The most important thing women can do for themselves in the quest for a normal birth?

2069578256_0f6bf014c5For the past year and a half, I have been thinking a lot about what helps keep birth normal. And yes, I know that the word ‘normal’ is very loaded and needs debating, and I will be doing that soon, but for today I’m going to ask you to let me focus on another aspect of the discussion. Because, as I’ve been facilitating my Recipes for Normal Birth workshops, I’ve spent a lot of time looking deeply at the research on what helps facilitate straightforward birth, and there’s one tip in particular that I would like to share with women.

Stay at home as long as possible in labour.

That is, in my humble but – if I may say so myself – reasonably informed and evidence-based opinion, one of the most important things that a woman can do in order to help give herself the best chance of a straightforward normal birth with as little intervention as possible. Because time and time again, research shows us that, the sooner a labouring woman who is planning a hospital birth enters the hospital, the more likely she is to end up with lots of intervention which may lead down the road to a more medicalised operative or instrumental birth.

Here’s some data…

One recent study which illustrates this really well was conducted by Wood et al (2015). They analysed data from 2033 women who went into spontaneous labour at term with a single baby, focusing on the relationship between how dilated their cervix was on admission to hospital and the likelihood that the woman would have a caesarean section.

The results were really clear. Women who went to hospital earlier were more likely to have a caesarean section compared with those who went later. If you want the numbers, then the cut-off point was 6cm, although please bear in mind the two important caveats here. One, midwives have long been stressing that dilation is only one element of labour progress, so I don’t want to emphasise the measurement element of this more than is appropriate. Particularly because, two, most women can’t or don’t wish to do vaginal examinations themselves, so they can’t possibly know whether their cervixes are 1cm, 5cm or 7cm dilated. The numbers aren’t the important bit in the translation of this into our conversations with women. The important bit is the message that staying at home for as long as she is comfortable doing so is one of the most important things a woman can do if she wants to maximise her chances of having a straightforward, normal birth.

What needs to happen?

There are a number of things that those of us who work with women can do to help this, and I am acutely aware that simply telling this to women may not make a difference. For a start, women receive mixed messages (on which I shall be riffing further in my upcoming book on normal birth, so I thank you for your patience and understanding) about when to come into hospital and about who is the expert on their body and baby. There is also a good bit of work to be done in the area of making time before labour to consider what needs to happen to make sure that everybody is comfortable with staying at home. By everybody, I mean the woman herself, her partner, any other relatives or birth partners and birth attendants.

Partners and families are key. If the woman can’t relax because her partner can’t relax, then she’s not likely to get to 6cm in a reasonable timespan, and she will end up transferring in for partner’s distress. But yes, birth attendants’ comfort levels are another important element. Sadly, some women transfer for caregiver’s distress as well, and that’s something which needs to be addressed. But these are not insurmountable, and helping women and their partners and families to develop strategies for staying at home as long as possible, even if they are planning a hospital birth, is a really simple way in which we can help reduce the caesarean section rate.

 

donatebuttonThis post was part of my 2015 blogfest, during which I wrote a blog post every day for two weeks as a way of saying thank you to those who are helping keep my free and ad-free information activities online. If my work helps you in yours and you would like to make a donation and help me keep all of these resources free and heart-funded through 2016, please click here and make a donation. Thank you for caring about women and babies.

 

Wood AM, Frey HA, Tuuli MG et al (2015). Optimal Admission Cervical Dilation in Spontaneously Laboring Women.  Amer J Perinatol. DOI: 10.1055/s-0035-1563711

 

2 comments for “The most important thing women can do for themselves in the quest for a normal birth?

  1. Anna
    December 8, 2015 at 6:08 pm

    Women who book a home birth can get a home visit in early labour, whether or not they actually intend to give birth at home. Encouraging women to do this would mean more women both staying at home, and having the reassurance of a midwife assessment. This seems to be a practical way of facilitating what you suggest. Anna

  2. hannah
    February 8, 2016 at 2:59 pm

    In helping to gauge how long to stay at home, I think it is important to try and get someone who trusts natural birth to support you at home with massage and emotional support. First time mums often go in to hospital because they think they will be safer and well taken care of. However the reality is that staff do not have the time or are unwilling to provide the support mums need. They tend to provide ”medical” care in the form of EFM or epidural but do not provide ”emotional/physical” care in the form of massage and encouragement.

    Mums need to know that labour pains are easier to manage in the comfort, security and privacy of home. Do not go to hospital until your contractions are at least coming every 5 minutes and lasting a minute. This usually indicates advanced labour.

    The second most important thing to have a normal birth, I would like to suggest is believing in your body and your baby’s ability to give birth in your own time and in your own way. You are the birth expert and not your doctor or midwife!! You are the professional. Say no to intervention. Most of what the hospital staff say is irrelevant or incorrect. That sounds crude but it is the sad truth. It may be hospital policy to give birth within 12 – 24 hours, but its not unsafe if your labour takes a different course. Labour may stop. It will start again when G-d dictates so. An un – interfered with birth is a SAFE birth. Most hospital policies are just that. Convenience policies. If contractions stop – great! Relax, eat , sleep, go home if you wish. Recharge your batteries so you have energy to birth. Dont give in to scaremongering tactics – your baby may get in distress. Note the clause ”may”

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