Book review: Birth in focus

Complete list of book reviews on the AIMS website

AIMS Journal, 2016, Vol 28 No 4

The beautiful cover photo, the photos inside, the introduction by Ina May Gaskin, the women’s stories told from different points of view, and the conclusion by Sue Brailey, provide a strong, coherent message that is powerful, profound and simple – when women and midwives know and trust each other birth nearly always unfolds straightforwardly, and when it doesn’t, it can still work well for the woman, her baby and her family. The combination of stories and accompanying photos weave into a holistic, reassuring story about the diversity, normality and magic of birth: ‘birth as it should be {…} safe, secure, surrounded by love and genuine happiness, caring and support’.

The stories include women from different cultures and circumstances. They include women of different ages expecting first or subsequent babies, women having twins, breech babies, babies after previous caesarean sections, women with medical conditions, women having home births, water births, hospital births and caesarean sections and women with male, female or no partners. This is not just a book about normal birth, it is a book about keeping birth as normal as possible while supporting each and every woman no matter how her birth unfolds, so that she can start her life as a mother feeling positive, strong and capable.

Through these extraordinary ordinary photo stories, themes about the Albany Midwives’ care and its impact emerge which show the importance of:

• inspiring women and families to believe that women are strong and capable birth givers and mothers
• providing good information and trusting women to make good decisions for themselves and their babies
• the long-term impact of relational midwifery care – 'years later, I still feel that wonderful sense of joy and achievement [...] They [midwives] gave me safety and protection.’
• respecting and accommodating each woman’s needs, beliefs and decisions in order to provide truly individualised support for her and her family
• having the skills, knowledge and honesty to discuss when medical help is needed – enabling decisions to be made quickly
• keeping pregnancy and birth as normal as possible whatever the circumstances
• supporting a women during transfers from home/normal birth to hospital/assisted birth so that the woman retains her sense of agency and she and her baby are kept safe emotionally and spiritually as well as physically
• cultural sensitivity, ‘it reminded me of being back home and I felt at ease’.
• humility, alertness, the ability to wait or act, and the experience to entertain the unexpected, ‘as midwives we know that all labours are different, and that we will never (however much we pretend it) be able to predict what will happen’.

The photos are not the usual soft focus, or as Hermione Wiltshire puts it in the book, ‘sanitised photographic platitudes’, of birth prevalent in our culture, but ‘real, raw labour and birth’ photos which are integral to the book. They bring the stories to life and inspire visceral confidence in birth.

Ina May Gaskin suggests in the introduction that the positive outcomes achieved by the Albany Midwifery Practice in South East London could be achieved almost anywhere, if the birthing woman is the focus of maternity care policy-making and practice. Evidence agrees with this. The stories demonstrate that keeping the woman in focus and maintaining excellent outcomes is achieved through midwives:

working with the community to inspire trust and confidence thus changing the predominantly negative culture of birth (‘we often talked about birth being an everyday miracle’)

being able to make skilled judgements about normality and when help is needed

having fast and easy access to medical and other services

advocating for women and providing clear information and advice, especially if women are making decisions outside usual policies and practices.

In the final chapter, Sue Brailey provides a clear, compelling and accessible theoretical framework drawing on a wide range of research, showing why and how the women cared for by the Albany Midwifery Practice had such excellent outcomes, how the Practice sustained itself so successfully, and how women’s and midwives’ autonomy was enhanced.

I applaud Becky Reed for her skillful weaving together of stories and photos, her deep respect for women and birth and for a book that could and should be read by women, families, midwives, student midwives and birth workers. A gem of a book, not to be missed.
Nadine Edwards