Particularly in the UK, there is a widespread fear and negativity surrounding birth which can be said to influence many women’s expectations and experience of labour. What do you believe to be the reason for this, and how does the UK perspective on birth vary from that of other countries, and also from the actual reality of childbirth?
I think fear of birth has been growing over past decades. Part of it is perhaps fear of the unknown - with birth taking place largely outside of our communities now, modern women don’t have much contact with the sights and sounds of labouring women. Also, unfortunately there are more and more ‘birth horror stories’ to be told - of course there have always been such stories but in our current time it is much more common to meet a woman who has had an unpleasant or traumatic experience than it is to meet a woman who has had a straightforward birth. So it’s actually quite rational to be afraid of birth if it’s likely that you will end up with an instrumental delivery or a caesarean - which in our modern culture, is very likely.
Could negativity and fear ever be seen to be a self-fulfilling prophecy when it comes to the childbirth experience, and to what extent does mindset influence the process and outcome (in your view)?
I think the problem with fear and negativity is that it can stop women from thinking about the kind of birth they want and preparing - which is probably the worst thing they can do! It’s so vital to learn about all of your options, to learn about your rights in the birth room, and to make a plan, not just for your ideal birth but also to make a Plan B, a Plan C and a caesarean plan, even if you don’t want to have a caesarean.
And yes, mindset plays a huge part in labour and birth, as it does in all other areas of life! If you expect something to be dreadful, you probably increase the likelihood of it being dreadful! You also risk becoming passive in the experience, of accepting it or ‘going with the flow’, rather than taking an active role.
In the Positive Birth Book, I explored the maths behind a normal labour, and worked out how much time on average you spend having contractions, versus the time you spend ‘not in any pain’. The results were surprising - 77% of the average labour is ‘pain free’! We have this image of birth being non stop agony and nobody really talks about the time you spend in labour when you are actually feeling all kinds of other sensations and emotions - excitement, strength, power, love, and the ever so slightly ‘trippy’ feeling that is common with the cocktail of hormones labour brings! I’m not saying that labour isn’t painful, of course - I’ve had 3 babies and found it excruciating at times, believe me! But I do think it’s interesting to shift our focus, in particular as so many women report being so terrified of having a baby.
Unfortunately how you feel in labour and how you experience and cope with the pain is not only connected with your expectations, but also with the quality of support you receive, and how safe you feel. For example, we know that having a relationship with your midwife - having got to know and trust her in your pregnancy - has a big impact on how women feel during labour, as does their environment: it’s best if their birth space is quiet, protected, dimly lit and cosy. However many women don’t have these basic things when they labour. They are in brightly lit, unfamiliar spaces, and attended by strangers. Then, when they struggle to cope with the pain, they blame themselves and think, “I was not tough enough. I was not up to the task of labour.” But in fact, they may well have coped very differently if they had been given better support and a better environment. We are not getting the basics of labour right, in our culture.
Are there ways that women can improve their chances of a positive birth experience, and also reduce their risk of intervention?
Yes there are absolutely ways of ‘maximising your chances’ of a positive birth! Learning about your choices and rights is the main thing you need to be doing. But I do think it’s important to stress that ‘positive birth’ does not necessarily mean not having any intervention, either. Some women who have a ‘text book’ natural birth feel very traumatised by it, others who have every medical procedure going feel great afterwards and at peace with what happened. Positive birth is usually about mindset, and about how you were treated. If you feel you have choice and bodily autonomy,
if everything is properly explained to you, if you feel in control of what is happening, and if you feel respected and heard by your care providers, you will probably feel like you had a positive birth experience.
Having said that, if you do want a low intervention or no intervention type of birth, then learning about how birth works, for example, learning about the hormones of birth and what increases or inhibits their production, can really help you to get the kind of birth you want. Also, if you don’t think you will get good one to one support from your standard care, you might think about investing in a doula or an Independent Midwife. These both cost money, but if the day of having a baby is very important to you, you might need to invest in it, just as you would do for a wedding or a dream holiday!
What would be your advice to women looking to overcome a fear of labour?
That’s a complicated question. If it is ‘extreme’ - then they might need to seek help and support to explore the roots of that fear and address them. This might be different for different women, but most commonly, it’s a previous traumatic birth and / or a history of sexual or physical abuse. This is the kind of difficult and emotional stuff that it can be very helpful to have professional help to unpack and make sense of.
If it is less severe, and doesn’t feel overwhelming, then they might consider attending a Positive Birth Movement group, reading the Positive Birth Book, and possibly watching some birth films - there are some good ones on the PBM website here: http://www.positivebirthmovement.org/watch-birth-films.html
Is it possible to have a positive birth even in the event of a previously stressful or traumatic experience?
Yes absolutely it is, and many women refer to their second birth as ‘healing’. It can be harder to prepare due to high levels of fear but often, because of the previous experience, you will know much better what to expect and will prepare in a different way. As I said in my previous answer, you might want to get some support to process your previous traumatic birth, too, as this will help you better prepare for your next birth.
An element of control is said to be a crucial part of achieving a positive birth experience. How is it best and possible to achieve this balance of medical guidance and self-assertion?
I think control is at the heart of some of these issues. One example I give might help: in your relationship with your partner, in the bedroom, you will - hopefully - know that you can always say, ‘no’ or ‘stop please’ or ‘I don’t want to’, and that this will be respected. You might actually never say these words! But if you did, you know that your partner would listen and respect you. So hopefully there is an unspoken balance in the power dynamic in your sexual life. Unfortunately, in the 21st century birth room, we are in a place where women often do not even know that they have a right to say ‘no’ or ‘stop please’. So there is a huge imbalance of power, which is unhealthy. Changing this imbalance isn’t about women going to war with their care providers, refusing all medical help etc. It’s simply about knowing that they can say no if they want to. This changes the power dynamic completely, and it changes everything from how women feel about themselves and their bodies, to the experience of birth itself.
It doesn’t go without saying that some of these problems go far beyond the birth room. Women do not always find asserting themselves comes naturally. We are quite culturally conditioned to be submissive in our interactions, to be on the back foot. Current movements like #metoo and #timesup are quite strongly connected with birth issues: they are about asking for respect and for bodily autonomy, which is what positive birth and the PBM is fundamentally all about.