Readers' blog: Natural birth is not an ‘elitist’ philosophy

A new word for ‘birthing women’ appears to have entered the Irish obstetric lexicon.

Readers' blog: Natural birth is not an ‘elitist’ philosophy

A new word for ‘birthing women’ appears to have entered the Irish obstetric lexicon.

At a recent obstetric conference on maternity and the law, birthing women have been referred to as ‘birthzillas’ by a leading Dublin obstetrician — ‘Are middle-class ‘birthzillas’ harassing hospital staff?’ (Irish Times, May 4).

Dr Aoife Mullally, who practises at the Coombe Women and Infants University Hospital in Dublin and at Portlaoise Hospital, explains that ‘birthzillas’ tend to be ‘over privileged, over anxious, middle-class mothers’ with unrealistic expectations of having ‘perfect births’, who ‘think they are the only woman who’s ever given birth’ and who…‘certainly think they are the only woman giving birth in the labour ward that day’.

She suggests that no doctor or midwife would carry out an unnecessary intervention.

However, there is ample evidence indicating that unnecessary intervention occurs frequently.

It has been recommended in recent UK childbirth guidelines that women be informed of the increased risk of intervention when birthing in a hospital labour ward, as compared to a midwifery-led birth unit, with no difference in outcomes for low-risk women.

Over-intervention in birth has been identified as a major health concern in The Lancet midwifery series.

Citing Western privilege as a reason why women should not choose to optimise normal birth physiology or decline

intervention is simplifying and misrepresenting what are actually quite complex issues.

As The Lancet series authors identify, while access to safe maternity care and emergency support is greatly needed in developing countries, the risk is the iatrogenic effect of over-intervention.

Natural birth is not an ‘elitist’ philosophy, as Dr Mullally claims, evidenced by efforts of obstetricians and midwives in resource-poor countries to prevent the effects of imported over-intervention, for example, providing home birth services in Sudan and midwifery-led models of care in India.

The association of a birth plan with ‘over privileged, over anxious, middle-class mothers’ with unrealistic expectations of having ‘perfect births’ is to deny women’s agency in what is, after all, a significant and profound event in women’s lives.

Birth plans are informative, discursive and flexible tools used by women and their birth partners, in conjunction with a known healthcare provider, to equip them for active involvement in decision-making during their birth.

This should be wholeheartedly embraced.

As midwives, we agree that women can be disappointed in their birth experience; however, rather than being due to women’s high expectations, we think that this is the result of a gap between women’s perfectly reasonable expectation of evidence-based, respectful care, and a lack of its provision in overcrowded maternity hospitals.

Evidence suggests that respectful, compassionate, relationship-based care where women are supported through decision-making processes, especially when things do not go to plan, is more meaningful to the woman and family.

The opinions reported here appear to show a lack of insight into the philosophy of optimising normal birth and the tenets of woman-centred birth care.

Women should feel as if they are the only woman giving birth that day. Overcrowded labour wards and patronising attitudes are not an excuse to expedite labour or ignore women’s birth plans.

Rather than quoting Dr Amy Tuteur, a strident critic of midwives and normal birth physiology, by stating that ‘birthzillas harass well-meaning hospital staff with unrealistic birth plans, egged on by ill-informed, overpaid midwives and doulas’ perhaps Dr Mullally should have turned to that country’s peak professional body, the American College of Obstetricians and Gynecologists (ACOG).

The US has the highest maternal mortality rate in the developed world, despite (or because of) high birth intervention rates.

ACOG now have a position paper on reducing unnecessary intervention in order to prevent primary caesarean section.

This identifies the need to increase access to non-medical interventions such as ‘continuous labor [sic] and delivery support’ which has been ‘shown to reduce cesarean birth rates’.

Just to be clear, ‘continuous labor [sic] and delivery support’ refers to the work of midwives and doulas, as well as birth partners.

A healthy mother and baby should not be the highest aim of a maternity system.

It should be the expected bare minimum of care — along with humanised and respectful care for women who feel valued in their decision-making.

Maybe the women of Ireland need to claim and market the notion of ‘birthzillas’ as a symbol of solidarity among Irish women against over-medicalised and paternalistic maternity services.

It may in time come to signify a truly diverse and inclusive maternity service where all women’s needs are truly addressed.

Midwives: Vivienne Brady, Ashamole Clive, Deirdre Daly, Margaret Dunlea, Louise Gallagher, Patricia Hughes, Felicity Kalu, Elizabeth Newnham, Colm O’Boyle, Magdalena Ohaja, and Jeannine Webster

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