The Active Birth Movement

Active Birth History014

The day when Janet introduced the phrase ‘active birth’ is possibly the most important one in the history of childbirth in Europe…since the day when the French doctor Mauriceau took control of this event and placed the labouring woman on her back — Dr. Michel Odent.

Screen Shot 2016-06-13 at 17.34.47The Active Birth Story

When Janet founded the Active Birth Movement in the  early 1980s, it began a revolution. A decade earlier, many hospitals around the world had adopted what was called ‘Active Management’ of labour—a highly technological approach, which favoured medical control over labour and birth.

Active Management was intended to standardise labour times to a maximum of 12 hours per woman. To achieve this, routine medical interventions were applied—induction of labour via amniotomy and/or Syntocinon® drip; epidural anaethesia or the use of narcotic analgesics such as Pethidine, Meptid or Diamorphine; and the attachment of sensors to provide continuous electronic monitoring of the fetus.

As you might have guessed, ‘Active Birth’ was chosen as a deliberate play on words—to contrast with ‘Active Management’ – giving the power of birth back to the mother. But Active Management was only the latest example of the over-medicalisation of childbirth. For hundreds of years, advanced nations had been steadily transforming birth from a natural process into a medical procedure. In 1980s Britain, to find women firmly in control of birth, you had to look back to the 17th Century.

givingbirth birth stool, 1580In the early 1600s, European women were in control of how they gave birth. They delivered their babies in upright positions, attended by other women in the secluded and familiar environment of their homes, according to knowledge handed down the maternal line. Midwives carried birthing stools from house to house, with many families passing them down the generations.

This maternal tradition had many advantages. Giving birth upright (by standing, kneeling, sitting on a birth stool or squatting) opens the birth canal, makes contractions more effective, and allows the mother to work with her body in harmony with gravity. It has also been discovered that a darkened and private birth environment stimulates hormonal responses and involuntary reflexes that lead to a better experience for mother and baby.

But in the 17th Century, traditions began to change. Forceps were invented by the Chamberlen brothers, who carried out early assisted deliveries under black drapes of secrecy and without anaesthesia. Not long after, European women began to labour lying back, under the instruction of male physicians. Some scholars claim the position became popular after the French King Louis XIV demanded that his mistress give birth on her back, so that he could get a good view.

152318-R1-E031From there, control over childbirth was gradually prised from women’s hands. The role of the midwife was diminished, and labour was manipulated to suit the birth attendants—but not necessarily the mother or baby. When Queen Victoria’s child was delivered under chloroform anaesthetic in 1853, the social elite of London followed suit, and birth became almost completely passive—as Janet says, “not only lying down, but unconscious”.

When she founded the Active Birth Movement, Janet made it her life’s work to spread the message  that “nature knows best”. She saw that routinely imposed medical interventions were often counterproductive for women having a normal labour—causing a cascade of avoidable complications. She recognised birth as a profoundly sophisticated physiological process, with its true beginning at love-making and conception, and its true end at the child’s growing independence from the mother. Finally, she realised that our scientific understanding of this process is incomplete—and that therefore, it should only be disturbed when truly necessary. Birth can unfold spontaneously and magnificently—if only we let it!

Janet’s First Baby

Janet gave birth to her first child, Nina, in 1973, when she was 24 years old. This was her first encounter with the conventional obstetric attitudes of the time:

“At my first antenatal visit in London, I found the labour ward very cold and clinical. My feeling was – ‘I’m having a baby, not an operation!’. So I changed my plans and went home to South Africa, where my aunt had had three successful natural births. The labour units there were smaller, and I thought I had more of a chance of getting what I wanted. 

I spent most of the labour in my Aunt’s home. Once I got into hospital, very close to giving birth, I was given an enema, my pubic hair was shaved, and I was told to lie down in bed. Nevertheless, it all went well—until the very end, when I was given an unnecessary episiotomy, despite the fact that I had been promised it wouldn’t happen. Luckily the birth itself happened quite quickly—and in my memory it was a beautiful birth. 

I can thank that episiotomy for the whole of my career that followed, because I was determined from then on to give birth in my own home, where such a surprise couldn’t happen to me. It set me thinking—’I wish I had been better prepared to be more assertive’. It made me determined to become a childbirth educator—to help other women having a completely normal birth to be more empowered, and resist needless interventions.”

The Beginnings of Active Birth

standing squat, IndiaJanet joined the National Childbirth Trust (NCT), and trained as an ante-natal teacher.  Looking for a less theoretical, more physical approach in her classes, she introduced yoga-based exercises, designed to increase the natural
widening and softening of the pelvic area and to help prepare the body for birth. This began the global phenomenon of pregnancy yoga—although Janet’s pregnancy yoga remains unique, in that it is not merely designed to be suitable and relaxing for pregnant women, but to prepare them for an active birth.

Around this time, while researching the history of childbirth, Janet first saw images of upright birth. It seemed clear that upright body positions were used for labour and birth across cultures. Pregnant herself, she could see how yoga helped her to become more comfortable in upright positions. But it wasn’t until the home birth of her second daughter, Kim, that she fully realised the importance of remaining upright.

During her birth I was mobile and active in the first stage, but closer to the end I sat down on my bed getting ready to give birth.  It was a not an easy birth, and I felt stuck. My GP had just come back from Botswana, where he had seen African women giving birth, and he reminded me that I could try squatting. 

It was immediately helpful, but I found it very difficult to stay squatting with my stiff ‘civilised’ ankles, and reverted at the very end to a semi-reclining position. Kim was born without an episiotomy despite having quite a big head and I was lucky to avoid a tear.

My midwife commented that if I had not squatted she doubted that I could have birthed her without intervention

Mulling the birth over, Janet realised how important it was to keep moving and adopt sensible positions in Labour.

By the time she was pregnant with her third son, Ias, she was practising birth positions well in advance—concentrating on squatting. Over months, the flexibility of her pelvis, knees and ankles improved, and she could adopt birth positions with ease.

IMG_0730During Ias’s home birth, it was a hot day in August, so I went for a swim in early labour. When the contractions grew strong, I followed my instincts, and kept changing positions from squatting, to kneeling, to walking, resting when I felt like it. I took a bath and was kneeling on the floor in the all-fours position when the urge to push suddenly came. I stayed on all fours and pushed Ias out that way. He was a large, 10lb baby. I had no tear, no grazes and a wonderful sense of control. I was triumphant! I had given birth , actively, and I was up and about withno soreness or stiffness at all after a day or two

Inspired by her experience, Janet began to teach women how to prepare for an ‘Active Birth’. She published her first  book, “New Life”, that informed pregnant women about their bodies and gave them yoga based exercises for childbirth. Thanks to photographer Anthea Sieveking, we have a record of some of the active births that resulted from this early work.


Stand Up for Birth-Rights!

152318-R1-E029Soon, Janet’s methods were getting publicity beyond North London – particularly after the work of Michel Odent, a French obstetrician and exponent of active birth, was shown on British television. Dr. Odent was achieving remarkable results at his clinic in Pithiviers, using a similar approach.

Meanwhile, the group of women who had attended Janet’s classes were trying to give birth in upright positions in local hospitals. Some were supported by the obstetrician Dr. Yehudi Gordon, an early champion of active birth, who contributed his authority to Active Birth and began a pioneering approach to maternity care in hospital. But others faced stubborn opposition, leading to conflict between doctors and midwives in the labour ward. Although 200 ‘active birth babies’ had been born safely under Dr. Gordon’s care, active births were banned , against his wishes.

Janet recalls:

Some mothers whose births were imminent were extremely distressed.  They rang me to express their feelings. As the person who introduced them to the concept I felt a responsibility to do something on their behalf. It seemed completely inappropriate for them to have to fight for the right and freedom to give birth during their labours.

In April 1982, Janet founded the Active Birth Movement, publishing the ‘Active Birth Manifesto‘, which laid out the significant body of research evidence in favour of remaining active in labour and birth.

ABC020 copyOn April 4th, with the collaboration of colleagues, Sheila Kitzinger and childbirth organisations, AIMS (Association for Improvements in Maternity Services), NCT (National Childbirth Trust) and Radical Midwives,  Janet organised and led a ‘Birthrights Rally’ on Hampstead Heath, demanding the restoration of support for active births. Over 5,000 people marched, and were addressed by  the newsreader Anna Ford, Sheila Kitzinger and Michel Odent.

That year, Janet told The Times:

I felt strongly that no consultant should be entitled to ban what is natural…We decided to hold a sit-in, or maybe a squat-in, at the hospital. When 5,000 people turned up from all over the country, we had to shift the protest to a nearby park. Luckily, it didn’t rain. I’m not at all against the advances of modern obstetrics but I feel that the consultants have completely taken over.

The rally was a huge success, and the ‘active birth ban’ was lifted.

Spreading the Word

Active Birth History016Janet seized the momentum of the rally, and entered into one of the most productive periods in her working life. In October 1982, Janet organised the first International Conference on Active Birth, at Wembley Conference Centre. Over 2750 people attended, half of them midwives. Alongside Janet, speakers included the world famous psychiatrist, R.D. Laing, Michel Odent, Yehudi Gordon and Sheila Kitzinger. The Lancet reported:

Mounting evidence that lying supine to give birth—the “stranded beetle” position—may be more painful and dangerous than delivery in any position chosen by the woman was offered by all the speakers…

The conference, as a whole, was a celebration of faith in the joyous nature of birth, and a gesture of solidarity among women deeply dissatisfied with present maternity services. The movement has gained momentum in the U.K. and it is affecting present obstetric practice.

The conference was so over-subscribed that the event was repeated in March, again to a sold-out audience.

A second book followed in 1983— the pioneering and acclaimed ‘Active Birth’. Here, Janet went beyond the exercises in ‘New Life’, setting out all the ideas and evidence that remain fundamental to active birth today:

Giving birth is essentially a natural bodily function, which occurs quite spontaneously and involuntarily at the end of pregnancy. It is part of a continuous evolution which begins with love-making and conception and ends in the growing independence of the child from his mother, during the first few years of life

The whole process of conceiving a baby, being pregnant, giving birth and mothering is part of the sexual and spiritual life of a woman, and is basically rooted in the natural and undisturbed unfolding of a series of physiological events.

In 1986, The Active Birth Centre opened, providing a permanent base for classes, workshops and trainings, and in 1989 another publication followed – The Encyclopedia of Pregnancy and Birth, co-authored by Yehudi Gordon.

Water Birth 

DSC_9567It was around this time that Janet’s attention turned to water birth. A deep pool of warm water can be very useful in an active labour—it provides an alternative route to medical pain relief, and the buoyancy of the water also supports the mother in maintaining upright positions. Janet’s husband, Keith, had designed a portable birth pool, as well as supplying the world’s first purpose-built water birth pool to Yehudi Gordon and his staff, now at the Garden Hospital in North London.

Janet used water during the birth of her fourth child:

janetTheo weighed in at 11lbs and this time I had a portable water birth pool in our bedroom. Labour was intense and as soon as I reached 5cm dilation I entered the pool. The buoyancy of the water made it much easier for me to relax. I was encouraged to let myself go without any inhibitions, and I remember making a tremendous amount of noise and reaching full dilation very quickly. 

Michel Odent, who was in attendance, suggested that I leave the pool for the actual birth. Given Theo’s size, we decided that I needed the help of gravity to get him born, so I used the supported standing squat position. He was born in two contractions despite his size, miraculously without a tear. The medical establishment would certainty have considered me ‘high risk’. I was 42, rhesus negative and had surgery on the uterus 3 years previously. These were the very reasons that I wanted to stay at home where conditions for a normal birth were optimal

Two years after Theo’s birth, Janet published the landmark book, ‘Water Birth,’ which has recently been updated and republished.

Today, Active Birth Pools has supplied water birth pools to over 80% of NHS hospitals in the UK; and many more around the world—millions of women have benefited from the use of water in labour.

Change is slow and there is still a long way to go before Active Birth becomes a real option for all women, but amazing progress has been made

Active Birth Today

 In the decades since the Active Birth Movement was founded, childbirth in the UK has progressed. Birthing Centres throughout the UK, both freestanding and within hospital trusts, are designed to facilitate active births. Despite the ever-escalating rate of Caesarean births, active birth is widely endorsed by the midwifery profession and has become a generic term. Many birth units are striving towards a better balance between nature  and  the benefits  of  science in the facilities they offer. Through a professional training programme accredited by the Royal College of Midwives, the Active Birth philosophy is  spreading across the country. Women are usually well provided for by the NHS, whether they want to give birth in a hospital or at home.  There  is  growing understanding   of   birth physiology and although change can be frustratingly slow, a gradual transformation of the birthing environment to one that is more conducive to the natural processes of birth continues.

Active Birth puts the birthing mother at the heart of this transformation from passive patient to active birth giver.  This empowerment, enabling the mother to be in charge of her own body, to move freely and choose the labour and birth positions she finds most comfortable, now informs and underlies all approaches to pre-natal preparation

The Active Birth philosophy of minimal intervention has been reinforced by developments in obstetric research and science — which continue to reveal the complex physiology of the birth process. For example, we now know that the placental transfusion of blood the baby receives after birth is rich in stem cells, iron and disease-fighting immunoglobulins, and that exposure to the mother’s bacteria during natural vaginal birth confers important immunological advantages to the baby. In turn, Janet’s teaching has evolved—including advice on how long to wait before cutting the umbilical chord, and even how to keep a necessary caesarean section as close to a physiological birth as possible.

Active Birth International 

As the situation in the UK continues to improve, the biggest challenges today lie in other countries around the world. Janet is determined to bring the wisdom of Active Birth to women everywhere. In addition to training midwives from around the world, Janet’s books have been translated into more than 15 languages, and she continues to tour and lecture internationally.

Since the 1980s, Janet has taught Active Birth all over the world—from Australia and New Zealand, to Estonia, Finland, Ireland and many other european countries.

In recent years Janet has focussed on introducing Active Birth to Turkey, Israel, Brazil and India. In Brazil, caesarean section is the norm for those who have access to medical care—with a caesarean rate of over 82% in the country’s private hospitals. The rate is 50% of all births, one of the highest in the word. Janet has visited Brazil four times, appearing on national television, speaking at public events and leading courses for mothers and midwives. There is now a Brazilian institute for Active Birth, and a new edition of Active Birth is being published in Portuguese.

In November, Janet will be speaking at the 2nd Annual Natural Birth & Breastfeeding conference in Dubai; and In April 2017, Janet will be leading a professional training retreat in India.

As the situation in the UK continues to improve, the biggest challenges today lie in other countries around the world. Janet is determined to bring the wisdom of Active Birth to women everywhere. In addition to training midwives from around the world, Janet’s books have been translated into more than 15 languages, and she continues to tour and lecture internationally.
Since the 1980s, Janet has taught Active Birth all over the world—from Australia and New Zealand, to Estonia, Finland, Ireland and many other European countries.

Active Birth has always been both pragmatic and positive. Founded on the belief that women know instinctively how to give birth and babies know how to be born, the usual outcome of an active birth is an ecstatic mother, a healthy baby and a wonderful start to a new family and a new life. Once a woman experiences this, and it is witnessed by her birth attendants, she also gives birth also to a new possibility for all women. Change happens one birth at a time. This change is slow, but it is also indelible and irreversible.