Along with every other professional with even the smallest interest in childbirth, I’ve been glued lately to the BBC’s wonderful “Call the Midwife” on Sunday evenings. It’s a cut above other historical dramas, because so many of the storylines are based on the true-life recollections of the late Jennifer Worth, who accurately depicted life in the poorest parts of 50s London in her three-volume series of memoirs – as opposed to being stitched together by modern-day script editors trying to tickle the tastes and feed the expectations of today’s viewers.
In particular the series blows apart the media-invented battle lines of childbirth with which we are all too familiar. You know – the never-ending battle between natural childbirth “fanatics” and “breastfeeding Nazis” versus “too posh to push” Victoria Beckham wannabes and yummy mummies. These stereotypes, like all stereotypes, don’t exist.
Instead we see how complicated the arguments around birth are. The undisputed heroines of the series are the brave, well-trained and resourceful midwives and nuns of the (fictional) community of St Nonnatus. Hard-working, disciplined and cheerful yet always kind, these women remind us of all the best female virtues, and especially of what a great profession midwifery is. They shine lights of good sense and learning into homes without disempowering the people they find there.
Yet even they have entrenched views that are not, strictly speaking, evidence-based. Regular viewers will have noticed women labouring on their backs in every episode: midwives of the era were pointlessly strict about women maintaining the “delivery position” with legs akimbo.
In last Sunday’s episode (3 February) we saw an eccentric pair of twins pitting their belief in herbalism against modern obstetrics. The pregnant one of the twins is discovered by the midwives labouring upright in a birthing chair and in semi-darkness. The midwives promptly switch on the lights and order her off to her bed – to lie on her back like all the other women.
Nowadays, well-trained midwives in the UK, especially those with experience of home births or births in birthing centres where an epidural isn’t the norm, might do the exact opposite. Finding a woman labouring on her back – the most uncomfortable position, and the least useful for labour – they might well gently suggest she gets off the bed and “mobilises”, which is midwife-speak for walking about the room, leaning on things.
This simple move can transform what feels like an unending misery into something effective where the woman feels she can work with her contractions instead of against them. Birthing stools are now standard equipment in our maternity units. Yet the 1950s midwives of Call the Midwife are horrified by the birthing chair – a “contraption” with, to their eyes, the air of an instrument of medieval torture rather than the simple, supportive technique of using gravity to help labour which it really is.
The best midwives might also suggest that, with the woman’s permission, the lights in the room could be dimmed – because they know that the stimulant of bright light activates adrenaline and thus works against the production of oxytocin. Nicholas Culpeper, the seventeenth-century herbalist referenced in the episode, knew from observation that women labour more effectively in darkness, but since his day, doctors had entered the birthing room en masse with their forceps, requiring light to see by, and the old midwives’ knowledge was unlearned. Once it was accepted that childbirth needed bright light, nobody tried doing it the other way…until research into oxytocin proved that Culpeper was right.
Which is why we suggest to our hypnobirthing clients that as well as practising deep relaxation to reduce adrenaline and tension, they avoid stimulation from bright lights and loud noise (especially inane chatter!). A good midwife can work by torchlight, I’ve been told! And while many mums are comfortable on their backs or lying on their sides, many others prefer to lean forwards over a birthing ball and can maintain their relaxation in this position. But you know what? What really matters is what the woman feels is right for her – it’s our job to make sure she has all the possibilities within reach.
This blog post was written for www.motherandchild.co.uk and can also be found there.