Active Birth – The Book
add two thumbnail pictures old and new editions of the book with headings and links to amazon for new book order
Although the story began long before, in many ways the publication of the book was the beginning of the outreach of Active Birth to a wider audience. The first edition of Active Birth was published in the UK in the early 1980’s, but the origins come from before then, through what I learned when my own children were born.
Over the years, so many women have told me that reading this book changed everything for them and inspired them to take charge of their birthing experience. It has been translated into many languages and continues to sow the seeds of change all over the world.
So how did it all begin. In the late 1970’s the maternity services in the UK were advocating an approach which was called ‘Active Management of Labour’. Make this link live to reference below this text This was pioneered and developed in Dublin, Ireland in the 1970’s (1). I was pregnant at this time with my first baby and not knowing much about birth, this approach in the local hospital seemed to be the only option.
The main principles of Active Management were that no labour should last more than 12 hours from the time that the beginning of labour was ‘diagnosed’. Membranes were artificially ruptured to stimulate labour if they had not already broken. Then if dilation of the cervix (neck of the womb) was not occurring at the speed of 1cm per hour, labour was stimulated by a drip of synthetic oxytocin and along with this went continuous electronic monitoring and use of epidural anaesthesia and the potential for further interventions was increased. Birth was converted to a timetable–driven mechanical process. It was an extreme medicalisation of birth and was not adequately backed by proper research, despite having a worldwide impact. Of course the woman was lying on her back throughout, the passive recipient of the medical management of her labour.
This was not how I wanted to give birth for the first time – I somehow knew that I could do it, like millions of women all over the world have done before me. Since there were no complications, I wanted a very different approach, where the warmth and sensuality of birthing was not controlled, my freedom and power were not taken from me. I wanted to give birth naturally and to welcome my first child with love. I knew instinctively, what we now know through the evidence of time and research, that this was important and would be best for my baby and best for me. The only good thing about Active Management in Ireland was that the mother was not left alone and had a student midwife with her continuously. Sadly this feature was not included when the model was imported to other countries.
So I did my own research and two important things became clear:
- A woman’s body is perfectly designed for giving birth – from the shape of her pelvis, to the function of the uterus and her hormonal physiology (this I learned later).
- Upright postures during labour and while giving birth harness the help of gravity. They have been used cross culturally by women the world over for thousands of years. This benefits the baby, the uterus and the mother, and results in a more efficient, more comfortable and often shorter labour.
I called my approach ‘Active Birth’, restoring the power to the birthing mother herself to ‘manage’ her own labour. This did not undermine the importance of the attendants, but implied a different style of minimal disturbance and no unnecessary intervention. It is a complete change of ethos and culture, whereby obstetric management is seen as back up, or is reserved for those women who need or want it. The woman in labour is free to move and to follow her instincts as to how she moves, breathes and expresses herself. Interestingly prior to this the time of birth was called a ‘confinement’ which neatly describes a birth where woman is expected to lie on her back in bed.
I wrote the Active Birth Manifesto Link to manifesto lower on menu http://abcu301.wpengine.com/about/active-birth-manifesto/ listing the research evidence and wrote the book, staged a demonstration and organised two huge international conferences in London. I found that midwives in the UK and many other countries and a few obstetricians (most notably Yehudi Gordon who supported and practiced active birth from its inception), warmly embraced Active Birth and things began to change.
The Active Birth book puts forward the argument that birth is a physiological process common to all mammals, including humans. Each labour happens involuntarily and spontaneously in its own unique rhythm and starts when the baby is ready to be born. Labour is also a highly individual personal journey– it is intensely physical and emotional, demanding all of the mother’s attention and energy and then rewarding her with ecstasy and joy as she meets her baby for the first time. It is a life-giving and empowering experience. It is not something that can be managed or controlled. But it can be easily disturbed.
The story of Active Birth is described and illustrated in more detail in the following sections. More than three decades have passed since then. Now in the UK ‘active birth’ is a recognised if not generic term which signifies that the mother wants the freedom to be spontaneous in labour, to move, to choose the most comfortable positions, breathe and express herself in her own way in an environment that is minimally intrusive.
Along the way I also wrote the Water Birth Book published in 2004 and participated with my then husband Keith Brainin in the design and spread of water birth pools for hire at home and installation in birth centres and hospitals. He has now continued with his company ‘active birth pools’ to design and build state of the art pools and other accessories, installing them throughout the UK and further afield. Add cover of the water birth book ( linked to amazon) and link to www.activebirthpools.com (Check)
The Environment for an Active Birth
Following the lead from other mammals, we know that there needs to be a low key, semi dark, warm room where the mother can labour without disturbance, in privacy and where she feels safe and secure. We have learnt over the years that a midwifery led birthing centre within a maternity facility can provide such an environment. Pioneers in this field were doctors Michel Odent with his primitive birthing room in Pithiviers outside Paris and Yehudi Gordon at the Garden Hospital and the Hospital of St John and Elizabeth where he started two pioneering birth units. These were the models for the birthing centres we have today. This is a popular choice for those women in the UK who feel safest when obstetric care is nearby. Most hospitals can provide this and most now also have a water birth facility. There are also some freestanding birth centres. For those women who prefer to give birth in their own home, there is good state midwifery provision and options of private care in hospitals and home birth with independent midwives. Look at any of our NHS birthing centres and you will see that they are custom designed for Active Birth, and run by midwives keen to support natural birth. This did not exist in the 1980’s. Women now have genuine choice.
For me this is a dream come true in some ways, and while it is by no means perfect or uniform throughout the UK, the improvement in 37 years is impressive.
However it did not happen by magic. This change involved the concerted effort over 3 decades of many different people, obstetricians, midwives, birth activists and groups in the UK, not least Active Birth teachers who trained with us to offer a workshop explaining what an active birth is, the benefits, and offering practical guidance to parents. To this day our training course link to professional training http://abcu301.wpengine.com/professional-training/ runs once a year and is attended by participants from all over the UK and the world.
Women requesting facilities for an active birth have been the biggest part of these changes.
This is a time when the focus of birth professionals keen to encourage natural birth is to understand the intricate physiology of birth and to continue to transform the birthing environment to an appropriate environment for birth. One that reduces anxiety and fear, feels safe and private and enables the freedom of the birthing mother. More like a bedroom than an operating theatre!
O’Driscoll, K, Meagher, D, Active Management of Labour(2nd edition), Balliere Tindall, 1986