I think we have, but I also think we need the docs as well. In The Positive Birth Book, I've tried to stress that, rather than perpetuate what I call the 'Tealights vs Forceps' battle, we need to acknowlege that truly safe birth needs both. We need to understand more about what makes women's bodies 'work' or 'not work' in labour, and we also need to have respect for the 'back up' and 'safety net' that the obstetricians provide.
Unfortunately at the moment it's the former that we've lost touch with. Whilst we happily provide pandas in the zoo and our pet cat with the basics they need to give birth and bond with their babies, when it comes to women we tend to forget that we also need to go back to the mammalian basics. We need to provide - darkness, safety, quiet, warmth, familiar people, calmness, and no interruptions - if we are to give women's bodies the chance to do what they were built to do. If we provide all this, and labour still does not progress as it should, then - and only then - we need to look for medical assistance.
And so, although the straw might be a little spiky on the knees, I think there's a lot we can learn from the idea of birth in a stable. Here’s a few reasons why it might be a more fabulous place to give birth than you might think:
OK, so there was an Ox and an Ass (we’ll come to them later), but it’s unlikely that Mary had to introduce herself again when the shift changed or talk through her birth plan with a dozen different strangers. This sense of privacy would have made her more likely to produce Oxytocin, essential to the progress of labour and birth, and often called the ‘shy hormone’, because it’s production can be hampered by interruptions. If you’re male or have never had a baby, this clip might help you understand how some bodily functions are very difficult under observation:
No glaring electric lights in the stable, just good old-fashioned darkness – and the glint from an unusually large star, I’m told. But a dimly lit corner of a warm safe place just ‘feels’ right for all mammals. When wild animals give birth in captivity, their human carers go to great lengths to make a dark, safe space for them, understanding only too well that problems can arise if they are disturbed. As well as the privacy that darkness offers, it’s also all about hormones: in darkness we produce melatonin, and this works in partnership with other hormones like oxytocin, essential to the progress of labour and birth.
There might have been some rolls of hay to lean on or a manger or two to hang off, but there certainly wasn’t a bed, and it’s likely that Mary delivered, like many women of that time, with the help of brightly painted birthing bricks, brought by the midwives and used to squat or kneel on. This ‘active birth’ – with the woman shifting position several times in response to her body’s needs – is rarely seen on One Born Every Minute, and many believe that the bed slap bang in the centre of modern delivery rooms gives women a strong message that this is the ‘way it’s done’. In reality, restricting movement makes for longer labours and putting women on their back narrows the pelvis making it harder for baby to get out.
Lucky old Mary would never have been told “Time’s up, you’ve failed to progress”, but for modern women, time features heavily in their birth stories. “You’ve been pregnant too long, we need to induce you”, “You’re not dilating fast enough, we’re going to speed you up”, “You’ve been pushing for over two hours, time for the forceps.” No wonder there was such a great sense of peace in that stable: what a relief it must have been to give birth without the sound of ticking in your ears.
In the modern age, we’ve become obsessed with cleanliness, perhaps to the point of threatening our well-being. Scientists are now beginning to understand the Microbiome, the colony of bacteria that lives on us and in us, and the vital role they play in our health. And guess when the microbiome begins? At birth. Scientists have found noticeable differences in the microbiome of babies born at home versus those born in hospital, and the difference is also clearly marked between vaginally and caesarean born babies, so much so that some women who have caesareans are choosing to manually 'seed' their baby with vaginal bacteria. We don't know very much about the microbiome yet, but it could be that being born vaginally, and in a home-from-home environment like a stable, could have made for a very healthy start in life.
The presence of animals in the birth room might seem odd, but perhaps it could have been strangely comforting, as this article of pets supporting humans at home births shows. Added to this, it’s surprisingly healthy: scientists also tell us that living in close proximity to animals may be good for our immune system and overall health. In fact, the scientist who led the study ‘The Home Microbiome Project’ went straight out a got a dog, having discovered that a key to good health was having a rich, diverse microbiome, and that this could be instantly improved by ‘opening windows, adding plants and getting a pet.’ Or, in Mary’s case, a stable, a couple of palm trees and a sheep or two.
One to one midwife
We don’t know for sure who attended Mary in labour, but almost certainly, a woman from Bethlehem would have been sought, and she would have brought herbs, birth bricks and a wealth of experience and reassurance. She would have stayed with Mary from start to finish – a luxury modern women in the UK can only usually rely on if they hire an Independent Midwife - which, due to an NMC ruling about their insurance, just got more difficult for UK women. The ‘one woman one midwife’ model of care that Mary enjoyed has been shown to improve both quality and safety at no extra cost, but it is yet to be implemented across the board in the UK, despite NICE recommendations.
A Doula or two
Forget the three wise men, it’s likely that Mary’s midwife had a helper or two and that the stable was filled with the birthing wisdom of women, who would have held her hand, looked into her eyes, and told her, “Yes you can” anytime she said, “No I can’t.” These days, women can hire a doula to bring this reassurance, and one study has shown that making this choice can reduce the chance of caesarean section from between 60 and 80%.
A ‘Hands off’ approach
For biblical women like Mary, the only hands on her in labour were probably simply those of reassurance, but not many 21st century women can make this claim. Even if they are one of the minority who give birth without caesarean, or instrumental delivery, they probably still have plenty of poking around, from the obligatory ‘sweeps’ to get labour started, to regular exams in labour to make sure they are not ‘failing to progress’. Whilst such exams may sometimes be helpful or necessary, often they do nothing but disturb the mammalian brain and undermine a woman’s confidence in her body. And the hands off approach in the stable probably meant that Mary had optimal cord clamping, with all the benefits that, two thousand years later, everyone is suddenly talking about.
No crib for a bed
In spite of the typical Nativity pictures, Mary and her newborn probably didn’t bother much with the manger but instead enjoyed all the benefits of immediate skin-to-skin once the birth was over. This instinctive response was over-ridden by the heavy-handed approach of the mid-twentieth century, when babies were whisked off to be washed and placed in the nursery. Now initiatives like Baby Friendly from UNICEF encourage mothers to reconsider the many benefits of skin-to-skin contact; from calm babies with more stable heart rates, to improved rates of breastfeeding, to better bonding, to a more diverse microbiome. And where modern women can often feel conflicted by confusing co-sleeping advice, Madonna and child presumably bedded down in a loving snuggle with no such worries.
We like to think we’ve come a long way since biblical times, and of course it’s true that birth is a lot safer now: in some circumstances, medical help is a life-saver. But in our rush to embrace medical technology, there are some things we’ve forgotten. We’ve built labour wards that might have every modern convenience but are missing some of the basic essentials. Let's hope that, in 2018, the Better Births initiative from the Maternity Review, birth campaigners, and policy makers might bring some new gifts to labour ward: darkness, privacy, freedom of movement, support from women we know, and trust in the process of birth.
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"I only wish I had read this when I was pregnant. Full to bursting with useful stuff!" Sarah Turner, The Unmumsy Mum
"One of my very favourite birth writers." Ricki Lake
"A great read: honest, lively, fresh and helpful. This book puts women in the driving seat which is key to positive change." Cathy Warwick, Chief Executive of the Royal College of Midwives
Writer Milli Hill is the founder of The Positive Birth Movement. Find her on twitter @millihill