RCM no longer promoting ‘normal’ birth!

The Royal College of Midwives (RCM) have announced they are ending their decade long campaign promoting ‘normal’ birth. ABOUT TIME TOO!

The campaign no doubt grew out of good intentions, in particular encouraging a return to more natural births. But as time has gone on, it has meant an increasingly unrealistic form of antenatal education has taken hold and become the norm. Incredibly with a caesarean rate of around 25% it is not unusual to attend UK antenatal classes which dismiss caesarean birth in a matter of minutes and which fail to talk about the implications of a ‘cascade of interventions’ and how to rationally manage this.

The RCMs change of heart has unfortunately come far too late for the many women who have had ‘normal’ birth promoted at the expense of informed guidance and whose expectations have been mis-managed to the extent they have experienced significant negative reactions to their birth. And let’s be clear about what this can mean:

  • delayed bonding
  • breastfeeding difficulties and early cessation of breastfeeding
  • no further pregnancies (even opting to adopt)
  • prophylactic caesareans
  • etc.

While I do not dispute the lack of sufficient funding in recent years has led to the woeful situation maternity care finds itself in, (which no doubt contributes to the increase in medicalised births-for reasons of both expediency and cost-effectiveness), this is however the current reality (albeit unacceptable). Women need information at their fingertips relating to ALL modes of birth and ALL interventions if they are to stand any kind of chance of coping with and feeling in control of their birth.

For a long time now, those of us monitoring maternity care have taken issue with the use of the term ‘normal’ with its implication that anything other than a totally natural birth is therefore ‘abnormal’. Women hear a lot about vaginal birth and coping techniques and practically nothing about interventions and caesarean birth. This absence has left many women so poorly informed that expectations rarely match reality. No wonder then that the incidence of emotional trauma has been rising.

It is great that the rhetoric around birth will be removing reference to ‘normal’ birth. However, I take issue with the blame the RCM appear to be placing at the door of the women themselves. On the one hand saying they don’t want to “contribute to any sense that a woman has failed” but then adding “unfortunately that seems to be how some women feel.” They do not appear to acknowledge the role their campaign has played in encouraging midwives to emphasize one mode of birth over another to the extent that balanced information is almost impossible to come by in many UK classes, ostensibly setting women up to fail.

As the Guardian article points out “the campaign was criticized in an inquiry into the deaths of 16 babies and three mothers at Furness general hospital in Cumbria between 2004 and 2013.” and found that the campaign appeared to influence a group of midwives to such an extent as to contribute to “unsafe deliveries due to [the midwives’] desire to see the women give birth without medical interventions “at any cost”.”

At its most extreme the campaign appears to have contributed to the loss of life-though the RCM strongly deny this. But at the very least it is clear the campaign has actively encouraged women to write birth plans specifying little or no pain relief and to be distrustful of all interventions thereby failing to prepare them adequately for the current realities of birth in the UK.

This change in rhetoric is very welcome, but only time will tell whether those midwives who strongly emphasize natural birth will actually adapt to offer a more balanced, open-minded approach to education, birth planning and the support of birthing women.