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Midwife Organisation Rules to Finally Stop Pushing The Idea of 'Normal Births'

14 AUG 2017

Midwives in the UK are ending a long-standing campaign on advocating for 'normal births' without any medical intervention.

They have admitted that using this term would make women who need medical assistance during childbirth end up feeling like they've somehow failed. Now a leading midwife organisation is moving on to a new strategy.


The Royal College of Midwives (RCM) launched their campaign for normal birth back in 2005, with the aim to "inspire and support normal birth practice."

"Most women of child-bearing age in the UK have less experience of birth than ever before," the RCM stated in 2005.

"They are much more averse to pain and feel that technology in all its forms offers choice and control."

While the campaign's goals did explicitly involve reducing 'unnecessary medicalisation', it wasn't really meant to simply promote natural birth at any cost.

But in practice the term 'normal' ended up carrying a loaded meaning.

"There was a danger that if you just talk about normal births, and particularly if you call it a campaign, it kind of sounds as if you're only interested in women who have a vaginal birth without intervention," chief executive of the RCM, Cathy Warwick told Chris Smyth at The Times.

"What we don't want to do is in any way contribute to any sense that a woman has failed because she hasn't had a normal birth."

Medical interventions for childbirth involve methods that help widen the birth canal and opening, the induction of labour, anaesthetic injections known as epidurals, and C-sections.


While there's nothing wrong with needing help, these medical interventions are on the rise. Right now, about four in ten women in the UK are giving birth 'normally' without medical help, while 30 years ago it was six in ten women.

C-sections in particular are becoming increasingly common, and, according to The Times, this factor was one of the triggers for the start of RCM's campaign for natural births.

According to the World Health Organisation (WHO), the ideal rate for C-sections should be between 10-15 percent of all births. Data shows that when that rate goes above 10 percent, there's no evidence for improved mortality rates for either newborns or their mums.

"Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems," the WHO stated back in 2015.

It's without question that there are immediate risks to having such surgery, such as infection and complications during healing. C-sections have also been linked to later obesity and to immunity problems in infants, but scientists are still working out the conflicting evidence on that topic.


And the potential dangers of having a vaginal birth are also part of this complex equation.

Just last year UK's Royal College of Obstetricians and Gynaecologists (RCOG) proposed that women may also need to be warned about the risks of having a natural birth, especially since the age for first-time mothers keeps increasing.

As we reported last year, C-sections are definitely saving lives:

[T]he evidence is mounting that, as first-time mothers get older, having a pre-planned, elective caesarian might in fact be the safest option.

At any age, vaginal births come with a risk of the woman's pelvic floor muscles tearing, as well as complications causing the baby to go into trauma, or forcing the mother to undergo an emergency C-section.

But in a situation where a 'normal birth' means one without any medical help, women who require interventions - even if it's an emergency - can end up feeling inadequate.

As Warwick told The Times, RCM is now addressing that problem with a shift from using the term 'normal birth' to the more neutral ''physiological birth'.

"If you have a caesarean section it doesn't mean that you're a failure," she said.

"Something has happened in your birth that means you need some help and support and it can still be a very positive experience."


For now, 'normality' and 'normal births' are still mentioned on the organisation's Better Births Initiative website, so we'll have to wait and see if the RCM will update its resources to its new term of choice.

Meanwhile doctors have already welcomed this commitment to changing the language.

"While we support the promotion of vaginal delivery, it is also important to stress that no woman should be made to feel their birth experience is 'abnormal'," says RCOG president Lesley Regan.

And the RCM has also announced they are starting work on new guidelines for the best evidence-based midwifery practice, with an advisory group set to publish its results late next year.