Milli Hill is a freelance writer and the founder of the Positive Birth Movement. Her book, The Positive Birth Book was published by Pinter & Martin in March 2017

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I’ve been thinking and writing about birth for just over a decade, and one of the things that’s interested me most over this time is the common cultural messages that women are given about childbirth. Here’s my top 3:

 

1. A healthy baby is all that matters

2. When you give birth you have to leave your dignity at the door.

3. There’s no point making a Birth Plan because birth is uncontrollable and unpredictable.

 

It’s so interesting how we absorb these messages from a young age, they roll off the tongue so easily, and we rarely think to question them. It can be very hard to be critical or analytical about ideas that have been so integral to every conversation we have ever had on a certain topic that we have come to accept them as fact. As Marsden Wagner says in this wonderful article about birth and culture, “Fish can’t see water”. 

 

If you are approaching birth yourself, you may well – consciously or unconsciously – have taken on board all of these messages, and they may well form a bedrock for your thinking about what having a baby will be like for you. You may also find that the messages are getting stronger: you’ve got a pen and paper out and are making some notes about optimal clamping and Auntie Shirley gently reminds you that, ‘the main thing is that the baby is happy and healthy’, or your obstetrician jokes that he doesn’t mind birth plans, ‘as long as they’re not laminated’. 

 

The message is subtle but clear. Don’t try too hard at birth, because you can’t control it, you just have to get through it, grin and bear it, and then you hopefully get a healthy baby and that’s the main thing to focus on. But is this message correct? And if not, is there anything that women and their partners can do to make birth better in the 21st century birth room?

 

The answer is complex, first and foremost because it’s wildly unfair to give women all of the responsibility for having a positive birth experience. What we know about birth trauma is that it’s most often not caused by the course birth takes on the day or the mode of birth itself – but that it’s more often rooted in the way that people are treated, cared for and spoken to. Surely, therefore, positive birth is the carers responsibility and beyond the birthing woman’s control?

 

Not quite. To draw an analogy, the current #timesup #metoo movement is not suggesting that women take responsibility for men’s behaviour, but it is suggesting that they raise their voices and take a stand against it. It calls for an attitude shift. It calls for women to have a sense of entitlement about other’s behaviour towards them. In just the same way, I’m calling for an attitude shift in pregnant women and a new sense of entitlement not just in the way they think about, plan for and approach their birth, but in the way they expect to be treated. 

 

Prior to motherhood, I worked as a creative psychotherapist – a profession which is pretty much 100% about CHANGE. What I learnt through this work and through my own therapy is that, whatever the situation, if you want to make change in your life, you have to start with yourself. You can waste an awful lot of effort and energy trying to change others: it’s pointless. What you can do is change yourself and your own approach and behaviour. When you do this, others around you will be forced to change. People cannot carry on behaving the same way towards you if you don’t behave, react and respond in the way they have come to expect. A bully needs a victim, a heartless boss needs a willing worker, a thoughtless husband needs a long-suffering wife. These changes can be hard, but even small shifts in behaviour can create really big ripples. Try it!

 

In the birth room, the power dynamic is often so strongly weighted against the labouring woman that she may not even be aware that she has choices and rights. Time’s up on that one. I think that if we as women approach birth informed, and with a strong sense of how we are entitled to be treated, then we will find that the system will simply have to change to accommodate us. 

 

In practical terms, this means ignoring those pesky cultural messages. Let’s briefly break them down one by one. 

 

1. All that matters is a healthy baby.

For most women and their partners, a healthy baby is the most important consideration of the birth, but it is not the only consideration – it is not ALL that matters. It needs to be demoted from ‘pinnacle of expectations’ and sent firmly to ‘baseline’. Telling women that a healthy baby is the only important thing about birth completely dismisses their experience and feelings as individuals who matter too. It also discourages women from taking an active interest in their birth choices – indeed, it is very often used as a casual reminder to a woman who is ‘getting a bit worked up’ about her options, to ‘calm down luv’ and remember that, ultimately, her birth doesn’t really matter. The phrase may be well-meant, but it’s time to confine it to the history books. Women matter too.

 

2. When you give birth you have to leave your dignity at the door.

No you don’t. Dignity and respectful care are vitally important to how you feel during and after your birth and if at any point you feel that you are not being cared for in a way that feels right to you, you have the right to speak out. Nothing can or should happen to you in your maternity care that you do not feel you have understood and consented to. Everything that happens to you should be clearly explained and you have the right to accept or decline any treatment. If you feel particularly worried about your bodily autonomy, right to privacy, or examinations during childbirth, talk to your midwife. Some women who have straightforward births, for example, do so without any vaginal exams whatsoever. Remember that everything is optional and that you are the one whose body it is and therefore you get to call the shots.

 

3. There is no point making a birth plan because birth is uncontrollable and unpredictable.

We might all dream of a world in which a birth plan is unnecessary, in which women know and have a brilliant relationship with their midwife, and in which they have the time to talk everything over well in advance of the birth so that she knows exactly what kind of person they are and what she will want in every scenario. Unfortunately, in most parts of the UK, we are currently a long way from that world. In an overstretched system, you may still not know your midwife, even though this has been shown to improve both outcome and experience. The NHS is working towards this, but in the meantime, why are we telling women not to make a birth plan against this backdrop? Making a birth plan is a chance to really think about all of your options (and there are LOTS!), and consider what you might want to happen in all kinds of different scenarios. You can make a Plan A, for your best birth where everything goes exactly as you hope, but you can also make a Plan B, C or even D, for the choices you would like to make if birth deviates from your chosen path. Even if you are hoping for a home birth in a yurt in your garden, you should still make a BPC Plan, for your Best Possible Caesarean. It’s true that birth can be unpredictable, but it may well be less so if you consider your options in advance. And whilst it may be uncontrollable, it doesn’t have to leave you feeling ‘out of control’. However birth unfolds, you still have choices.

 

All of these cultural messages are interrelated because they all boil down to the same point: what happens in birth just happens, that’s how it is, that’s how it’s always been, accept it. I hope this article has encouraged you to reconsider whether this is actually true and to point you towards new ways of thinking about birth. 

 

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Possible next steps:

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Make a birth plan. The Visual Birth Plan icons from the Positive Birth Book are free to download if you click here. They can be used in conjunction with the Positive Birth Book as you learn more about your options.

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Find your nearest Positive Birth Movement group. You can do this by visiting www.positivebirthmovement.org/groups and allowing the site to know your location. PBM groups are free and are a great place to find support and information during and after your pregnancy. 

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