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I think there is an element of truth in what you say Sophie - I also think that the kind of birth women think about when they hear the word 'normal' or 'vaginal' is one that includes being confined to the bed, induced or augmented with a drip, left in pain without support, subject to time constrictions and set in an athmosphere of fear and anticipation of faliure. It is not suprising that this kind of birth has long term physical and psychological consequences, and that women want to avoid such an event. Unfortunately, the term and notion of normal birth has been hijacked by technocracy, and so women in many countries dont have a good benchmark for what physilogical birth actually is, and for what the outcomes (short and long term) could be if we could do birth in the context of midwifery (by midwives, obstetricians, and others involved) that is set out in the Lancet Series on Midwifery. unfortunately, also, most research studies include the kind of technocratic birth I have described in the 'normal birth' group when they make comparisions, thereby missing the point about what happens when healthy women and babies (the majority of any population) experience labour and birth in an atmosphere that supports the individally unfolding physiological processes of the dynamic interaction between mother and baby, respecting womens capacity to labour effectively, and not imposing reductionist populatoin-based 'norms' on them. Normal birth thus becomes reified as problematic, when it is in fact what we do to normal birth that is the problem. the analogy is the way breastfeeding was managed, monitored and measured in the 1970's and 1980s. We have recognised the harm that did to women and babies, but we are still living with population attitudes that were formed a generation or two back as a consequence. We probably have the same journey to undertake for normal birth - but as researchers I think our task is to try to get together data sets of healthy women who have had a truly physiological birth (from around the world) and to look at the longer term outcomes of these women, compared to healthy women who have been subject to population based 'just in case' interventions. this may provide interesting data that can then be used when this kind of debate comes up (as it does with wearying regularity...) All the best Soo ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Sophie Alexander [[log in to unmask]] Sent: Thursday, July 28, 2016 8:33 AM To: [log in to unmask] Subject: Re: Society has / is loosing the notion that SVD is the "default" setting for birth and that other settings should be an answer to some evaluated anomaly In Belgium they earn exactly the same for a CS or an SVD or an IVD Sophie Alexander MD, PhD PERU (Perinatal Epidemiology and Reproductive health Unit) Ecole de Santé Publique Universite Libre de Bruxelles 808 route de Lennik 1070 Brussels Belgium Tel +32 2555 4063[X] De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Grace Omoni Envoyé : jeudi 28 juillet 2016 08:58 À : [log in to unmask] Objet : Re: Society has / is loosing the notion that SVD is the "default" setting for birth and that other settings should be an answer to some evaluated anomaly I believe that fear of birth and perhaps a right to choose has lead women into thinking CS is the best option into giving birth. The Obstetricians have not helped either because payment for a normal birth is very low but a CS they have more than a months'salary coupled with the daily charges to come to hospital to review the woman. Prof. Grace Omoni, PhD Director, School of Nursing Sciences University of Nairobi President, Confederation of Africa Midwives Associations (CONAMA) Chair, Lugina African Midwives Research Network (LAMRN) ________________________________ Date: Thu, 28 Jul 2016 05:47:30 +0200 From: [log in to unmask]<mailto:[log in to unmask]> Subject: Society has / is loosing the notion that SVD is the "default" setting for birth and that other settings should be an answer to some evaluated anomaly To: [log in to unmask]<mailto:[log in to unmask]> Question In our hospital, we have recently acquired a very nice Swedish obstetrician and we had a seminar on: “How do the Nordics do it?”. In the Nordic countries there are very few “formal” midwife units, but still they have very low CS rates (14% in Iceland), and excellent outcomes. We discussed in particular the work of Mary Blomberg and co-workers. At the end of the discussion, we came to the idea that it is more about “values” and “lifestyle” than anything else. The little Swedish children spend their time facing the tough weather, possibly even camping in the snow. And not challenging everything all the time. And when pregnancy and childbirth occur, the Nordic woman-who-has camped-in-the-snow doesn’t go through the throes of intense self-questioning, and just does it (SVD without epidural, followed by long and efficient breast feeding). DO you believe this? Sophie De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoyé : mercredi 27 juillet 2016 22:15 À : [log in to unmask]<mailto:[log in to unmask]> Objet : Re: Risks of vaginal birth - from 'The Conversation' Excellent observation Carolyn All the best Soo ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Carolyn McIntosh [[log in to unmask]] Sent: Wednesday, July 27, 2016 9:13 PM To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Risks of vaginal birth - from 'The Conversation' Normal physiology and function is the default position for any aspect of health care. Where illness or disability interrupts normal function the goal of treatment is to return the body as close as possible to normal physiological function. I can think of no other aspect of health care where individuals can freely choose drastic and costly medical intervention without a clear medical rationale. The default position for birth should always be normal physiological birth. Treatment should be offered when it is medically indicated. Carolyn McIntosh Senior Midwifery Lecturer Otago Polytechnic On 27/07/2016 9:21 PM, "Macfarlane, Alison" <[log in to unmask]<mailto:[log in to unmask]>> wrote: ‘Why do we assume a “natural” vaginal birth should be the default option<http://theconversationuk.cmail19.com/t/r-l-guhkln-jknlldudu-d/>? Informing pregnant women about the relative risks and benefits of vaginal births and caesarean sections would empower individuals to choose what's right for them, argues Maired Black. ‘ Alison Macfarlane School of Health Sciences City University London 1, Myddelton Street London EC1R 1UW Phone (0) (44) 207 040 5832 Email [log in to unmask]<mailto:[log in to unmask]> http://www.city.ac.uk/people/academics/alison-macfarlane This email and its contents are the property of City University London. If you are not the intended recipient of this message and any attached files, please delete it. 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