What is a normal birth?

The concept of normality refers to a purposeful reduction in the number of interventions used in pregnancy, labour, birth and postnatal period. The definition for normal birth is specifically applied to vaginal births without the use of technology or medical interventions. This would exclude onset of labour using induction methods, pain management such as epidural or spinal anaesthetic, and the use of forceps or ventouse.

The principles for normalising birth can also be applied where women may choose to have interventions or may require specialised care for existing medical problems, social circumstance and for any complications that may develop. In such cases, it is expected that women must receive appropriate multidisciplinary care whilst also promoting normality.

Measuring the current status of the service

Across the UK, there are currently no standardised or service level indicators for measuring the progress being made for achieving normality and the proportion of normal births. For England and Scotland, the annually published maternity statistics provide an overview of the type of interventions used at the onset of labour, for pain management and the birth. This can be used to understand the proportion of births which are vaginal with no technological or medical interventions. However, the equivalent datasets are not available in Wales and Northern Ireland and estimates need to be used as part of assessing progress towards normal births.

Measurement of the number of technological or medical interventions have taken place for a birth does not currently take place as part of the routine statistics in any of the four countries. As part of achieving normal births for 60% of women in UK, it is necessary to understand the triggers for interventions, the clinical context where reductions can safely and appropriately be applied and the way in which care is given throughout the pregnancy, birth and postnatal period which can maximise the opportunities for physiological births. Audits and surveys can be used as part of understanding the current context and making evidence-informed improvements to the maternity service.

Increasing the focus at service level

Despite a number of standards and guidelines, the UK is still not making sufficient progress in ensuring that normality is promoted and is part of the plan for the majority of women. From the design of the birth environment to practice, maximising the opportunities for normal births and following the principles of normality can improve outcomes for women and their newborns.