Safe birth

Childbirth is a timeless, instinctive life process. Nature has perfected the interplay of hormones between mother and child over thousands of years. For that reason, one way to ensure safety is make the mother feel secure and well-looked-after so that she can open up completely and surrender herself trustingly to the physical process she is undergoing.

 

What does safe childbirth mean?

Geburtshaus Zürcher Oberland: more than 4,500 natural births since 1993

In the field of midwifery and obstetrics, safety is defined by two key criteria. The number-one priority is to protect the lives of the mother and the child. The second criterion is that mother and child should come through the birth unscathed, i.e. they should be in good health and should remain so going forwards.

Childbirth is a natural process which, if it proceeds normally, requires neither medical intervention nor medication-based support. There is growing scientific evidence that in healthy pregnant women, the only requirement to make the birth as safe as possible and minimise the risk of complications is to respect the natural, physiological birth process without intervening unless there is a clear medical indication for doing so (see the WHO recommendations and NICE guidance below). Our birthing centre statistics corroborate this finding.

 

Midwifery: how to ensure safety

One way to improve safety in the field of midwifery is to ensure that the mother feels safeThat’s all well and good, but what makes mothers feel safe? It is worth pursuing this question, as we normally make decisions with the part of our brain that is responsible for conscious thought and intellectual/analytical decision-making: the cerebrum.

During childbirth, however, it is not the cerebrum that is in control but the brain stem, which functions in a completely different way to the analytical cerebrum.The most primitive part of the human brain, the brain stem is the hub of our instincts and the control centre for all basic bodily processes such as heartbeat, breathing and digestion. In addition, it is responsible for choosing one of the three behaviours of fight, flight or freeze in the event of a threat. This is one of the reasons why we attach such importance to providing a protected setting at the birthing centre.

 

“Women need to know that hospital and obstetrician care may not be the best way to achieve an optimal birth, and that planned out-of-hospital births (home or free-standing birthing center) are a safe option for healthy women (Enkin et al., 2000; Leslie & Romano, 2007).”

Source: Safe, Healthy Birth: What Every Pregnant Woman Needs to Know, Judith A. Lothian, in Journal of Perinatal Education, 2009 Summer; 18(3): 48–54

Trust your gut instincts

Your intuition can provide valuable guidance when it comes to choosing the right place to give birth, as it forms the bridge to your instinctive brain stem, which takes control during childbirth.

It is important that you stand by your values and needs. Be honest with yourself – and your partner.

  • If you choose the birthing centre because you feel safe and well-looked-after there, then this is the best choice for you and it will increase your chances of a natural birth.
  • If you choose the hospital because you feel well-looked-after medically and by the staff of the hospital, then this is also the right decision for you.
  • But if you choose the hospital mainly because you want to meet the expectations of your partner or your family, your body will probably react as described above, which can have a negative impact on the course of your labour and birth.

The cornerstones of safe birth

The following criteria for healthy care during childbirth are practically identical to our definition of natural birth and ensure a high degree of safety:

  1. Spontaneous onset of labour: let labour begin on its own (Amis, 2009)
  2. The woman is active: move around and change positions throughout labour and birth (Shilling, 2009)
  3. A trusted environmentcontinuous care by people the woman trusts (her partner or friend, a doula, etc.)(Green & Hotelling, 2009)
  4. The art of skilful restraint: avoid all unnecessary medical interventions (Lothian, 2009)
  5. The use of gravity: avoid giving birth on the back. The woman follows the physical urge to push (DiFranco, Romano, & Keen, 2009)
  6. Undisturbed bonding: the mother and the baby remain together at all times (Crenshaw, 2009)
Source: Safe, Healthy Birth: What Every Pregnant Woman Needs to Know, Judith A. Lothian, in Journal of Perinatal Education, 2009 Summer; 18 (3): 48–54.

 

We also believe that the following are important:

  • One-to-one care by a midwife: every woman is looked after by her own midwife during the birth.
  • Trust in the body’s signals: longer breaks (in labour) are allowed as they help the mother to recover.

Even if there are no guarantees, the outcomes of out-of-hospital midwifery care are impressive proof that low-intervention, supportive and individual care during the pregnancy provides the best conditions for a positive course of the entire motherhood.

As our experience and the Geburtshaus Zürcher Oberland statistics since 1993 confirm, the more trusting and unimpaired your approach to the “adventure” of childbirth, the more likely it is that the birth will proceed healthily and safely.

WHO recommends natural birth

The experts of the World Health Organization (WHO) recommend midwife-led models (i.e. birthing centres and home birth) as the safest and healthiest option not only for antenatal check-ups but also for giving birth, provided that the pregnancy was without complications and the birth is also expected to progress normally. According to the WHO, the great majority of pregnant women (85-90%) are healthy, and natural birth is recommended for them.

WHO recommendation

Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well-functioning midwifery programmes.”

Midwife-led models safer than hospital birth

The NICE guidelines in the UK came to the same conclusion at the end of 2014. The key finding of this broad scientific study by the National Institute for Health and Care Excellence (NICE) was: where pregnancy has been straightforward and the birth is also expected to be straightforward, midwife-led care during labour is safer than hospital birth for both primiparous and multiparous women.

The Chairwoman of the NICE expert commission, Professor Susan Bewley from King’s College London, rightly emphasised that every woman’s freedom of choice must be respected, however.

And what do women want?

The great majority of pregnant women primarily want a healthy baby and a natural, active birth. This was the result of a survey conducted as part of a study on caesareans by the German health insurer GEK in 2006. If this is also what you want, then we look forward to welcoming you at a tour of the birthing centre soon!

Sources:
  • Lauer JA, Betrán AP, Merialdi M, Wojdyla D. Determinants of caesarean section rates in developed countries: supply, demand and opportunities for control. WHO; 2010.
  • GEK caesarean section study, Lutz U, Kolip P. Schwäbisch Gmünd: GEK – Gmünder Ersatzkasse; 2006; quoted in, among others, Kaiserschnittgeburten in der Schweiz (p. 21), Synthese wissenschaftlicher Analysen als Grundlagenbericht zur Beantwortung des Postulates Maury Pasquier(08.3935) by the Federal Office of Public Health, 2013 [in German].
  • Quote from Cochrane Review: Midwife-led continuity models versus other models of care for childbearing women (Review), Hatem M, Sandall J, Devane D, Soltani H, Gates Sprepared, published in The Cochrane Library 2009, Issue 3, page 2f.
  • NICE press release of 3 December 2014.
  • The entire NICE guidance in English: Recommendations place of birth and Full guideline.

Let nature take its course

Every natural birth follows its own rhythm. Midwives have mastered the art of skilful restraint. We monitor the natural course of the birth to a high medical standard and only intervene if there is a medical indication for doing so.

Where necessary, we use suitable obstetric measures in consultation with you and your partner. You can rest assured that we will treat you as a person rather than a “case” at all times.

Geburtshaus Zürcher Oberland is committed to the principle of evidence-based medicine (see our philosophy for more information on this). This means that we only use measures whose benefits in obstetric practice are clearly evidenced and whose advantages for the mother and child outweigh any potential disadvantages.

The newborn’s umbilical cord is not cut immediately. We wait until the energy has stopped pulsating between the baby and its placenta.