My grandmother gave birth to all of her babies at home. There were simply no other options (Lee and Wickham 2000). But by the time her daughters were ready to birth, just a couple of decades later, they were offered (and in some cases recommended to take) the option of going into hospital instead. By the time her granddaughters gave birth, home birth was a minority pursuit that in some cases we needed to fight hard for. Her great-granddaughters will soon be embarking on their own pregnancies and will – at least in theory – be able to decide between a range of birth environments, including home, hospital, birth centre and – somewhat ironically – clinical spaces which are designed to look homely despite the fact that they aren’t anybody’s home at all.
THE JOYS OF HOME
As someone who spends a lot of time travelling with my work, I really love coming home. I take pleasure from engaging in small domestic activities after being away – lighting a fire in the log burner, cooking a meal in our own kitchen, cosying up under a quilt in my corner of the living room with some quilting and a favourite TV show. I love the variety and stimulation of travel, but I also love the feeling of getting into my own familiar bed. I love arriving home in the daylight, especially in the colder months, after a long journey home, and knowing as the sky darkens that I don’t have to go out again that day.
I want to acknowledge before I go on that home isn’t always the safest or happiest place for everyone, and we should always take care not to assume that is the case. But many of us experience a kind of joy in domesticity that sits in happy contrast to the adventure of going out and about into the world.
It was probably because thoughts of domesticity have been particularly on my mind during a recent long travel period that I was really struck by the title of a paper written by a group of Australian midwives: How domesticity dictates behaviour in the birth space: lessons for designing birth environments in institutions wanting to promote a positive experience of birth (Mondy et al 2016). The authors of this paper describe the movement to make institutional birth environments more homely and detail the different kinds of research that have already been undertaken to explore issues relating to space, place and birth. Their work takes us another step forward, as they set out, “to explore, describe and compare birth spaces with different domestic characteristics and how labouring women responded and/or worked within these spaces during the labour process” (Mondy et al 2016: 38).
There is a lot to be gained from reading their paper in its entirety, if this is an area that you’re interested in, but I want to highlight a few key points that really struck me. One was the table describing the behaviours of the women who didn’t show characteristics of domesticity in their birthing space. The descriptions included notes like, “SM keeps all belongings in the corner of the room”, “belongings kept in her suitcase (visitor status)”, “support person stays sitting in the corner of the room unless advised to move” and, “only uses equipment as provided to her, follows all of midwife’s instructions, including going to the toilet” (Mondy et al 2016: 39). I have witnessed and been saddened by all of these tendencies (and more) in real labour wards, but seeing them documented in the text of research findings somehow renders them more poignant. I can only hope that lots of people will read them, be affected by them and be inspired to do more as a consequence; but even as I write that, I remain aware that it’s not an easy situation to change. Some of what goes on in the birth environment is dictated by cultural trends that those present have little awareness of, let alone influence over.
MAKING THE LABOUR WARD HER OWN
There are positives in this study as well, though. Although most of the women who birthed in the conventional (hospital) birth spaces “acted and interacted with the space in a passive way” (Mondy et al 2016: 41), one woman did not. A woman whom the researchers called Florence and her family took ownership of the space and made the labour ward room their own:
“The mechanism by which Florence was able to modify her own response to the non-domestic birth environment and eventually enforce her individuality on her birth experience was through her own domestication of the space. She brought with her a large contingent of family. In essence her family appeared to ‘fill’ all the available spaces. In addition, Florence brought linen and pillows from home, remained in her own clothes, chose aromatherapy oils that she believed would assist her labour, played music of her own choosing and produced a birth plan, outlining her needs and beliefs. Florence was also creative in using equipment in unconventional ways” (Mondy et al 2016: 42).
A FUNDAMENTAL TENSION
It would be remiss of me not to mention that the midwife who cared for Florence found this a bit challenging. This raises a fundamental tension that needs to be addressed – although, if I am really honest, I can understand why Florence’s midwife might have felt this way. The bringing of birth into hospital led to midwives needing to take on a particular set of roles and responsibilities in the unique environment of the labour ward and this, in turn, created norms, rituals and expectations which cannot easily be eradicated over night. There is a lot to unpack here, and it’s something that I want to talk more to midwives about. But it’s not the work of a day.
BIRTH SPACE IS IMPORTANT
I imagine it won’t surprise you to learn that the women in this study who birthed in a birth centre or at home behaved very differently from the majority of women who birthed in the hospital environment: “The domestic birth spaces appeared to make it easier for labouring women to place themselves or remain at the centre of care and support” (Mondy et al 2016: 44). Overall, this analysis, which is just one aspect of a fascinating and growing body of research into this area, shows that birth spaces play an important role in shaping a woman’s experience and also that there is much more to this than we have previously realised.
Maybe by the time my grandmother’s great, great granddaughters give birth, we will have figured out that there is a better, more respectful, more woman-centred way. And that it involves consideration of what makes people feel safe and happy, in the very broadest sense of those words.
Lee P and Wickham S (2000). ‘And that was that!’ Midwifery Today, 54: 41-42.
Mondy T, Fenwick J, Leap N et al (2016). ‘How domesticity dictates behaviour in the birth space: lessons for designing birth environments in institutions wanting to promote a positive experience of birth’. Midwifery, 43: 37-47. http://www.midwiferyjournal.com/article/S0266-6138(16)30197-8/abstract
photo credit: Rsms Another corner of my home via photopin (license)