By Katie Hickey
Before I became a doula, I was a practising veterinary surgeon. I’ve had medical doctors joke with me about my change in career and ask if I will specialise as a ‘doula for animals’. To which I always reply, with a smile on my face, ‘No, because animals are not interfered with unnecessarily like humans are’.
I have worked in many different fields within veterinary medicine over the past 10 years and it was my love of horses that spurred me to pursue life as a vet (pun intended). It is interesting to explore the differences in the way we treat humans during the birth process compared to animals. I have chosen horses in particular for the sake of this article for several reasons; I have experience working with them as a vet and they are incredibly valuable animals.
Racehorses are often worth tens of millions of dollars, it’s BIG business. The most expensive racehorse sold for breeding purposes is reported to have cost $70 million. The breeding of horses, particularly for racing, is a highly specialised area, and it’s taken extremely seriously by owners, care givers and veterinarians alike. Horse owners and managers are given recommendations for how to care for mares during pregnancy and foaling (giving birth) as when things go wrong there are often very serious consequences and potentially huge financial implications.
Many of you will be familiar with the commonly used analogy during antenatal classes about how animals give birth. It is often discussed especially in terms of the natural physiology of birth, the hormones that are involved and how you can create a supportive environment to help encourage our natural hormones and therefore the natural birthing process.
For animals in captivity, including horses, the emphasis is to avoid disturbing them at all costs. Horse owners often feel the temptation to rush in and lend a helping hand. It is hard to resist feeling as though you are part of this miracle of nature. 95% of mares will foal with no complications and require no assistance at all.1 Intervening during a normal foaling can do more harm than good; mares will often stop straining and walk off if disturbed. This could delay the foaling process and put the foal’s life at risk.
Most mares will foal at night and prefer, if not require, a quiet, dark place to foal without disruptions. Even though it is advised by most veterinarians to keep a frequent watch on mares approaching the foaling time, disruptions can delay the onset of this stage of labour. There are CCTV-type camera systems that can be purchased to help keep a watchful eye on the mares but from a distance so as not to cause interference of any sort. Any type of ‘watching system’ that helps support a quiet, dark, uninterrupted environment will help the mare.
Niles Newton documents the response of labouring mice to fear and stress. She discovered that, 'When the mice were disturbed, especially by a lack of privacy, catecholamine surges shut down early labour. Later in labour, hormone release was inhibited and the fetal-ejection reflex did not occur (Newton, 1987; Newton, Foshee and Newton, 1966). In both instances, nature responded to threats, potential or real, in the birth environment and protected the mother and her young. Newton went on to describe the similarities in the hormonal orchestration of making love, giving birth, and breastfeeding. In each, hormones facilitate the process—indeed, are integral to it—and all are easily "disturbed".'2
Why is it, then, that our current birthing system seems to be working at complete loggerheads with what we know and understand about the natural physiology of birth? Could our current birth system be to blame for our high rates of intervention during childbirth?
Dystocia is when birth is difficult and/or slow and can be caused by multiple different factors. It can occur in the active first stage or in the second stage of labour. The frequency of dystocia in humans is reported with a large range and affects approximately 21–37% of first-time mothers and 2–10% of mothers who have given birth before.3 The incidence of dystocia in horses is reported to be 4–10%.4
You might be wondering what the incidence of dystocia would be in humans if our birth environment was focussed on being a quiet, dark and uninterrupted safe space, much like for our horse companions? We can look at Ina May Gaskin’s statistics from her aptly named birth centre, ‘The Farm’, and we see that 94.7% of births are completed at home and they have a 1.7% caesarean birth rate,5 compared to the UK national statistics where over a quarter of all births end in caesarean section.6 The most common reason for performing an emergency caesarean is—you’ve guessed it—‘failure to progress’, another way of describing dystocia.
There are several comedy video sketches that explore what would happen if we were expected to have sex, or go to the toilet, under the same conditions that we are expected to give birth in;7 I encourage you to have a look! There’s also the AIMS book, The Princess and the Poo, which explores the birthing environment and how it affects labour.8, 9
So, whilst I very much enjoy my work as a doula, I would much rather that in the human birth world there was no need for doulas to help protect the sacred private space around birth. I would go as far as to say that having a doula present at birth in UK hospitals to me sometimes feels like closing the stable door after the horse has bolted, as we are somewhat powerless against the enormous birth machine that has been created.
Given the current environment that most people give birth in—in hospitals, with bright lights, continuous electronic monitoring, frequent disturbances, multiple strangers present in the room and the constant threat of intervention—it’s a miracle that anyone is able to give birth at all! It is certainly not surprising that our current rates of dystocia and intervention far exceed those seen in the horse world.
Katie Hickey BVetMed is a former vet, a doula and mother to two girls.
2. Do not disturb: the importance of privacy in labor Judith A. Lothian. J Perinat Educ. 2004;13(3):4–6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/
4. Indications and surgical techniques for caesarean section in the mare R. M. Embertson. Equine Veterinary Education. 2002;14(S5):60–64. https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/j.2042-3292.2002.tb01795.x
5. Preliminary report of 2,844 pregnancies: 1970–2010 The Farm Midwifery Center. http://thefarmmidwives.org/preliminary-statistics/
8. The princess and the poo Lara Fairy Love. https://www.aims.org.uk/shop/item/the-princess-the-poo
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.
The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: email@example.com
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