As I am sitting in the birth centre waiting for the next woman to start her labour journey I’m thinking “what is ‘normal’ for pregnancy and birth in 2019?”
We often talk about risk, whether someone is ‘high risk’ -this could be due to mother medical history, previous birth or pregnancy related problems and therefore under the care of a consultant, or ‘low risk’ – where there are no medical or pregnancy issues and under the care of the midwife and therefore known as ‘normal’. But if you are not ‘normal’ does that make you abnormal?
It’s not nice to start pregnancy with the thought of being normal or not!
Will we need birth centres in the future?
When we look at the number of women that choose to birth on a labour ward, which can be up to 89%, what does this mean for our birth centres? The midwife led environments known as birth centres can be within the main maternity unit, known as ‘alongside’ or on a separate site known as ‘freestanding’.
Midwife led is for women where their pregnancy is ‘low risk’.
Labour wards are often for women and babies who have more complex needs, requesting pain relief such as an epidural or have a ‘high risk’ medical or previous pregnancy history.
Midwives work really hard to encourage pregnant women to consider choosing a midwife led birth environment but in reality there is such a small percentage of women who are deemed ‘normal’.
When the labour ward is bursting at the seams and bordering on ‘no room at the inn’, and the birth centres are empty, it can sometimes feel a bit heart-breaking when you are waiting to run the birthing pool and turn on the twinkling lights!
Is TV giving the wrong impression?
So what can we do?
Helen is 42 years old and expecting her first baby.
Helen is fit and healthy and would otherwise be ‘low risk’ but due to being 42 she is actually ‘high risk’ and therefore recommendations for her may include more monitoring of her baby’s movements, her blood pressure and additional ultrasound scans. She may also be offered an induction of labour and a birth on the labour ward.
Could we look at offering Helen something different to support her choice?
Sarah on the other hand is having her second baby
Sarah’s first was born by caesarean section and therefore she would be deemed ‘high risk’, but she would like a pool birth as she didn’t get the birth she ideally wanted with her first baby. She would like to birth on the alongside midwife birth centre as she feels this will make her feel calmer and hopes her labour will progress differently this time.
As she has already had a caesarean Sarah may by offered addition monitoring of her baby’s heartbeat during labour, to not use water and to go to the labour ward for birth.
Surely we could find a way of supporting Sarah’s wishes in a safe way?
Both of these scenarios are just examples, but there are a country full of Helens and Sarahs, who may want to be offered more choice.
As a midwife who is passionate about everything that is ‘low risk’ and ‘normal’, I would like to look at the women we are caring for and see whether the boundaries of risk could be looked at again.
“We need to realise that women are changing”
They are getting older, may have needed help to get pregnant, may be bigger and 25% of second time mums will have already had a caesarean.Is any one of these our new ‘norm’ in 2018?
We need to be supportive, encouraging and open about women’s expectations, and this requires time and being able to really get to know the women that we are looking after and for them to get to know and trust us too.
There may be chances to look at the way we offer our antenatal care. We need to hear what women really want.
I know when I was expecting a baby, I wanted to see the same midwife, who I trusted and who knew me. If this is what I want, surely there are other women who want that too?
When we share the positive birth stories between each other, the celebrations of when things go well and remind women that as midwives we are the experts in low risk pregnancy and birth, then we can start to change the impression of the fear around pain and birth.
Let’s start with positive thinking and hopefully we will see better outcomes for women – and happier midwives!