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In ide out

Women are claiming more control over the way they give birth. but conventional medical techniques can‘t be ruled out. argues Catherine Fellows.

Until l visited a heavily pregnant friend ofmine recently. I thought that birth was the inevitable conclusion of nine months of mind-boggling interior activity. I had no idea that ifshe is to be in control ofthe event. the expectant mother has to work her socks off in more mundane ways. [don’t mean choosing names and buying nappies: I am talking about swatting up on psychoprophylaxis. amniotomy and pethidine: about writing birth plans and attending regular classes.

The ironic thing is that my friend Sarah‘s study was all geared towards making her birth as natural as possible. Since the (ills. women have begun to ask questions about the way their deliveries are handled by the medical profession. Not so long ago women were routinely artificially induced on their ‘due' date. and having been told to lie flat. were subjected to all manner of interference regardless of individual need. They would wake up from a drug-induced nauseous blur to find a creature with a label on its wrist in a cot nearby. and rows ofstitchcs that made sitting down agony for weeks.

'l‘hankfully. today most maternity units accept that birth is not an illness. but a natural process in which a mother should be thoroughly involved mentally as well as physically. with as little outside intervention as possible. This is not only because the birth of her child should be a thrilling and memorable occasion for her. but because ‘alternative' approaches have proved beneficial from a medical point ofview. Much of the pain and many of the complications that can arise in childbirth. are caused by a woman being tense and resistant to her own body a situation that can easily occur ifshe is fearful through ignorance. and in an inhospitable. alien environment. Giving birth is far easier ifyou are uninhibited and in touch with your body. a state that most of us have to learn to achieve. Breathing techniques. yoga and even self-hypnosis have proved highly effective in easing the pain of contractions and allowing woinen to relax their muscles for birth avoiding foetal distress and tearing.

Simply to move around and adopt

different positions during labour can dislodge a foetus that may have become stuck between the pelvic bones. and avoid the need for forceps. or even a Caesarian section. Likewise. lying in a warm bath. or being given a massage by a partner can take the edge offthe pain. with no side effects. whereas a drug could make a woman unable to concentrate and assist in pushing. not to mention to enjoy the imminent arrival. and contribute to post-natal depression.

The Winterton Report on maternity care. released from the House of(‘ommons in March this year. was a major breakthrough for midwives and other campaigners in its recognition that an interventionist. highly technological approach is not best for most uncomplicated deliveries. lt

conceded that in these cases. there

was no evidence to suggest that home births were any more risky and

An interventionist, highly technological approach is not best for most, uncomplicated


that the continuous care of an independent or community midwife offered great advantages over the ‘pot-luck‘ system ofstandard hospital care. where even if the person on duty is sympathetic to the mother‘s wishes. no relationship has been allowed to develop. However. it will take time for the recommendations of the report to be fully implemented. and at present. the woman's right to choose. which it endorses. is severely limited. While ‘alternative birth' is increasingly accepted as a concept. the structures are not yet in place either to inform all women of their options. or to make those options such as home and water births available to them. It is generally true to say that expectant mothers today can get what they want. but only ifthey know what to ask for. and have the confidence to keep pestering until

Worth the wait: Sarah and bliy Mercy

l they get it.

Which takes me back to Sarah. She was strenuously advised against home birth because this was her first baby. Though it would have been her legal right to have been attended at home had she insisted. she agreed to deliver in hospital. determined to have as little intervention as possible. In the event. baby Mercy took 40 hours to arrive. by which time her mother had benefited from practically every medical trick in the book but in no way should this be seen as a failure. Thanks to her preparedness. Sarah still felt she was in control of her birth. She was lucky enough to have a particularly sympathetic midwife. It was not until she had broken the rules and fed Sarah sandwiches. had her in the most imaginative contortions. sent her for baths. and got husband John stroking her nipples in an attempt to stimulate her uterus. that she finally resorted to gas and air. an amniotomy (breaking the waters) and hormone injections to speed things up. By then. the couple had every reason to trust her implicitly when she explained that these were necessary as Sarah was getting very weak. and would otherwise have needed a (‘aesarian Throughout they felt that they knew what was happening to them and why.

Sarah and John‘s case is a reminder that the value of modern medical know-how should never be underestimated. However. thanks to the persistence of midwives such as theirs. it looks as though maternity care is heading towards being one area of the health service where incontrovertible alternative wisdom is taking over the institution.

Useful Contacts .' Association of Radical Midwives; local contact. Helen Shallow, ()3! 228 25 74. National (,‘lzildbirtlz Trust; local contact ( Glasgow ) l’. Hume. lnvergarry Grove. Thorn/[c Bank. 04] 638 22 75; local contact (Edinburgh) Nadine Edwards. Stockbridge Health Centre. 1 India Place. 031225 919/ (9.3()—/l..?()am only).


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