Normal Birth
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www.birthchoices.co.uk

What is Normal Birth?
The World Health Organisation definition of normal birth is:
"Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously [without help] in the vertex position [head down] between 37 and 42 completed weeks of pregnancy. After birth mother and baby are in good condition."

(World Health Organisation (1997) Care in Normal Birth WHO WHO/FRH/MSM/96.24)


The Association of Improvements in Maternity Services (AIMS) has extended this definition to exclude:
“..normal birth does not include one where labour has been induced or accelerated by drugs, or has involved artificial membrane rupture, epidural anaesthesia or episiotomy. This definition may also be equated with natural birth - birth without interference. It may also be called physiological birth or straightforward vaginal birth”.

(Beech, B.A. (1997) Normal Birth - Does it exist? AIMS Journal. Vol. 9 No 2 p4-8)
See also this fantastic AIMS article about Normal Birth


The BirthChoices definition is a basic starting point of physiological normal/natural childbirth. We have deliberately avoided a purely physiological definition because we believe that ‘normal’ birth has as much to do with the mother's emotions, choices and beliefs as it does with her physiology and that it means more than just the baby being born via the vagina.

It is a well researched and known fact that the emotional and social aspects of childbirth can and do impact on not only the lived experience of birth but also the progress of physiological birth - think of the women you know that have regular contractions that disappear as soon as they reach hospital. This definition, or the use of the word 'normal', should not be confused with what is common i.e. interventions such as routine induction for ‘post maturity’ that are currently accepted as normal birth in the UK.

Therefore, we would like to differentiate between the use of the term ‘normal birth’ and the ‘common experience’ of childbirth.

The BirthChoices definition of normal birth is:
“Normal birth is when the mothers uterus spontaneously contracts, her cervix dilates, her baby moves through her pelvis and she gives birth,
she expels her placenta and breastfeeds her baby. She does this without any ritual or routine interference, disruption or distress caused by others. The place of birth is chosen by her and her instinctive movements are unrestricted and respected. This happens at the natural, unprovoked end of her pregnancy as part of a normal, physiological, psychological and social life process”.

(McNamara, C. (2008) Normal Birth –www.birthchoices.co.uk)


What is commonly accepted as 'Normal' during Childbirth?

Increasingly, people are referring to 'having a normal birth' without realising they're actually referring to a birth that involved a high degree of intervention. We believe that there is a difference between having a vaginal birth and having a normal birth. The common experience of a so-called ‘normal’ birth often includes the following:

  • Induction
  • Being observed / minimal privacy
  • Continuous monitoring
  • Restriction of food and fluids
  • Artificial membrane rupture
  • Being forced to give Birth lying on the back
  • Hospital Birth
  • Routine Vaginal examinations
  • Arbitrary time limits
  • Early cord clamping
  • Oxytocic drugs for the third stage
  • Being instructed on how and when to push
  • Having labour and birth ‘managed’ by others

Why is NormaL Birth good for you & your baby?

According to research, when a woman's hormones have led the birth of her baby (not artificial hormones or an arbitrary time-limit)
a normal birth promotes:

  • a faster postnatal recovery & less postnatal pain
  • An increase in self-esteem
  • Better bonding between mother & baby
  • A reduced chance of postnatal depression

Obstetrician Michel Odent has also written these fantastic research-based articles which explore the alarming effects of the increasing medicalisation of birth:

The Long Term Consequences of How we are Born

After the MMR Fuss: Autism from a Primal Health Perspective

Comments on the Concomitant Epidemics of Caesareans and Childhood Asthma

"Normal" Birth Traditions in the UK - article

When the woman is nearing the end of her pregnancy she will be advised that her body is no longer a safe place for her baby to remain and that with each passing day it becomes a more dangerous and life threatening environment for her baby. This is because doctors ‘know’ that at the end of pregnancy placentas can cause the death of babies without warning by suddenly ‘packing up’ or by being ‘too old’.

To remove the impending danger to her child she will be given a date (that is convenient for her hospital) to be forced to labour, the date may be changed at any time depending on whether it is a public holiday or if the hospital is very busy. On this day she will be taken by her birth partner to a very large building filled with dozens of other pregnant, labouring and post natal women. She will be shown into a room with perhaps four or five other mothers at various stages of this ‘life saving’ process. She may or may not continue to be supported/accompanied by her partner, friend or family depending on the time of day and whether the care givers have allowed them to come in or stay.

The mother will not have met her care provider before, so may feel somewhat anxious and afraid. However her birth partner will be able to console and comfort her (during visiting hours) so this should not be a problem. Once the woman has been admitted to this public place she will be required to lay down on a bed so that an electronic monitor can assure the staff that the baby is healthy. She will also need to change into night clothes, a hospital gown or clothes that are easy to remove, and then remove her underwear - this is to allow staff easy access to her vagina at all times.

Once the staff are reassured that the mother's body has not failed or caused her baby a serious problem already and that they judge the baby to be healthy enough to withstand the powerful drugs and other interventions they have planned to use (they can tell this from looking at the machine attached to the woman) one of the staff will then insert their fingers into the woman’s vagina to locate her cervix.

This may be very uncomfortable for the woman but she knows that it is necessary to save her baby from the likely death that late pregnancy can provoke (she has been very well informed of this many times during her pregnancy), so she remains very patient while this procedure is carried out. The caregiver will tell the mother if she can reach the cervix enough she will use a long plastic instrument with a hook on the end to tear the protective membrane around the baby. Hopefully this will cause the mother to start to contract, but if not, within an hour or two the mother will again be moved to another unfamiliar room, to be cared for by someone else that she has not met before, for the administration of very powerful drugs into her veins that will force her uterus to contract frequently and strongly-the rate of this will be decided by the staff.

Throughout this time the woman will have her mobility severely restricted due to the attached monitor that is keeping her baby safe by recording its heart rate - which may be compromised by the drugs given to the mother- for the staff.

 
If during the initial examination of the woman’s vagina and cervix the caregiver determines that the woman’s cervix is not ‘ripe enough’ to tear the protective membrane open, then a pessary of another powerful drug will be inserted into the vagina in the hope of ‘ripening’ the cervix for labour to begin or to make enough room to tear the membrane open. Again the woman will have her mobility restricted. This ritual will be repeated six hours later if the woman has failed to labour. It may also be repeated again the next day.

Once the mother is in labour she will then be cared for by one caregiver through to the birth - at least until it is time for them to go home/have a break etc..when another caregiver will take over. Her partner will be allowed to stay with her during this time. It is common to not allow other family members or supporters - even at the mother's pleaded request - to enter the birth room as they could get in the way of the staff.

Birth rooms in the west are designed to enable the staff to act quickly in the frequent emergencies that occur in these very large centres. There is usually a large electronic or mechanical bed that the woman remains on to labour and birth-this is essential because the attached machine can not always record the heart rate of the baby if the mother is allowed to mobilise freely. It is also essential that staff are able to see the mothers vagina and perineum at the point of birth in case they need/want to perform a large cut to the vagina called an episiotomy.

There is usually very little or no other furniture in the room other than a chair for the partner to sit on, and the necessary emergency equipment. The caregivers generally keep the large overhead lights on so that they can constantly watch the mother for signs that her body is failing to perform as the paperwork or Dr in another room, suggests it should. If the woman becomes distressed, noisy or finds coping under these difficult circumstances, she can be given further drugs to paralyse her from the waist down - this is very common and a normal part of the birth ritual in these circumstances.

Every two to four hours the caregiver will again examine the mother's cervix - if there is any doubt as to the findings, or the cervix is not dilating at 1cm an hour - then another caregiver or doctor that the mother may or may not have met before, will be asked to also examine the woman’s cervix. It may take two or three people to examine the cervix to really establish the information they want. If she is lucky the mother will have dilated at the required rate to allow the labour to continue without further intervention.

Once the staff have decided that the mothers cervix is fully dilated and she is ‘allowed ‘to push they will keep her on her back on a high bed .

If she does not make good/quick or enough effort when instructed to then the staff may strap her legs in special supports called lithotomy poles, this allows everyone present an unobstructed view of the woman’s genitals as she is forced to bear down on command - caregivers often shout loudly at the woman at this time in an effort to encourage her.
  
This may take some time and again the staff will determine how long they will allow or direct the woman to push before they use a suction pump with a special cup that is attached to the baby’s head which allows them to pull baby out by force.

Should this fail they can also try to use large metal instruments called forceps, that are placed around the baby’s head while still in the vagina, to pull it out. A large cut to the vagina is necessary in this case-but is easily repaired by the Dr so is not really a problem to the mother. In some unfortunate circumstances the mothers’ body resists all attempts to force the labour or birth and the only solution to save the baby is for it to be extracted abdominally in surgery.

Once the baby is born it may be handed to one or other of the attending caregivers for them to make sure that the mother has not damaged the baby during the birth. If she is lucky the caregivers will put the baby onto the mothers chest while they clamp and cut the cord quickly before ‘checking it’.

Once they have established that the baby is well they will then allow the mother to hold the baby until the staff are ready to weigh, dress and assess the baby for signs of abnormality. Once the caregiver has pulled the placenta out and stitched up the cut to the vagina the mother will then be allowed to try to breastfeed her baby.

After another hour or two the mother will be moved again to a large room full of many other new birthed mothers with their babies while her partner is sent away-this isolation from familial support lets the staff ignore/direct the mother as necessary, depending on what they feel she needs, without interruption. After a day or two the staff will decide if the mother can take the baby home, but she must be patient waiting for them to decide as they have a lot of paperwork to do and that is their priority at that time.

The mother and her partner are usually very grateful to the staff for working so hard to force her dangerously inefficient body to labour and so saving the life of her child. For many thousands of women in the UK each year this is the reality of their ‘normal birth’ and is the accepted modern traditions of birth.


McNamara.C. (2007) "Birth Traditions in the UK". www.birthchoices.co.uk Normal birth 2008