"Normal" birth? Read the research and weep

By Jean Robinson

AIMS Journal, 2001, Vol 13 No 4

New research shows that only a quarter of women in the UK truly have a normal birth. AIMS research officer Jean Robinson reports on the study's findings.

Whilst politicians and the media are concentrating largely on the excessively high caesarean section rate, AIMS has been trying to raise awareness that the official statistics for- "normal" births (i.e. births where the baby emerged from the vagina without the aid of forceps or vacuum) include many labours and births which were anything but "normal" from the point of view of the woman.

Now we have a useful piece of research where birth records from five consultant units in one region were analysed to see how many women had a labour and birth without intervention - without induction of labour, speeding up of labour, artificial rupture of membranes, an epidural or an episiotomy. Research midwife, Soo Downe, labour ward manager Carol McCormick and AIMS Chair Beverley Beech are the authors of the Study.

Caesarean rates at the five hospitals varied from 195 per Cem to 22.3 per per cent. Vacuum and forceps deliveries ranged from ll.1 per cent to 15.4 per cent. Between 61.9 and 70.7 per cent of women had what were called "spontaneous vaginal birth".

Details were obtained of 1464 births. The records classified 956 of them as "normal". In fact most of those women (596 of them) had inter- ventions and they were in fact "obstetric deliveries" Nearly half (45.7 per cent) had artificial rupture of membranes, a fifth (20.1 per cent) were induced and 14.2 per cent had labour speeded up (this figure rose to more than a fifth of women having their first child). Nearly a quarter (22.5 per cent) had epidurals - again, this was higher for women having a first baby and 7.2 per cent had episiotomies (14.1 per cent for first babies).

In fact only a quarter - 24.6 per cent - of the women classified in hospital statistics as having a normal delivery had a Spontaneous labour and birth. For women having their first child it was only 16.9 per cent compared with 30.1 per cent of those who had given birth before.

As the authors point out, when we talk of women choosing caesarean sections we have to be aware of what the alternatives are. There is an urgent need to look at the culture of birth in consultant units.

AIMS has its say

At last we have some hard figures providing evidence. When women journalists who have just had their first baby write in the upmarket broadsheets of their dissatisfaction with "natural childbirth" we Suspect it is unlikely that they have real experience of it - unless they were one of a small minority of 16.9 per cent. And how many of the truly spontaneous births, we wonder, happened to arrive at the hospital too far advanced for interference?

And this study just covers the most basic and obvious interventions. It does not tell us how many women were allowed and encouraged to adopt what ever positions they wanted, how many had quiet and privacy according to their needs and so on. We think positions for the delivery should be recorded in all birth statistics - and hospitals (like those in Northern Ireland) which apparently never deliver a woman on all fours would have some explaining to do.

Whilst we campaign for Women to be helped to give birth at home when they wish to, most will continue to give birth in large consultant units.

Making normal birth possible for them is going to mean huges change in the culture of maternity care.

References

1. Down S, McCormick C and Beech B, Labour interventions associated with normal birth, Br J Midwifery, 2001; 9; 602-6.