Once thing that the natural childbirth movement has for it is science. Did you know that only 12% of guidelines in maternity services are formed from grade-A evidence? Everything else is grade B, C or D or just what is done as standard. I am obsessed with evidence. I am a huge nerd for peer-reviewed studies. I'm the one saying "Do you KNOW what percentage that risk is? How else can you make an informed choice?" emailing articles late into the night to people trying to make a decision.
For example, I know that as a low-risk second-time mother the safest place for me to be is at home and far away from any maternity unit or hospital. Simply change the place of birth and you can see the interventions such as epidural, episiotomy, assisted delivery, caesarean section climb up. I am the same person. Place of birth matters and yet home birth is still considered risky and brave? I beg to differ.
I cannot do my job without this evidence. I cannot support women to make the best choices for them without it. And yet...
My hero, Ina May Gaskin. Ina May runs her own birth center in the United States and believes that a woman who is emotionally supported in her labour rarely needs intervention. She keeps her own evidence and statistics of her births. I love her and I believe in her work with all my heart. I KNOW that is the way birth is meant to be. She began with little to no knowledge and built it up through experience.
Dr Tadashi Yoshimura, author of "Joyous Childbirth Changes the World" speaks of his disdain for evidence. He is an obstetrician who had a change of heart in the way he supported women and now runs a birth center. He asserts that all statistics are based on disturbed, medicalised birth and are NOT accurate for his birth practice. He and Ina May both report caesarean section figures of around 3%... coincidentally the same percentage as women who are physiologically unable to breastfeed.
I agree with him. I believe in him.
How can I love evidence-based decision making and yet love these two pioneers of undisturbed, uncomplicated birth? I read Yoshimura's book with frustration as I said to myself "How lovely for you in a peaceful birth centre in Japan - how is your opinion relevant to those of us working with women, consultants and midwives in South Wales? Undisturbed birth doesn't exist here. We need the evidence to navigate choice and negotiate care in less than ideal circumstances."
I came to the conclusion that they are my Utopia. In my dreams every woman gives birth with an Ina May or Yoshimura. When there is no fear of birth, no intimidating appointments, no scaremongering. I doubt that will happen in my lifetime. Rationally, realistically, this model of Evidence-Based Decision Making is the best that we've got. It feels a bit like treating the symptoms rather than the cause. I am furious, daily, with what I'm hearing and seeing in our hospitals.
Sitting in a room full of women feeling like I'm preparing them for the system rather than working to dismantle it. My love of evidence is contrary to my love of uninhibited birth. I hate the patriarchal, medical system of birth and a large part of my job has now unfortunately become toughening women up to face it, dare them to challenge it. It feels so wrong.
In the interests of women facing the medical system I share as much evidence as I can so they can make rational, thoughtful decisions - completely opposed to instinctive, intuitive birthing. I once spent a long time with a woman going over everything that could possibly happen for her birth plan, and came away feeling like a failure, thinking that what I really should have said is "I have confidence in your body's ability to birth your baby". It's what I believe. I support all choices. But what if all this evidence and informed decision making is detracting from everything that I believe to be true about birth? That it is normal, and that the majority of interventions arise from that simple PLACE of birth and the stress the system puts mothers under.
Discussing once with a client planning her home birth we touched on undisturbed birth, call it 'freebirth'. We were both enamoured with the concept. Ecstatic, unhindered. I know it exists, even though I've never seen it. I hope one day I do.