March 20, 2003

Waterbirths and the "nanny state" in Britain

There is an interesting article in the current issue of The Practising Midwife ( March 2003) titled “Women’s Experience of Waterbirth”. It describes the feedback that was received from 189 women in five different birthing centres who gave birth in water.

One of the main findings was that women demonstrated a strong desire for using water during labour and that they saw it as therapeutic. However, one astounding figure was that 88.3% used Entonox (nitrous oxide) during their waterbirth. There were even a couple of women who were given Pethidine or Meptid while using the bath.

I find this astonishing. Practitioners in other countries would find this high rate of drug use associated with waterbirth quite disturbing. There is always a potential for complications arising from the use of any drug and it could be difficult to manage a woman in a tub or bath should such an event occur. Some women, for example, become quite drowsy and even nauseous on Entonox, and a drowsy woman in a bath could pose quite a risk.

All this begs a basic question in my mind, however. The use of water is widely considered, and promoted, as an alternative to drug use in labour. This is certainly the message that women in countries outside Britain are given and it is understood by the woman as well. However, it is not an expectation amongst midwives in Britain. For example, I was shown the scavenger system for removing Entonox from the ambient air in the new Guys and St Thomas’ “Home from Home” Unit in London last year. They even had outlets for the system beside the bath!

I think that this study, and its results on the use of drugs in combination with water, is an example of the wimpish attitude of British women and midwives towards labour and dealing with pain. I see it as another manifestation of the “nanny state” that is such a feature of people’s expectations here. Women have such low expectations of their abilities in this country that they insist that they have as much help as possible in labour and whilst water is a useful tool for easing pain, they don’t consider it enough. It also reflects a widely held view that “Entonox is harmless” to the baby (although clearly a risk to the staff, hence the need to actively remove it from the labour room!).

I get so frustrated that midwives here are unwilling to encourage women to labour without any external props. If the midwives don’t think women can handle labour pain without “a little something” then women will never believe it of themselves. The result is that women get their drugs and never discover the powerful insights and strengths they could gain from labouring using just their own resources, and midwives fail to experience the true nature of midwifery.

People overseas see Britain as a bastion of midwifery practice. I wonder if it really is..... perhaps they still have a lot to learn about women’s abilities and inner strengths when it comes to birth. They are certainly busy devaluing the concept of Birth Centres that has been accepted in other countries.

Meanwhile, today I am travelling to Jersey for another Active Birth workshop,. I have been given strict instructions by the organisers that I am not to mention waterbirth or homebirth during the program. We shall see about that!

Posted by andrea at March 20, 2003 09:39 PM

Comments

I am a midwife who strives to aid women to achieve intervention free birth. However, as with breastfeeding, women have lost confidence in their own ability to be successful at either.
It takes a long time to change a culture and I believe that forward steps are being taken within maternity units. Women labouring in the pool who remain there with the aid of entonox is far more preferable to me than them leaving the pool for Diamorphine. Unfortunately many women do not believe thgey have inner strengths and that needs to be addressed.
I agree wholeheartedly that drug free labour is the ideal. However, I will not deny women props if that is what is going to help them cope. The fewer women having epidurals and opiates in first labours can only be beneficial for them in the long run.

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