Giving birth is a remarkable, self-affirming achievement for every mother. Nothing else can compare with bringing a new life into being out of one's own body. But this astonishing achievement can be diminished through disempowerment.
An institutional culture where 'patients' are expected to be passive, where birth is seen as an everyday occurrence and where the skilled clinician Is omnipotent can compromise a woman's sense of achievement. Most of these things are not done deliberately, but they can be the unintentional consequences of an approach to childbirth that doesn't properly value the woman's experience.
For her to be able to make the most of her achievement, she needs to feel that she has been able to make decisions for herself, that she has enjoyed the respect and support of those around her and that she was at the centre of this extraordinary event of childbirth.
Whatever the situation
Sometimes the circumstances of a birth, or a woman's choices, present an even greater challenge. The environment where you are required to practise may be far from what you consider ideal. Or it may be that intervention of one kind or another is required. How can you still help her to feel a real sense of achievement?
This situation requires some thoughtful reflection. You will need to look at the experience of birth from everyone's perspective (particularly hers). Your own experiences as a midwife may well be influencing the way you respond, particularly if you have experienced similar situations that had less than happy outcomes or heard 'disaster' stories from colleagues.
Think carefully about how you would respond to circumstances that might arise, without falling into the trap of believing that because something might happen it necessarily will. Focus on solutions - thinking and talking in terms of 'problems' emphasizes the negative aspects of the experience, and will suggest to the woman (and others) that you think something may go wrong.
If there doesn't seem to be a solution, then you are faced with a situation that has to be accepted and worked around. If she insists on a homebirth on the sixteenth floor of a tower block, then your challenge Is how you adapt to this situation as safely as you can. Concentrate instead on the positives - what kind of support will you need? If, despite the circumstances, you can make this a safe, rewarding experience for her, your own sense of achievement will be even greater. Communicate with the woman and her family. Also establish communication channels with your supervisor of midwives, support services, acute unit personnel and ambulance service (if relevant) - ensuring clear roles In advance. When these lines of communication have been set up, you won't need to worry about having to establish them later.
All births can be rewarding. Even the woman who has a caesarean section under general anaesthetic still has the miracle of a newborn baby. But certain kinds of birth may be more rewarding than others. A woman who goes through labour without analgesia or intervention will experience a birth with the full potential of which she is capable, enjoying one of nature's great 'highs' thanks to her increased levels of endorphins. This is where our skills In encouraging support and facilitation of normal birth are fundamental.
But even when we try to encourage natural birth, we can still help her to feel that if she subsequently chooses, or requires, pain relief or technological intervention, she hasn't somehow failed.
Sharing power and responsibility
As with so many other issues to do with childbirth, a woman's sense of achievement is overwhelmingly linked with the extent of her power and control. When there is a sharing of power between woman and midwife, empowering the woman, her fulfilment will be much greater.
However, many women feel extremely vulnerable at this time. They can be strongly influenced by ‘authority figures' such as midwives, obstetricians, GPs and family members. Often this results in the woman feeling compelled to accept their decisions as her only options, allowing them to tell her 'what is best' for her baby.
To help a woman to be in tune with her power, and then to see her through the birth of her baby, is to see a her truly empowered and confident in her own ability to achieve her potential. This can be powerfully fulfilling for you, as well as for her!
Tips and tricks
-
Think about her fulfilment - and yours! How will the choices and information you offer to a woman contribute to a more fulfilling experience for her? Next time you are at a‘booking interview' be aware of what is behind the information you give. Is it your own desire (or your employers' desire) for risk avoidance and convenience? Does it empower the woman, or play on her fears? Are you emphasizing solutions, or dwelling on problems?
-
What birthplace options do you and your service offer? What challenges do you think are presented by each option? How would you facilitate a woman's sense of achievement irrespective of place of birth? Do you feel you've had the opportunity to develop your skills In normal birth practices In various environments?
-
Tune in to her sense of achievement! Be aware of it as labour progresses and think about how this could be enhanced. Then tune in to your own sense of achievement. How is it for you? Does this feel like a shared achievement? Enjoy discussing with women the important issues in their lives and facilitating women's decision-making for themselves.
Further reading
Kirkham M (ed) (2004)
Informed choice in maternity care Palgrave Macmillan, Hampshire
Leboyer F (1993)
Birth without violence Cedar
Odent M (1984)
Birth reborn Souvenir Press
Raphael-Leff J (1991)
Psychological processes of childbearing Chapman & Hall, London
