By Janet Balaskas
Active Birth is not new. Its a way of describing how women the world over have always behaved during labour and birth throughout history since time immemorial. It was only 300 years ago in 17th century France when forceps were first invented, that the notion of women lying down for birth first became common. This made it easier for events to be managed by the birth attendant and the baby to be delivered a trend which continued for the next three centuries and which still haunts us today.
This was the start of modern obstetrics and led to the sophisticated medical back up for birth that we can be thankful for all over the developed world today. However, along the way, the birthing mother became disempowered. Birth, for the majority of women, became a medical event carried out in a clinical environment. Age old wisdom and midwifery skills were lost and forgotten. By the late 19th century, most women became passive patients rather than active birth givers and the semi reclining stranded beetle posture for giving birth became the norm.
When I trained as an ante-natal teacher in the late 1970s the aim was to educate women for a natural birth. Hoping to manage without drugs, women were learning breathing and relaxation techniques, but were still being prepared to labour and give birth lying down or semi reclining, mostly in a medicalised environment. Despite this preparation, the majority of these women ended up with a whole cascade of interventions and a complicated birth. The whole atmosphere surrounding birth was one of fear and the general expectation was that women need help to have a baby.
Disappointed with these results, I decided to do some research into how women have given birth in other cultures and other environments. I very soon saw that cross culturally, labouring and birthing women were standing, kneeling or squatting and were generally assisted by the presence of other women. It dawned on me simultaneously that the anatomy of the female pelvis is ideally designed for labour and birth in upright positions.
I coined the phrase Active Birth in the early 1980s, when the first women I taught began to use upright positions. It was a deliberate play on the words Active Management of Labour which were used at the time to describe the medical style of managing birth with induction of labour, epidurals, electronic foetal monitoring etc.
Today we have progressed a long way from these early beginnings. Active Birth has become a generic term and we are moving closer to a much better balance between nature and the benefits of science. There is growing understanding of birth physiology and a gradual transformation of the birthing environment, whether home, birth centre or hospital to one which is more conducive to the natural processes of birth.
In an Active Birth the mother herself is in control of her body. She moves and changes position freely she is the birth giver. Whereas in an actively managed birth, all the power is taken from her, her body is controlled and she is a passive patient. An Active Birth is one where the first resort is the mothers own instinctual and natural resources and the last resort is medical intervention. It is based on the principle of the Hippocratic oath first do nothing.
When they are needed, medical interventions can often be adapted for use in upright positions, so that even when a birth is difficult and needs obstetric support, the basic principles and benefits of birth physiology can often still be observed as much as possible. Obstetrics is there as back up to serve women when there are difficulties or complications.
Change is slow and there is still a long way to go before Active Birth becomes a real option for all women, but amazing progress has been made in just over two decades, since the Active Birth Movement was founded in 1981. I am often asked what and where is the Active Birth Movement? It is not an institution or an organisation. It is simply a way of describing the tide of change which is arising all over the world as awareness and consciousness about the true nature of birth awakens.
No-one is in control of the Active Birth Movement it is not a method. It is a global transformation in the culture of birth and a rediscovery of ancient wisdom, principles and common sense. The power in the Active Birth Movement belongs to the birthing mother.
Trust your body
If you would like to give birth actively, the first thing to learn is how your body is ideally designed to birth a baby and inherently knows what to do. Given the freedom and privacy in labour to follow your instincts, you will probably want to move your body and change positions to make yourself as comfortable as possible during contractions and while resting in-between them. At its most practical level, an active birth involves having the freedom to use upright positions such as standing, walking, kneeling or squatting.
Simple props such a mat on the floor, a chair, a beanbag, a low stool or a birth ball can help to support you comfortably in these gravity effective positions.
These days you may well find that your midwife will be encouraging you to use them and may even provide them for you. This means that you are free to be led by your own powerful intuition, to move spontaneously and guide your baby through the birth canal in the most effective way through your natural movements.
When birth is active you are encouraged to stay out of bed in labour. For example you could try sitting upright on a chair leaning forward, kneeling on all fours on the mat or over the ball, or standing and walking. Its easy to move your body in response to the contractions by bending and swaying, circling your hips, or rocking forward and back. Alternatively you may settle into a comfortable position sitting or kneeling, propped up by lots of pillows, so that your partner or midwife can massage your back, shoulders or feet. When your body is relaxed and free to move, your breathing becomes deeper and more spontaneous. You are likely to release sound freely as you move, which will help you to express and release pain as it arises and cope more easily with the intensity of sensation during labour and while giving birth. The sounds and movements I have described are universal to birthing women.
How you can benefit from an active birth
During labour your babys head moves slowly down deeper into the pelvic canal as it emerges from the dilating cervix. In these positions your pelvis is at the best possible angle for gravity to help the process. Numerous studies have shown that this is likely to make labour shorter and more efficient.
Being free to move and choose your own positions has some other advantages too. Its easier for your uterus to do its work, so the contractions tend to be less painful than if you were lying down. Freedom of movement, free expression of sound and the natural forward tilting of the uterus helps to modify the pain and are likely to reduce the need for medical pain relief.
There is also a better blood flow to the placenta when you are upright and breathing deeply, so that your baby receives plenty of oxygen and there is less risk of foetal distress developing. There is no compression of the internal blood vessels as there may be if you lie for an extended period on your back or in the semi-reclining position. Foetal distress is a common cause for a caesarean section or the use of forceps or ventouse to deliver the baby quickly. Blood flow to the placenta and the baby is optimal in upright positions.
In the second stage, when you are ready to give birth, choosing a kneeling, supported squatting or standing position will help you to use your energy in the best way while you are pushing. It is much more effective and powerful to push with the help of gravity and the rotation and descent of the babys head is easier. There is no ideal position for giving birth and this varies from woman to woman. You may use several upright positions during this phase of the birth and can give birth in any one of them. The supine or reclining position is by far the least advantageous working against gravity and reducing the space within the pelvis. When you are upright the pelvic joints are unconstricted as they would be lying down and this allows a degree of movement and expansion of the pelvic diameters so that the internal shape of the pelvis can accommodate the babys head with maximal space as it descends in labour. In the final stages, the back wall of the pelvis (sacrum and coccyx) are free to move back increasing the diameters of the pelvic outlet to make plenty of space for your baby to come out.
After your baby is born and you are enjoying the pleasure of holding him or her in your arms for the first time, its a good idea to sit upright so that you can hold your baby skin-to-skin and position your baby well for the first contact with the breast. Then, while you are welcoming your baby and the first breastfeed begins, gravity will be helping your placenta to separate and your uterus to contract down efficiently to prevent excessive blood loss.
In an Active Birth partners are often actively involved in giving both emotional and physical support. This active sharing of the birth experience can be very fulfilling and memorable and is a good start to a new relationship as parents and the start of your new family.
An Active Birth usually results in minimal trauma for the baby during the birth process. Generally the baby is likely to be born in optimal condition, bonding after birth and the first breastfeeding are facilitated and the mother generally feels good and recovers well from the birth, which makes caring for the new born baby easier.
Two important elements in an Active Birth are the quiet presence of a supportive midwife and the right kind of atmosphere in the labour room. The room needs to be comfortable, warm, calm and peaceful so that you have enough privacy and security to let yourself go, to be noisy if you need to and to relax and rest in between the contractions without distractions.
When the lights are turned down low or the curtains are drawn and it is quiet, your body produces high levels of the special hormone called oxytocin which stimulates good strong contractions. You also produce floods of hormones called endorphins, which are natural painkillers and relaxants. Combined with the benefits of being upright, these hormones help you to forget about everything else, to sink into your labour and concentrate on the contractions. Once you can relax with it, labour usually progresses well leading to an efficient second stage and a successful birth for all concerned.
Its important to understand that labour and birth are involuntary, in that the uterus contracts spontaneously, firstly to open the womb and then to give birth to the baby. All of this happens without your conscious control. Its not about doing anything and is more to do with relaxing and letting it happen.
From beginning to end the entire birth process is stimulated by these hormones. They are produced by the old brain or hypothalamus. We have this in common with all other mammals, and like them, we need to feel safe and protected in order to secrete the birth hormones effectively.
These are the very same hormones we produce when we make love, which is why the renowned French active birth pioneer Michel Odent calls them the love hormones. Think about the kind of environment you like to be in when you make love, or how mammals usually choose a warm dark and secure place to give birth and you can guess what kind of atmosphere you will need to encourage good secretion of these love hormones during labour.
Miraculously, the hormones of birth are also promote love and attachment. In the hours after an Active Birth, both you and your baby will have a huge level of love hormones coursing through your bloodstream which will help you to bond and fall in love immediately after the birth.
The help of water
An important innovation in the ideal birthing environment for an Active Birth has been the introduction of water birth pools. These are now becoming much more widely available and many hospitals and birth centres have installed pools. They can also be rented for home births. In addition to gravity, water is another of natures elements which has enormous power to support your instinctive resources in labour.
Experience has shown that its best to think of using water in mid labour, when you are about 5 6cms dilated. Labour is usually very intense at this stage and you may well feel that you need some help this is the ideal time to enter the birth pool.
After half an hour or so of being in the warm water you are likely to enter a very relaxed state where you can go to a deeper level inside yourself and let go to the power of the more active phase of labour. This is the time to let your body take over, to trust in nature and to surrender to the involuntary forces that are opening your body and bringing your baby to birth.
The warm sensations of the water on your skin will help to modify the pain and the buoyancy of the water relieves you of your bodys weight. This helps enormously to make you more comfortable in upright positions and to conserve your strength and energy. Its much easier, for example to move or to squat in water.
Your partner can sit right beside the pool or even get in with you to massage and hold you. Once in the pool, you are unlikely to notice the world outside the rim of the pool or how much time has passed. It helps you to stop thinking and to be in your body. There is an increase in oxytocin secretion when you enter the water which peaks after about 2 hours, so you may find that contractions become stronger and you reach full dilation within a few hours.
When you feel you are ready to push and give birth to your baby you may decide to leave the pool and have your feet firmly planted on the ground or you may decide to remain in the water for the second stage. Provided there is good progress and no sign of any complication, birth in water can be easier for the mother and gentler for the baby.
After the birth
There is no denying that going through an Active Birth and experiencing the pain of labour is a huge challenge that will probably stretch you to your limits and beyond. In the peak of the experience, just before you are ready to give birth to your baby, you may feel despairing, as if relief will never come. Yet the nature of birth is that pain comes and goes. In between contractions there are intense moments of peace, bliss and even ecstasy.
The moment you are holding your baby in your arms for the first time you are likely to forget almost instantly the pain you have been through to get there. Instead, a feeling of enormous exhilaration may arise. I often think this must be something like the way a mountaineer may feel reaching the peak of Everest and seeing the view at the top for the first time.
However you give birth, producing a baby is an achievement you can be very proud of. While aiming for an Active Birth, its important not to forget that the baby is more important than the birth! While birth is very rarely easy and sometimes the challenge is to get through the experience with all the medical help you can get, having an Active Birth is an empowering and life transforming experience for many women. Starting from the basic wisdom that its best to keep upright and with a few simple modifications to the environment, I have seen over the years that most women can have a much better experience of birth than they might otherwise have done.
A vision for the future
Active Birth involves a true partnership between the woman and her midwives and doctors, which encourages her to be an active participant in her care rather than an a passive patient. This sense of partnership empowers her to be actively responsible and involved in all aspects of her care, so that her birth is an active birth whether she manages it all naturally, opts for an epidural or has a Caesarean section.
Midwives are the traditional guardians of natural active birth and have the skills and intuition to enable the right emotional and physical environment for a physiological birth. Active Birth involves a humanistic approach where the obstetricians need to hand over the reigns to midwives for normal births. It also involves encouraging more women to give birth at home and providing homelike birth centres in hospitals.
Active Birth is based on the physiology and facts of nature. It is the safest and the most satisfying approach to birth for everyone concerned and will, I believe eventually become standard practise in the years to come. It will take time for people to let go of old habits, for understanding to penetrate and change entrenched ideas and dispel the myth that science can do better than mother nature when it comes to birth.
My vision is that Active Birth will become a widely available option for all those women who choose it all over the world whether they are giving birth at home, in a birth centre or a hospital. I hope that millions more women discover the joy of natural childbirth and are able to welcome their babies to this world with the gentleness, love an sensitivity that is their birth right.
I hope there will be a time when no-one knows it wasn’t always like that.