Normal birth: What's in a name?

Since the RCM abandoned its campaign for normal birth and removed the word from the website, midwives have struggled to come up with another term that describes their expertise. If we are “experts in normal birth” and “normal” is no longer used, how does that affect our role as guardians of normal birth? And how do we know how many of those births take place if we don’t have a name for them?

Do not disturb canvaMany midwives and researchers, me included, have used the term ‘physiological birth’ but in one of those little flashes of insight I recently realised “physiological birth” is an oxymoron.

Birth is physiological.

It could be argued that this is hair splitting over a name, but the de facto abandonment of the word “normal” is another step in marginalising the role of midwives. So, what are we calling it and what is the rate in the UK?

Ah, I hear you say those births are called unassisted’ or ‘spontaneous’ vaginal births, it’s certainly the term used in the data collection systems. Ok so unassisted or spontaneous vaginal birth it is then! These are the births in which midwives’ have been trained to have expertise. Our speciality, you could say!

So how are we doing in our work, attending and supporting women and birthing people to have unassisted vaginal births or spontaneous vaginal births, what are the rates?

Well, we don’t exactly know because unassisted or spontaneous vaginal births are births where no instruments are used and interventions are included, like epidural, ARM, continuous electronic monitoring and a managed third stage.

Births without intervention aren’t counted and they don’t have a name! If these births are invisible what are the implications for the midwifery profession and for those who give birth? What a dire situation for a professional body! We need to act with some urgency before the midwifery professional becomes obstetric nursing at best and defunct at worse. It’s imperative we take action, we must do whatever we can to reclaim our expertise to make birth safe again so women and birthing people leave our care whole, happy, intact and ready for the journey ahead, undamaged.

First let’s name those births “where the woman commences, continues and completes labour with the infant being born spontaneously at term, in the vertex position, without any surgical, medical, or pharmaceutical intervention” (ICM) and considers “any cultural, environmental or behavioural influences in the care environment that negatively impact on the exquisite neurohormonal balance that is an integral part of the process” (NMC) as UNDISTURBED BIRTH. Because that’s what they are!

Next, we demand that they are counted! These figures describing the number of birthing women and people who do not require intervention or have their births disturbed for non medical reasons are required as much as the figures for forceps and caesarean births. They are not included in the National Maternity Services Data Dashboard. They are not included in Hospital maternity systems. Physiology should be the baseline and then we see how many interventions are needed or requested. This way we can see clearly the state of birth.

 “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek” (Barack Obama).