New Active Birth: A Concise Guide to Natural Childbirth - Janet Balaskas

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an intensive care setting. The whole pregnancy is seen as a pathological condition terminated only by delivery. The modern high-tech obstetrician actively manages labour with all the technology of ultrasound, continuous electronic monitoring and oxytocin intravenous drip. Many obstetricians have never had the opportunity to see a truly natural birth. To turn the process of bringing new life into the world into one in which a woman becomes simply the body on the delivery table rather than an active birth-giver is a degradation of the mother’s role in childbirth.

      We are now beginning to discover the sometimes long-term destructive effects on the relationship between a mother and her baby and on the family, of treating women as if they were merely containers to be relieved of their contents and of concentrating attention on a bag of muscle and a birth canal, instead of relating to and caring for the person of whom the uterus and the vagina are a part.

      ‘Bonding’ is a fashionable term today. In many hospitals special time is devoted for bonding and there must be few midwives and obstetricians who would not claim that they consider bonding important. But everything that happens after delivery is the outcome of what has gone before. Bonding is either spontaneous and easy, or made virtually impossible by the atmosphere at delivery and by the care a woman is given as a person, not merely a ‘para 1’, an elderly primigravida, a maternal pelvis, a contracting uterus or a dilating cervix.

      The way we give birth is important to all of us because it has a great deal to do with the kind of society we want to live in, the significance of the coming to birth of a new person and a new family.

      When we hand over responsibility for choosing between alternatives on the basis of what we believe to be right, we hand over responsibility for the quality of the society we, and our children, must live in.

      Sheila Kitzinger

       Introduction

      The concept of ‘active birth’ is a milestone in the history of childbirth. Bringing together these two simple words is by itself a work of genius: ‘active birth’ covers a huge scale of meanings, at different complementary levels.

      The first level might be described as muscular. When you just have a glimpse of some pictures of ‘active births’ you notice that at the end of the labour, when the baby is coming, many mothers are vertical, hanging on to someone or something, or leaning forward on something, or in a supported squatting position, or kneeling …

      At the second level you penetrate more deeply into the physiological process of childbirth. Childbirth is first a brain process. When a woman is giving birth by herself, the active part of her brain is the primitive part. It is this part which we have in common with all the mammals, the part which secretes the necessary hormones. A woman gives birth actively when she can secrete her own hormones, or, in other words, when she does not need synthetic hormones from a drip, or any other kind of medical intervention. The activity of the primitive part of the brain implies a reduction of inhibitions coming from the ‘new’ brain, the neocortex. The factors which can disturb this brain process, this change of conscious level, are not easily eliminated in the context of modern obstetric units: privacy, semi-darkness, silence, and, at the same time, the proximity of an experienced person.

      At the third level ‘active birth’ refers to the attitude that society as a whole has towards childbirth. In our society childbirth is completely under the control and under the responsibility of medical institutions. Pregnant and labouring women are called ‘patients’. Medical institutions include modern midwifery. Modern midwives, trained in obstetric units, are not any longer mothers helping other mothers. When a newborn baby is not healthy, the medical institution is considered as responsible. The concept of ‘active birth’ has been introduced by women who want to take back the control and the responsibility of childbirth. They consider the medical institution as a resource to use in precise circumstances. What a provocative challenge at a time when the negative side effects of obstetrics are better and better known!

      The day when Janet introduced the phrase ‘active birth’ is possibly the most important one in the history of childbirth in Europe … since the day when the French doctor Mauriceau took control of this event and placed the labouring woman on her back.

      Michel Odent

       1 What is an Active Birth?

      During the rapid development of modern obstetrics in the last three hundred years, women have lost touch with their power as birth-givers. We have almost forgotten how a natural physiological birth unfolds.

      An Active Birth is nothing new. It is simply a convenient way of describing normal labour and birth and the way that a woman behaves when she is following her own instincts and the physiological logic of her body. It is a way of saying that she herself is in control of her body while giving birth, rather than the passive recipient of an ‘actively managed’ birth on the part of her attendants.

      By deciding to have an Active Birth you will be reclaiming your fundamental power as a birth-giver, a mother and also as a woman. You will also be giving your baby the best possible start in life and a safe transition from the womb to the world. Should an unusual difficulty or complication arise, you will be free to make use of the safety net of modern obstetric care, knowing that you have done your very best and also knowing that this is your choice and that the intervention was really necessary. In this way, even the most difficult birth can be a positive experience.

      Preparing for an Active Birth during pregnancy will lessen the likelihood of complications arising. It will also ensure that you approach the birth of your baby in optimal health, which will enhance and hasten your recovery, whatever happens.

      If you give birth actively you will want to move around freely during the early part, or first stage, of labour, choosing comfortable upright positions such as standing, walking, sitting, kneeling or squatting. In between contractions you will find ways to rest in these positions, comfortably supported by pillows. As you approach the expulsive or second stage during which your child will be born, you will continue to use the upright positions which are most comfortable or practical. At the end, for the actual birth, you will use a natural expulsive position (usually supported) like squatting or kneeling.

      An Active Birth is instinctive. It involves you giving birth quite naturally and spontaneously through your own will and determination, having the complete freedom to use your body as you choose and to follow its urges. Active Birth is an attitude of mind. It involves acceptance and trust in the natural function and involuntary nature of the birth process, as well as an attitude or appropriate positioning of your body. It is not merely a vaginal extraction or delivery in which the attendants are in control and you are a passive patient. It is more comfortable, safer and more efficient than a passive ‘confinement’. This is supported by the many scientific studies comparing women who are active in labour with those in a passive recumbent position (see here).

      Some women, left to themselves, will instinctively know what to do in labour, but most of us, having no example to follow, need to be made aware of the possibilities of using various upright positions in order to discover our instincts. This can easily be done by practising the birth positions and movements which are most appropriate and comfortable during your pregnancy. The yoga-based exercises in this book will lead you towards your own instincts for labour and birth, while cultivating the right and natural body habits for a healthy pregnancy.

      The Question of Birth Positions

      A growing number of women, midwives, nurses, obstetricians and childbirth educators are questioning positions that characterise modern labour and birth practices, and the passive, patient-orientated role demanded of women in contemporary maternity care. The specific practice that is being criticised is the almost exclusive use of lying down (recumbent) positions for childbirth known as supine,

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