Control in labour: is it an illusion?

Womens bodies were designed to birth

A few days ago, a friend sent me this and said it made her feel bad.  I understand where she’s coming from.  There is a belief, not confined to any particular group or organisation, that women are capable of having a normal birth every time with no intervention, and that everything will be ok because that’s what your body is designed to do.  This may not be explicitly stated but often goes hand in hand with a distrust of intervention and a denial of potential problems in a pregnancy.  I think this is a very, very dangerous path to go down.  And no, not because I think birth is inherently dangerous or risky.  I do believe that nature gets it right most of the time.  I believe that for the most part, women are able to give birth with little or no intervention and that most of the time, a natural birth confers the most benefits to mother and baby.  MOST OF THE TIME.  But if you believe that all women are capable of a natural birth, unaided, unassisted, every time, then it strikes me as a very illogical position to hold.  All you have to do is look at nature to see that natural disasters happen, animals die giving birth and baby animals are stillborn. Nature doesn’t get it right all of the time.  The human body is capable of many great feats, but is still also subject to things going wrong randomly and by chance: young people have strokes, children get cancer… I don’t understand why the human female body would be exempt from these whims of nature at the time of childbirth.  Countries with insufficient medical attention have much higher levels of life-threatening complications resulting from childbirth.  Preventable complications.  And while poverty and socio-economic status remain factors in these complications, it would be foolish to pretend that adequate health care wouldn’t save lives during childbirth.    

I think that if you follow this sort of thinking, there are a few possible outcomes.  First of all, you do all your planning and preparation and you have a wonderful, normal birth.  Wonderful, I wish everybody could have that, I really do.  I really wish that every woman who planned and prepared for her birth had exactly the birth she wanted.  However, if you believe that this is the way it should be and that you were in control and made it happen, then someone must have done something wrong when your friend has a forceps delivery or a caesarean section.  So, you might start to feel superior to her and feel like she didn’t do enough, or she wasn’t strong enough to stand her ground and achieve her perfect birth, that she’s just not quite as good as you at the whole birth thing.   

Alternatively, maybe like your friend, you didn’t have the birth you wanted.  You feel like a failure.  You feel like you should have done better, prepared more, been stronger in labour, written a better birth plan… Because after all, your body is capable of having a normal birth, so you failed, right?  Feeling like a failure is a terrible way to feel following a birth.  Parenthood is a big enough transition without having to feel like a failure right from the start. I have WAY too many friends who feel like this and it really makes me sad and angry that wonderful women who are wonderful parents should feel so much pressure when they have done their best and tried their hardest in labour. 

Or, perhaps you feel angry with the midwives and medical staff involved in your birth.  You feel that they intervened too much, or didn’t respect your birthplan, or coerced you into decisions you didn’t feel were yours.  If they didn’t respect you or didn’t give you true choices then, absolutely, please feel angry with them.  Please follow it up, write about your experience and send it to your maternity unit.  Ask questions about why things happened.  Ask WHY the various interventions happened and were they really necessary?  Don’t stop until you get satisfactory answers; it’s vitally important that you get a resolution.  Undeniably, there ARE still too many interventions in labour.  We know that as midwives and doctors.  We know that unnecessary interventions can have negative consequences. I also understand that the push for normal birth is a reaction to the high level of (often unnecessary) intervention in birth. But maybe… maybe… some of those interventions were necessary.  Just because you agreed to an intervention doesn’t mean it was the wrong decision or that it was unnecessary. Occasionally the benefits of an intervention DO outweigh the risk.

In my mind, what’s lying at the bottom of all of this is control.  Or more appropriately, the illusion of control.  At one end of the spectrum there are women who feel that provided they get all their ducks lined up in a row they, through sheer will power they will achieve the normal natural birth they wanted.  There is strong evidence that indicates that MANY decisions made during pregnancy will improve the chances of having a normal birth.  So for example, having a birth outside of hospital, knowing the midwife who will look after you in labour, having support from the same person throughout labour (be it a midwife or doula) or undergoing other preparation like hypnobirthing, Spinning Babies exercises etc can all add to the confidence a woman has in her ability to give birth.  I absolutely believe that trying to do as much during your pregnancy and being mentally prepared for it will increase your chances of having a normal birth (I wouldn’t be teaching my classes otherwise) but there has to be a small element which is just down to luck – everything just happened to go right on the day.  You can’t always control the forces of nature. Nature gets it right, most of the time.

At the other end of the spectrum you have the health care professionals who are obsessed with risk and managing it.  This is also about control but from a completely different perspective.  By instituting guidelines and protocols for every single potential scenario in pregnancy and labour (or at least, that’s the way it feels) their desire is to be able to prevent an adverse outcome and minimise risk in every case.  For one thing, this is incredibly restrictive. It doesn’t allow for women to labour and birth outside of a strictly controlled regimen.  Any deviation results in an intervention.  I myself have looked after women who I knew were ok and would be perfectly capable of giving birth, but were outside of the established protocols so therefore had to be “managed” differently.  Unless we trust nature to get it right most of the time, we will never see the wide range of “normal” when it comes to birth.  Sadly, I think that as health care professionals sometimes we forget that even with the most robust of protocols, occasionally nature reminds us that ultimately, she is in control, not us. Life is risk and you can’t remove those risks completely. 

I’m not really surprised that there seems to be such animosity between the two ends of this spectrum.  Both groups of people are approaching labour from such a diametrically opposed position.  There can be a lot of misunderstanding on both sides, and I often sit uncomfortably somewhere in the middle, because I can’t agree with either extreme.  I can’t really understand women who want to freebirth or ignore very real risks in order to avoid intervention because I know that while most of the time things are fine, occasionally nature throws us a curveball and things don’t go right; in these situations I know how critical medical help can be.  I just want to make sure it really is informed choice and they have an honest picture of what birth is.  As a midwife, I will continue to support women to have the birth they want, even if personally, I don’t agree with their choices.  At work, I can’t really agree with some of my colleagues who see birth as a risky process and that a birth is only “normal in retrospect”.  It can be really difficult to support women who want to birth outside of established protocols, because of the pressure from the system.

How do you feel about birth?  How do you feel about YOUR birth? I suspect that most of it has to do with where you feel your control lies – do you feel like YOU are in control of your pregnancy and birth, or do you think health professionals are in control?  Or ultimately, is nature in control?

Big thanks to my friend Nicole Schlogel who got me thinking about control in labour one day as we chatted about birth… She suggested that perhaps, nature is in control rather than us.


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