Mother and midwife power gives results

Yvonne Roberts warns that the risks associated with
intervention make natural childbirth worth a second look.

Natural
birth is often portrayed as a middle-class fad associated with earth mothers,
incense and the indigestible contents of health food shops. "Modern"
women opt for Caesareans and medical intervention – not necessarily because
they must, but to avoid the pain of labour and maintain control of their
schedule. Meanwhile, for consultants, natural birth means uncivilised hours.

But unnatural births carry a penalty. A
recent study showed that a high proportion of women who had elected, or had
been required, to have a Caesarean were so traumatised they had no further
children.

Nevertheless, figures released last week by
the Department of Health revealed that most mothers undergo intervention – a
Caesarean (one in five births), induced labour or delivery by instruments. All
of these methods carry considerable risks. Also, only a third of mothers
receive one-to-one attention from a midwife during labour.

Against this backdrop, the achievement of the
Albany midwifery practice is all the more impressive. Based in a deprived area
of south east London, it employs the equivalent of six full-time midwives. In
1999, a two-year evaluation of the practice was begun in which women were
referred by local GPs. It emerged that a high proportion of women using the
practice – 45% – were from African, Asian and other ethnic minority groups, and
many of these were asylum seekers.

The practice’s philosophy is that the
mother-to-be should exercise informed choice over where and how she has her
child – at home or in hospital. She receives continuous care from the same
midwives who address anxieties and monitor mother and child.

The difference in outcome is staggering. Only
18% of the women had Caesareans compared with 25% of those using King’s College
London; 93% breastfed from birth (75% in other practices); 43% opted for home
births (11% in other practices); and 69% wanted no pain relief compared with
18% in other practices. Women in the Albany practice had far fewer episiotomies
and instances of depression.

Becky Reed, one of the midwives there, says
that many of the Albany mothers, in spite of acute poverty, recovered well
physically and mentally, making far fewer demands on health and social
services’ resources. And they were happy with the choices they had made.

The key to Albany’s success isn’t difficult
to detect and emulate: power lies with the mother and the midwife – and doctors
do less.

Evaluation of the Albany Midwifery Practise Final
Report March 2001, contact 020 7848 3605.