Childbirth used to be shrouded in secrecy. Now is the information age: monitors, men, many ‘support’ people – and video cameras – are welcomed into the delivery room, and anyone can watch a live birth on the internet. Then why is the truth about natural labour and birth still so elusive?
Let’s face it: it’s rare for a mom to say that she knew exactly what was going on during every stage of labour and birth. Should she know everything? That’s a loaded question, really! Absolutely, she should; after all, it’s her birth and her body! When information is withheld from her, she feels scared and dis-empowered On the other hand, the neocortex, the brain’s seat of thinking, rational processes and conscious planning, inhibits the instinctive ‘old brain’ processes which are so important for the unfolding of natural birth physiology. ‘Knowledge imparting’ must always include sharing the role of these subtle yet overwhelmingly powerful processes.
Embracing the essence of ethics
Midwives have an ethical responsibility to be honest with the women they care for. How many moms are told that an induction or a C-section is absolutely necessary – when, actually, a long-weekend is coming and the doctor has made holiday plans? How many babies born via C-section because they weighed ‘more than 4kg’ really weighed that much at birth? Surely an ethical midwife must trumpet these discrepancies from the rooftops?
Acts of omission
‘Leaving out’ information is equally harmful. Sometimes, miscommunications can be unintentional – when you say ‘what a big baby!’ moms don’t interpret ‘big’ as ‘healthy’; they understand it to mean ‘you’re going to have a difficult and painful birth; you’ll probably need a C-section’. And what about telling a mom that her low-lying placenta needs watching? The obstetrician knows that it’s probably not placenta praevia, but the mom-to-be gets the message that there’s something wrong with her placenta. She may agonise over it for the next few weeks, feeling helpless because there’s nothing she can do to ‘fix’ it. Obstetricians often don’t have or take time to explain their observations and comments to moms. That may not be right, but two wrongs don’t make a right either, so it’s up to midwives to provide some clarity!
The Cochrane Database shows us evidence that will help midwives to help women regain their birth power:
- Perineal massage reduces perineal trauma during birth and perineal pain after birth
- Amniotomy increases the risk of C-section and doesn’t shorten labour or increase contractions
- Upright labour postures have a possible increased risk of postpartum haemorrhage, but are associated with shorter first-stage labour and fewer epidurals and C-sections
- Supine labouring positions increase risk of fetal acidosis and prolonged labour
- Women should be supported to be mobile during first-stage and upright during second-stage labour
- Fetal monitoring has high rates of false positives
- Pelvis size can only be determined by allowing trial labour to take place
- Sonography cannot accurately determine a baby’s weight late in pregnancy
- Fasting in labour doesn’t guarantee an empty stomach or lower acidity, and can lead to reduced energy levels
- Enemas carry a risk of infection and don’t effectively prevent leaking
If knowledge is power, then let’s start empowering women with the truth; that is, the whole truth!