The Magic Circle: Birthing Better for Everyone through Skills and Choice
Introduction:
Common Knowledge Trust (CKT) ,centered in Nelson and in the process of reaching out globally through our website and online birthing skills courses, was created to spread important “common knowledge” to all humanity. Our Trust supports the concept and philosophy that giving birth is an activity and that all expectant families should have the opportunity to become skilled birthing mothers and fathers/others to accomplish that activity with the best outcomes, both subjectively and objectively.
I have been involved in the effort to spread birthing skills around the world since these skills were developed by hundreds of families in the 1970’s in the USA. These families were mostly residents of faith-based communities, and the mothers were almost all what would be described as “high-risk.” The birthing skills they developed were tested and found to be effective in many varied birth environments.
These families, not believing in birth control, needed skills in order to ensure the survival of the mothers who were birthing multiple children. Probably there is no better test of the viability of the birthing skills they discovered than their own success in birthing better. I immigrated to NZ in 1995, encouraged by the new maternity system led by midwives, hoping that the birthing skills would be embraced and would assist the births of many thousands of NZ women.
A philosophy of natural birth had taken hold, however, and while some women were able to choose not to have medical interventions, over the ensuing years more and more medical intervention has been necessary. Needless to say, midwives did not embrace the birthing skills that the high-risk families had developed twenty years previous, with one exception: midwife Andrea Vincent. She, at first reluctantly, and then with increasing enthusiasm, has required her families to learn the birthing skills of CKT.
For fifteen years she has been keeping records of her birthing families, in comparison to a local hospital, and those statistics are in the Appendix at the end of this article. Her results speak for themselves: skills work, making births safer and saving the government huge amounts of money in neonatal medical care. Andrea has single-handedly demonstrated the value of having families self-learn birthing skills and lessen the burden of responsibility on the midwife and/or medical carers.
I will discuss the history of NZ maternal care later in this article, and how resistance to skills has led to a new tipping point in our wonderful midwife-led national maternity health care system.
We have the opportunity to create the most mother/baby-friendly maternity health care system on the planet. In our short national history, we have already come close to that, only to have the goal tantalizingly withdrawn by unexpected results of supposedly enlightened policies.
Now, with c-section rates sky-rocketing under midwifery care, to equal rates in other countries dominated by OB/Gyn care, and a new study from the University of Otago suggesting poorer outcomes for babies born under midwifery care than under OB care, questions are being raised as to the competency of midwives to care for and properly assess risks to birthing women.
Recent magazine articles, in North/ South (Oct.2016), The Listener, October 8-14 2016, and The Spin-off, Oct. 8, 2016, have posed the question whether midwifery care is as safe as it could be, and whether planned C-section should be routinely offered to older mothers.
Where we are now
“The birth of a child is the most important event in life for most Kiwis…” commented Jonathan Coleman, Minister of Health, at the 2016 NZCOM Conference. Everyone knows that birth and death are the most significant events in people’s lives without a doubt.
Minister Coleman’s statement is profound. He’s nailed it, but how does this statement align with the issues facing childbirth today? A “most important event” can be either negative or positive. It can never be neutral. We have to ask this question: Who is responsible to make every effort to ensure that this most important event is as positive as possible, while reducing or preventing some of the negative?
Obstetricians believe a healthy baby and mother is what makes the most positive impact on this most important event. OBs use standards of care as well as high-level skills to achieve that goal. Do OBs care whether women “feel positive” about this most important event? OBs would claim that they do. Midwives and natural birth advocates might have a different opinion. We don’t know what most women feel about OBs here in NZ.
Midwives also believe a healthy baby and mother is what makes the most positive impact on this most important event. Midwives use recognized standards of care to maintain the health and wellbeing of both mother and baby. They care very much about a woman’s subjective experience. Midwives established a Partnership Model that supports women’s choices as the foundation to achieve a positive subjective experience. Midwives also have a clearly stated “non-medical” approach to birth as a pathway toward both these goals: a healthy mother and baby, and a positive subjective experience for both mother and baby.
Families certainly believe a healthy mother and baby is what makes the most positive impact on this most important event. And every woman wants a positive subjective experience for herself and her baby. Presently families use the pathway of “choice/Birth plans,” expecting to achieve the most positive subjective experience possible.
It is the aim of this article to demonstrate that something else is needed in the equation of choice equals positive subjective experience.
Choice means what you want, but is it fair to expect midwives to make those choices happen? In a Partnership, each partner must have responsibilities. The family, after choosing the birth they want, and the type of care they desire, must take personal responsibility for preparing to make their choices a reality.
The mother is the most important person in the birth of her child – she has the freedom to manage her own behaviors, whether constructive or destructive to her and her baby’s wellbeing. It is essential common knowledge, for all peoples and all births, that every mother knows and practices behaviors that will help her birth her child.
A woman armed with self-knowledge is empowered to assess, adjust, and advance the progress of her own labor to the benefit of herself and her baby. The subjective experience of birth is entirely individual, dependent upon each woman’s unique consciousness and choices of behavior during labor and birth. Thus no one else but the mother herself can make her own experience positive or negative, depending upon her own self-assessment of how she managed herself, and her attitude towards the birth activity as a whole.
The mother alone is responsible for making the experience positive, and mothers who have had extremely medicalized, surgically invasive births have triumphed because of their positive attitudes towards what happened, welcoming their babies with as much joy as the mothers who have birthed without any medical interventions at all. And some mothers who have had few or no medical interventions have hated their birth experience and felt tortured throughout their labor, certain that they never want to birth again.
Currently, no one is mentioning the importance of families’ responsibility to make the most important event of birth as positive as possible, as well as reduce or prevent some of the negative. Only the care providers are made responsible, and they cannot possibly shoulder all the responsibility for a “normal” and “natural” activity that occurs within the sanctity of another person’s body. Medical science can serve greatly; midwifery skills and psychological support can also assist the process marvelously; but in the final analysis, it is the mother herself who determines how the birth goes, and it is her consciousness and attitude that determines the quality of the experience.