Normal birth - what does it mean to you

[Olderbutnotwiser]

Hi
I have been a midwife for ten years and I have an interview for a senior post next week and have to give a presentation on 'keeping birth normal'. I have loads of info so far but mostly from a midwifery / medical perspective and would appreciate coments on what the phrase means to you
Thanks

Message withdrawn

Oh, GOD, yes, Pruners - that "oh" that women get when they hear that they may well not have needed the interventions they had.

Same goes for bf. The "oh, I didn't know that" moment where women realise they might have continued with bf, had they only known x, y or z.

Ironically, it was my obstetrician who stopped me having interventions. The midwives were all setting up for forceps when he came in, gloved up, took away the gas and air and helped me deliver my daughter naturally. Had a couple of stitches, and it bloody hurt, but god bless that man.

Message withdrawn

Hi Older...

I haven't read whole thread, but wanted to try to respond to your query.

I think a lot of people equate a 'normal' birth with a vaginal delivery (possibly with minimal intervention). When I was pg again after my elective section, a lot of people asked me if I was going for a 'normal birth' second time round.

On one level, I feel that the word 'normal' is out-of-place here. My elective section was for grade IV placenta praevia and happened at 36 weeks (thankfully not as an emergency) after I'd been in hospital (bleeding intermittently but sometimes heavily) since 27 weeks. I was initially very distressed by the fact that I wasn't going to have the 'normal' birth that I'd hoped for, but at best (and thank God the best did happen) an elective section with a slightly early baby and at worst a crash section with a very prem baby and all kinds of dangers to me and the baby. (At first, I kept wanting to discharge myself, so the midwives and doctors were quite graphic with me about what might happen - right up to the point where I bled to death and my baby died too - if I did so!) I felt that I'd been robbed of a normal birth and inserted into a scenario over which I had no control.

Thankfully, I had wonderful care during my time in hospital and nine weeks in which to get used to the idea. Looking back on it now 7.5 years later, I don't feel that there was anything too abnormal about my dd1's birth. The things that still feel 'odd' about it are the fact that I wasn't in labour at all and knew when it was going to happen (neither of which is necessarily a bad thing). I was also unprepared for the difficulties my dd would have after birth (NGT-fed for two weeks, no sucking reflex, very small, etc.). But I know that the birth experience I had was the only possible one in the circumstances, and as such it also feels 'normal' to me.

Dd2 was a VBAC. Very straightforward labour apart from a longish 2nd stage (2 hours), no pain relief (except TENS and water) and home from hospital within 12 hours. But a VBAC does not ever feel like a 'normal' birth either. There are too many battles to be fought (e.g. against continuous foetal monitoring, against time-limits, etc.) and too much information which seems not to be freely available (rupture statistics, the need to avoid epidural and induction, etc.) but which is essential if the mother is to feel (sorry - don't really like this word but) 'empowered' in labour.

So... I have had two experiences of birth, neither of which are 'normal'. On the other hand, they were both highly positive experiences (largely thanks to the wonderful midwives who looked after me and a hugely skilled and sympathetic consultant )

However, a more postive way of looking at 'keeping birth normal', especially from your point of view as a midwife, would be to think of what you can do to make each woman's experience as 'unscary' as possible. To make her realise that what is happening to her is 'normal'... and that allows also for complications (so I had a totally normal elective for placenta praevia... everyone knew what they were doing, no-one was freaked, the whole experience was calm and positive). Likewise, when I had my VBAC, apart from one midwife who booked me in and described my birth plan as 'very demanding' (on the phone, but in my hearing ), everyone treated me as if I was completely normal. No-one balked at my request for intermittent monitoring, no-one timed my second stage (in theory I should only have been 'allowed' to push for an hour...), a midwife did stay with me throughout my 2nd stage, which I think might be unusual and I assume was because I was having a VBAC, but no-one made me feel that I was doing anything out of the ordinary.

Now, what should be the case is that every woman should come out of her labour feeling like that. So 'normality' might not necessarily equate to a drug-free, intervention-free vaginal birth (although in some cases that might be the ideal), because that option won't be available to all women. But all women should feel that giving birth (whichever way it happens) is a normal and enjoyable event, not a trauma, not something to be terrified of, not a disappointment. I feel so lucky that I was able to be helped during my time in hosptal with dd1 to come to realise that my elective section did not make me a failure, but that I was giving birth to my daughter in the best (indeed, the only) way possible for the both of us. Some wonderful midwives and, in particular, some wonderful midwifery students from Thames Valley University [don't mind name-dropping in this instance, as they were fab] helped me to see that. (The scaremongers who could only tell me I should feel glad I wasn't bleeding to death were all the sodding consultants - though not my own consultant, who was also great!)

So... I have gone on and on at length. But if you can help people to come to terms with what is right for them and for their particular circumstances, then you have gone a long way towards making birth normal, imvho.

Good luck with the job interview.

PS My best friend, who is far from stupid and not uninformed either, described her first labour as 'disgusting and unnatural' and ended up with an emergency section 2nd time round. Her jaded view of the whole process makes me feel very sad, and I wish that someone had been able to make her feel more normal from the beginning....

Brilliant post Ellhell. Your experiences don't sound a million miles away from mine - c-section which wasn't what i would have chosen, but medically necessary, followed by VBAC. As you so clearly point out, most women will feel empowered if they know that their birth has been managed in the way they need, and if those needs have been sensitively communicated to them. I was in floods of tears when first told I'd need a CS. By the time I left the consultants office, thanks to a gentle and patient explanation, I knew it was the right thing. And with the VBAC, I felt empowered that like you, I wasn't bulldozed into a second CS. It's when women realise after the event that they've had unecessary interventions that they end up feeling that they've had a rough deal.

Hmmm interesting one. I would question what they mean when they say 'normal'. Do they actually mean a birth that is not overly medicalised, ie a natural (with minimal intervention and probably but not necessarily, minimal pain relief provided)?

I suspect that is the case... but I would be on the phone to the interviewer asking a few questions before I even started that presentation. If you couldn't get hold of them I would start by giving your interpretation of what you think this means and by having a discussion of the responses you got to asking this question on mumsnet!

Good luck...

I would be inclined to take an interpretive perspective and point out that perhaps 'Normal' is not the correct definition as no two are the same, they present in patterns but perhaps calm or controlled (controlled as far as keeping the parents happy) or even uncomplicated is a better definition?

Good Luck!

You can start by questioning the use of the term normal, is it the same as natural, if most births ended in c section then that would be normal. i'd assume it means natural, minimal intervention, without epidurals etc

raise the possible interpretations and then say for the purpose of this presentation am going to infer that normal equates to natural

also you can only keep it 'natural/normal' if this is indeed withing your power. This can only mean then that it's a question of pain relief rather than if it was a breach birth or something more complicated - these are out of your control and not advised to have normal births.

Bree I don't think anyone is suggesting that having a normal Birth is more important then the Baby....just that how we give Birth is important to women in general and that a traumatic Birth can effect on a mothers and a Baby's wellbeing...

Sorry biffo, didn't mean to be rude, it's just that I wasn't het up to begin with, I was just stating, what somebody else, I think hunkermunker said, that 'normal' is a loaded term for issues surrounding childbirth and motherhood. Just didn't put it quite so eloquently.

I totally appreciate that birth follows a physiological process which midwives should aim towards. It's just the word 'normal' I find a little problematic, after all if somebody's mental/psychological state was described as normal (as opposed to?) it would be a bit of a taboo. There are obviously shades of normal, who is 100% normal? And I believe in childbirth there are also shades of normal, i.e this woman might have her waters broken artificially, this one have pethidine, this one episiotomy etc etc. As often or not this could be as much to do with hospital protocols or time constraints as deviations in the labour. And rightly or wrongly we do attach a lot of personal significance to the way we give birth. That was ALL I meant!

By the way I'm due with my second in 8 weeks, and am aiming for a more natural birth this time, but will try not to get 'het up' if things don't go according to plan, lol!!

is it not true to say that 'normal' is defined by society, and therefore subject to change? it was 'normal' for my mum not to breastfeed my sisters and I at the time we were born, and equally as normal to try and avoid having a fully formula fed baby from birth when i recently had my child. our attitude to what is best for the baby has changed, as does our attitude to birth (it used to be 'normal' to be put under to give birth - a long time ago).

maybe if you substitute 'common' for 'normal' it becomes clearer, and less offensive. it is more common to have a vaginal birth than a c section, but that doesn't mean having a c section is abnormal.

and if you can call it 'best practice' to attempt to use as little intervention as possible rather than 'normality', then maybe that's less offensive.

what this discussion highlights beyond anything is how emotive and personal this subject is, and that is surely a good point to raise in your interview: normal is not a fixed place, but is what works for the mother and baby in each case.

Good luck with your interview and presentation

my thoughts are normal is a term that is subjective and emotive, means so many things to many people.

new mum - normal might be shared anecdotes/what she saw on tv/literature read etc. so the expectation will be unique to her and different from someone else

normal shift for midwife might be VB or a well managed ventouse

normal staff grade shift might be a C-Section, team quickly assembled, no major complications

normal is shaped by expectations and implicit inthis is that a midwife can not give too much information. eg not good practice to be avoidant in case it spoils mum to be desire for normal

i would emphasise information to cover every eventuality, and allow thought/discussion of norms and normal

Students normally have expectation of attending a birth, is this normal for mum to be observed

o so much comes up

I have also been a mw for ten years (although after a years maternity leave might not remember what to do ). I feel that a normal birth is a completely physiological one which can include entonox, water and other non pharmacological methods of pain relief, pushing should not be directed unless there is a reason to at the time such as concern for the mother or fetus. Whilst it is not abnormal as such to use pethidine, epidural, regular examinations, directed pushing, routine syntometrine etc, these things all have some sort of impact on the mother and the baby.

I personally always thought I would have normal deliveries and despite some traumatic things that I have seen as a midwife I had complete confidence and a belief that I could do it. I did not tell anyone this before hand incase they all felt that I was unrealistic! Luckily for me it was not unrealistic and I was over the moon that I had done it without even needing syntometrine.

To me it means a natural delivery without epidural, induction or intervention (ventouse/forceps) and without episiotomy or serious tearing.

To me it means a natural delivery without epidural, induction or intervention (ventouse/forceps) and without episiotomy or serious tearing.

Thank you everyone for all the interesting discussion my query has generated. My interview and presentation went really well and I have been offered exactly what I wanted ( a part time senior community midwife post )so really happy. Thanks again

congrats

Yay! Well done, Olderbut...

congratulations

Message withdrawn

welll done