‘We do not birth in a vacuum’
Part 1 – Western birth in the 21st Century
Humans have walked the earth for around 200,000 years. Our success as a species is living proof that human birth is overwhelmingly successful. It is also one of the very few things which unites all humans. We are all born.
The structures and systems that we’ve created for birth in Western, industrialised societies are in their infancy by comparison to the length of time we have been birthing our young. The methods we now regularly use to test, monitor and measure pregnancy are extremely modern inventions. Likewise, our choices and preferences for where and how our babies are born and what we consider to be ‘normal’ in birth are also a very modern ideas. In this first of a two part series we’ll explore how our birthing norms have shifted in recent years and how that may have impacted how we look at and feel about birth.
Societal norms together with the structures and systems we’ve created for birth make up our ‘birthing culture’. This culture forms the backdrop for our births. Whether consciously or unconsciously and whether they are welcomed or unwelcome we take all of these influences in to birth with us. We do not birth in a vacuum.
21st Century births
It’s fair to assume that our birthing culture and the systems we’ve created to manage birth would feel very alien to our ancestors. Indeed, for many of our Grandmothers the way we birth now may feel very strange compared to the norms and choices of their own births just 2/3 generations ago.
In the latter half of the 20th Century we have witnessed a rapid increase in the shift from birth being viewed as a normal ‘life event’ which could be managed in the community setting to birth being seen my most as a significant ‘medical event’ requiring close monitoring and management. In turn, our perceptions, expectations and beliefs about pregnancy and birth have evolved and shifted in to closer alignment with the systems we’ve created.
It is more than likely that our grandmothers birthed at home. Their pregnancies were sometimes undiagnosed, often un monitored and their births regularly attended by community midwives and family members alone. The primary place for birth to happen was at home, in a community setting without the need or expectation for obstetric intervention or hospital care (save for emergencies).
Fast forward to 2021 and just 2.1% of births now happen at home. . Birth is now an event which occurs in hospital or in a clinician led unit, behind closed doors shrouded with a veil of mystery and a sense of the unknown. In normal events an expectant parent goes to hospital with a bump and comes home with a baby. What happens in between is somehow lost.
Witnessing birth is not part of our early formative experiences as it once was. For many people the first birth that they see or experience will be when they come to do it themselves. Instead, the experience and knowledge of birth is now considered to be the preserve of a small number of people with significant training in medicine and midwifery.
As such, the potent first-hand knowledge we gain from witnessing how life begins in our communities; the sights, sounds and movements of birth is being lost from our collective conscious. Instead, what we hand down to the younger generation can be a simplified, guarded, and often ‘sanitised’ version of birth. This narrative can overlook the delicate, nuanced, ebb and flow a physiological birth. Additionally, it will often miss out the intensity and undulating nature of the emotional journey we take when we birth.
The perception of birth as ‘a medical event which can occasionally occur without intervention’ rather than birth as ‘a normal life event which can occasionally benefit from medical intervention’ seems to be the prevailing attitude in 21st century birthing culture. This shift in the idea of birth is often referred to as the ‘medicalisation of birth’.
Gains and losses of medicalised birthing culture
Many will point to the great benefits of medicalised birth. The improvements in infant and maternal mortality rates are amongst the first benefits often cited. Technology and training mean we are now able to diagnose and treat abnormalities and complications during pregnancy. Scanning our babies is generally considered by most to be a normal and much anticipated rite of passage. This window in to the lives of our unborn babies feels hugely beneficial for a large number of expectant parents and is therefore a much welcome modern phenomenon. Perhaps the greatest advancements have been with safety in caesarean births. Understanding of infection control, anaesthetic techniques and post-operative care have no doubt improved outcomes and experience for birthing people and babies who experience this type of birth. We can be grateful for these improvements and conveniences. At the same time however, we can remain cautious about how far the pendulum should swing.
Alongside improvements in safety we have also witnessed an increase in birth interventions. In 2019/20, 55% of births were spontaneous vertex deliveries (meaning ‘normal’ vaginal births.) The remaining 45% included some sort of intervention. These interventions include induction and/or augmentation of labour, the use of ventouse, forceps or unplanned caesarean births. In the last ten years we have seen a year on year increase in the number of births which were induced (started artificially by care professionals). This figure has risen from 20% in 2008/09 to 33% in 2018/19. The total rate of caesarean births in the UK has also increased. From just 3% in the 1950s to the current rate of around 20% of all births (including planned and unplanned caesarean births).
Arguably, these statistics reflect some of the values and priorities of the systems and structures we’ve created to manage birth in the 21st Century. They are also a result of the increasing medicalisation of birth in our culture. In a cyclical nature these statistics (all which refer to lived experience of those people who birth) inform, validate and perpetuate beliefs, attitudes and fears we have as a society about this ancient, adapted process of birthing our young.
In Part 2 we’ll look more at the systems of birth and their apparent values. We’ll ask why they do what they do and what the impact may be felt by birthing people.
- Human birth is an ancient, adapted and highly successful human event.
- We do not birth in a vacuum. We are born in to and conditioned by our birthing culture; the beliefs and values which surround us and the systems and structures created to manage birth
- In a short period of time we have seen a significant shift from birth being viewed as a fairly straightforward life event to it becoming a medical event requiring close monitoring and management by medical professionals. This is referred to as the medicalisation of birth.
- Statistics suggest birth we are now increasingly likely to experience medical intervention in birth. In the last 10 years alone there have been significant increases in rates of induction, assisted births and caesarean births. Currently just 2% of births happen at home.
- As we have largely lost birth as an event in the community the stories and knowledge we hand down to our children are perhaps a less potent than they once were. What we present back to them can miss out nuance in pursuit of a sanitised version of events.
Consider who and what influences your perceptions of birth. It could be your family, media, books, education or your lived experience. What ‘stories’ have been passed on to you?
Acknowledging the various influences can help you make sense of your thoughts and feelings on birth.
 Office for National Statistics Birth in England and Wales Statistics 2019: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2019
Distribution of the method of childbirth delivery in National Health Service (NHS) hospitals in England in 2019/20
 NHS Maternity Statistics 2018/19