Supporting hospital birth.

Part One: why harm minimisation?

The idea of “harm minimisation” came about when people caring for drug addicts began to formulate ways to limit the potential damage from drugs in those simply unable to cease pursuing their own addiction, or slowly working towards that end.

Much like the fall out of drug abuse, trauma from managed hospital birth is so commonplace today as to be almost unremarkable. Despite women’s birth experiences clearly reflecting how little hospitals serve our greater wellbeing, we continue to access those institutions. This is then behaviour which parallels that of other damaging addictions and as such requires harm minimisation strategies in place.  

While many sources encourage women to hand their power to the institution, or provide lists of utterly pointless information to pacify women into feeling safe, this article will provide a context within which to view hospital birth that will also suggest some safer practices for women in that environment. Some concrete examples will also be included in Part Two.

Being docile and compliant are traits which are praised and rewarded in women and so it is within the hospital system as well since it is a place which regulates and controls women. Unfortunately this does not reduce the potential harm from unnecessary interventions which are easily performed upon most women despite how they cause physical and psychological trauma.

Women who have the means to birth at home, financial, physical and emotional, will still take themselves into the hospital even when their previous experiences have been negative. The programming of women to listen to authority figures, combined with how comfortable most of us are with feelings of fear and a lack of control, mean that until women begin to move towards liberation in their lives more generally we will continue to pursue this dangerous path.

Despite copious evidence in existence internationally about the dangers of birthing in hospitals, and the equally compelling evidence demonstrating both the safety and desirability of evidence based care in the home, the vast majority of women in Australia still attempt to birth their babies in hospitals.

A complex layering of factors from the personal to the wider community, from the history of midwifery moving out of the hands of consumers and into institutions, and a desire to control and regulate women’s bodies, have all contributed to this situation.  The false consciousness which exists in our society that hospitals are safe places for birthing women is so utterly entrenched that supporting women to move beyond it can seem an overwhelming, and certainly a disheartening, task.

No other oppressed group colludes quite so much in it’s own oppression as women.

Once a woman has put herself within the reach of the hospital (And I do not say, “chosen” for it can hardly be considered choice when she does not know the choice exists and most women are unaware that homebirth is even an option.) those who seek to support her must begin to work at minimising the likely and potential harm from this contact.

The safest way for birth to proceed is in an environment which supports the normal physiological process. Women require freedom of emotion and movement, familiarity, safety, dim lighting, warmth, sustenance and companions who are well known to the woman, and who are also well known to her.

Obviously in an institutionalised birth setting, even the most caring midwife is going to be unable to supply most of those. Indeed most women are also unaware that these factors are both essential and desirable in the process. The fortunate woman who has come upon someone who can support them in planning for their hospital experience may be open to harm minimisation strategies, even if she is unable, or unwilling to actually make the safest choice and birth at home.

For the very small number of women to whom obstetric technology could be of benefit, there is still immense benefit to birth support. Planned caesareans for genuine medical need, for example, can still take place in a way which is safer for a woman and her baby’s longer term mental and physical health even though it is a dangerous procedure in the short term.  There is always room for respect of the mother-baby dyad regardless of the necessities of a genuine emergency too and a good birth plan with strong supporters to pursue it can go a long way to supporting a woman through such a trauma.

Part Two: Physical ways to minimise the harm of hospital protocols and staff on birth.