New Active Birth

A concise guide to natural childbirth

JANET BALASKAS

Foreword by Sheila Kitzinger

Introduction by Michel Odent

An Imprint of HarperCollinsPublishers

Contents

Cover

Title Page

Preface by Janet Balaskas

Foreword by Sheila Kitzinger

Introduction by Michel Odent

1 What is an Active Birth?

2 Your Body in Pregnancy

3 Yoga-based Exercises for Pregnancy

4 Breathing

5 Massage

6 Labour and Birth

7 Water Birth

8 After the Birth

9 Postnatal Exercises

10 Active Birth at Home or in Hospital

11 A-Z Reference

Active Birth Manifesto

Recommended Reading

Useful Addresses

Reference List

Index

Acknowledgements

About the Author

also by Janet Balaskas

Copyright

About the Publisher

Preface

My first daughter, Nina, was born in 1970. I attended preparation classes and was hoping for a natural birth. I was active until strong labour began and then I lay passively in bed, semi-reclining, for the last three hours. Fortunately there were no complications and I managed, with enormous effort and the help of an unnecessary episiotomy, to give birth to her spontaneously.

I discovered active childbirth during the birth of my second daughter, Kim. During this pregnancy I had taken up yoga and enjoyed practising the yoga postures, finding some of them particularly beneficial as the pregnancy advanced. A study of the history of childbirth revealed how some of the yoga postures, especially squatting, had been used throughout the ages as birth positions. An anatomical study of the female pelvis clarified that these postures relaxed and ‘opened’ the pelvic canal and were ideal movements to adopt when trying to evacuate its contents.

Consequently, when it came to labour, I began by following the usual instructions given in antenatal classes and made myself comfortable in the semi-reclining position, focusing on some breathing techniques. Progress was slow and while the breathing techniques kept me calm and centred, they seemed to distract me from the labour. Eventually I decided to get up and try some of the positions I had practised during pregnancy. The change in progress was dramatic and it dawned on me, for the first time, that it is necessary for a woman to move and to be in harmony with gravity in order to help her body to open up in labour. I realised then, that squatting, and its variations, is the logical position for any woman to adopt while giving birth and is the most important position to practise during pregnancy. I resolved there and then to improve my squatting before my next labour.

During my son Iasonas’s birth I kept active; walking, squatting and kneeling, and gave birth to him on all-fours. It was a marvellous experience. I had an entirely new sense of control and knew instinctively what to do. I was up within hours of the birth and felt none of the aches and pains I had for a week or two after my previous births, despite the fact that he was almost a 10lb baby. I was astonished how fit and well I felt after the birth, and suffered no exhaustion or depression in the following months.

Recently, number four was born, also at home. Theo weighed in at 11lbs and this time I had a portable water birth pool designed by my husband Keith, in our bedroom. Labour was intense and as soon as I reached 5cms dilation I entered the pool. The buoyancy of the water made it much easier for me to relax. I was encouraged to let myself go without any inhibitions, and I remember making a tremendous amount of noise and reaching full dilation very quickly.

Michel Odent, who was in attendance, suggested that I leave the pool for the actual birth. Given Theo’s size, we decided that I needed the help of gravity to get him born, so I used the supported standing squat position. He was born in two contractions despite his size, miraculously without a tear. The medical establishment would certainly have considered me ‘high risk’. I was 42, rhesus negative and had surgery on the uterus 3 years previously. These were the very reasons that I wanted to stay at home where conditions for a normal birth were optimal.

My own birth experiences are not unusual. Since 1978 I have been teaching yoga to pregnant women and more than 80 per cent of them have succeeded in giving birth naturally and actively to their babies. Most of them had no previous experience of yoga and their ages have ranged from 19 to 49. It has been a joy to observe how readily their bodies responded to the yoga. As their flexibility improved, their health and happiness increased. At the end of pregnancy most of them were in touch with their birthing and motherly instincts and could approach the birth with confidence. The experiences of these women have added to my personal conviction and won support from their midwives, doctors and obstetricians.

Many women enjoy the benefits of yoga so much that they are back in the mother and baby exercise sessions two to three weeks after birth. This is so, not only in the case of the mother who has a normal, problem-free birth, but also for those who have needed the help of forceps or Caesarean section.

Over the years I have seen that active labour and the adoption of natural, upright or crouching birth positions is the safest, most enjoyable, most economical and sensible way for the majority of women to give birth. There is no disruption of the normal physiology of labour, no interference with the hormonal balance, postnatal depression is rare and problems with breastfeeding and mothering are less likely.

The majority of labours – managed well – should be uncomplicated. No special equipment is needed and the birth can take place in the simplest environment or in the most sophisticated hospital delivery room.

Active Birth is natural and instinctive. Left to her own devices it is the way a woman will behave during labour. In preparing a woman for an active birth, my aim is to help her get in touch with her own birth-giving instinct.

Giving birth is essentially a natural bodily function, which occurs quite spontaneously and involuntarily at the end of pregnancy. It is part of a continuous evolution which begins with love-making and conception and ends in the growing independence of the child from his mother, during the first few years of life. The whole process of conceiving a baby, being pregnant, giving birth and mothering is part of the sexual and spiritual life of a woman, and is basically rooted in the natural and undisturbed unfolding of a series of physiological events.

The best way in which a woman, entering into motherhood, can prepare herself is from her own body.

The yoga exercises I recommend are not unnatural movements imposed upon the body. On the contrary, they are instinctive and simple movements we could all make with ease. It is a kind of physical ‘remembering’ rather than a system of exercise. In fact, many of the exercises in this book came from my observations of the movements made by my children when they were very young. By watching them, I realised how stiff, as adults, we have become; how we have lost contact with the range of movement nature intended us to have. A toddler will squat with ease for a long time, feet flat on the ground, back straight and rising up from this position when he learns to walk.

It is well known that the more civilised we become the more we forget our natural habits. Today we are able to ensure a reliable medical back-up for all women in the event of complications and the mortality rate has improved by the life-saving techniques of modern obstetrics. However, I have seen all too often in my practice, how the widespread use of routine obstetric technology, inappropriately applied to normal labour, disturbs the natural birth process and causes many of the problems it was designed to prevent. In some hospitals, birth has become an abdominal or vaginal extraction conducted on a conveyor belt. The result is that most women are completely out of touch with their own instinctive ability to give birth, and midwives are losing their intuitive skills as they depend more on technology. Many women have never seen a birth or even held a baby by the time they enter motherhood. The natural skills of giving birth and mothering are no longer handed down from woman to woman, generation to generation.

We can regain a link with our primitive female heritage by re-educating our bodies in the habits, movements and postures which are instinctive to the child-bearing woman. In pregnancy the whole tendency of the body is towards health and vitality and it is a unique opportunity for a woman to work on herself.

The main concern of this book is with normal birth and the common variations from the norm, which can usually be dealt with without obstetric intervention. Women who have prepared in this way and then found themselves faced with an unexpected complication or have needed the help of pain-relieving drugs, often find ways of successfully combining Active Birth with obstetric procedures.

I hope that this book will help to bring to light the simple common sense of childbirth which has somehow been obscured in the advance of modern obstetrics, and will help women to rediscover their own inner resources for giving birth to their babies.

THE ACTIVE BIRTH MOVEMENT

In the late 1970s a group of women in North London, recognising the benefits of Active Birth, attempted to give birth in upright positions in a local hospital.

Some of them met with success and were positively encouraged by obstetrician Yehudi Gordon and his staff to do so, while others encountered stubborn opposition. Conflict arose within the labour ward which resulted in a ‘ban’ being placed on Active Birth. Some mothers whose births were imminent, were extremely distressed and rang me to express their feelings. I felt responsible for introducing them to the concept. It seemed completely inappropriate for them to have to fight for the right to give birth instinctively, during their labours.

Consequently the Active Birth Movement was founded in April 1982 and the Active Birth Manifesto was written (see Chapter 11).

The occasion was marked by a demonstration on Sunday, 11 April which we called the Birthrights Rally. Originally, we intended to hold a ‘squat-in’ in the hospital foyer, but within a mere three weeks so many people were offering their support, that we ended up on Hampstead Heath with a crowd of 6,000. The rally was a protest against hospitals which denied women the right and freedom to move about in labour and to give birth in upright, squatting or kneeling positions, despite mounting evidence as to the advantages.

Michel Odent, whose work in France was featured in the same year on BBC2, was in London and came to speak at the rally along with Sheila Kitzinger, the newsreader Anna Ford, and other friends of Active Birth. The occasion was memorable and there was a change of attitude at the hospital which has been able to accommodate women wanting Active Births ever since. Thankfully, the Active Birth Movement has not needed to stage another demonstration as hospitals throughout London and further afield have gradually been adjusting to the climate of change. Although there is still a long way to go, the principles of Active Birth are being put into practice more widely, as our knowledge of the normal physiology of the birth process increases.

Our main function since then has been educational, providing conferences, lectures, workshops for parents and professionals, as well as training facilities for Active Birth teachers. We also provide a free advisory service from our London centre (see Useful Addresses).

The use of upright postures and mobility in labour are not unique to our part of the world and change has been happening simultaneously in many countries over the last decade. The Active Birth Movement is now international and has branches all over the world, many of whom have had great success in stimulating change. It is run entirely by women like myself, who have rediscovered childbirth through their own experiences. They are women who have chosen to get off the obstetric delivery table and to give birth instinctively. Consequently they pass on what they have learnt to others and through their work they are creating a new tradition of womanly wisdom, helping women everywhere to regain their autonomy as childbearers.

It is to them that I dedicate this book.

Foreword

Here is an important voice in childbirth. Janet Balaskas is speaking to those women who want to grow in self-awareness and to use their bodies actively in labour. In her childbirth classes Janet Balaskas stands for activity rather than passivity, for movement rather than immobilisation and a woman’s right to choose whatever position she finds comfortable throughout labour and delivery.

The teaching in this book is revolutionary. Yet it is age-old. All over the world and throughout recorded history women have chosen upright positions to give birth and it is only we in the West who have had the extraordinary notion that a woman should lie on her back with her legs in the air to deliver a baby.

But to get women upright is to do much more than help them find a comfortable posture. It is to turn them from passive patients into active birth-givers. It is to challenge the whole obstetric view of birth in Western society. This is based on the assumption that childbirth is a medical event which should be conducted in an intensive care setting. The whole pregnancy is seen as a pathological condition terminated only by delivery. The modern high-tech obstetrician actively manages labour with all the technology of ultrasound, continuous electronic monitoring and oxytocin intravenous drip. Many obstetricians have never had the opportunity to see a truly natural birth. To turn the process of bringing new life into the world into one in which a woman becomes simply the body on the delivery table rather than an active birth-giver is a degradation of the mother’s role in childbirth.

We are now beginning to discover the sometimes long-term destructive effects on the relationship between a mother and her baby and on the family, of treating women as if they were merely containers to be relieved of their contents and of concentrating attention on a bag of muscle and a birth canal, instead of relating to and caring for the person of whom the uterus and the vagina are a part.

‘Bonding’ is a fashionable term today. In many hospitals special time is devoted for bonding and there must be few midwives and obstetricians who would not claim that they consider bonding important. But everything that happens after delivery is the outcome of what has gone before. Bonding is either spontaneous and easy, or made virtually impossible by the atmosphere at delivery and by the care a woman is given as a person, not merely a ‘para 1’, an elderly primigravida, a maternal pelvis, a contracting uterus or a dilating cervix.

The way we give birth is important to all of us because it has a great deal to do with the kind of society we want to live in, the significance of the coming to birth of a new person and a new family.

When we hand over responsibility for choosing between alternatives on the basis of what we believe to be right, we hand over responsibility for the quality of the society we, and our children, must live in.

Sheila Kitzinger

Introduction

The concept of ‘active birth’ is a milestone in the history of childbirth. Bringing together these two simple words is by itself a work of genius: ‘active birth’ covers a huge scale of meanings, at different complementary levels.

The first level might be described as muscular. When you just have a glimpse of some pictures of ‘active births’ you notice that at the end of the labour, when the baby is coming, many mothers are vertical, hanging on to someone or something, or leaning forward on something, or in a supported squatting position, or kneeling …

At the second level you penetrate more deeply into the physiological process of childbirth. Childbirth is first a brain process. When a woman is giving birth by herself, the active part of her brain is the primitive part. It is this part which we have in common with all the mammals, the part which secretes the necessary hormones. A woman gives birth actively when she can secrete her own hormones, or, in other words, when she does not need synthetic hormones from a drip, or any other kind of medical intervention. The activity of the primitive part of the brain implies a reduction of inhibitions coming from the ‘new’ brain, the neocortex. The factors which can disturb this brain process, this change of conscious level, are not easily eliminated in the context of modern obstetric units: privacy, semi-darkness, silence, and, at the same time, the proximity of an experienced person.

At the third level ‘active birth’ refers to the attitude that society as a whole has towards childbirth. In our society childbirth is completely under the control and under the responsibility of medical institutions. Pregnant and labouring women are called ‘patients’. Medical institutions include modern midwifery. Modern midwives, trained in obstetric units, are not any longer mothers helping other mothers. When a newborn baby is not healthy, the medical institution is considered as responsible. The concept of ‘active birth’ has been introduced by women who want to take back the control and the responsibility of childbirth. They consider the medical institution as a resource to use in precise circumstances. What a provocative challenge at a time when the negative side effects of obstetrics are better and better known!

The day when Janet introduced the phrase ‘active birth’ is possibly the most important one in the history of childbirth in Europe … since the day when the French doctor Mauriceau took control of this event and placed the labouring woman on her back.

Michel Odent

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