The World Health Organisation Gets With The Programme For Labour And Birth Guidelines.

“Tell me about the birth!”  was a frequent request after the birth of my first child.  As with most things motherhood-related the glossy version I told didn’t really match the reality. What really happened was that I arrived at hospital 2cm dilated, convinced I was actually about to have the baby, and was offered pethidine to presumably quieten down the hysterical woman who had barely even started her labour.  Knowing nothing about the drug, but not being particularly stoical, I leapt at the chance, hitched up my gown and was duly injected. I promptly fell into a drug-induced sleep reminiscent of wilder hallucogenic times, whilst my husband caught up on some sleep of his own. 

Coming round I was 9cm dilated and in the eye of the storm.  Cue ensuing panic, bawling pain, and no idea what was going on.  Nobody attempted to reassure me, it was a busy London hospital, and the midwives were overstretched.  It was impersonal at best and hurt like hell.  Without being asked I was given an episiotomy, (I’m still not sure why) and then the baby was whisked away from me for checks before being put on my skin.  Nobody was talking to us, and we didn’t feel empowered to ask.  They all looked so, well, busy.  However, it was pretty quick for a first birth (under 9 hours) and, by all accounts, pretty straightforward.  I didn’t feel that I should, or indeed, could complain, not when horror stories of 3 day labours abounded. 

Quite soon after my son was born visiting hours were over and my husband was asked to leave.  Knowing no better we complied with this request and I was left alone with my new baby.  The ward was full so I was put somewhere, all alone, with a brand new baby, terrified and without the faintest clue what to do.  I stared at this helpless little creature next to me and felt overwhelmed and totally discombobulated.  There was no almighty outpouring of love (thankfully this came later) and I was left asking myself, “Why don’t I feel anything?”

A good birth goes way beyond having a healthy baby.  The World Health Organisation has taken steps to address this issue in its newly released document, “Intrapartum Care For A Positive Childbirth Experience”.  It’s a weighty 212 pages, which may not make ideal bedtime reading, but the main gist of the document is that childbirth is a normal physiological process and it advises all health care providers to recognise there are variations and have the patience to let the process unfold naturally.

There are many physical and emotional reasons why starting off parenting a newborn benefits from a healthy, positive birth.  The correlation between stress incontinence and medical ‘assistance’ with the birthing process is strikingly high.   The WHO states that, “The increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience.”

The document includes 56 recommendations that take a human rights approach to childbirth.  Some of these recommendations include:

·      Midwife-led continuity of care models, in which a known midwife or small group of known midwives supports a woman throughout her pregnancy, birth and post-natal care, are recommended for pregnant women in settings with well-functioning midwifery programmes.  Well, there’s a slice of common good-sense if ever I’ve seen one.  I wish they’d added a PS.  ESPEICALLY for first time mums. 

·      A minimum cervical dilation rate of 1cm/hour throughout active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labour progression.  A slower than 1cm/hour cervical dilation rate alone should not be a routine indication for obstetric intervention.  Hallelujah!  All women are different!  Our bodies respond differently. There isn’t a magic formula that suits us all.

·      Encouraging women to be mobile and adopt an upright position during labour is recommended if the woman is low risk.  Is it possible to edit every film or TV programme ever made with a birthing scene of the actress lying on her back, actually impeding her baby’s delivery to this world? 

·      Women in the expulsive phase of the second stage of labour should be encouraged and supported to follow their own urge to push. No way.  Somebody has realised that the fundamental biological urge to bear down is more likely to be right than the incredibly well-qualified and well-intentioned doctor watching and saying, “Hold it, hold it, ok, now you can go….”

·      The mother and baby should not be separated and should stay in the same room 24 hours a day.  Yes, yes and yes. 

It seems madness to have to now recommend ‘doing nothing’ unless needed, but that is exactly what this document is saying.  The WHO should be commended for clearly stating what good maternity care looks like and I hope the gospel spreads far and wide. 

To conclude, each and every birth is different, but should be a positive and life-changing experience.  Currently this is not the case for all those who give birth.  On a positive note, my second birth, in a different but equally busy London hospital, was a delight.  I was kept well informed by the same midwife throughout, there were relaxation techniques made available, no sense of panic or urgency and everything was calm and measured.  I felt safe, secure and in control. 

As for the third, well he arrived so quickly I barely had time to register what was going on, although the immortal line from my (very gay) midwife will stay with me for ever.  He urged me to have some gas and air, saying, “Suck on this darling, it’ll be the most fun you’ve had since 1999.”  How did he know?!

To any pregnant ladies out there, trust your instincts.  Block out any bad birthing stories, and find some that are truly positive and life-enhancing.  Surround yourself with supportive friends and relatives who will empower you.  Have some birthing classes if you’re scared.  Watch One Born Every Minute and see how differently women give birth.  There’s no right or wrong way, just your way.  Remember, your baby is working just as hard as you to get out.  It’s a team effort, both of you working together, not against each other.  Drop your shoulders.  Remove your tongue from the roof of your mouth.  Breathe.  I wish you all the luck in the world.