Help yourself to a straightforward birth

by Jilly Rosser (first published in NCT's New Generation, 2002)

If you would prefer to give birth without interventions, midwife Jilly Rosser can suggest things to do to make that more likely.

Although some women definitely need interventions or a high tech birth for the safety of their baby or for themselves, many more women (probably as many as 85%) can give birth safely without them.

In pregnancy

If you are without complications or high risk factors, book to have your baby at home or in a freestanding birth centre. There is good evidence that birth at home is as safe or safer than hospital birth for you and your baby when you are both in good health without medical problems. There is lots of evidence that you are more likely to avoid interventions such as drips and episiotomy if you avoid a consultant hospital for your birth. You are also less likely to have a forceps or caesarean birth even if you do transfer to a consultant unit during labour.

Choose midwifery care for your pregnancy

When you realise you are pregnant you can go directly to a midwife. There is no need to see your family doctor unless you wish. When you have your first antenatal check you will be asked about your antenatal care. Unless you have a medical need to see a hospital consultant during your pregnancy, you can see only your midwife, (or your midwife and your family doctor). A midwife will provide more of your care closer to your home. Also with midwife care you are more likely to go into labour yourself and to be more satisfied with your antenatal care.

Prepare your mind, body and spirit

There are lots of ways to prepare for the birth. The NCT provides antenatal classes for you and the person who will be with you at the birth. Yoga is particularly beneficial in pregnancy. It helps you stay healthy, calms anxiety, gets rid of aches and pains and prepares you for labour. Many women have found that learning how to centre themselves, to relax and to let go is of direct benefit when labour gets going.

Choose your birth partner(s) with care

Don't assume that a husband or partner is the only person or the best person for the job of being your labour supporter. There is evidence that a close female friend or relative can be helpful. Ideally, choose somebody who has had straightforward births themselves, who is calm and quiet and you can communicate with openly. If your partner is not keen on being there, consider options. A few men are so anxious and uncomfortable that you would both be better off if he stayed outside for some or all of your labour.

Try to avoid anxiety

This will mean different things to different people. You may be made more anxious by the blood or other screening tests offered to you in pregnancy or they may be essential for your peace of mind. Remember - these tests are only offered to you, they are not compulsory. Whether or not to have them is entirely up to you.

Learn ways to deal with any anxiety maybe give yourself the time and space to sit quietly for a few minutes every day while you connect with the calming influence of your own breath and the presence of your baby inside of you.

Another idea which can help, is to think of any future event that is making you anxious (in this case, the birth) in retrospect. Go forward in time in your mind until you are there 15 minutes after the event. Notice that it has gone well and everything is just fine. Enjoy this feeling for a few moments. Then ask yourself, where is the anxiety? If it hasn't gone, repeat until it does. If it's relationship difficulties that are making you anxious, try to deal with them openly and gently or get help. Resentment and anxiety are not helpful mental states to have for a straightforward labour.

Write a clear birth plan

Writing a birth plan helps you think through what matters to you and may help you when you talk to others about what you want. It is worth emphasising the approach you would like from your caregivers (see below) as well as the specifics about the way you plan to cope with pain. It is fine to show your birth plan to the midwife caring for you in labour and you can ask your birth partners to remind your caregivers about your wishes, should that become necessary.

Help your baby into the best position

Your labour will be easier if your baby is in the easiest position - head down with the back of their head at the front of you. Getting onto all fours, wiggling your hips, avoiding sitting with your knees higher than your hips may encourage the baby to lie in the best position. Ask your midwife or antenatal teacher for more details.

In labour

If possible, avoid having your labour induced. All too often, the induction of labour sets off a 'cascade of intervention' and before you know it you have been drawn into having drips, electronic monitoring, epidurals and all the trappings of a medically complicated, high-tech birth. If you go two weeks over your dates, you can ask to have regular checks on the baby rather have your baby induced. Only 5% of babies come on their due date so pregnancies of over 40 weeks are common.

If you are having your baby in hospital:

• Stay at home as long as possible if you think your labour has started, especially if this is your first baby. Spend the early part of your labour in your own surroundings, keep moving and carry on with normal activities as long as possible. You can try going for a walk, having a bath, cooking a meal, making love, dozing in between contractions - anything that will help you go into strong labour feeling calm and self-possessed.
• Opt for the midwife listening in to the baby's heart at intervals. The midwife can use either a small ultrasound device called a Doppler or the little trumpet-like tube called a Pinard to listen to the baby's heartbeat. Avoiding continuous electronic fetal monitoring if you have a low risk pregnancy will make you less likely to have a forceps birth or a caesarean, and is just as safe for you both.
• Keep on the move. Changing position during labour is of great benefit, both in helping you deal with the contractions and in encouraging the baby through the birth canal in the best position. You might like to try swaying, rocking, wriggling your hips, walking and going up and down stairs. Think of coping with the pain of contractions rather than removing it. Some of the best ways of coping with pain are: immersion in warm water, changing position, massage, emotional support from someone calm that you know and trust and encouraging the release of your own hormones such as endorphins (see below).

Wherever you have your baby:

• Encourage the release of oxytocin. Oxytocin is the hormone your body will produce when you go into labour. It makes the uterus contract strongly and regularly. Oxytocin is prevented from working properly in labour by a whole range of things, including fear, anxiety, embarrassment, anger and oxytocin drips (which flood the oxytocin receptors in the muscle of the uterus).
• Encourage the release of endorphins. Endorphins are nature own pain relievers and give you a sense of well being. They are produced throughout pregnancy and labour and, if nothing stops them being released normally, help you to cope with the pain of labour. The endorphin levels in mother and baby after a straightforward birth are at their highest ever level - like after orgasm, but more so!
• Avoid stimulating the 'rational' part of your brain. If the rational part of your brain is stimulated it can override the primitive part of your brain where oxytocin and endorphins are produced. The rational brain is stimulated by things like bright light, people asking you questions and expecting you to answer in sentences and you feeling that you are being watched or judged. Your rational brain can be 'turned down' in labour by you having privacy and quiet, having the lights low and feeling safe. Your body knows how to do this. When you understand what helps and what hinders the process you can create the right environment around you - and help yourself to a straightforward birth.

Our thanks to the National Childbirth Trust for allowing us to reproduce this article.

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For more information about Normal Birth (including research and statistics) you can visit the Normal Birth Pages on the BirthChoiceUK Professional Site.