For 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.
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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