While I’ve been involved with growing a skilled birthing population and with hundreds of families developed a set of universal skills to achieve that goal for all types of births, childbirth has never been my political passion. The degradation of our Earth has been my driving concern. Yet these two areas of my personal life have existed far apart until September 12, 2014 … a day I will always remember. While weeding at the Buddhist Temple nearby in my service work, I was listening to several presenters from a 9 week free webinar called Spring of Sustainability 2014. Each week was dedicated to a different aspect of crisis we are facing: vanishing species, air, water, food supplies even the economy. The driving force was to ask these 60+ presenters: ‘What gives you hope?’ And the compelling message was Changing The Dream.
Being blessed by a quirky way of listening, a certain internal question has been always been a motivator for me: ‘What’s wrong with this picture?’ For example, within my beloved political passion for our precious environment as soon as the word ‘sustainability’ came on the scene that question was triggered as it had been many years earlier when childbirth advocates strived to given Women choices in childbirth.
These two presenters made these two statements and suddenly my environmental and childbirth worlds came together. One presenter said this: ‘Make certain that your Plan is commensurate with the size of the Problem’. The other said: ‘We need to consider the Story that has created our world today and change the Story if we want a different one’.
In an Oprah Lightbulb Moment all the work Common Knowledge Trust has done for all these years to grow a skilled birthing population was ‘the Plan is commensurate with the size of the problem’ in childbirth. And we have to change the Story.
Before we jump into childbirth, let’s look at the Environmental/Economic Story that is leading our Earth to what looks like an environmental meltdown. And the environmental woes are directly linked to the Economic Story we’ve been told, told ourselves and lived for the past few generations. This is as true for childbirth as it is for our economic and environmental present. We are where we are because we’ve done what we’ve done and we’ve done that based on the Stories we’re told.
Over the past 150+ years (The Industrial Revolution) we’ve told a Story like this in its most simple form .. “The earth is perpetually abundant. We can take as much as we what we want for as long as we want. The oceans are big enough so we don’t have to worry what we dump into them.” Extend that Story for yourself.
The Economic Story runs like this … Money rules. The Free Market will bring wealth to everyone. Everyone can live as modern people do with as much stuff. The business of business is to make a profit for shareholders. The business of Government is to help business. And the business of individuals is to accumulate as much money and stuff as possible. Extend that Story as well.
We find ourselves where we are now … a polluted Earth … water, air and soil and an Economic system that aggregates money up to a wealthy few and strips it from the rest. Most of us recognise in order to change both of these we must have a new set of Stories to guide us. In many ways we need a Great Renewal. We need to regenerate, redesign, replant, renew and refurbish the way we live on our Earth and the economic structure.
Is there a Plan commensurate with how Big the Problems are? Doesn’t seem to be. But childbirth in modern countries seems to be easier to change.
The Story was … ‘follow your doctor’s orders. Birth is a medical issue and should be treated as such’
It seems as though everyone thought that the PROBLEM in childbirth was a lack of choice. So people geared up politically to institute choices and those choices were all about more ‘natural birth’. In other words, people thought the PROBLEM was a need to have more NATURAL BIRTHS. That makes sense because if Choice is institutionalised and more women choose elective Caesareans or more medical care then those people who saw a problem in childbirth would say ‘hey, wait a minute that’s not what we meant’.
A whole bunch of people have been passing on this Chidlbirth Story … ‘We need more natural births and the way to get that is to give women more choices’. There are more things that go with ‘more choices’ such as: midwifery care, home births, saying no to interventions.
In other words enough people believed the problem in childbirth was not enough natural births and the way to achieve this goal was to put in a BIG PLAN that was equal to the HUGE size of the problem. In many countries around the world, passionate childbirth advocates have been trying to put local, regional and national plans in place to solve this problem … fewer and fewer natural births.
Anyone who knows anything about the politics in childbirth, installing a Choice-based Childbirth Approach has been incredibly challenging and extremely difficult to achieve.
One country has achieved it!
In 1990 New Zealand put in place The Plan that would solve the Childbirth Story of what the PROBLEM was … not enough natural births. This Plan was designed to cover the many complex issues of The PROBLEM. Not enough natural births comes from a steadfast belief that ‘pregnancy and birth are a natural/normal life event’ for women and not an illness.
The Plan to solve the Childbirth Story of not enough natural births by creating a Choice-based solution had two prongs: The System (with whom and where women can birth) and pregnant women (choices and control)
The Systems Prong:
- Midwifery led maternity system
- Direct Entry trained (non-medical midwives versus nurse midwives)
- An autonomous professional organisation of midwives (not part of the Nursing Board)
- An extensive training program designed by the autonomous Midwifery Professional Organization.
- No shared care with obstetricians
- Are primary care and offer Continuity of Care to all expectant parents
- Have a Partnership with Women
- Respect Women’s Choices
- Give women total authority of decision making about the care they want and don’t want
- A midwifery profession that ‘promotes and protects physiological birth’
- Three groups of professional midwives
- Those who work in hospital (paid by the District Health Board)
- Those who are independent (paid by Section 88)
- Those who work in secondary care
The first two groups both have their own clients, can deliver at home or hospital, can continue care when secondary care is needed as the Lead Maternity Carer. The difference between these two are funding sources and scheduled shifts vs independent hours.
The latter group are women who work as midwives and who do not want their own clients and want shift work.
The Women Prong:
- Every woman has a continuity of care midwife
- Every woman has a primary care midwife who is their Lead Maternity Carer.
- Women know what they want and don’t want in their birth and those choices should be respected.
- Women can say no to any type of care they don’t want or don’t believe is essential.
- The role of Women in the Partnership is to create a Birth Plan of what they want and don’t want and what they expect of their Lead Maternity Carer.
Evidence-based maternity care is the foundation of the New Zealand Maternity System.
Let’s go back and refresh our memory. Those with a passion for childbirth saw a huge problem … not enough natural births or more medical births. They saw this as a Big Problem and they set about devising a Plan big enough to address the Big Problem and this has become the Childbirth Story that most expectant families and birth workers work within. This is the Story (history) that has led us to where we are.
The Plan has only been put in place in one country … New Zealand. Pretty much all the elements that were thought to address the Problem with a Plan solution … increase natural birth and decrease medical births were put in place since 1990. We should be able to see if the Childbirth Story we pass on that the solution to having more natural births is to change the System and give Women Choices is working then New Zealand statistics should show an increase in more women choosing natural births and achieving that.
In 1990 when the Plan was put in place the Caesarean rate in New Zealand was 12.9% … higher than the WHO recommendation at the time which was 9%. Globally there had been an increase in Caesareans and medicalised births and concerns by various stakeholders.
By 2012 the Caesarean rate under this Plan was close to 30%!
This has to lead to reflection. If the Childbirth Story we’ve been telling ourselves and others is that the cause of the Problem was a lack of Choice leading to increased medical births which thereby decreased natural births and the Goal was to increase natural births by decreasing medical births by installing a Plan to change the System brought about by increased choice by Women has been right then New Zealand should have experienced a drop in Caesarean rate within the past 25 years.
This leaves us with considering whether the Childbirth Story which put in place a Plan to address the Problem was the right story. And this is where we have to look at a very, very small yet significant set of ‘practice based evidence’ statistics. They are so small as to be perceived of as insignificant. If they had not been collected in New Zealand they would have looked like a personal success for the birth provider or evidence that her clients were very special and self-selecting.
However, they reflect an intentional effort to see whether shifting the Childbirth Story, The Problem, the Goal and The Plan could show significant overall changes.
Childbirth is no different and that’s why that very tiny set of statistics is so important to understand. They reflect (notice the ‘re’ word) a new Childbirth Story that re-evaluated the Problem , that has reconsidered (another ‘re’ word) the Goal and redesigned a new Plan.