I have seen some wonderfully designed spaces in which women can give birth. I have also seen women give birth beautifully (and, I would say, optimally) in settings that would seem to contravene every goal of the optimal birthing space ideology.
The woman's own nesting, which I believe is hormonally driven more than the result of intelligent planning and preparation, seems to be the key. Nesting can include the choice of setting, as well as the choice of people who make up that woman's birthing team. Nesting also enables the woman to change her plan if her situation requires it, without losing the ability to proceed normally.I don't want to be critical of the optimal birth space ideology.
The reality in my world is that each birth space is often very different from what the woman had planned or wanted, yet women are able to give birth in that wonderfully spontaneous way, without any regrets.
It would be naive to imagine that a woman's home is automatically the optimal birthing space for her.
I need to do a postnatal visit now, but hope to get back to this post later, and write some more.
[Melbourne readers may know that a private hospital in Hawthorn had recently set up a beautifully designed birthing facility, which has closed its doors after just a few months' operation, because the plan was not working, and there were too few women making bookings.]
NESTING and optimal birthing conditions
Nesting is one of those normal physiological functions that everyone knows about, but rarely pays much attention to. While researchers have for a couple of decades looked seriously at the impact of the love hormone oxytocin, and the 'fight-or-flight' adrenal hormones, on the birth and mothering behaviours of laboratory animals, nesting doesn't seem to raise research interest or dollars.
A woman anticipating the birth of her child will usually have a 'to do' list, including stocking and preparation of food and other consumables, washing and setting out baby clothes, and packing a bag for herself and her baby in preparation for a stay in hospital, or 'birth kit' items in readiness for giving birth at home. This process of getting ready would be recognised broadly as 'nesting'. I have known some who feel the need to clean windows, and sweep, vacuum, and dust almost obsessively in the days leading up to the labour. This is all intentional nesting, driven mainly by the woman's intellectual grasp of the enormity of the job that lies ahead.
With the establishment of spontaneous labour, physiological nesting becomes more pronounced. Women who thought they would like to have the other children present for the birth of their sibling will often withdraw into a secluded space. Women who have a plan to call a trusted midwife will often call her, just to check that she is able to come when called. Nesting can continue until the peak of first stage, often called 'transition', when the woman must give up conscious control and surrender to the work of bringing her child out of her body.
Women who plan to go to hospital to give birth face a nesting conflict. It goes something like this:
"If I go to hospital too early my labour might fizzle. If I stay at home I won't want to move when the labour becomes strong." It's their natural nesting drive that makes them want to find the place where they will give birth - not the street address, but the actual room, with its contents, and the actual people with whom she will need to communicate.
Women who are booked at a modern hospital Birth Centre, where there are well-designed birthing rooms, often experience a conflict about the availability of a room. They know that if the rooms are all in use when they arrive, they will be admitted to a standard hospital suite. They have heard stories about how often this might happen. Other matters of 'nesting' concern might focus on the times of shift changes in the hospital.
I have, on occasion, been called to a 'planned' home birth, only to find that the woman and her home show no sign of nesting. This dysfunctional nesting is, I think, a sign that the woman's sensitivity to natural instinctive urges has been in some way shut down. The woman's labour can continue without nesting, and the baby can be born, "ready or not!"
Returning to the initial question of this blog: is there, and what is, an optimal space for birthing?
I would refine the question further, and add the word 'physiological' - the space for medically managed care in labour and childbirth must be very different from the space that enables and supports and protects physiological processes. Here are a few ideals for that space:
- a place that the woman has chosen to be in
- a place that the woman is happy to continue in, as labour progresses
- a place where the woman can receive care, support, and guidance from a trusted midwife, and other chosen people
- a place where the woman is able to cover windows, dim lights, and make other physical adjustments when she wishes
- a place that allows the woman to feel private and unobserved
- a place where the midwife, as the responsible professional at the time, is confident that the wellbeing of mother and baby are being protected.
As with all other basic life events, "the best laid plans of mice and men ..." There can be no guarantees. The only people who we can be sure will be at a birth are the mother and her baby.
The optimal space for physiological birthing in suburban Melbourne should not be very different from the optimal space for physiological birthing for Inuit women in Nunavik in the Arctic Circle. The type of bed or birthing pool; the colour of the walls or the pattern of the furnishings - these things can be nice, but are of little significance to the woman giving birth. The woman's feeling of unintruded privacy, as she reaches the point of surrender, knowing that her midwife is *with* her, is the essence of optimality.
Your comments are very welcome.