In this guest post, doula and facilitator of Positive Birth Movement Belfast Anne Harper presents a range of references.
Anne is a writer and blogger, and the founder of Dispelling Breastfeeding Myths. She is passionate about supporting families and informed choice. She has three children.
WHAT IS 'POSITIVE BIRTH'?
The idea of 'positive birth' as defined by the 'Positive Birth Movement' is as follows:
'A positive birth means a birth in which a woman feels she has freedom of choice, access to accurate information, and that she is in control, powerful and respected. A birth that she approaches, perhaps with some trepidation, but without fear or dread, and that she then goes on to enjoy, and later remember with warmth and pride.
A positive birth does not have to be ‘natural’ or ‘drug free’ – it simply has to be informed from a place of positivity as opposed to fear.'
The Positive Birth Movement is a 'grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media.
We aim to challenge the current epidemic of negativity around childbirth by bringing women together to Meet Up, Link Up, and Shake Up Birth.
'There are free 'Positive Birth' groups all over the UK and throughout the world which meet regularly, and are run by facilitators (usually doulas or midwives).
WHY IS 'POSITIVE BIRTH' IMPORTANT?
Birth is a pivotal event in the lives of women and their babies. A positive approach to birth has the potential to help provide women with a sense of control and the social support needed to reduce the risk of PTSD and its associated negative onsequences.
Representations of birth in the media often depict childbirth as a traumatic and painful event, and this can increase women's anxiety and fear about giving birth[3,4].
Fear and anxiety about giving birth have been shown to increase the likelihood of a woman experiencing childbirth as a traumatic event, and to increase rates of cesarean section,[5,6,7,8,9,10].
Cesarean section increases maternal mortality & morbidity[12, 13, 14] and studies have shown that women who have c-sections report less overall satisfaction with birth, experience higher levels of post natal depression/ PTSD[15,16], and other negative psychosocial outcomes.
Babies born by cesarean section are more likely to spend time in NICU are less likely to be breastfed and also acquire a different microbial profile to those born vaginally. It is thought that c-section:
'may have, possibly via gut microbiota development, significant effects on immunological functions in the infant. While early infancy is a critical phase in the development of the immune system, aberrations in gut microbiota development and thereby in the immunologic homeostasis may have a long-term impact on the infants’ future health'
'Studies show that infants born by cesarean section are at an increased risk of allergic rhinitis, asthma, celiac disease, diabetes mellitus, and gastroenteritis'[22,23,24]Fear of childbirth (and it's associated risks) can be decreased and a woman's confidence 'significantly increased by childbirth education including observation of others performing successfully during labour'  (N.Lowe 1991).
It's the idea that if someone believes they can do something, they are more likely to do it[26,27,28].
This is sometimes known as the 'self-efficacy' theory (CBSEI).
The recent 'Dignity in Childbirth' survey by the UK Charity 'Birthrights' found that women still experience significant issues relating to control and consent during childbirth. Included in their findings was evidence that more than 1 in 10 of the women who gave birth in hospital or birth centres did not consider they had consented to medical procedures and almost 1 in 4 who had an instrumental birth felt they had not consented to procedures.
'It is against the law to give medical treatment to a pregnant woman unless she agrees to it. This is known legally as giving her consent.'It's not hard, therefore, to see why child birth is considered by some to be a human rights issue. Antenatal preparation and a woman's ability to exercise bodily autonomy, choice, and control over her birth are thought to help reduce the risk of PTSD [31, 32, 33, 34, 35, 36].
Stories & discourse about birth from within a woman's personal network have been found to be influential on the formation of her childbirth expectations.
Green, Coupland and Kitzinger (1990) found that negative expectations of childbirth were associated with less fulfilling and satisfying birth experiences and that women with negative expectations reported less emotional well-being after birth. Interestingly,
'high expectations were not found to be bad for women, although low expectations often were. Information and feeling in control were consistently associated with positive psychological outcomes.'
HOW 'POSITIVE BIRTH' HELPS
Physiological birth relies 'on the release of [..] natural oxytocin, as the main component of a complex hormonal flow' . Nurturing the secretion of oxytocin is a key part of facilitating the birth process. Fear produces adrenalin (and other hormones) which can act against the hormones of physiological birth [40, 41]. An understanding of the hormones of birth can help women to plan their births more effectively.
For mothers who give birth by cesarean section, information about the procedure, and the ability to make informed choices about their care may be important factors in making the experience of birth 'positive'.
A 'positive' approach to birth can be facilitated by sharing stories and information in a supportive atmosphere which respects a woman's right to choose how and where she has her baby and her bodily autonomy. Regardless of how babies are born, if a woman feels she has made truly informed decisions, and has been treated with respect and compassion she is more likely to remember the experience as a positive one.
'Giving birth is a life-changing event. The care that a woman receives during labour has the potential to affect her – both physically and emotionally, in the short and longer term – and the health of her baby. Good communication, support and compassion from staff, and having her wishes respected, can help her feel in control of what is happening and contribute to making birth a positive experience for the woman and her birth companion(s)' (NICE Guidelines 2014)
THE POSITIVE BIRTH MOVEMENT – GROUP PEER SUPPORT:
'The women spoke about the positive birth meetings as a place where women could receive social support before and after the birth of their baby. The group was also spoken about as a place where women could access information about birth which focused on positive experiences. This was seen as a valuable alternative to the focus on negative birth stories which were seen as promoting fear. '
'Knowledge is empowering because it is an essential step toward stepping away from fear'.
With the recently updated NICE guidelines around birth putting more emphasis on 'normality' and research supporting the safety of midwife-led care and home birth for low risk women, the landscape of birth is changing in the UK.
Regardless of where a woman gives birth, the discussion about bodily autonomy and rights in childbirth is growing louder around the world. With the financial burden of non-communicable diseases growing worldwide experts have begun to ask questions about the role birth may have to play in guarding against some of these illnesses. Others are asking if the way we give birth might impact on our future evolution through epigenetics.
The role that a more 'positive' approach might play in changing the culture & practice around childbirth has yet to be seen, but the Positive Birth Movement is likely to be right at the heart of any change. Find your local group here.
2. 'The effects of childbirth-related post-traumatic stress disorder on women and their relationships: A qualitative study' - Susan Ayers, Andrew Eagle & Helen Waring
3. “Even More Scared”: The Effects of Childbirth Reality Shows on Young Women’s Perceptions of Birth – L. E. Rink
4. 'Vicarious Birth Experiences and Childbirth Fear: Does It Matter How Young Canadian Women Learn About Birth?' Kathrin Stoll, MA, PhD, Wendy Hall, RN, PhD
5. 'Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women' - J. Fenwick, J. Gamble, E. Nathan, S. Bayes, Y. Hauck
6. 'Women's fear of childbirth and preference for cesarean section – a cross-sectional study at various stages of pregnancy in Sweden' – K. Nieminen, O. Stephansson, E. Lena Ryding.
7. 'Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women.' - Green JM, Coupland VA, Kitzinger JV.
8. 'Fear of childbirth during pregnancy may increase the risk of emergency cesarean
section' - ElsaLena Ryding,Barbro Wijma, Klaas Wijma, Håkan
9. 'Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth' – U. Wadenström, I. Hildingsson, EL Ryding
10. 'Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers' -INGELA WIKLUND, GUNNAR EDMAN, ELLIKA ANDOLF
12. 'Maternal mortality and morbidity in cesarean section.' Petitti DB.
14. 'Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.' Liu S , Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS
15. 'Increased risk of postnatal depression after emergency caesarean section.'
Boyce PM,Todd AL
16. 'Adverse psychological impact of operative obstetric interventions: A prospective longitudinal study' - Jane Fisher,Jill Astbury, and Anthony Smith
17. 'Cesarean childbirth and psychosocial outcomes: a meta-analysis.' DiMatteo MR,Morton SC,Lepper HS,Damush TM,Carney MF,Pearson M,Kahn KL.
18. 'Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery. ' Geller EJ, Wu JM, Jannelli ML, Nguyen TV, Visco AG.
19. 'Comparison of the breastfeeding patterns of mothers who delivered their babies per vagina and via cesarean section: An observational study using the LATCH breastfeeding charting system' Havva Cakmaka, Sema Kuguoglub,
20. 'Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns' Maria G. Dominguez-Bello, Elizabeth K. Costello,
Monica Contreras, Magda Magris, Glida Hidalgo Noah Fierer Rob Knight
21 & 24. 'Mode of Delivery – Effects on Gut Microbiota and Humoral Immunity' Anu Huurre a Marko Kalliomäki Samuli Rautava Minna Rinne Seppo Salminen b Erika Isolauri'
22. 'Mode of Delivery and Offspring Body Mass Index, Overweight and Obesity in Adult Life: A Systematic Review and Meta-Analysis' Karthik Darmasseelane, Matthew J. Hyde, Shalini Santhakumaran, Chris Gale, Neena Mod
23. 'Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies'
24. see 21
25. 'Measurement Tools in Patient Education' chapter 24 'Childbirth Self-Efficacy Inventory' Barbara Klug Redman
26. 'Research overview: self-efficacy – a key construct for antenatal education' - Virginia Campbell
27. 'Maternal confidence in coping with labor. A self-efficacy concept.' Lowe NK
28. 'Expectations, experiences and satisfaction with labour ' Slade et al., (1993)
29. 'Dignity in Childbirth' Survey – Birthrights UK
33. Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice' D. Bailham and S. Joseph, University of Warwick 2003
34. 'The Psychological Impact of Birth Experience: An Underreported Source of Trauma in the Lives of Women ' - Kathleen Kendall-Tackett, PhD, IBCLC
35. 'The Childbirth Experience: A Study of 295 New Mothers ' - Ulla Waldenström W M, BA, Dr Med Sci*, Ing-Marie Borg RNM, MN,Brita Olsson RNM, MN, Margareta Sköld RNM, MN and Sigrid Wall RNM, MN
36. 'Antenatal Preparation and Labor Support in Relation to Birth Outcomes ' Bennett, A., Hewson, D., Booker, E. and Holliday, S. (1985)
37. 'The childbirth expectations of a self-selected cohort of Western Australian women.' Fenwick J, Hauck Y, Downie J, Butt J.
38. 'Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women.' Green JM, Coupland VA, Kitzinger JV.
39. M. Odent, 'Childbirth and the future of Homo Sapiens' 2013, pub Pinter & Martin.
42. 'Caesarean Section: A Positive Birth Experience' - Fiona Barlow pub. NCT 'New Generation' Magazine (1997) http://www.caesarean.org.uk/articles/CSAPosBirthExp.html
44. Report for local NHS (not yet published) re. Positive Birth Group Derby
45. 'Birth Matters' – Ina May Gaskin pub. Pinter and Martin (2011)
46. The Birthplace cohort study- key findings https://www.npeu.ox.ac.uk/birthplace/results
47. World Health Organization, Global Status Report on Noncommunicable Diseases 2010
48. 'Missing Microbes: How Killing Bacteria Creates Modern Plagues' - Martin Blaser
©Anne Harper 2015