Untimely Birth

In her story of Kaiya's Birth, Louise made the following observation: "I see why the clock is considered the first intervention as I became very focused on this measurement rather than focusing on my body and getting on with it." (Where the Heart Is: Stories of Home Birth in New Zealand). Indeed, the clock intervenes with the natural birth process in numerous ways, both in the all-important labouring woman's headspace, and in the management of her birth by her care providers.

Surely interventions in childbirth should only be considered if the wellbeing of the mother and/or her baby is compromised. A clock cannot measure how distressed a yet-to-be-born baby is becoming. Nor can a clock measure the physical and emotional wellbeing of the labouring woman. Yet the concept of 'time' is frequently cited as a reason for pressuring birthing women to undergo medical interventions. And it is perhaps that same concept that casts shadows over a birthing woman's self-belief when giving birth, increasing her fears and doubts, and denying her those important labour hormones that cease to flow when she is fearful. How different might the culture of birth be if we did away with the clock? And how might such a revised birthing culture impact on the care women receive during labour?

When a pregnant woman asks her midwife, "How do I know when I need to contact you in labour?" a typical response might be, "When your contractions are x minutes apart, and are lasting more than x seconds in duration." Now, imagine there was no way of timing contractions, what might the midwife's response be then? Perhaps something like, "Call me when you feel the need for me to be there." This would require that the woman listens to her labouring body and that she trusts that she'll know when the midwife needs calling, and that the midwife trusts the woman to know what she needs, and when she needs it. Overall, it's a much more respectful response because it implies trust in the birthing woman and her process, and gives the woman reassurance that her midwife will support her as she needs it in labour. As well, it alludes to the individualised nature of each birth, as opposed to a 'one-size-fits-all' approach.

With no time-frames against which to judge a woman's progress in labour, many common interventions would become obsolete. We currently have a maternity system that determines a woman's progress by how quickly her cervix dilates, how quickly she pushes her baby out, and how quickly she births her placenta. If there was no way to time these aspects of her journey, how would her caregivers know when interventions were warranted? (I hope you heard the sarcastic tone with which I asked that question). Either the woman would tell them (often women know when something is 'not right' during their labour), or there would be signs that something untoward was going on - the baby's heart might slow down a lot, the woman may experience unusual pain, she may start bleeding, her blood pressure might go up, or her temperature; there are all sorts of cues that prompt a woman and/or her caregiver to contemplate whether a particular intervention is necessitated - time, alone, should not be one of them.

Instead, we currently have a system of care where, if the woman isn't dilating fast enough (assessed by way of numerous vaginal examinations), or if her contractions are too spaced out or too short (sometimes assessed by strapping the woman up to a CTG machine, inhibiting her ability to move around or use a birth pool), then speeding up her labour with a syntocinon drip is somehow deemed the appropriate course of action. Wouldn't watchful waiting be a safer approach, especially given the rise in epidural rate and caesarean surgery that accompany syntocinon augmentation? As well, one method sends the birthing woman the message that, 'you are failing at this birthing thing,' and the other, 'you know how to give birth - your labour will progress in it's own way.' A woman's trust in her birth process plays such a key role in the smooth progression of her birth... and it's undoubtedly much easier to maintain such trust when her caregivers are unwavering in their own.

Without time expectations and constraints we'd see much less vaginal examinations performed on labouring women, much less epidurals, and far fewer caesarean, forcep and ventouse deliveries. We'd see less episiotomies, less oxytocics used in the birth of the placenta, less immediate cord clamping, and less birth trauma and it's resultant breastfeeding and bonding struggles. Because when we do away with the clock, we inevitably do away with boxing birthing women into 'norms' within which she must sit; care becomes individualised. Birthing interventions occur only when they are needed. Perhaps most importantly, women are listened to, and they become good at listening to their capable birthing bodies - trust in one of life's most natural events is restored.

The journey of a woman's birth should not be viewed as a time-line of events. It is a story, one which ebbs and flows in physical and emotional intensity, and speaks of the passage of a person from womanhood to motherhood. This important birthing journey can only be told by her, because, of utmost importance to her birth process are the things which she tells herself in labour, what she believes about herself and her birthing body, what fears she has and how she overcomes them, and how she feels both inside herself and about herself, during and following her birth.