“Less is more” was the take-home message for me from the 11th International Normal Labour and Birth Conference where professionals from 20 different countries converged from 10–13 October 2016. Professors, midwives, obstetricians, doctors, epigeneticists and more were presenting their latest research on the many different aspects of childbirth.
Medical Intervention in Childbirth: Less is More
In essence, “less is more” refers to medical intervention in childbirth. In low-risk cases, often the less medical intervention, the better the outcome for mum and baby. This is not to suggest that medical assistance should be avoided at all costs – certainly in many cases, obstetric care is not only helpful but it can be life-saving. It’s more about finding the right balance between the mother’s and baby’s needs when it comes to birthing.
But the reality is, often medical intervention is given when the mother would prefer to have a more natural, less invasive pregnancy and birth and a lot of the time women don’t feel like they are given the choice or the support.
I heard studies from Iran, Brazil, the UK, Canada, Norway, USA, New Zealand and of course Australia. It was quite overwhelming in some ways that there has been so much research into this area for so long and although we know what works best for mothers, positive action doesn’t always happen as hospitals and entrenched health systems can be hard arenas to make changes in.
In other countries it’s also a case of who is in charge, their gender and what their agenda is when it comes to childbirth – it’s a murky road to navigate.
Mums Need to Speak Up and Be Heard
The one thing that stood out that EVERYONE mentioned was how important it is to talk to mothers. Ask mums how they’re feeling, what they would like, how they would ideally like their birth to go. And the good news is that organisations are now willing to take more notice of this than ever before.
I got the impression that midwives as a group saw themselves as holistic practitioners, always listening and trying to do what’s best for mothers, but that they often come up again bureaucratic difficulties. Of course this is generalisation. There are always exceptions.
So the time is ripe for women to speak up and say how they truly feel when it comes to childbirth. This, it seems, is how we mums are going to get our needs met. Sure it’s not easy as we are all different, but what research shows is that the majority of women want to try for a natural birth, see how they go and they’d like to be supported doing that. If it doesn’t work out and the need arises for obstetric care, then they are open to that to ensure the health of their baby.
The Role of Midwifery in Reducing Medical Intervention and Caring for Mothers and Babies
Safety is always a big concern. But human beings are so complex and safety means different things to different people. What has been found to work the best in terms of getting the safest outcome is midwifery-led care, where the pregnant lady gets to know her midwife one-on-one throughout the pregnancy and the midwife is there for the labour. This way, a good solid relationship is established and any problems can be picked up and transferred on if necessary to an obstetrician.
Research about the importance of midwifery has existed in numbers for many years now. Trial after trial has proven it; however, I also heard from Dr James Harris from Kings College London that it can take up to 15 years for known solid research to reach the bedside at the hospital.
Potentially this is because it’s hard to hold back when it comes to giving care to birthing mothers. It can seem counterintuitive to think that less could be more – that less intervention could actually give better outcomes. That in low-risk pregnancies, less meddling with the labour process is exactly what’s needed. And that kind of care is delivered best by a midwife.
It’s almost part of our human make-up that more is better. More money is better, right? More food is better? Well, to an extent – but when you reach the tipping point it’s not better anymore. You can’t digest your food or you can’t handle your money.
More more more is not always the answer and it’s the same for technology and birth. Sometimes less is more. It’s all about striking the balance but with childbirth, it’s much tricker terrain to manage.
Different Mums, Different Needs: Defining What’s Right for Your Birth
For each woman, the right balance needs to be found between her individual health situation and the care provider she has chosen.
So it is critical for high-risk women to have their care plan sorted (you may require a scheduled cesarian section). But where possible for the low-risk pregnant woman, letting normal physiological labour start and establish on its own is preferable for the ultimate outcome of happy healthy baby and happy healthy mum.
Letting labour take its natural course is desirable for many reasons:
- To allow the incredible dance of the love hormone oxytocin to start doing its thing. Developing high levels of oxytocin in your body can get your contractions moving beautifully and powerfully as well as start your lactating process. It also helps with the bonding process and the development of that hormone in your baby. It’s an incredible hormone and is the love drug of all of our loving relationships – not just the one between mum and bub. When the synthetic form of oxytocin (syntocin) is used during labour, it down-regulates your own internal production of it, which ultimately can have an impact on how you feel later and the bonding process with your baby.
- The more that normal physiological labour is allowed to just happen, the more your body can get cracking with what it’s supposed to be doing, which is to give birth. An ideal environment for birth includes:
- Dimmed lighting
- A feeling of being safe and not watched
- A feeling of being supported by all those around you
- Limited numbers of people around you
- Feeling private.
… The trouble is that these things can be difficult to attain in our modern medically focused birthing world.
There was fascinating research discussed on the impact of the place of birth – as in the actual environment where birth takes place, and how that played into the way the birth turned out. The effect of environment was statistically significant, much more than you may think.
I could go on and on. I’m super interested and intrigued by all of this because birth is such a central part of the human race. I feel that women need to know as much as possible what all their choices are, understand how their bodies work (to an extent), make an informed choice about what they want and be supported in their decision, whatever that is. That choice could be “I really want to try for a natural birth”, it could be “I’ve read about how my hormones work, I understand what I’m saying yes and no to but I still want an epidural during my birth” or it could be “I feel that based on my situation a c-section is the safest option for me and that’s what has been recommended”. It’s a human rights issue.
I wish I had been able to get all the incredible references down! I do plan to go and find them so I can get back to you at a later day, but for now I just wanted to pass on the general vibe of what I was learning about medical intervention in childbirth, natural birth and labour, listening to mothers and the role of midwifery at this wonderful conference.
I plan to write more on this topic and wade through all of the research I was listening to. If you’re interested in research I’d love to hear from you as sometimes I think it’s possibly boring to other mums whereas I find it just fascinating.
At the Red Tent we support women all the time throughout their pregnancy in the lead-up to their birth. We thoroughly enjoy it. One of my first questions to clients is “how are you feeling about your birth?” This gives me a good idea of where you’re coming from so I can give you any information that may be relevant to support you through one of the most exciting and full-on experiences of a woman’s life.