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What is 'Normal Birth'
Normal can be defined as 'the usual, typical, or expected state or condition'.
In 2023 31% of births in the UK were cesarean section, with 10-15% instrumental births. If we add to this the rate of inductions (33% in 2022-2023 but some trusts are now upto 50%), this leaves very little room for spontaneous, non-augmented, vaginal births (Physiological birth).
So although this news article uses the word 'normal' in the place of physiological, I would argue that a normal birth in the UK is one that is medicalized in some way!
What about the 'natural birth' movement?
This is the idea that women should be able to give birth how and when they choose, and medicalization should be avoided unless necessary (UNLESS necessary!).
Starting in the 1980's at the peak of medicalization, charities like the NCT (did you know they used to be called the Natural Childbirth Trust?) promoted physiological birth and provided antenatal education to families in the hope that they would be able to make informed choices.
Though as with any 'movement' there are always those that take it to the extreme, the overwhelming majority of the 'natural birth' movement has always been grateful for medicalization when it is necessary and has put out the message that while birth is a physiological process that usually works safely when uninterrupted, it can require intervention and there is always associated risks.
Do women want a 'natural birth'?
A study in 2013 found around two-thirds of women would prefer a natural birth.
This isn't surprising as physiological birth has been shown in the evidence to be the lowest risk for both mum and baby (unless there are other medical complications to consider).
10-15% of women choose an elective cesarean, but its hard to determine how many of those are due to medical conditions that make vaginal birth impossible (eg placenta previa) or other situations where they are encouraged to have a cesarean (eg breech birth, twins or a big baby).
I do not doubt that for some women in the absence of a medical need, a cesarean is still the appropriate choice for them, and the number of these cases is so low among the sea of potentially 'unnecessary' elective cesareans or emergency cesareans caused by a cascade of over medicalisation.
The push to reduce cesarean rates.
It was not the natural birth movement that started the push to reduce UNESESARRY cesareans.
The World Health Organization released a statement saying there “is no evidence showing the benefits of cesarean delivery for women or infants who do not require the procedure” and that, since 1985, “the international healthcare community” has considered the ideal rate to be between 10% and 15%.
Over 12 years the rate of cesareans in the UK doubled, and groups were set up that included members of the NCT, the Royal College of Midwives (RCM), and Royal College of Obstetricians and Gynaecologists (RCOG) to reduce these levels.
And this is where it gets interesting.
No one was 'after' the women who were choosing cesarean because it was the right choice for them, the natural birth movement has informed choice at its core.
Although as an aside here - if you are choosing a cesarean because you are terrified of childbirth, because of the images you have seen in the media or stories you have been told, I would encourage you to unpick that before setting your sights on major surgery.
No one was 'after' the cesareans being done because of a real medical need.
It was the unnecessary cesareans that people wanted to reduce.
The villainization of natural birth in the Ockden report
In 2022 Donna Ockenden finalised her report into a number of failings in Shrewsbury and Telford Hospital NHS Trust which led to the harm and deaths of a number of women and babies.
This Trust had lower than average c-section rates and had been praised for this. In their drive to reduce their rates, they had been refusing elective cesareans, and delaying the decision to operate in emergency situations.
One women was quoted saying:
''I Felt that my concerns during labour were not addressed, that I was made to have a natural birth when an emergency c-section was more appropriate just so they didn’t dent their precious natural birth rate target. I felt like I was on a butcher’s slab.'
The report stated
'We also note the committee recognised that maternity units appear to have been penalised for high caesarean section rates and recommended that there should be an end to the use of total caesarean section percentages as a metric for maternity services. We note the progress on this with the recent advice from NHSEI to trusts to stop monitoring caesarean section rates.
The recognition that Shrewsbury and Telford Hospital NHS Trust had a lower than average caesarean section rate (and was often praised for this) was identified in our first report. We noted that some mothers and babies had been harmed by this approach, and we welcome the committee’s findings and the progress on this.'
The push for natural birth is being used as a scapegoat to excuse the NHS repreatedly failing women and babies.
Are Midwives dangerous for 'pushing' natural birth?
Well, first of all, if we go back to our 'normal' birth discussion, I want to know where ALL these Midwives are that are PUSHING physiological birth on women who don't want it.
I found it hard enough to find a midwife to support the physiological birth I wanted and not sabotage it at every opportunity.
I know there are wonderful midwives out there, but I honestly do not think they are in the majority anymore. That is my opinion, Id love to be proven wrong.
The article I screenshotted at the beginning of this blog argues that Trusts are still advertising for Midwives to support 'normal/natural/physiological birth and that they shouldn't be as that has been proven to be DANGEROUS for women and babies.
A midwife's primary job is to support physiological birth, just as an obstetrician is primarily a surgeon.
The International Confederation of Midwives (ICM) still has the position of supporting birth as 'normal'.
They define normal as:
A unique, dynamic process in which fetal and maternal physiologies interact with the woman’s psychosocial contexts.
A process whereby the woman or gender diverse person commences, continues, and completes labour with the infant being born spontaneously at term, in the vertex position, and without surgical, medical, or pharmaceutical intervention.
So including that they must be able to support and be willing to promote this in a job advert isn't unreasonable.
What is damaging maternity care then?
Well a recent CQC report found that Overall, 48% of Trusts were rated as inadequate or requiring improvement with around a quarter receiving a lower overall rating than when last inspected. On the single issue of safety, 65% were judged to be failing.
Areas of concern included:
staffing shortages, with nurses fresh out of university taking on tasks better suited to more senior midwives and doctors
problems with equipment, including call bells not working and poor pain management
delays to emergency Caesareans, because operating theatres were unavailable
limited access to toilets and showers and patients left lying in blood-stained sheets, compromising privacy and dignity
cramped, noisy and overheated wards
inconsistencies in the way safety incidents were monitored and recorded, including major emergencies such as significant loss of blood and internal injuries recorded as causing low or no harm
bad leadership and management creating blame cultures and low morale
triage problems, with women facing delays being assessed and not being prioritised properly
evidence of discrimination against people belonging to ethnic minorities, including a lack of support for women whose first language was not English
The pushing of natural birth isnt mentioned.....
In conclusion
No natural birth is not dangerous it's the safest way of giving birth for the majority of people.
No, I don't believe everyone should aim for a natural birth, I believe in informed choice, you do you.
What is dangerous is putting your targets above the safety of women and babies, pushing natural birth on those who do not want it, and delaying life-saving operations for the sake of 'natural birth'.
NHS maternity care is failing on many levels, none of which can be blamed on natural birth.
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