Allie 168Normal Births:  How can we keep things normal?

The last 30 years have seen significant changes in the social context of childbearing and as a consequence midwives, doctors, and women are becoming more dependent on technology in labor and birth.  This has occurred despite recommendations that a greater emphasis should be placed on the social context of childbirth and health.  Midwives believe in the short-term and long-term health and social benefits for mothers, children and families achieved by maximizing normal birth as part of maternal choice.  This is more likely to succeed if birth is placed within a social and family setting.

The following tips are to help midwives enhance the birth experience and improve your job satisfaction too!

Wait and See:  The one single practice most likely to help a woman have a normal birth is patience.  But in order to be able to let natural physiology take its own time, we have to be very confident in our own knowledge and experience.  To do this, we need to be able to acquire more knowledge and experience of normal birth and know when the time is right to take action.

Build her a Nest:  Mammals try to find a warm, secure, dark place to give birth and humans tend to do the same.  But it is the feeling of security and confidence that is important, rather than the environment itself.  If we can find ways to help women feel more private and confident, we will greatly improve the likelihood of having a normal birth.

Get her off the Bed:  Gravity is our greatest aid in giving birth, but for historical and cultural reasons, society generally makes women give birth on their backs.  We need to help women understand and practice alternative positions antenatally, to feel free to be mobile and to try different positions during labor and birth.  Once she is comfortable, try not to move her unless she wants to, or unless the position becomes inadvisable for fetal or maternal reasons.  If a vaginal exam is necessary, could it be done from the back, on a chair, side-lying, in the tub?  Yes!

Justify Intervention:  Technology is wonderful, except when it gets in the way.  What we are beginning to understand is that one technological intervention is likely to lead to further interventions, creating a “cascade” of interventions ending in an abnormal birth.  We need to ask ourselves “Is it really necessary?” and do not do it unless it is indicated.

Listen to her:  Women themselves are the best source of information about what they need.  A medicalized culture of ‘knowing best’ means that we are not good at asking her.  We are also losing our skills in being able to read her non-verbal signals:  body language, gesture, expression, noises, and so on.  What we need to do is get to know her, listen to her, understand her, talk to her and think about how we are contributing to her sense of achievement.

Keep a Diary:  Midwifery can be a bombardment of experiences, making it difficult to remember what happened last week, let alone last year!  However, one of the best sources for learning are our own observations, especially since we can look back at them and realize what we have learned and discovered.  Consequently keeping a diary is one of the best ways of consolidating experience.  Write down what happened today:  how you felt, what you learned.  Then look back over what you wrote last week, last month, last year….

Trust your Intuition:  Intuition is the knowledge that comes from the multitude of perceptions which are too subtle to be noticed:  listen, watch, sniff, touch, pay attention to feelings, and these perceptions begin to build up into a pattern.  With experience and reflection we can understand what these patterns are telling us–picking up and anticipating a woman’s progress, needs, and feelings.

Be A Role Model:  Our behavior influences others–for better or worse!  By practicing the other seven tips listed here, and by being seen practicing them, we set a good example for others to follow.  Midwifery really does need exemplars who can model the practices, behavior and attitudes that facilitate normal birth.  Start being a role model today!

Taken from the “Campaign for Normal Birth”, the Royal College of Midwives. 4/2005

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