In this blog, I’m going to take you on a bit of a journey. I need you to see the whole picture, so that you can understand exactly where things went wrong and how we are in the situation we are now in. First off, I have to take you back to before the creation of the NHS. To a time when women had their babies at home. Much of my knowledge around this comes from a book by Tina Cassidy, “Birth: A History.” As well as being an absolutely fascinating read, its relevance in understanding how we got into the current situation roars from its pages.

Here in the UK and in America, before we had doctors and obstetricians, and the NHS to manage our births, we had midwives. They may not always have been called midwives, but they were the experienced women in our families and communities. These experienced women might support the birthing woman, telling her when she should push, rest, or walk; offering a massage, a remedy, a change of position, quiet companionship, and much more. The decline of midwives and their experience came quickly in America; however, in the UK, midwives became licensed and fell under the umbrella of the NHS. Birth continued to be in people's homes, or birthing centres and hospitals. Unlike America, midwives still maintained and still do maintain responsibility for normal births, with obstetricians only intervening in what are considered high-risk cases. The advent of pain relief (Twilight Sleep, Morphine, Epidural, etc.) offered hope that the mother didn’t need to suffer the pain of birth. However, this led to more interventions because the mother could no longer feel her contractions. The normalisation of pain relief meant more and more births were taking place in hospitals with obstetric intervention.

When Kate Bauer, the executive director of the National Association of Childbirth Workers in America, asked why epidurals were pushed on mothers, she was told that it made the patient easier to manage. Being easier to manage meant lower  nursing costs. And that, to my mind, is the crux of much of the breakdown of midwives being able to guide mothers gently as they had of old; the breakdown in trust in women's own bodies and confidence in their abilities to birth their baby without intervention. Additionally, where caesarean sections were initially established to assist in the birth of babies where the mother had deformities of the pelvis, usually because of rickets, there was a later movement around  the world of mothers electing to have a ceasarian section rather than going through what they considered the hard work of labour.

From this, we can see how we were born and grew up in a society that normalised the medicalisation of birth. While here in the UK many women want to go on to have a natural birth, the speed at which interventions are freely available, the undermining of mothers' confidence with comments thrown out without thought such as “Are you ready for some pain relief now?”, combined with the lack of midwives on the labour wards and in the community, make it much harder  than it should be.

In my own pregnancy at 40 years old, I was told that I should book in for a C-section because at my age I was at high risk. ‘Geriatric’ was the word used to describe me. I was flabbergasted! High risk of what, I’m still unsure. However, I went away and looked for the studies to confirm if what I was being told was true. I did find one small study which suggested that women over a certain age were at higher risk of problems in birth. However, the study participants were all morbidly obese and the study dated  from the 1960s. I refused to be referred for consultant care and instead demanded to speak to the consultant midwife. I explained to her what I had learnt; she agreed that it was a ridiculous suggestion that I was at higher risk than any other birthing woman, and I told her that I would be birthing my baby at home. We had a good chat about the difference between hospital policy, real evidence and our legal rights, which left me in no doubt that under our current system, if you don’t agree with something you are being told, you should ask for the evidence, studies, or research. You should take the time to look carefully at  the wording. That, of course, is easier when you have time to go away and do the groundwork to fight your corner. On the whole, whilst I got what I wanted and needed, it was upsetting and exhausting having to fight against what felt like an entire system, to move forward with what should have been automatic.

So how does our ability to birth become eroded in the hospital environment? From the point that our labour starts, and we put in a call to the maternity unit, we are effectively on the clock. It is perceived by hospital policy that your birth now needs managing. I’m going to give you a few examples of how we lose control of our birth. However, I caveat this with the fact that there can be many paths to intervention. I will also caveat with: sometimes, intervention is necessary because of medical conditions such as diabetes or gestational diabetes, cholestasis, high blood pressure, foetal distress, or historical complications such as preterm birth and many more. In those cases, the medicalisation of birth is a wondrous thing.

Before I go into the possible paths that lead to medical intervention, I want us to think about how many of us unquestioningly trust what we are told. In my case above, had I not gone away and looked for evidence, I would have accepted what I was told and brokenheartedly scheduled my caesarean section. I may have felt I had failed as a mother for not falling pregnant quickly enough and possibly felt that my miscarriage in between the birth of my children had been another failing because it meant I was pregnant later in life and therefore too old.

Now, let's for a moment look at how mammals give birth and consider  how this aligns with how we, historically, would have birthed before hospitals were an option.

• Mammals often labour between dusk and dawn, including humans. (Note that this is when hospitals are normally staffed the least with the least experienced doctors on shift.)
• Between dusk and dawn, it is generally darker and quieter. This means a mammal’s neocortex, the thinking brain, is less likely to be disturbed. Throughout the night and during a physiological birth, the limbic system is allowed to take over, meaning she can drift off into her own world and really connect with her birth experience. The pituitary gland and hypothalamus, normally suppressed by the neocortex, can now do their thing, releasing the love hormone oxytocin and stimulating uterine contractions as well as many other things. And so, with the neocortex not activated by lights, noise, internal examinations, heart monitors, the midwife’s sing-song voice, the cleaner crashing through the door to empty the bins, etc…etc, the hormones of birth can shine. She can listen to what her body needs to do, and the more relaxed she is, the more she is able to  open and soften for an easier birth.

Because we are not able to listen to our instincts, because our neocortex is switched on, and because we live in  a culture that does not encourage  questioning medical professionals (so  we accept what we are told without asking for evidence, and sometimes hospital policy and protocol undermine our legal rights or what is actually  true), we are, in effect, going into our births (and this is controversial) and handing over our trust, in the case of what should be “normal” births, to a system that doesn’t trust women's bodies to do what we are perfectly designed to do in most cases.

Effectively, birth is looked at as something to be fixed. And where there are problems, isn’t our NHS brilliant for fixing that? However, it is as though women's bodies are considered broken, and this is ultimately because we aren’t given the environment that supports a physiological birth: time, quiet, calm, minimal interference, a kind word, and safety.

Have you noticed in David Attenborough films that when a doe has found a quiet and safe space to birth, if her birth is disturbed by a predator, even if her fawn is in the process of being birthed, everything will stop? Labour will stop, her neocortex is activated, "fight, flight, or fawn" is triggered, and she will do what she must to make her escape. If she is lucky, she will then find another safe space and she will continue with the birth. It is no different for humans. How many times has labour been progressing beautifully at home, and yet, after the stressful journey to hospital, being put on the hospital bed, with a foetal monitor attached and likely an internal examination having taken place, the labour stalls; only for mum to be asked if she would like a little help or to be induced? And there begins  the undermining of her confidence in her own body to be able to birth her baby without intervention. Of course, everything has stopped, she has left her safe space, and her neocortex has been activated. She may still be having contractions; however, the cervix is closing up or stalled in opening, and until she feels relaxed and calm again, they won’t soften and open. And so the energy being used to cope with those contractions is wasted. If she is lucky, she will be assisted by one of those fabulous midwives that gets it… they quietly walk in the room and tell mum how well she is doing. She suggests she turns down the lights, says, "Shall we get off the bed, try moving around a bit, mum?" or "Change position," and tells mum to take a few deep breaths, to see if she can get herself into her calm space. She suggests dad gently holds her and supports her physically if that's what she wants, and maybe it’s putting on some calming music… but like magic, labour starts again, with good progressive contractions, and labour progresses beautifully.

Ina May Gaskin, who wrote Spiritual Midwifery, speaks about her experience with  women on ‘The Farm’ when she takes in birthing women. She discusses  the direct correlation between tension and sphincter muscles. She encourages women to blow out through their lips like a camel, and in doing so, tension in the mouth, jaw, and neck is  released, and consequently so are all the muscles needed to relax and soften to allow the baby through the birth canal. Essentially, the more tension that is held, the harder the work of labour is.

There is so  much more to this concept than I have been able to put here, but I really hope you can see how none of it was your fault. And don’t be disheartened if you think you might like to have a baby in the future and are worried about what to do. I’ll be putting up a blog on things you can do to have the birth that you want, whether  that’s a physiological birth or caesarean section. If you can’t wait for that, why not book an appointment with me, to talk through how you can prepare for your birth?