Rebirth Festival, Athens, April 2025 – Keynote talk

Background: AIMS is a member of ENCA - the European Network of Childbirth Associations¹. Each year, one of the member associations hosts a two day gathering of birth activists from across Europe. In 2025 we came together in Athens for two days of national updates and supportive discussion, drawing out common themes, ideas for action and offering mutual support. This year, on the following day, many ENCA members also took part in an outdoor birth festival designed for families in the Greater Athens region. In the historic setting of Plato’s Academy - now a city park - families and birth workers gathered for a day of celebration and information-sharing. Some ENCA members ran a popular rebozo workshop². Jo - this year’s AIMS representative - was honoured to give the following invited talk, which was simultaneously translated for the audience present.

My name is Jo and I am delighted to be joining you here today to address the important theme of this gathering: natural birth and the importance of the survival of the knowledge and practice of straightforward natural birth³.

Because in the UK, and here too I think, it’s not an exaggeration to fear the cultural extinction of the practice of natural birth.

That is, women birthing in the way that our bodies are designed to do, in an environment where there is an absolute understanding that it is us who should decide how, when, where and with whom we birth. With supporters who treat us with respect and dignity, and with a proper appreciation and determination to uphold our human rights.

Because we all know: the way that our healthcare professionals in our maternity systems support us needs to change, founded on a good understanding of how our bodies are designed to work, so that they might support, rather than that undermine the physiological processes of birth.

And I have just come from a 2-day meeting of colleagues from across Europe, where our shared concern about these issues was evident. Thank you to our Athens hosts who made this meeting possible - in the beautiful surroundings of Spiti Thilmasou in Chalandri. Thank you to fellow members of our European network, ENCA – the European Network of Childbirth Associations. Coming together, every year, it is so important that we have an opportunity to connect, appreciate and sustain how we are all working - in our different countries – on this critical issue. This year, it has been a pleasure and a privilege for us to all learn a little more about the particular issues here in Greece.

Please note that I am not a midwife or medically trained in any way. Rather, I stand here as a mum of four and - thanks to my eldest daughter - a brand new grandmother. And as a volunteer working alongside other women in the UK, in an organisation that we call AIMS – the Association for Improvements in the Maternity Services. An organisation made up of a succession of volunteers - mostly mothers and grandmothers - who have been working together to campaign to improve maternity services for 65 years. And we are still working!

In this talk, I want to tell you a bit about me and how I have come to this work.

Then I will explain a bit more about AIMS, and our work to ensure that respectful natural birth remains a possibility in the UK.

I will then offer some reflections that I hope you here in Greece will find useful.

Because I do not believe that the physical and mental violations that women are suffering all over Greece - during and as a result of their maternity experiences - should continue. We - you deserve better. But we need to insist on this as the users of the service. The system will not change unless we raise our voices.

So, let me quickly explain how I got interested in this topic.

Twenty years ago, and with my smallest children around me, I went back to university. Studying geography, I took the opportunity to examine why so few women give birth at home. Why is it not a space that appeals to more women? That led me to focus on how many of us develop imaginaries⁴ of birth that exclude the very possibility of planning to give birth at home or in another out-of-hospital setting. This, of course, is linked to our confidence in our ability to birth, and our understanding of what it means to have a safe birth.

So I embarked on another study, this time to understand more about the contemporary birth culture in the UK, and how women use their agency, skill and knowledge to navigate labour and birth successfully. I wanted to see what strategies we use to give ourselves the best chance of achieving successful straightforward births.

But this focus was swiftly interrupted. I instead heard from women how they are routinely faced with hostile, infantilising and disrespectful treatment, and unnecessary routine medicalisation. This led them to use their agency, skill and experiential knowledge of birth within our current maternity services in quite a different way.

They sought not so much to improve their chances of a straightforward birth, but to avoid it, for example with a caesarean birth, early inductions, or a reliance on the disabling pain relief of the epidural.

So I noticed that women’s experiences of giving birth in the UK - rather than helping us to become more confident about our ability to birth - more often lead us to believe that the physiological process of birth - at least in our traditional hospital settings - is dangerous, abnormal and unnecessary.

This all sat uneasily with the claim of healthcare researchers who tell us that ‘most women want a normal birth’. Well, I think there’s a big difference in saying we want something and really working to make it - or being open to having it - happen. If we are experiencing - or regularly hearing about – routine harm in the maternity services, it is not surprising that we lower our expectations about our ability to birth in a way that leaves us both physically and mentally well, and instead start to accept that near inevitable harm that will instead result from our encounters with the maternity services. That we – women – do not matter enough for things to be any different, for us to be free of violation as we birth.

How can we break this vicious circle? For too many of us, I wonder whether our dependence on the maternity service routines is one of the problems we must tackle. Is this dependence founded on a belief that others can do much of the work for us/ decide what needs to be done to achieve a safe birth?

Does this dependence entice us into institutional spaces that are actually very poorly designed for the facilitation of labour and birth, and that work to interrupt rather than support the physiological process of labour and birth?

My sense is that birth is just too embodied a process to successfully outsource the work in that way, although that is perhaps what many women - consciously or not – choose to do.

And in the UK, we are learning - with the help of our university researchers - that home is far safer a place for us to birth than we have been previously told. Indeed, researchers looked at many years of UK data, as part of study we called Birthplace. And thanks to further evidence, we can - officially - now tell women with confidence that if they have a straightforward pregnancy and everything looks good, then it is generally SAFER for them to stay at home to give birth.

What we had been convinced of in the 1960s and 70s – that the hospital was the safest place to give birth – is simply untrue.

And this leaves us with further questions. It is important to have a system that has the capacity to offer medicalised support when needed and in the case of emergencies. So in over-using this system, are we placing too high a burden on the service, such that it increasingly struggles to deal with emergency and life-threatening situations? In our use of the service, are we encouraging a workflow that routinely delivers ‘too much medicalisation too soon’, resulting in other women receiving treatment that is ‘too little too late’?

So this leads to other questions.

How can we play our part in ensuring that the maternity services are better organised to deliver care in the places, at the times, by the people that are right for us, as individuals? How can we ensure that we use the skills of highly trained midwives - in our communities - to their fullest extent, rather than confusing this with the need for a routinely medicalised factory line approach in our acute hospitals.

These are questions that are on the one hand common across our countries, but demanding solutions that are tailored to our local systems, each steeped in their particular histories.

That is why I find it so inspiring that you are gathering here today. We – you - have work to do together. As mothers. In our communities. In partnership with those midwives who understand fully that they are there to support our choices and enable our access to more specialised medical care where necessary, not to take over our births and push us into spaces that are poorly designed to allow our bodies to birth and our babies to be born gently.

Let me tell you a little about how a small group of women have come together to do this in the UK.

AIMS - the Association for Improvements in the Maternity Services was set up in 1960, as we started to understand the poor treatment women were getting as birth shifted into our hospitals. We wanted this to change.

We celebrate our 65th birthday this year. It is an organisation that is built on the unpaid work of women, mostly mothers and grandmothers.

AIMS has two main activities. We support women - and their supporters - to navigate the current maternity services, offering access to the information they want and need. We run a helpline and we publish accessible and evidence-based information and discussion, on our website, in books and in our quarterly journal (no longer printed but instead available for free online). Then, we campaign nationally for improvements to the maternity services.

Much of our campaigning work focuses on the pregnant woman’s right to autonomy - our right to make decisions about our bodies, and about where, how, when and with whom we give birth. We highlight the need for personalised care. We remind decision makers that a one-size-fits-all industrial approach to birth is not a safe or acceptable approach.

And after decades of this work, we are proud to see that national policies and guidelines around maternity care in the UK are really pretty good.

• We work tirelessly as a team to engage in policy discussions and review proposed policy documents to ensure that the principle of women’s autonomy is always central. Treatments or interventions can be offered - alongside information about risks, benefits, alternatives - but never imposed. On paper at least.

• We work to retain the possibility that women can be supported by midwives to give birth at home and in other out-of-hospital birth settings. On paper at least.

• We have achieved a UK wide policy that seeks to implement relationship-based midwifery care for everyone in the UK, offering women a chance to build a relationship with a midwife over her whole maternity journey. We have good evidence – from its early implementation – that women like and benefit from this model of care. But we are realistic – we are likely still decades off seeing that implemented as a universal offer. Resistance to the value of this social model of care is high.

• We highlight how many of our maternity healthcare professionals still do not understand enough about the physiology of labour and birth – which is crucial if they are to both facilitate it well and to detect emerging problems and escalate care where necessary. We explain why support for normal labour and birth is something that we expect women to have access to, and that it is something of value. We challenge those who see it as a dangerous pursuit, led by dangerous midwives, that is misguided and that should be banned. We challenge the idea that midwives should not positively value and promote straightforward birth, whilst they should also remain compassionate whatever type of birth a woman needs or chooses.

• We are continuously reviewing – and giving feedback on - the pros and cons of so many new policy initiatives and guidelines. We are busy!

But in the UK, where the power in maternity care delivery is highly fragmented and repeatedly being re-organised, this national action only takes us so far. Across the country, we continue to face problems with getting a progressive national policy framework implemented. We continue to hear many accounts of poor maternity care.

But at AIMS we persist in our efforts. We know that we have been successful in nudging forward a range of improvement initiatives. 65 years on, we feel that there is no case for our retirement. We relish working within an increasingly busy and diverse maternity services improvement community. There is much scope for new collaborations, and we see new energy being brought to the task of much-needed maternity service transformation. This can bring challenges too, of course, but we are stronger together.

So that’s a little bit about how we have organised in the UK.

Coming now to a close, I hope I might have inspired you a little to think about how the consumer lobby might further organise across Greece, to hold those responsible for your maternity services to account, to deliver on the improvements you want to see.

But enough from me. I am truly honoured to take part in your festival today, and I am excited to see how you will organise yourselves going forward to ensure that every woman who seeks the support of the maternity services in Greece can be assured of receiving safe, personalised, compassionate and competent maternity care, in the place, with the people and in the way that is right for you. You, your sisters and daughters deserve no less.

But next, let us hear from Gianna, a wonderful women centred practitioner – in midwifery and much else - on the very important business of exactly why the facilitation and achievement of the physiological process of labour and birth is so important to our and our babies’ wellbeing.

Thank you very much.

Footnotes

1. Read more about ENCA here: ENCA – network for improvements in perinatal care for mothers and babies
2. Case Study: Rebozo
3. In the UK it has become almost impossible to advocate for ‘natural’ or ‘normal’ birth. This is because the terms have been tainted by the suggestion that high-profile failings in some maternity services were due to them “prioritising normal birth at any cost”. For this reason, AIMS campaigns in the UK for maternity services to be ‘physiology informed’ and to be led by women’s decisions about the type of birth they want. For more information, please see the AIMS position papers on these topics here: Physiology-informed maternity services and Decision-making in Maternity
4. "The imaginary (or social imaginary) is the set of values, institutions, laws, and symbols through which people imagine their social whole. It is common to the members of a particular social group and the corresponding society. The concept of the imaginary has attracted attention in anthropology, sociology, psychoanalysis, philosophy, and media studies." Imaginary (sociology) - Wikipedia.