May 2011 - Our Voice in Action

Today’s Birthing Practices

by Natacha Major (NSG student), adapted by OPHA Reproductive Health Workgroup

When it comes to birthing their babies, women today are routinely offered an array of obstetrical interventions such as epidurals, Caesarean sections, labour augmentations and inductions. With these choices emerge many unanswered questions:

  • Is the natural process of labour and birth safe, or is it risky?
  • Do these interventions actually improve the process of labour?
  • What exactly are the parameters of &lddquo;normal” childbirth?

The Ontario Public Health Association’s Reproductive Health Workgroup is developing a position statement to support and protect normal birth. This position statement will seek to explore the above questions by discussing what is known culturally as “normal” vs. what is physiologically normal during childbirth. By reviewing the literature, as well as the care practices that support and facilitate this normal process, recommendations for strategies to support clients in their decision making process will be made.

Background

The Society of Obstetricians and Gynaecologists of Canada (SOGC) released a joint policy statement in 2008 on Normal Childbirth, identifying labour augmentation, artificial rupture of the membranes and any type of labour pain reduction (e.g., epidural) as being part of normal childbirth. According to the SOGC, the only interventions not recognized as being part of the normal birthing process are the use of forceps or vacuum extraction, Caesarean sections, induction prior to 41 weeks of gestation, as well as routine episiotomy, and general anaesthesia.

Although this statement was approved by the Canadian Association of Midwives (CAM), the latter continue to define a normal childbirth as one that is spontaneous, delivered through the efforts of the mother, and is undisturbed by any routine use of drugs or interventions.

The CAM’s principles are based on the baby’s and the mother’s capability of giving birth without using pharmacological or medical interventions. For example, one of the important components of the Canadian Midwifery Model is encouraging free movement and instinctual behaviour during labour, which is not possible once the mother receives an epidural.

Although the SOGC recognizes the benefits of a labour and birth that is free of interventions, they frequently opt for a more cautious approach. As a result, some physicians turn to interventions because they anticipate complications. It is important to keep in mind that there is a medical reason behind every obstetrical intervention, and there are times when these interventions are essential to reduce perinatal morbidity and mortality.

While necessary in certain situations, it is important to ask if medical interventions in labour have become so common that they are now considered normal practice. According to the the Perinatal Partnership Program of Eastern and Southeastern Ontario‘s (PPPESO) Annual Perinatal Statistical Report 2007-2008, Canadians have seen a 45.0% increase in Caesarean sections in the last 10 years.

Table 1 below shows the percentage of several interventions used in labour and birth in Canada, 2006-2007, according to the Canadian Maternal Experience Survey 2009 [PDF].

Although we have yet to agree on what should be considered a “normal” labour and birth, it is important that health care providers prepare expecting mothers for this process with all the facts in order to allow them to make informed decisions.

As providers of care for pregnant women and their families, it is our role to advocate for and to support new parents in their decision making process, provide them with the information they need and encourage them to have a birth plan that includes the level of intervention that feels right to them. It is also essential that parents are informed about the importance of keeping an open mind and to be flexible regarding their wishes as each and every labour and birth experience is special, unique, and remarkable.

 

 

References

Canadian Association of Midwives (2010). Midwifery Care and Normal Birth [PDF].

Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, & Gyte GM. (2006). “Caesarean section for non-medical reasons at term.”

Lowdermilk, Perry & Bobak (2003). Soins infirmiers périnatalité. Quebec: Groupe Beauchemin

Perinatal Partnership Program of Eastern and Southern Ontario (2008). Annual Perinatal Statistical Report 2007-08.

Public Health Agency of Canada (2009). What Mothers say: The Canadian Maternity Experience Survey [PDF].

Society of Obstetricians and Gynaecologists of Canada (2008). Joint Policy Statement on Normal Childbirth [PDF].

Society of Obstetricians and Gynaecologists of Canada (2010). Normal Childbirth -You are having a baby. Learn what you need to know about normal childbirth.