The perfect birth ideal that can harm women

The ‘perfect birth’ ideal that can harm women

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  • Author, Amanda Ruggeri
  • Rolle, BBC Worklife
  • February 18, 2023

Please note: This story contains details of traumatic births that may be sensitive to some readers.

When Emma Carr became pregnant in 2021, she had a vision of her ideal birth. Basically, she wanted to feel empowered, heard, and in control.

But like many women, Carr’s vision went much further. Specifically, she hoped for a “natural birth” often described as a normal birth with as little medical intervention and painrelieving medication as possible.

She went two ways. One of these was the popular approach of “birth hypnosis”. Hypnobirthing, as it is known in English, teaches relaxation and breathing exercises to reduce pain and keep the mother conscious during labor.

And following her instructors’ recommendations, Carr watched videos of healthy, happy, traumafree births to keep her optimistic.

“You look at all these videos of babies being born and it’s so beautiful,” says Carr, who is 36 and lives in London. “They come off very easily, women hug them and you say ‘this is going to happen to me’.”

But when Carr’s waters ruptured, the fluid contained meconium the stool of the fetus, which can be dangerous for both mother and child.

She rushed to the hospital and the doctors told her to get the baby out immediately. And two hours later she was lying under the bright surgical lights.

Far from her ideal a normal birth without interventions her baby was born by caesarean section. And what was worse, Carr says, was how unprepared she felt for this outcome, so focused — after all the encouragement she received in the classes — was she on creating a positive attitude.

“If I hadn’t had in mind how it ‘should’ have happened, I wouldn’t have felt like it was a failure,” she says. “I only wish [meus instrutores] to be a little more open about how these births go. Which doesn’t always work just because you hypnotized the birth.”

Carr says that during her pregnancy her friends tried to warn her that she might not have the birth she was hoping for. But she ignored them, thinking that they probably weren’t doing the same training as her.

“You don’t listen to the people you normally listen to because you have these other people in your head telling you that your birth should be natural and magical, that your body was designed perfectly for it,” she says. “But I don’t think it was mine.”

Many women really benefit from this approach to childbirth. Some even experience the ideal scenario they anticipated. With the right techniques—like breathing, affirmations, or massage—some people claim that childbirth can be pleasurable and even orgasmic.

But other women, like Carr, are in shock, and not just because of the traumatic birth. They feel fixated on that vision, unprepared for the many reasons that could keep them from it. And because of that, his experience was even worse.

The beginning of the movement

For much of human history, women often died in childbirth up to one in 100 births in the 17th and 18th centuries, until scientific advances, including antibiotics, meant that maternal deaths fell.

As the medical community expanded its attention beyond safety, narcotic pain relief techniques such as epidural became commonplace in many countries. Even today, maternal mortality is highest in countries that may not have adequate medical care to treat the same complications that are more easily treated in other parts of the world.


After preparing for “ideal” birth experiences, some women feel like failures when they have to undergo medical procedures like a cesarean

Many people prefer modern pain management during childbirth as the most suitable option for them, which is also recommended by many doctors. But other women and health professionals believe the birthing process has gone too far in that direction. They claim that overreliance on medical procedures can be unnecessary, dangerous, and even dehumanizing.

For example, in the 1960s, women in wealthy countries often gave birth under anesthesia. They may not have felt pain, but they were also unable to remain conscious to make momentary decisions about their care.

Today, many women fight for — and even idealize — what is often referred to as “positive childbirth.”

A term “positive birth” coined by British activist and founder of the Positive Childbirth Movement, Milli Hill, was not originally intended to describe a specific type of labour. The meaning of the phrase has expanded.

“A positive birth doesn’t have to be ‘natural’ or ‘drugfree’ — it simply has to be done with a positive perspective, not out of fear,” the movement’s website says. That is, “You can have your baby with a positive attitude in the hospital or at home, with or without medical intervention”.

The site highlights that a positive birth is indeed an experience in which the woman feels “free choice, access to accurate information, and control, empowered, and respected.” It’s also a birth she “will cherish and later remember with fondness and pride.”

Still, many women who attend the positive childbirth classes say they sense an underlying tendency to specifically idealize “natural” births.

An important part of the emphasis on how childbirth can be “positive” is accompanied for some faculty by lectures on how a woman’s body is “designed” for childbirth and the subtext might say that medical intervention hinders this process, instead of watching it.

For example, an important basis of many of these approaches is that anxiety and agitation increase the production of hormones such as adrenaline, which can delay labor and make labor worse.

Using techniques that include making the birthplace feel welcoming and comfortable; Support from a birth partner (or team); use of breathing techniques or meditation; and most importantly, when you go into labor relaxed and confident, you can stimulate the production of oxytocin, which speeds up labor and reduces pain.

The popularization of “natural” childbirth has a long history, beginning at least in the 1930s—curiously, more or less at the same time that the first college of gynecology and obstetrics was founded.

For many women, such approaches have never been important. If you want to give birth with as little pain as possible, why not just use all the modern health interventions and medicines available?

But for others, this image of the ideal “natural” birth prevailed, reinforced by a growing prebirth industry. Beautiful stories of relaxed water births are common on social media, with healing music and candles everywhere.

There are many benefits to these birthing moves, including the intent to shift decisionmaking to the people who are about to give birth. But as cultural ideals of “positive” and “natural” proliferate, there’s also a downside for some women.

No amount of relaxation classes or techniques can overcome the reality that every birth has different circumstances; that there are large racial and ethnic disparities in the quality of care; that maternity care generally may be subpar; and that women sometimes feel pressured to accept interventions. Even the simplest goals of feeling empowered or having pleasant memories of going into labor can feel out of reach.

It should also be noted that the investment of time and money required for some of these courses makes them inaccessible to many people. They can cost as little as US$50 (approx. BRL 255) or up to more than US$1,000 (approx. BRL 5,100) for onetoone lessons and usually require at least several lessons.

Proponents of this approach claim that medical professionals must be willing to address these issues without requiring mothers to lower their expectations.

But in the meantime, for women whose labors don’t go as expected, having a very specific — and often idealized — view of birth in the back of their minds can put undue pressure on what is, after all, an unpredictable experience. And at worst, they feel like they, or even their babies, have failed.

The ideal, but not the norm

The “natural” birth, in which everything develops perfectly and without intervention, is still far from the general norm.

In 2020, for example, data from the Centers for Disease Control and Prevention in the United States showed that about a third of all births in that country involved some form of labor induction — and a third of those were by cesarean section.

Home births, often considered the quintessential “natural” labor, accounted for just 1% of the total.

But for many people who emphasize natural childbirth as the goal of their “positive” approach, their births don’t always go to plan, which can be detrimental.

Some moms claim that reality caught them by surprise because they were only focused on their ideal birth — and their grief was greater when they didn’t have the perfect birthing experience they wanted. In one study, 15% of women who had an unplanned cesarean said they felt they “failed.”

In Toronto, Canada, 38yearold Andie Perris wanted “the most natural experience possible” when she was pregnant with her first child.

She took a birth hypnosis class, listened to relaxation audios, and read American midwife Ina May Gaskin’s book On Childbirth, “full of stories of joyous births by women who love their babies.” Kids have kids breathe easy while their bodies take over,” says Perris.

“I had seen and heard these beautiful birth stories, and that’s what I expected from myself since I had done all the work,” she says. “I really believed it would change the outcome of my birth.”

But Perris was in labor for almost 24 hours. Her pelvic floor was “completely destroyed”. The child could not descend properly and was eventually born by aspiration. The mother had postpartum hemorrhage.

Analyzing what happened, she says that she probably should have had a cesarean, but she was against it.

“I felt like there was only one ‘right’ way to have my baby, so I really focused on that right way,” says Perris. “And of course there isn’t just one right way. But I was very caught up in that view of how nature “intended” you to have a baby.”

Because she was so focused on maintaining a positive attitude during her labor, Perris said she was unprepared for the possibility that things might turn out differently. Therefore, “I had a very hard time adjusting when things started to go wrong.”

For her second child, she tried listening to the same relaxation audios she used to do when preparing for her first. But they increased her fear so much that she had to stop.

British doula Emiliana Hall is the founder of The Mindful Birth group, which helps women prepare for childbirth. Hall says his approach avoids idealizing every form of birth, preferring to cover all possible outcomes.

She says she’s now seeing a wave of women becoming secondtime mothers who say their first experience after a “positive” approach to childbirth didn’t go as they planned.

According to Hall, the problem isn’t just that they had a negative experience, but that they blame themselves for it. And that could be the risk of such a mindsetfocused approach, she says.

Many courses recommend only hearing positive birth stories or even replacing negative words like “labor” with “waves” to ward off fear and anxiety and thus stress hormones and theoretically pain. So when a woman is experiencing pain or trauma, she may wonder if it was because she wasn’t relaxed enough.

“If that doesn’t work, they feel like they failed or that it was just a waste of time,” says Hall. “But there are so many things you can’t control.”

Hall says he’s careful to use even the phrase “positive birth” in his classes. Despite teaching techniques that make childbirth easier, she recognizes that there are no guarantees that everything will go according to plan.

‘I can’t get lucky all three times, can I?’

It is clear that many mothers have found the positive approaches to childbirth helpful and even transformative.

In Berlin, Germany, 32yearold Edwina Moorhouse thought these techniques sounded like “hippy” stuff. But after telling an avid YouTube vlogger about her experience, she shed her skepticism.

“I really wanted to have that joy that you see she has,” she says.

Moorhouse took a course in childbirth hypnosis, practiced breathing techniques, and underwent weekly acupuncture sessions. She had a quick and easy water birth.

Her second birth was similar. And when she had her third baby, she brought pink Himalayan salt lamps, big headphones and warm socks to make the hospital room feel more welcoming. He was completely converted.

“I can’t get lucky every three times, can I? There has to be a reason for that,” she said.

“To think that I would religiously listen to MP3 audios about hypnosis in childbirth with my third child, flood my brain with positive stories on YouTube, spend a world of money on this shampoo that smelled like instant pain relief I was completely unrecognizable compared to the woman who got pregnant six years earlier,” says Moorhouse.

In fact, there is evidence that the techniques taught in many of these birthing classes reduce pain and the use of epidurals, reduce the number of procedures and the duration of labor itself, result in fewer cesareans, and improve maternal perceptions of the can improve childbirth. However, these results cannot always be replicated, as some aspects seem more useful than others.

An extensive study showed that some popular elements, like having a trained birth partner present or using relaxing music or massage, helped reduce a woman’s likelihood of remembering her birth experience as “negative” other techniques were but less helpful.

Another study showed that music, yoga, and relaxation techniques like guided meditations can help reduce pain. However, there was no difference in reducing the number of medical procedures, including caesarean sections, or the number of women who eventually required pain relief with medication.

From a medical point of view, it is generally accepted that all procedures have their own costs and risks and therefore should not be performed unnecessarily or in the case of pain control procedures without the full informed consent of the mother.

For example, epidural anesthesia may be associated with a longer second phase of labor, a greater likelihood of requiring instrumental delivery, and, in rare cases, fever or nerve damage.

But women who take “positive” approaches to childbirth say the underlying message can sometimes go further, leaving people feeling any intervention is “bad.”

“The message is that you were made to do this, that it’s natural for women to do this since the beginning of time, that your body knows what it’s doing and your baby knows what it’s doing.” Lifestyle blogger Beth Sandland, Founder from the digital magazine The Motherhood Edit.

“I wouldn’t say it promotes fear. But I’d say there’s certainly an underlying message that ‘hospitals don’t necessarily work in your best interest. Doctors don’t necessarily have a realistic approach to a physiological birth.'” in some classes and social media accounts that Sandland, 26, has been watching.


For many mothers, autonomy is the most important aspect of a “positive” birth

However, interventions alone are not necessarily decisive for an experience being considered “positive”. In fact, research has concluded that one of the most important aspects that determine whether labor was positive for a woman is the length of labor.

Mothers with shorter labor were happier even when the time was shortened by an intervention such as increasing oxytocin. And considering the effects of prolonged labour, the researchers concluded that “interventions that prevent this may result in a ‘net benefit’.”

Of course, interventions can also save the lives of many women.

“The form of presentation is that you don’t have to do what they say. And the doctors are in a way there to harm you,” says Carr. “They say, ‘Oh, it’s not dangerous. It is natural.’ That may be true, but not always.”

“I think there was a risk for me,” she continues. “Had it not been for medical intervention, one of us might not have survived… I don’t think I would have had that baby easily in the wild.”

“I studied like for an exam”

A big part of the positive birth movement involves empowerment.

In fact, feeling in control and involved in decisions is a big part of the positive experience. And even when complications arise during labor, some women find techniques to help them stay in control helpful.

In Glasgow, UK, 34yearold Anna Murray made all sorts of preparations for the birth.

“I studied for an exam,” she says. Murray took private classes with a doula, read books, and took a course in childbirth hypnosis with yoga. She even had a Google Drive folder with all her yoga audios and videos for different birth positions.

Ultimately, Murray needed an unscheduled cesarean. Her baby had outgrown and sat in a fixed position so that no movement could turn her.

But she says the breathing techniques helped her stay calm on the operating table. “Staying calm during labor can help no matter what you have,” says Murray. “But in the end it’s not possible to have more control over what happens.”

Murray’s birth is an example of how differently mothers currently experience the ideal of a positive birth. For some, it unfolds exactly how they dreamed it would and provides the techniques to aid the process. For others it is a bitter disappointment. And still others, like Murray, can use techniques as helpful tools to make the best of difficult situations.

After all, for many women, the most important aspect of a positive birth can be summed up in one word: autonomy. It’s not just about feeling empowered, whether on the ward or giving birth at home. It means not feeling pressured to deliver in a certain way.

And culturally, it means acknowledging that every woman’s physiology, medical conditions, and birthing process are different, and being careful not to idolize any particular experience as the ultimate ideal, whether under anesthesia or in a candlelit bathtub.