Back to the bare necessities, the simple bare necessities: the importance of movement in labour
Review of Francoise's 'Micromoves for the Intrapartum' workshop
Just before three years of midwifery training drew to a close, a small group of students were fortunate enough to partake in ‘Micromoves for the Intrapartum’, a workshop with Birthlight’s founder, Françoise Freedman. With the possibility of absorbing new information seeming like a tall challenge as graduation loomed large, the sweetness of simplicity was met with both relief and incredulity: “How did we not know this before?” No textbooks. No pen and paper. No guidelines. Just our bodies and a pinch of common sense. Under Françoise’s charming direction, easy yet purposeful movements led us through the journey of childbirth. The overarching message: movement in labour is imperative and we have a duty of care to wholeheartedly embrace it.
Much like our physical and emotional states are inextricably linked, the capacity of the pelvis – arguably the single most important bony structure in childbirth – is influenced by the many other bones that surround it. Movement, therefore, is not just helpful in labour but vital. Textbooks describe the mechanisms of labour in relation to the baby’s presenting part in the pelvis, most commonly the head. The baby’s head engages at the pelvic inlet and descends into the pelvic cavity, which encourages its head to flex so that its chin is tucked right into its chest. This creates the smallest diameter possible allowing the baby to rotate and descend further into the pelvis. The smallest diameter of the baby’s head now fits the widest diameter at the pelvic outlet where the baby’s head will extend as it is born. The baby will continue to rotate and align its shoulders and body with its head in birth. It sounds complex and deceptively uniform. However, the workshop highlighted that the activity of the mother and her baby in labour result in a uniquely dynamic process – each woman and baby is a different size and shape and almost all women have an asymmetric pelvis. Naturally, therefore, the pelvic frame requires tiny adjustments possible through movement to help birth a baby.
The guided movements were simple and made complete sense; yet this in itself raised questions: “It’s so easy. It should be the bread and butter of the birth room but it isn’t.” Indeed it isn’t – how can it be that these seemingly simple skills are missing from midwifery education? Midwives, the ‘guardians of normality’, are not being adequately trained to utilise basic techniques that promote natural labour. Is this an omission, signifying a forgotten art in the wake of a dominant narrative of medicalised birth? Perhaps, but one could also argue that it reflects a failure of our profession to recognise the changing nature of our society and adapt to its changing needs. Françoise spoke of an obstetrician working in London last century who encouraged his wealthier private clients to scrub the floors having observed a greater ease in the labours of the washer-women of the East End. Without suggesting that we circulate mops and buckets as part of antenatal preparation, we must acknowledge the potential impact a more sedentary lifestyle has on both the health and wellbeing of the mother and her own familiarity with her body, and the subsequent impact this may have on labour. Modern day mothers may need more support in finding their own path: encouraging a greater awareness of the body in pregnancy could have a positive impact on the labour process and ease of recovery, as put forward by Sutton and Scott’s Optimal Fetal Positioning theory.
So what’s the secret formula? It turns out that there isn’t one. Instead midwives should focus on encouraging a women’s own instinctive birthing behaviour by creating a calm and supportive environment and nurturing self-trust. Now retired from independent midwifery practice, Mary Cronk (Midwives, 2015) reflects on the need to avoid prescriptive care in favour of letting women take the lead in their births, championing the art of astute observation and reaffirming the belief that women are the childbirth experts. In Margaret Jowitt’s Dynamic Positions in Birth, she adopts the viewpoint that both woman and child innately know how best to navigate themselves through labour but it is those routine interventions that restrict this instinctive behaviour, such as the culture of birthing on a bed, that lead to more complicated labour patterns. In addition, Dr Rachel Reed argues that the culture of controlled pushing, both the instruction to resist the urge and the cheer-led finale, may be more damaging than productive, alienating the women from her own feelings and judgement. Needless to say, the evidence-based benefits of woman-centred, individualised care once again reveal themselves to be under-practiced and much needed.
Lest we forget holistic care! Steeped in the quagmire of risk factors and documentation, it is easy to overlook the interplay between the body and mind in labour, and the need to ease both physical and emotional tensions alike. We were told that the ‘light’ in Birthlight in part denotes the importance of maintaining a ‘lightness’ in pregnancy: a lightness of movement, a lightness of thought, a lightness of atmosphere. By way of demonstration, our day was punctuated with a series of ‘silly walks’: scientific in origin, humorous in delivery, they bought laughter into the room. And laughter, as we all know, is associated with oxytocin production – another arrow thrown in the battle to protect normality in labour!
Enjoy inventing some silly walks of your own, and whilst you experiment, be mindful of every twist and turn and lift. Relish in the beauty of your body’s capacity to accommodate your chosen path, and salute your pelvis – the facilitator of silly walks and natural childbirth. And a special thank you to Françoise and Birthlight for delivering such an insightful and invigorating session.
Naomi and Tamsin
Reproduced from women, wombs and words blog