Why does physiological birth matter?

AIMS Journal, 2023, Vol 35, No 1

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The theme for the March 2023 issue of the AIMS journal is, dare we say it, physiological birth. Carolyn Warrington opens this editorial by explaining why physiology-informed care enhances every birth and protects the well-being of the whole family.

Carolyn Warrington

AIMS has recently published a position paper calling for physiology-informed maternity services that are designed and act with an understanding of physiology. As we state in that paper we believe that this approach is key to underpinning a holistic approach to maternity safety. This means having a focus on avoiding causing harm to the long-term well-being of the whole family, including their mental health, as well as on reducing the risk of mortality and short-term physical harm.

There has been much discussion about ‘misguided pursuit of normal birth at any cost’ which AIMS is concerned has undermined the focus on understanding physiology and how that understanding can optimise birth in all settings, however the baby is born.

In one setting, this might be maintaining a quiet “oxytocin bubble” to support a physiological placental birth. In another, it might mean leaving the cord intact while initiating the resuscitation of a baby born at the threshold of survival.

We believe this fresh approach is key to developing safe, respectful services that focus scarce resources where they are needed. This is about understanding the science that underlies birth physiology, enabling births to be supported to happen without unnecessary intervention, or, where it is appropriate, with the support of obstetric interventions and advances in a way that works with, not against physiology.

Our position paper¹ outlines our aspirations. The campaigns team are looking for help to develop a vision of what a fully physiology-informed maternity service would look like, a checklist of actions needed to achieve our vision, and case studies of how an understanding of physiology has improved maternity services. Want to get on board? Please email campaigns@aims.org.uk

Author bio: Carolyn is a birth enthusiast and an advocate of parental choice and human rights in birth. She had a beautiful home birth with her first baby, followed by a medicalised twin birth. She is a home-edding parent of three, and just happens to be an obstetric senior registrar!

²

The issue opens with my (Alex Smith) every-day description of the physiological process of labour and birth, linking biological facts to the labouring person’s lived experience. Doula Natalie Meddings, follows by setting her knowledge of physiological birth into its current political context and asking the controversial question, ‘is physiological birth a dangerous cult or a scientific fact?’ Birth artist Sophie Jenna reflects on her personal birth journey and shares some of her beautiful artwork with AIMS readers, while author Sallyann Beresford brings art into the title of her piece holding that there is an art to giving birth and setting out her five key principles for supporting physiological birth. Midwife, aromatherapist and yogi, Nicole Schlögel, considers the socio-cultural birth environment and its impact on the birth experience, which is followed by a report on the ‘Biomechanics for Birth’ courses run by Molly O’Brien, who is also a midwife.

Moving away from the theme of physiological birth, but all interlinked in their different ways, we have a number of other important contributions to this quarter’s issue. Dr James Munro introduces Care Opinion, an online feedback platform for health services across the UK, and AIMS volunteer Leslie Altic tells us about Continuity of Midwifery Carer schemes in Northern Ireland. The AIMS Campaigns team review the latest MBRRACE report, which covers the confidential enquiries into maternal deaths and morbidity in the UK and Ireland over the three-year period 2018-2020, and Nadia Higson reports on a recent conference that was looking at various aspects of the impact of Covid-19 on maternity and child services and how these can inform services as they rebuild. Next we have a fond farewell to, and from, Julia Cumberlege and Cyril Chantler, champions for changing childbirth for the better, written up for us by Jo Dagustun, and this is followed by the very sad news of the death of Beverley Lawrence Beech. Beverley was Chair of AIMS for forty years and it was her strong and fearless voice that brought me to AIMS and that echoes still. In this issue she is remembered by Debbie Chippington-Derrick. Last but not least, there is the AIMS Campaigns team’s list of everything they have been doing since December.

We are very grateful to all the volunteers who help in the production of our Journal: our authors, peer reviewers, proofreaders, website uploaders and, of course, our readers and supporters. This edition especially benefited from the help of Anne Glover, Carolyn Warrington, Jo Dagustun, Danielle Gilmour, Joanna Rana, and Josey Smith.

The theme for the June issue of the AIMS journal is birthplace. We will be looking at the social and political forces that shape people's feelings and decisions about place of birth, as well as what current research shows about holistic safety and the place of birth. With this theme in mind, we warmly invite reflections on personal birthplace decisions, and any accounts of births in unusual places! If you have a story to share, please email editor@aims.org.uk for further information.

Alex Smith (Editor)