BirthingBetter Three Childbirth Concepts: Unknown, Skills, Choice

The Broad Understanding of The 3 Childbirth Concepts Based On The 3 Global Childbirth Goals:

1. Live Mother (and in modern societies also a live baby)
2. Suffering in childbirth
3. Recovery of mother and baby short and long term

Bringing the childbirth Concepts and Goals together:

• Never know … true
  •  Anything that can happen, could happen.
    • Systems get built around those ideas
  • Nothing you can do about it.
  • Traditional cultures thru out time … do/don’t
    • Why? #1 Goal …. live mother
    • Accept #2’ … suffering
    • Post natal do-don’t trying to deal with #3 .. recovery
  • After WW2 modern world/modern maternity care
    • Response to traditional living
      • Decrease #1 and in 1980s decrease baby death
      • Medical pain relief
      • Recovery ignored
    • Several things happened
      • Beginning of Natural Birth Movement
      • Rise of a response to ‘therefore there’s nothing you can do about it’ by bringing skills to

The crux of the gaps in NZ midwifery care as well as the global gaps in childbirth come from three simple words: Normal, Natural, Physiological

• Natural, normal, physiological  (n/n/p)
  • True
  • Not separate out surgical birth
    • Birth of every baby is important to each family
    • Going to hospital, being prepped and surgery is the activity of birthing a baby.
    • Pregnancy ends when a baby is out of a woman’s body
  • We’ve talked about 3 Health Systems, 3 Goals and now we have to talk about 3 Childbirth Concepts and why to fill in the gaps in NZmidwifery care and shift global response to childbirth, we must bring at least 2 of these Concepts together and the 3^rd when applicable.
  • Why do we need to understand 3 Concepts?
    • Societal message
    • The ideas behind the message, words, actions, possible systems, policies and aLL have goals.
      • Primary are 3 Goals
      • Secondary NBM: natural birth, pain-free, no medical care.
    • Now that we’ve investigated how NBM interprets n/n/p, let’s look at how traditionl cultures did
      • Anything that might happen can happen
      • Does and Don’t’ list of Things
    • The medical profession interprets the same way
      • Anything that might happen could happen

1^st No Way To Know Concept

• Always existed and will forever
• Never know what your birth will be like
• The other two Concepts evolved to respond to #1 and the sentence that follows; ‘Therefore, there’s nothing you can do.
  • Traditional cultures dealt with Do and Don’t
    • Because normal, natural, and physiological means: anything that might happen will happen
  • Recent modern Maternity
    • Same … anything
    • AMPS (assessments, monitoring and procedures)
  • Very recent NBM (natural birth movement)
    • It’s not necessary to do anything because Natural
    • Physiological: being randy, being hungry/cooking … they are also n/n/p but we put skills around these things.
  • After WW2 as birth was medicalizing
    • 3 OBs …. Lamaze, Grantly Dick Read, Bradley
    • Divide birth into low-high risk
      • But few tragedies
      • NBM acknowledges few tragedies and assume, few problems and few risks which is the NZ midwifery logo
      • Tradional/Modern acknowledge few tragedies but acknowledge more problems (resolve) and more risks
      • This is the big divide
        • We build ideas, words, actions, systems. Policies that have desired goals/results
      • What should be the desired Goals?

#2 Skills-based Concept

• If low-risk (not everyone … a huge gap) learn skills to achieve 3 separate goals
  • Natural birth (let it happen), pain-free (don’t be afraid) without medical care
    • Then more: home birth, be left alone
  • Huge benefit HA Brant and generation mid60s-70s in US
    • Huge reduction of #2 Goal
      • Not acknowledged … huge gap!
    • NZ didn’t have same history
      • CB .. Parent Center was targeted to low-risk
        • Why HA Brant study is so significant
      • Multiple millions of US families benefited
        • All families/without choices

Choice-based Concept

• Rise in Global CB conversation and NBM
• Both NZ and US birth advocates felt Skills had not achieved the 3 NB goals so shifted to ‘choices’
• Removed skills
• Normal, natural, physiological interpreted as safe, easy, manageable, few tragedies, leave women alone to achieve: natural birth, pain free (no fear) without medical care … cows and cats, discover by self, home birth, midwifery care, AmPs = interventions/imposed