This was published 8 years ago
Childbirth program cuts rates of epidural and caesarean, researchers say
By Kate Aubusson
Minerva McKell was "shattered" when her first labour was not the idyllic experience she was expecting after taking a course that focused solely on the benefits of natural birth.
"The birth of my son Banjo was so traumatic. I wasn't prepared," she said.
"The pain really took me by surprise … I felt like a failure.
For a long time I was so scared of labour I didn't want to have anymore kids," she said.
Minerva McKell (with daughter Cleo) says she felt like a failure after her first birth.Credit: Peter Rae
But when she went into labour with her second child, Cleo, she was armed with skills she learned from a childbirth education program called She Births.
"It was really empowering ... It sets you up for saying if you need something then you're not failing yourself, you're not failing your baby," said the Balmain mother.
"I knew what to expect and I had the techniques to overcome it," she said of her vaginal birth.
A childbirth course based on the She Births principles dramatically reduced the rate of medical interventions, a Western Sydney University study found.
"The course helped take the fear away": Amanda Robinson.Credit: Wolter Peeters
The results raise serious questions about how women are prepared for labour, the researchers say.
The trial of the antenatal course, which focused on pain relief techniques, found it significantly reduced the use of epidurals and caesareans.
Amanda Robinson with her oldest son, Jasper, and twins Luca and Tristan.
Women enrolled in the two-day program had a 65 per cent lower epidural rate and a 44 per cent lower caesarean rate than women offered a standard course, found the 'complementary therapies for labour and birth' study published in BMJ Open.
They were taught evidence-bas
d the problem with current hospital-based programs was their focus on medical interventions and that they covered pregnancy through to the first few weeks of a newborn's life.
"Birth is seen as 'a day in the life', rather than something you need to be prepared for," said Dr Levett of WSU's National Institute of Complementary Medicine.
"Our method was effective because we approached birth education in a different way. We gave women options," Dr Levett said of the trial, based on a childbirth education program called She Births combined with acupressure for labour and birth protocol.
A rapid increase in medical interventions and a concerted push by women's rights advocates to give women more control over their labour prompted the the state government to introduce the Towards Normal Birth policy in 2010.
The landmark initiative aimed to increase the vaginal birth rate to 80 per cent and had ambitious targets for vaginal births.
But the latest figures from Health Statistics NSW show less than 57 per cent of mothers in NSW had a vaginal birth in 2014, compared with 58.2 per cent in 2008.
The rate of women being induced has jumped from 34.9 to 38.6 per cent since 2012 and more women are having serious haemorrhages after birth.
Critics of the current push towards natural birth argue the goal should be reducing complications in childbirth rather than cutting the rates of - often live-saving - interventions such as epidural and caesarean sections
Setting targets may lead to women having longer, more difficult labour. In the UK women may soon be given official advice about the risks of vaginal births as well as caesarean sections.
During labour, women find themselves caught in a "cascade of interventions", with epidurals increasing the risk of artificial augmentation, caesarean and tearing, Dr Levett said.
"There will always be a percentage of births that need medical intervention, but we wanted to give couples lots of different tools to manage their labour so that it becomes a reserve option if something goes wrong," she said.
Women enrolled in the WSU trial had half the rate of inductions, were less likely to experience perineal trauma and their labours were on average 32 minutes shorter, the study of 176 Sydney women with low-risk first pregnancies found.
Nadine Richardson, the creator of She Births, said the program aimed to help women manage the intensity and pain of labour, ease their fears and quash the judgment surrounding childbirth.
The course occupied the middle ground between hospital programs and the "hardcore natural cult" that created unrealistic expectations around natural births, Ms Richardson said.
"I've seen so many women secretly, quietly ashamed that they weren't able to have a natural birth. They felt like they had done something wrong.
"I saw women in shock when they felt pain, and were terrified of asking for medical assistance," she said.
Amanda Robinson was just over 34 weeks pregnant with twins when she went into labour. The trained nurse braced herself for the epidural that is almost routine for multiple births.
Just 34 minutes after arriving at the hospital fully dilated, Ms Robinson gave birth to her son Luca. His brother Tristan soon followed.
"We were the talk of the hospital. A lot of the nurses and midwives hadn't seen a vaginal birth of twins with no epidural," Ms Robinson, 34, said.
Three years earlier she was enrolled in the WSU trial while she was pregnant with her first son, Jasper. She had always wanted a natural birth.
"The biggest thing for me is that women really fear childbirth and the course helped take the fear away," she said.
"I felt really empowered to have the birth that I wanted … but we were also reassured that intervention is OK, and sometimes necessary."
The skills she was taught allowed her to remain calm and accept the necessity of an induction during her first labour.
"It also made a huge difference with the twins. I believe the outcome could have been completely different if I hadn't used those techniques," she said.
Obstetrician and gynaecologist at the Royal Hospital for Women Associate Professor Andrew Bisits said he was amazed by the findings.
"Several studies have attempted to decrease the rate of epidurals and caesareans and it's not often we meet with success," Professor Bisits said.
The participants were largely well off, well-educated women, a demographic that boasts the highest rates of epidural use and caesarean section.
President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Professor Michael Permezel said suggestion that epidurals and analgaesia was something to be avoided ignored the wishes of a large proportion of pregnant women.
"The priority for many women is to have as natural a birth as possible, but that's not suitable for everyone.
"The priority of many other women is good pain relief and find it incredibly helpful to be reassured that an epidural is available to them," Professor Permezel said.
Ms McKell was not enrolled in the trial.