In new guidelines released by the World Health Organization, doctors are urged to trust in women’s ability to give birth without assistance.
The new recommendations are a welcome focus on birth as a normal event in women’s lives.
Doctors Should Support Normal Birth, WHO says
The WHO says the new guidance ‘highlights how woman-centred care can optimise the quality of labour and childbirth care through a holistic, human rights-based approach’.
For many decades, women have been encouraged to give birth in hospitals as the safest option. The current model of maternity care puts control of labour and birth in the hands of care providers.
This medical management of birth has ensured women are exposed to unnecessary medical interventions, which not only interfere with normal birth, but can lead to ongoing physical and mental trauma.
Care providers who work in obstetric settings are more likely to intervene during labour, because of their training, and a lack of exposure to normal birth.
Over the last few decades, birth interventions have become ‘normalised’, due to risk avoidance practices.
What Is Risk?
Standard maternity care divides pregnant women into two groups: low and high risk.
Women who are low risk are those who are unlikely to have complications when giving birth. They have pregnancies uncomplicated by health problems and their babies develop normally. The WHO estimates the vast majority of the approximately 140 million births that happen every year are low risk.
High risk women are more likely to experience complications when giving birth, due to current or past factors. These factors include gestational diabetes, heart or blood pressure problems, repeat miscarriages, multiple c-sections… the list goes on.
The definition of risk is the possibility or chance of something negative happening. In birth, risk means the chance of something happening and having a negative impact on the health and wellbeing of mother and/or baby.
It’s important to know whether your care provider is talking about absolute or relative risk when discussing your maternity care.
Absolute risk is the actual risk of something happening to you. Relative risk is the risk of something happening to you in comparison with the risk of it happening to somebody else.
If there is a 1% chance of an adverse event occurring, it also means there is 99% chance it won’t happen.
The 1% risk also needs to be compared with the risks involved in alternative care options. For example, the 1% risk of uterine rupture during a vaginal birth after a c-section should be compared with the risks of complications following an elective c-section.
Is Normal Birth Risky?
Women are led to believe the care they receive in hospital settings is designed to manage risk and to reduce the chances of a negative event happening.
In actual fact, obstetric settings are more likely to create problems, because of the overuse of technology, interventions, procedures etc.
Procedures and interventions are often presented as risk management tools. In fact they exist to reduce the risk of litigation for doctors and hospitals.
Care providers aren’t exposed to the wonders and variations of normal birth. In many cases, hospital midwives rarely see a woman in spontaneous labour, or witness an uncomplicated breech or twin birth.
There is an expectation an unmanaged labour allows too much possibility for ‘things to go wrong. This persists, despite evidence that shows, time and time again, labour unfolds on its own, without help, when the right conditions are met.
How Do We Decide What’s Best For Birth?
We manage and cope with risk every day of our lives – quite often subconsciously. Most of the time we avoid negative situations because we undertake risk management without even thinking. Even so, a totally risk-free life isn’t possible.
In high-income countries such as Australia and the United Kingdom, birth is considered to be safe – particularly in comparison with countries where women have little to no access to health care and trained attendants.
The current maternity model of care, however, views birth as inherently risky for mothers and babies. It suggests the key to safety during birth is the management of risk. This view of birth is applied universally, rather than to each woman’s specific background and situation.
Where women plan to give birth depends on how they view birth and what choices are available to them. In some countries, birth at home is considered safe for low risk women and is supported within the maternity system.
In other countries, such as the US and Australia, access to maternity care depends on health insurance and women might have limited choices.
Generally, women who plan to give birth in hospital tend to accept the idea birth is medically risky. Most women don’t even consider how their choice of birth setting and care provider might have an impact on their birth.
They might be aware of the potential for increasing their risk of interventions, but they either believe it will not happen to them, or interventions will only happen if absolutely necessary.
Making informed choices about their birth care depends on women having unbiased information and support from their care providers. This helps women to put their own risk into perspective, and ensures they can make informed decisions.
Are The WHO Guidelines Good News For Birthing Women?
Women need to know there is an inherent, simple wisdom in nature’s plan for birth. And women need to be the focus of decision making and to experience birth on their terms.
In its new guidelines, this is the message the WHO wants pregnant women and their care providers to take away.
Is there potential risk in giving birth? Yes. But we can minimise the risk by having knowledge, confidence, support from carers who trust birth, and by avoiding unnecessary medical interventions.