Things that improve your chance of birthing without medical intervention
I have written and re-written this post several times.
It’s about childbirth, you see. Is there anything more personal and political than baby-making (or not making)? Even the most well intentioned writing can ignite a firestorm of comments about what women ‘should’ or ‘should not’ be doing with their bodies when they are pregnant or giving birth.
I’ll be as upfront and transparent as I can. This blog post is about evidence-based choices* that women can make to reduce their chance of experiencing medical intervention in childbirth. It is based on this great video (where you can find more details about the research) of a conference presentation by Associate Professor Yvette Miller.^
Explainer: By ‘medical intervention’ I mean such things as the use of episiotomy (when a clinician makes a cut to increase the size of the opening of the vagina), forceps, or caesarean section (when a cut is made in a woman’s abdomen and uterus to birth her baby). Most (but not all) women indicate a preference for childbirth with minimal medical intervention. There is good evidence that such intervention is not always (but certainly can and are) used to the benefit of women and their babies (see here, here, here, here and here for examples of related literature and policy). This isn’t specific to childbirth; the concept of ‘too much medicine’ is being explored in other areas of healthcare as well.
Disclaimer: Women are entitled to evidence-based information about all their options for childbirth, and the associated risks and benefits. There are so many factors that combine to produce a completely unique experience for every single woman, pregnancy and birth. (Kind of like how fingerprints are completely unique to every single person on Earth.) What they choose for themselves, their bodies and their babies is their choice.
Without further ado, here we go!
Wait! One more thing. This research is based on the definition of ‘birth without medical intervention’ as being that which started spontaneously (i.e. no induction); did not involve forceps, vacuum or episiotomy; baby exited vaginally; and no epidural/spinal anaesthesia was used. (Age and other risk factors were also controlled for #stopblamingwomen)
OK, let’s go!
Things that improve your chance of birthing without medical
The type of care a woman has during pregnancy and birth is highly predictive of several outcomes, including the use of medical intervention during birth. Compared to women with a private obstetrician (who are the least likely to experience birth without intervention [even when accounting for risk factors]):
- Women with a private midwife were 3.2 times more likely to birth without medical intervention
- Women with public midwifery care (a team of 4 or less midwives) were 2.2 times more likely
- Women with GP shared care were 2.0 times more likely
- Women with standard public care were 1.8 times more likely
- Women having a spontaneous start to labour (i.e. not being induced) were 1.4 times more likely to birth without intervention
- Women who were able to move around throughout labour (i.e. not being constrained to laying on a bed only) were 1.3 times more likely
- Women who had the same care provider throughout labour and birth were 1.2 times more likely
- Women who did not give birth while laying on their back (i.e. how almost every movie and television show portrays birth) were 1.1 times more likely
- Having the baby monitored continuously (i.e. all the time without breaks) made it 0.30 times less likely that a woman would birth without medical intervention. Or, inversely, a woman who had intermittent monitoring of her baby was 3.33 times more likely to birth without medical intervention
- Feeling rushed/hurried during labour
- Being in water in a pool or bath during labour (during birth is a different story)
- Giving birth outside of business hours
Like all aspects of life, there are things you can control and things that you cannot. Birth is no exception. I often hear people tell women they should let go of any expectations they have for birth because it’s all too unpredictable anyway. Regardless of the inherent unpredictability of our bodies (and life in general), women are entitled to make choices about, and be involved in, all aspects of their healthcare. If they have a preference for birthing with minimal intervention, they should be made aware of the factors they can control (e.g. model of care) that make this more or less likely. (We know, however, that most women are not informed about all their options for maternity care, let alone which may best align with their preferences.)
While this post reflects the established problem of ‘too much medicine’ for women in childbirth, there are many women worldwide who experience ‘too little medicine’ in childbirth. And it’s not always in the settings that you may first think of. Black women in the UK, for example, are FIVE times more likely to die when giving birth than white women. This is APPALLING. I have heard people say that privileged birthing women shouldn’t complain about receiving potentially unnecessary intervention when there are women and babies in desperate need of life-saving intervention. (These people are usually doing nothing about either problem.) All women are entitled to high-quality, evidence-based and respectful maternity care that fosters their full social and economic participation.
I’ll say it again: all women are entitled to high-quality, evidence-based and respectful maternity care that fosters their full social and economic participation.
Author: Dr Kate Young
*For some women, these ‘choices’ won’t actually be ‘choices.’ Obstetric or private midwifery care might not be affordable or geographically accessible to some, for example.
^ For the sake of transparency, I spent a year working with the research group who developed and implemented the Having a Baby in Queensland surveys, I have previously analysed and published some of the survey findings, and my honours supervisor was Assoc Prof Miller (the woman presenting in the video).
Photo by Sergiu Valenas on Unsplash. Definitions provided for birth terms are based on those from Birth Speak.