Melissa Thomas, Jenny Hallam and Chris Howard share feedback for Positive Birth Groups
The Positive Birth Movement (PBM) is a community group started by Milli Hill in 2012 with the aim of informing women of their birth choices, sharing positive birth stories and offering support for women during and after their pregnancy. The group is a non-profit organisation and pregnant women and mothers are invited to attend regular meetings held in their area free of charge, although if a hall is hired a group may share the cost between them.
Anyone can create a Positive Birth group and become a facilitator, so facilitators have a wide range of backgrounds, some are trained doulas and midwives, others are women who are passionate about birth and want to offer support to women in their community. The idea is simply to make it easy for women to gather, communicate, support each other and share information. Positive Birth Movement meetings are open to all pregnant women, mothers and birth professionals and are guided by a different discussion topic each month, which is set by the online umbrella group.
Currently there are over 170 regional groups within the UK and a number of groups worldwide. Consequently, the Positive Birth Movement can be considered to be a grass-roots organisation which aims to empower pregnant women through information and authentic birth stories. Within the group, a positive birth is conceptualised as any birth in which the woman felt empowered through access to information and freedom of choice, so any birth from a homebirth to a caesarean can be positive.
In 2013 Melissa Thomas, the facilitator of the Derbyshire Positive Birth Movement, carried out a set of interviews to explore women’s birth experiences with specific reference to the support they received before, during and after the birth and their experiences of the Positive Birth Movement. Prior to carrying out these interviews, she received training in research ethics and interviewing skills from Dr Jenny Hallam at the University of Derby. Melissa went on to facilitate face-to-face interviews with six women who attended PBM meetings. Each interview lasted between one and two hours and was transcribed verbatim for analysis. The women had a range of birth experiences and this led to them sharing a diverse range of birth narratives.
Five women between the ages of 25 and 39 were interviewed. One was expecting her second child and the others all had two children. They had all joined the PBM after the births of their first baby, except for one who had joined following her second birth.
Most of the women spoke about the importance of accessing information during their pregnancy relating to birth choices and what to expect during their birth experience. However, many of the women reported that their midwife and other healthcare professionals offered limited support and information and women reported that they had to be proactive and find out information for themselves during pregnancy.
‘You shouldn’t have to work so hard to get that information and like I say I appreciate the midwives don’t have all the time in the world and they don’t, they don’t have every resource in the world but even if they can just signpost you to places where I could’ve got that information, you know.’ Vicky
Many of the women were left to find information themselves, paying for private antenatal classes. Women reported mixed experiences of these. Comments included private antenatal classes focusing very much on pain and medical intervention.
‘The private antenatal class was very focused on pain relief options and what can go wrong. They didn’t want to kind of, they were supportive about birth plans but they said, “but it will probably change on the day.”’ Sarah
Groups such as pregnancy yoga were spoken about positively.
‘The best support I got was through the pregnancy yoga with a lady called Stella who was amazing. She taught me all about the breath, about understanding what your body goes through in birth, how you might feel, how you can help yourself, how you can gain control. Not about controlling the birth but how you can help yourself to birth naturally.’ Teresa
Women found much of the information they were able to find was unhelpful, with negative birth stories setting expectations that the birth would require medical intervention.
‘I think there’s too much negativity surrounding pregnancy and birth in the media and within our society. I think there’s a lot of assumptions made that are taken as the norm which need to be dispelled so that most women have positive birth experiences, instead of just a few.’ Jessica
Women spoke about the way in which the medical staff communicated with them and their birth partner and how it played an integral role in shaping the birth experience. There was a real split in the birth narratives as the women recounted practices that led to very positive or negative experiences. Good practice was aligned with healthcare professionals giving the birthing mother choice, clearly explaining her options and only taking action when clear consent was expressed. This disrupted traditional doctor power relationships and enabled women to play an active role in the decision-making processes from a position of power.
‘They explained very well, they explained what they were doing, they always gave me a choice, they never did an internal without my permission, they never took Emma away from me without my permission, in fact they actually helped me with establishing breastfeeding, kind of like, can I touch you? Is that alright? They never just kind of man handled me.’ Teresa
Bad practice was discussed in terms of closed and forceful communication, shrouded in medical jargon.
‘It became a very real threat which made me worried and it kind of put up all the old feelings again. I was very scared.’ Alison
Respect was a key element that shaped birth experiences. The women spoke about respect in two ways. First, it was discussed in terms of receiving personalised care. Some of the women likened giving birth in hospital to being part of a production line.
‘It was just like a flow chart for them and there’s the outcome and you just have to work your way down this flow chart and without ever thinking that anything else might help. It was very medical, rather than anything else. It was just, each step was just another medical step for them.’ Alison
Other women spoke about the personal connection they developed with the midwives who attended their births. Acts such as holding the birthing mother’s hand and providing words of encouragement were valued as it was seen as evidence of genuine care and compassion. The mother felt as though she was being treated like a person.
‘At the time I think I felt quite comforted by the fact that there were people there to take over, to help me and they were really nicepeople, they kept saying really positive things, you know, they kept calling me a “super star” which makes me laugh now but it wasreally nice at the time because it felt like I was doing well, I was being supported and they were pleased and everything was going well.’ Jessica
Secondly, respect was discussed in relation to birth plans and the women spoke about the importance of being listened to andhaving their birth choices respected. Positive birth experiences were closely linked to the medical staff listening to the woman’s choices and respecting them. During these experiences, the midwives had acted as an advocate and ensured that birth plans were implemented.
‘We made a decision to come off all the monitors and go into the bathroom so I could refocus and get away from everything and she actually, although I got the impression she didn’t 100% agree with what we were doing, she did spend a lot of time on her hands and knees in the bathroom with a hand held Doppler listening to Molly’s heartbeat because the consultants were saying that the heart beat was dropping and they wanted me to be on continuous monitoring. So she did support us in that way.’ Sarah
These women stressed the importance of personalised care and a connection with staff who demonstrated genuine care and compassion. They spoke about the personal significance of the birth experience and the importance of this being reflected in the care they received.
The women spoke about their experiences of the Positive Birth Movement. Meetings were presented as a valuable source of social support where pregnant women and mothers could meet like-minded people.
‘I think it’s been lovely to meet like-minded people, to meet people who’ve had positive birth experiences, you know, that have been really different from mine, but still really positive and I think it’s always nice to share these experiences. It gives hope to other women, I think it’s been really lovely when there’ve been pregnant women in the group who haven’t had babies before or who are having second or third babies and want a more positive experience, I think that’s fantastic. It’s a brilliant social group as well as a support group for me and for lots of women who I’ve met.’ Jessica
The relevance of the group was also discussed for women who had suffered birth trauma as it provided a supportive space in which these mothers could work through their feelings.
‘My mum, she ended up with an emergency caesarean in the end and you know she did have a tough time and I think maybe had and I know we’regoing back thirty two years now, but had she been able to come to a group, get the support, let go, have a chat, work out, you know, what was positive about it maybe she’d feel very differently about that experience.’ Vicky
Positive Birth Movement meetings were also presented as aspace in which women could access information relating to pregnancy and birth that empowered them to make informed birth choices and learn about their rights.
‘... when someone says, “oh, my god, so I can say no to that?” And you’re like, “Oh yes! You can! Say no to it, you don’t have to do it.” And it’s, it’s quite, it must feel absolutely daunting for them. ‘cause I guess for me, my, all my research and my confidence in saying no has built up over four years between Rowan’s birth and my impending second birth.’ Harriette
Finally, the women spoke of common misconceptions about the Positive Birth Movement, that the group may be viewed as an extremist organisation which places women under pressure to have ‘natural’ births. The women discussed how this was very different from their experiences of the group as a space that supported women’s birth choices whatever they may be.
‘Yeah, definitely and I think some people do get the impression the Positive Birth Movement is women saying “you must do this, you must have homebirths, you must give birth up against a tree in a wood” and it isn’t like that, it’s about women saying “these are the choices you have, these are the options you’ve got, you choose what is right for you” and there’s no judgement in there.’ Sarah
Women spoke about the group as an empowering space in which the mothers who were sharing their birth stories were able to educate and women hearing the stories received knowledge about birth and their rights, and the positive birth stories discussed in meetings were a valuable alternative to negative birth stories which are prevalent in western society.
We acknowledge that there are limitations to this piece of work. Firstly, this is a small group of women from a particular Positive Birth Movement group and, as such, self-selecting, which may lead to differences between them and the general population. However, their experiences are similar to those found in other research.1 Also, as the interviewer was also the group facilitator, there may have been a reluctance to give negative response about the group.
The women’s experiences of the Positive Birth Movement meetings suggest that the group could be a valuable space for pregnant women as it enables them to gain access to information about birth that may not be offered by the NHS. Information about birth choices and rights could facilitate positive birth experiences by helping women approach birth from an empowered position. This in turn could enable them to establish a good relationship with their midwife and receive the personalised care they want.
Melissa Thomas, Jenny Hallam and Chris Howard
University of Derby
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