When we think of a good birth, we tend to think of one where both mother and baby are alive at the end.

What happens before – the labour and the birth itself – seems to be less important than the final result.

Of course everyone wants mothers and babies to be healthy. That’s a given.

And when assistance is needed, we’re grateful for the medical technology that’s available to help.

Today, however, we are in the midst of a birthing crisis.

Women in developed countries are experiencing ever increasing numbers of interventions – most of them unnecessary for a healthy outcome.

At the same time, women in developing countries are without the medical support they need to birth safely.

There’s no balance. And often there’s no room in the equation for the person who is actually the most affected – the birthing mother.

A Good Birth Is More Than The Baby Being Born Alive, World Health Organization Says

The World Health Organization (WHO) believes a good birth is one where women are placed at the centre of their care.

WHO has recently updated its recommendations on intrapartum care. These recommendations are designed to set a global standard for the provision and experience of care during birth.

The WHO guidelines reflect the need for maternity care providers to widen the focus – from simply making sure mothers and babies survive and towards ensuring they have the best possible physical, psychological and emotional outcomes.

What Is A Good Birth?

The obstetric maternity care model is medical based, and looks at a good physical result as a successful outcome. It ignores the emotional and psychological results, which are important in how the birthing woman feels about her birth. Obstetric models of care see much higher levels of intervention – even for women who have healthy, low risk pregnancies.

The midwifery care model traditionally encompasses a holistic approach to birth. This means it views birth as normal and also addresses the important emotional and psychological aspects of a woman’s life. As a result, in midwifery led models of care we tend to see far less intervention and interference in the normal process of pregnancy and birth.

But is only a non medical, vaginal birth defined as a good birth? Does having a surgical birth, involving pain relief or a c-section, mean a good birth isn’t possible?

The short answer to this is, no.

Good quality maternity care places the physical, emotional and psychological health of the birthing woman at the centre. She feels physically and emotionally safe, respected, connected and in charge, regardless of the place in which she is birthing, and the way she is birthing.

So much of this comes down to care providers, their attitude and their philosophy with regard to birth and birthing women.

Let’s look at this a little more closely:

#1: Freedom To Choose

Typically, in obstetric settings, birth has rules placed around it. They are called policies, and might be set by hospitals or care providers such as obstetricians. The rules are really risk assessment tools, and have little to do with each individual mother-baby pair.

Many women will agree to these rules because they aren’t aware they have choices – to ask for more information or other alternatives, or even to refuse consent. Many procedures today, such as vaginal exams or electronic fetal monitoring, are simply done as part of the routine – even when there is little evidence to support their use.

The Listening To Mothers Survey IV shows increasing numbers of women feel pressured to accept medical interventions, such as induction, epidurals and c-sections.

A woman who is given quality care will feel free to ask for information and support in order to make the best decision for herself and for her baby at the time. She won’t be pressured or feel coerced into allowing her agency to be removed.

#2: Respect

Being treated with respect at one of the most vulnerable times of your life is critical to how you will experience it. The idea of respectful maternity care has changed over the last few decades, largely as a response to increasing reports of obstetric violence.

Many women look at the time of Twilight Sleep and assume obstetric violence started and ended then. But this isn’t so. Abuse and disrespect are growing problems in many countries, including developed countries.

Disrespectful care includes:

Physical, verbal or sexual abuse
Stigma and discrimination
Failure to meet professional standards of care
Poor rapport between women and providers
Health system conditions and constraints.

Respectful maternity care is an important part of the overall quality of care women receive. It is also a human right. Recently, WHO called for the prevention and elimination of disrespect and abuse of birthing women, stating:

“Every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth”.

A good birth is one where both the birthing woman and her care provider share a mutual respect for each other’s role; this creates a positive birth experience.

#3: Birth Knowledge

Modern women have very little personal experience of pregnancy and birth before they have their first baby. In terms of human evolution, until recently the opposite was true. Girls and young women would have observed and participated in birth support, learning and understanding the normal process as it happened. This diminishes the unknown, which is the main cause of fear.

A good birth is one where women are prepared before the event, so they understand what is happening and why. The vast majority of women can give birth without medical assistance. To understand how that is possible, women have to go back and reconnect with what their bodies can do.

This doesn’t necessarily mean they need to plan every detail, but just to understand what makes birth tick so they can make the best choices in the moment as birth unfolds.

Good quality independent education about birth can make all the difference when the moment arrives. It isn’t always possible to plan for one particular birth outcome but women can be prepared for birth and make sure it is a positive experience.

#4: Personal Safety

Feeling safe means different things to different women. Some prefer to be in the security and comfort of their own homes. Others want, and might need, the safety of having medical assistance on hand. Women generally want to have a skilled birth attendant nearby, even if it’s simply to observe, and be available on the rare occasion something changes.

Birth is supposed to be a lot safer today than it ever was. But it’s hard to feel safe when there is so much information out there telling women how dangerous and unpredictable birth is.

How do you find the sense of safety you need?

The best way is to do your research and work out what makes you feel safe – all the medical bells and whistles, a water birth in your living room, or something in between? The what, who and where questions are critical; what birth do you want, who is likely to get you that birth, and where is that type of birth most likely to happen?

#5: Confidence

Any child development experts worth their salt will tell you how important parent-child bonding is in the first days and weeks after birth. Research shows the best way to predict the future physical and mental health of a child is to look at the quality of bonding that occurred in the child’s early life with her primary caregiver.

A woman who has a good birth begins her life as a mother high in confidence and satisfaction. She knows she can meet the challenges of motherhood and give herself fully to the bonding process with her baby. This is the best possible start to life her child can have.

A woman whose birth experience was traumatic will be at a disadvantage from the first moment her baby is born. She has to carry the weight of her damaged physical and mental health, as well as cope with the transition to motherhood. Without intensive support, this mother is less likely to thrive. Bonding can be affected, which then has an impact on her baby and his future life.

We need to rethink, seriously and urgently, how we judge what makes birth successful. It’s no longer acceptable to say it was a good birth simply because there are two people alive and breathing at the end. We need to make the emotional and psychological health of mothers and babies a priority as well.

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