Natural Birth is your Birthright
by Prunella Briance
Prunella Briance is the founder of the National Childbirth Trust (NCT).
This paper was presented at the second International Conference held in Kiev in 2003. Since 1956, when I alone founded what was then called Natural Childbirth Trust, this work has never left me and over the years I have had much experience in teaching the proven work in natural birth first expounded by the English GP Dr. Grantly Dick-Read, and in speaking internationally in many countries including the UK, USA, Singapore, Georgia, France, Germany, Japan, Hungary, Poland, Ireland, and now the Ukraine. In 2002, I was invited to help the mothers to found their own Natural Childbirth Trust. Their results were so successful and impressive that, in 2003, I was flattered to be invited by the medical profession to talk at their international conference and to give my suggestions on their pride and joy: the Baby Friendly Hospital, under the auspices of the World Health Organisation. This proved to be very interesting and my ideas, I think, took root. A greener birthing room with plants and cushions in place of those rigid hospital beds, soft lighting, soft music if liked, freedom to adopt whatever position is found to be themost comfortable. A film was made of all this and now in Ukraine they are publishing my book Childbirth with Confidence , so the journey was well worthwhile! In Ukraine, their anti-infection procedures are ahead of ours, they have no rate of 'staph' infection as the hospital is only concerned with maternity and not with illness. Furthermore, they all wash hands and wear sterilized gowns, slippers and headscarves to cover the hair. Perhaps soon even school-leavers will have been taught that birth was never intended to be a dreadful medical experience.
Recently I was sitting next to a very ancient retired obstetrician who told me, without prompting, that in his opinion Dr. Grantly Dick-Read single-handedly revolutionized the understanding of birth. Now Dr. Dick-Read, whose life-work I try to explain, always insisted that he had never invented anything new, but that he had merely observed that birthing was like a beautiful statue which needed to be cleaned up until it could be seen in its true light.
Despite going through all his medical training it was from experiencing two simple examples of birth that he was made aware that his training had been wrong. This was, of course, contrary to all the modern available information of the most learned men in the obstetric profession, but this man was primarily a fighter; he believed in force, not of the military kind but in the force of mother-love. He then felt inspired to set out on his lonely course of proving that 97% of healthy women, given the opportunity and encouragement, could give birth without interference, injury or shock. The remaining 3% were mainly sick women or those whose previous experience had damaged them, leaving them incapable of giving birth naturally. For these cases medical intervention is a boon and a blessing and the skill of the attendant is greatly appreciated. But, medical intervention should never be used as a matter of routine, yet today we see that interference with the normal course of labour has become normal and routine and this will continue until women themselves demand their right and restore their instinct and understanding of how birth can be. They should know, for instance, that Dr. Dick-Read never examined a woman internally unless his external observations were unsatisfactory. If so this was with the greatest gentleness and respect for the feelings of the mother. Women are learning now how they can help themselves; due to the stress of our busy lives they need to equip themselves with accurate knowledge. This needs to be learnt and practiced.
I find it annoying that those who superficially understand this approach try to cash in on Dr. Dick-Read's life-work without giving him credit and without knowing anything about his life and the strictures which he faced from his own profession. These individuals manage subtly to alter the natural teaching to suit their particular technique, thus destroying the validity of proved medical experience. For instance, those who follow yoga have over-emphasised the value of this discipline unnecessarily, although certainly the practice of relaxation and appropriate breathing is vital and Dr. Dick-Read adapted a few yoga techniques which had been taught to him by an Indian Officer when he had been gravely wounded in the spine during the First World War. Later on this modified yoga was used to teach women in childbirth and it certainly proved its worth! Then the physiotherapists got their act in and overemphasised the importance of exercises. We know that good posture and natural exercise such as walking and swimming are important as well as, obviously, practicing the attitudes one uses during birth such as squatting. Seldom is this attitude used by European women, who can learn from the Chinese and Africans who adopt this position easily without stiffness or pain. Then the exercise to strengthen the muscles of the pelvic floor is most important for both sexes. Then we have the under-water brigade; it is lovely to relax in water - not too hot for the sake of the baby, but birth was not intended to take place under water. It was Dr. Michel Odent who first, by chance, found that women liked to labour in water and preferred to stay in for the delivery, though this was only because they failed to get out in time.... Nowadays this seems to be acceptable and is fine providing the attendants are experienced and that the baby does not drown or the placenta does not separate early. Recently I read that a well-known London hospital had stopped encouraging water birth for this reason.
A few years ago I made a special expedition to visit Dr. Odent in France and arrived at the right moment, for a young midwife was giving birth to her first baby. It was a very hot day and the birthing room in the local hospital was darkened with a blanket over the window. The husband was there and the doctor himself was sitting unobtrusively on the floor. The mother was standing up, nude in the middle of the small room, she was perfectly silent and controlled and there was complete peace and quiet. I just put a finger on her shoulder and whispered 'courage' and the baby came out feet first fast without any difficulty at all. The doctor lent forward to catch it and then the parents were left alone with the baby still attached to the placenta. No hurry, no fuss, no interference. To witness this was an uplifting experience and I admit to a few tears of emotion to see such an example of what can be allowed to be accomplished today in a hospital birthing room. Michel told me that he, as a surgeon in Africa for twenty-five years, had found that he was being asked to perform too many caesarian sections, which is why, being a man blessed with natural intelligence, he began to encourage natural birth and certainly succeeded. At this point he was unaware of the previous work of Grantly Dick-Read.
Some people with the best intentions tend to frighten the women they would help by giving them too much detailed information and by talking about different kinds of pain relief. Dr. Dick-Read never had instruments and drugs displayed in the labour room although they were readily available should the need arise. The idea is not to give women the idea that birth is necessarily a painful affair requiring drug relief. The teaching of pain relief is quite worng and must be stopped, it should never have been part of childbirth education. Dr. Dick-Read always emphasised that the best teachers are mothers themselves, but those who are not so fortunate to have experienced the joy of a natural birth can learn, if they will for good work can be done by correct teaching, following the natural pattern. Recently I was told by a well-known general practitioner who writes for The Times newspaper in London that when he was in training he remembers that people did not find natural birth at all interesting but boring. Whereas some ghastly disaster had all the students enthralled. This is awful and it does happen; no doctor who thinks this way should be at the side of a woman in labour, but should choose some other specialty, not natural birth.
Birthing is merely a human function like any other bodily function. The arrival of a new baby is a holy event. Trouble occurs only when fear turns to tension which in turn causes pain, and excruciating pain can be experienced unless this cycle is broken and the woman loses her feelings of extreme fear. Of course it is of great importance that those handling birth should be well versed in the natural process. As I have already said Dick-Read always emphasised that ideally mothers should teach their children for they are best equipped to do so. But those not so fortunate can, as a man can, teach, but cannot feel the experience themselves which is a disadvantage for them. Nowadays unlike fifty years ago, young medical students and midwives are not obliged to witness natural birth in the home. It used to be the practice that they had to attend some twelve home births during their student days. Home birth in the UK is only about l% which is a sorry state of affairs. 'Staph' infection and other diseases are rife and dangerous in general hospitals both for new mothers and their babies, which is why we press for birth at home or birth centres away from disease associated with birthing in hospital.
It is of vital importance that attendants should avoid careless talk - a whispered conversation, a word of anxiety, for the labouring woman is astute and can become terrified of what might happen. Her senses are extremely alert to suggestion. What she needs is a staunch, peaceful experienced presence at her side, encouraging, coaching or coaxing her through - if that is what she wants and needs.
Every expectant mother should be taught how to deliver her own baby just in case the birth happens unexpectedly - in a car, or anywhere. In 1958 it was I who asked Dr. Dick-Read to add a chapter to his classic and latest edition of Childbirth without Fear showing how to give birth without help. I am pleased that this was well received by women; it is an essential boost to confidence and competence.
Dr. Dick-Read always referred to the arrival of a new baby as a holy event which should be given the reverence such an event deserves - gentle handling, no bright lights, no noise or haste. The importance of leaving mother and baby together is of great value to both. The placenta should not be extracted by force nor the cord separated until it has become blanched and dry at what came to be known as 'Read's patch'. The vernix is a protection and should not be washed off. If the baby is encouraged to crawl up the mother's skin to her breast this is excellent for the physiological effect is to cause the womb to tighten up and prevent bleeding which is minimal in a properly conducted natural birth. The baby will suckle when it is ready.
Women are capable of giving birth, they were constructed for this purpose - with understanding and faith they can prove it. It is now your responsibility to pass on this information if you feel that it is true and honest. I expect to hear great things from Ukraine - thank you for listening to me.
This speech was given by Prunella Briance by invitation in Kiev in 2003, under the auspices of the World Health Organisation and the Ukrainian Centre for Natural Birth.
You can email Prunella at prunella@pinterandmartin.com.
Published with kind permission from Prunella Briance. (c) Prunella Briance 2006. All rights reserved.
