can help them.

One high-profile obstetrician recently relating the birth experience to the advances in agriculture, transport and energy production reminding us alarmingly of the language previously used in the "active management of labour", when women's bodies were viewed as machines that were frequently "inefficient" and in need of acceleration.

It has seemed that the health professionals that care for women today had largely moved on from this strange and controlling discourse, and it's disappointing this may not be the case.

The bottom line here is that what women want is to be able to make a real choice, for the health service to offer them that choice, and for that choice to be based on having all the information needed to make an informed decision.




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