Whether you make an informed choice to have a home birth, a hospital birth or even one up a mountain, swinging from a length of tinsel, I believe the crucial element that is fundamental to enabling women to achieve the birth they want is control.
I am regularly contacted by women who are having or have had very bad experiences with their pregnancies & labours & in my opinion it is often the feeling of not being listened to, being badly informed or patronised, or being made to feel that decisions were taken out of their hands that leads to conditions such as post traumatic stress disorder & postnatal depression.
I think it's high-time women wrestled back the control of their births, instead of being swept along by the bog-standard system. To get the birth you want you have to first understand what conditions might facilitate the best outcome for your personal circumstances & then plan around that, using basic common sense.
It might be, for example, that you have a medical condition which means a planned caesarean section would provide the best outcome for you & your baby. In which case, I would suggest that you examine the minute detail of what's involved in a caesarean - ask your midwives & friends that have undergone one to give you a blow-by-blow account. THEN decide for yourself what you can do to make that experience more palatable - tailor it to your needs & then go on to write a detailed birth plan.
If you want to achieve the best birth, don't follow the NHS factory production-line
Do whatever feels right for YOU.
SO WHAT ARE THE OPTIMUM CONDITIONS FOR A NORMAL HUMAN BIRTH?
Right ladies, hate to break it to you, but fundamentally you are nothing more than a...................... mammal. Yes, you may live in a nice house, drive a sporty car, wax your bikini line & shop at M&S, but however far we try to remove ourselves from our natural state, we can not get away from a few biological facts:
1. You are a mammal
2. Your body needs to give birth in the best conditions suitable for a mammal.
So, what are these 'best conditions'? Well, in order for your body to function properly & release all the lovely hormones responsible for squeezing out your baby, it's a very simple recipe:
1. semi-darkness
2. peace & quiet
and above all else:
3. PRIVACY
The legendary Obstetrician & Surgeon, Michel Odent states that in order for women to realise their own physiological potential, they need: "..intimacy; any interference of her privacy inhibits labour. But on the other hand she must not feel alone. An experienced and caring woman is often the only person who can satisfy all these disparate needs. An authentic midwife is a mother helping other mothers give birth.....Warmth, semi-darkness, silence, whispered words - all these things reinforce intimacy and spontaneity and make it easier for the labouring woman to feel free in any position".
So, that's what you need, now what do you get in an average hospital birth? Semi-darkness? Not usually - staff need to see what they're doing during their various examinations & machine readings, so the lights must be left on. Silence? Hardly in a ward full of labouring women! Privacy? Don't be daft now - admittedly many women are left unattended during labour for long periods of time, however, it is unlikely you'll experience any kind of privacy when you're flat on your back with your legs akimbo & a midwife you've probably never met before directing your PUSHING. And that's if your birth is 'uncomplicated'. If you 'need' a ventouse, forceps or a caesarean, you can expect around 10 strangers in the room all staring at your twinkle. How about a hormone-led birth? Definitely not if your hormones are dictating a pace slower than the standard 12 hour time-limit.
So how on earth can you ensure conditions are right for your mammalian body to perfom well 'on the night'? Well, avoiding the use of routine interventions is a good start. I shudder at the thought of anything with the word 'routine' attached to it as it implies a bog standard service, not necessarily one that's right for YOU.
However, I think it's important to point out here that interventions aren't always a bad thing. ANYTHING that deviates from a normal land birth can be considered an intervention - in which case even waterbirth, which is regarded as a tool to enhance normal birth, can be classed as an intervention. And as long as an intervention is truly necessary in a specific situation & not a matter of routine, then we can't universally condemn its use.
Below are a few suggestions on how you might go about getting the birth you want - pick & choose which ones you feel are suitable to you, but overall when you're making the decisions on how & where you'd like to give birth, keep asking yourself :-
"will this place / person enhance the right conditions for me & my baby or block them?".
SUGGESTIONS ON HOW TO GET THE BIRTH YOU WANT
1. Book a home birth - In March 2006 the NMC finally provided definitive, unambiguous guidelines that support women's choice to have their babies at home - this means that no NHS Trust can refuse a woman a home birth. OK, let's just clarify that - a Health Trust can refuse to provide a home birth service, however, if you are in labour at home & call for a midwife, the midwife is duty-bound to attend you - and that duty is held over & above the one she has to her employer. A midwife's professional duty is to you & she can be hauled up infront of a hearing if she fails to attend your needs in labour. Therefore, if you ask for a home birth & are refused, the best advice is to print out the NMC's guidelines (link above), show it to your midwife & inform her that you will be staying at home for your birth. It is then up to her to take the situation further with her employers - it is not your problem.
One of the benefits ( there are hundreds) of booking a home birth is that you can change your mind at anytime & either transfer to hospital in labour (which is what you'd do if you booked a hospital birth anyway) or you can rebook to transfer your care to hospital at any time during your pregnancy.
I definitely believe, while our chances of attaining a normal birth in hospital are so low (one estimate stands at less than 10%) most women should book a home birth or out-of-hospital birth centre as a matter of course.
The main advantage of booking a home birth is that you call the shots - it's your home, your own environment & anyone coming into that has to abide by your rules - in hospital it's their rules, at home it's yours.. Add to that the fact you're surrounded by your own germs (therefore less likely to suffer an infection), your own toilet (less likely to encounter it covered in other women's blood - I hope) & as many family & friends as you wish (not my thing personally, but I can see why some women like that). You can also eat what you like to keep your energy up - in hospital they prefer a nil-by-mouth, especially if you've had an epidural, incase they have to operate (no wonder you get knackered with no food in your belly).
Other advantages? Of course! Semi-darkness, peace & quiet & PRIVACY. No strangers wandering in & out, you can switch the lights on or off according to how YOU want it, no monitors, move about where you like & even tell everyone to bugger off & leave you alone if you want! I could go on..........
For all your Home Birth queries, go to The Home Birth Reference Site, which is bursting with easy-to-digest information.
ALL the research that has been done states that for a woman who has undergone a normal pregnancy, a home birth is just as safe, IF NOT SAFER, than a hospital birth. And do bear in mind that anyone who tries to state to the contrary will lack any evidence of research & will also have their own agenda i.e. a midwife who is not confident in peforming home birth or an obstetrician who has never attended a single birth outside the confines of his/her hospital. They're easy to spot - they will likely trot out a piece of scaremongering anecdotal advice (about a woman or baby that died / nearly died / suffered brain damage / fell off a cliff because of a home birth) accompanied by a knowing look. Don't be bullied, just politely ask to see a copy of the research on which they base their well-thought-out opinion & then ask how many home births they have personally attended.
2. Write a detailed birth plan - Don't just write 'I'd like a natural birth with gas & air' and think that's going to be it. Think carefully about how you're going to try to achieve the birth you want? What methods are you going to use to cope with the pain? Giving birth isn't a walk in the park - for most people it's damned hard work that needs to be carefully prepared for. Try to include as many eventualities as you can, such as how would you feel if 5 student Drs were stood at the end of your bed during a vaginal examination, or what your thoughts on episiotomy might be? Do you want a physiological third stage or a managed one? Do you agree with induction & if so, what methods do you find acceptable? Formulate back-up plans if things don't work out the way you'd hoped - we all know what our ideal birth would be, but what are you going to do if things don't go according to plan? I find once again the Home Birth Reference Site to have one of the best & most thorough guides to writing your birth plan - and even if you plan to birth in hospital, Angela's guide will give you plenty to think about that you might not have previously considered. Birth plans are a vital tool for communication between you & the health professionals who will care for you during your labour, so include as many details as you can.
3. Continuity of care - All the research done in this field concludes that the continuity of carer is one of the most important aspects in ensuring better outcomes for Mums & babies. If you can't guarantee that you're going to know the midwives who will attend you when you go into labour, you may want to think about hiring a doula. As wonderful as my husband was while I was in labour with my first child, I found that it would have been much more helpful to have someone else there who was experienced in birth. Doula UK is the best place to look for a trained doula in your area but a word of caution - Doulas are supposed to provide you with support around the time of your birth, not advice. Unfortunately, however, there seems to be a growing current trend for some dodgy doulas setting themselves up as pseudo-experts in birth - they are NOT. If you have any doubts or queries about your pregnancy or labour always CONSULT A MEDICAL PROFESSIONAL (a midwife or Obstetrician) - they have at least spent years studying birth, as opposed to downloading some cod advice from the internet.
4. Research, research, research - It amazes me that so many women go into pregnancy & birth without hardly picking up a leaflet to find out what they're letting themselves in for. I swear most women put more effort into researching their new kitchen than they do their own pregnancy & birth. I had one friend who was much happier to attend a couple of classes run by the hospital & then just see how things went on the day.
Pregnancy & birth have the most dramatic & sometimes irreversible effects on your body & yet very few women actually find out about what it all entails. Perhaps it's because we're bombarded with other women's silly advice & horror stories that leaves many feeling they'd 'rather not know'.
I certainly don't subscribe to that way of thinking - to me, knowledge is definitely power & the more knowledgeable you are about your pregnancy & birth, the more autonomy you can retain over your baby & your body. So, don't just attend your hospital-run birth classes & think you're now something of an expert (especially seeing as most of these classes are based on a hospital, medicalised birth). Read & digest as much information as you possibly can - let's face it, you've got no excuse not to with those long long weeks towards the end of your pregnancy (although it's probably best not to cram at that stage).
5. Optimum Foetal Positioning - Once again it's the Home Birth Reference Site that has the best article. This tells you everything you need to know about how to get your baby lying Occiput Anterior - that is, with his / her back running along your belly, not your back. If your baby is in this position when you go into labour, you're more likely to have a smoother ride. If your baby is Occiput Posterior - with its back running along your spine - your labour is likely to be alot longer & more painful as the baby has to turn a full 180 degrees before it can attempt to make its exit.
6. VBAC (Vaginal Birth After Caesarean) - If you've had a caesarean (or even two or three) & would very much like a vaginal birth next time around, the most amazing website to find detailed, easy to digest, research-based information is www.caesarean.org.uk It's a truly fantastic website run by 2 members of AIMS & I especially recommend the articles & FAQ section. It's teeming with information that Obstetricians definitely won't divulge, so go there, absorb & empower yourself with some excellent knowledge. The myths, scaremongering & downright lies that surround Caesarean Section & VBAC are an utter disgrace.
Please also have a look at Angela Horn's excellent research.
And incidentally, according to one recent study in the USA , your risk of uterine rupture during a VBAC after one single previous caesarean is 0.7% & the risk increases to only 0.9% if you've had multiple caesareans. Plenty of food for thought.