Where Does the Pressure for an ‘Ideal Birth’ Come From?

Aug 24

8 min read

Pregnant mother holding her abdomen, surrounded by conflicting ideas about birth

In my last blog, I explored the idea of the “ideal birth” and why I don't believe there is one particular type of birth that deserves that title.

But that leaves another question...

If women are feeling pressure to achieve an “ideal birth”, where is that pressure actually coming from?

I don't think there is one simple answer.

Natalie Morris recently wrote powerfully about her own experience of a five-day labour and the expectations she had absorbed about birth beforehand. Her experience is valid, and the pressure she describes feeling around birth deserves to be acknowledged.

But acknowledging that experience doesn't necessarily mean accepting a simple explanation for where those expectations came from.

If we want to understand why women feel pressure to achieve a particular kind of birth, we need to look more widely at the different messages and influences that shape our expectations long before labour begins. The pressure women feel around birth comes from lots of different places: our maternity history, antenatal education, the experiences of the women around us, social media, our own beliefs and expectations and sometimes our faith.

And all of those things deserve examining.

We can't ignore the history

In my previous blog I mentioned that there is historical context here that we shouldn't pretend doesn't exist.

The 2015 Morecambe Bay Investigation, chaired by Dr Bill Kirkup, found that maternity care at Furness General Hospital had been influenced by a small number of dominant midwives whose “over-zealous” pursuit of natural childbirth “at any cost” had, at times, contributed to unsafe care, that had devastating consequences for women and babies.

That matters.

More recently, however, Baroness Amos's National Maternity and Neonatal Investigation reached a more nuanced conclusion. When questioned by the Health and Social Care Committee, Baroness Amos explained that her investigation had actively looked for evidence of normal-birth ideology and had not found evidence that it was nationally prevalent.

Importantly, she did not say that it had never existed, or that individual women had not experienced it. But within our current maternity services there is not an agenda to pursue physiological births regardless of the consequences.

And I think we need to be able to hold those two things together.

There have been times and places within NHS maternity care where an ideology around “normal birth” has become unsafe. That is documented fact. That does not mean that women entering NHS maternity services today are being pressured by midwives to birth without intervention.

But ideas filter beyond the organisations in which they began. They enter professional education, antenatal education, books, social media and conversations between women. And once an idea has become culturally embedded, it can take a long time to unpick it.

So perhaps some of the pressure women feel today is an echo of something that was much more explicit in the past.

What are we teaching women about birth?

Natalie Morris also wrote about her experience of antenatal education and the message she felt she received: essentially, if she prepared enough, believed enough and endured enough, she would achieve the birth she wanted.

I have a real problem with that.

Not because I think we should stop teaching women about birth physiology. Quite the opposite. I teach antenatal education, and I think understanding the physiology of birth is essential.

Birth is a physiological process. Women have been giving birth for millennia. Understanding hormones, the nervous system, movement, environment and what is happening within your body can remove some of the mystery and fear surrounding labour.

There is also good reason to talk about fear.

The fear-tension-pain cycle, first described by Dr Grantly Dick-Read, describes how fear can activate our stress response, creating tension within the body and increasing our perception of pain. Helping women feel safe, informed and supported therefore matters.

But teaching birth physiology should never become:

If you relax enough, breathe properly, think positively and believe in your body, you are gaurenteed a physiological birth.

Because that isn't true.

When I teach women about birth, we also talk about what might happen if things deviate from what they are hoping for. We talk about interventions. We talk about different routes birth might take. We talk about choices they may face along the way.

I don't believe we need to dwell on every possible complication until a woman enters labour terrified of everything that might go wrong. But neither should we pretend those possibilities don't exist.

There is a balance. And one of the things I say repeatedly is this:

We cannot control birth, but we can influence it.

We can make choices about where we birth, who supports us, our environment, interventions, movement, pain relief and many other things that can influence how labour unfolds.

But birth isn't a maths equation. A + B does not inevitably equal C.

You can do everything “right” and your birth may still take an unexpected turn.

And if antenatal education doesn't make that clear, we risk women interpreting an unexpected birth not simply as something that happened, but as something they failed to achieve.

We also absorb other women's births

Long before most women attend an antenatal class, they have already been learning about birth.

We've heard our mothers' stories. Our sisters' stories. Our friends' stories. We've watched birth on television (through "documentaries or dramatisations). We've heard the jokes and the horror stories.

Those narratives matter.

During the radio discussion that prompted me to write this series, Esther Heim described growing up hearing how easily her grandmother had given birth.

Birth was presented as something women simply did.

Her mother's experience was very different. She had two difficult births.

Imagine carrying the expectation that something should be straightforward and then discovering that, for you, it isn't.

That discrepancy can leave incredibly complicated emotions behind.

But I think the opposite is increasingly true too.

Many women now reach pregnancy having heard very few straightforward birth stories.

Intervention during birth is common within UK maternity care. That isn't inherently good or bad; sometimes intervention is wanted, appropriate and lifesaving. Sometimes it isn't.

But it inevitably shapes our cultural understanding of what birth looks like.

One of my homebirth clients once reflected on this after her own birth. There had been complications and despite birthing her baby unassisted at home, we ultimately transferred into hospital.

Among her friendship group of five women, she was the only one who had an unassisted birth.

I don't share that because her birth somehow got a “higher mark” than theirs. That's ridiculous.

Birth isn't a competition and an unassisted vaginal birth isn't a medal.

I share it because our expectations are formed by what we see around us.

If every woman you know has needed an induction, an instrumental birth or a caesarean, it is understandable that you might enter pregnancy wondering whether your body will be capable of giving birth without those things.

So women can find themselves squeezed from both directions. One narrative says:

Your body was made to do this. Trust it hard enough and everything will be fine.

The other says:

Birth is inherently dangerous. Your body probably won't manage it without medical help.

Neither gives women the whole truth.

And then there's social media

Social media isn't particularly good at nuance and birth is no exception.

At one end of the spectrum, you can find content essentially suggesting that all women should simply freebirth; that birth works perfectly when left alone and that medical involvement is the problem.

At the other, you'll find people suggesting that women should simply have an induction or a caesarean. As though medical intervention itself is risk-free and uncomplicated.

Neither extreme is helpful.

I have no problem with a woman making an informed decision to freebirth. Women have autonomy over their bodies and get to make decisions that I, another health professional or anyone else might not make ourselves.

Equally, a woman may make an informed decision that a planned caesarean is absolutely the right birth for her.

The problem comes when our choice becomes the choice we believe everyone else should make.

Birth is too complex for that.

There are benefits, risks and trade-offs to every option. Individual women have different medical histories, previous experiences, priorities, fears, beliefs and interpretations of risk.

Perhaps one of the biggest problems with the idea of an “ideal birth” is our tendency to universalise our own experience.

This worked for me, therefore it should work for you.

Which ignores our individuality.

What if my faith tells me my body was made to birth?

There is another layer to this conversation for Christian women, and it's one I will explore properly in the next blog in this series.

We often say:

“God designed my body to birth my baby.”

This is something I wholeheartedly believe, and it is a truth I reinforce with the women I work with through affirmations, guided meditations and antenatal education. I want women to understand the incredible physiology of their bodies and to approach birth with confidence rather than fear.

But believing that God designed our bodies for birth is not the same as believing that physiological birth is the only possible — or faithful — outcome.

Our bodies are wonderfully designed, but birth is not predictable. Sometimes complications arise. Sometimes intervention becomes necessary or is the right choice for you. Sometimes birth takes a completely different path from the one we had hoped and prayed for.

The difficulty comes when “God designed my body to birth” quietly becomes:

“Therefore, if I trust God enough, pray hard enough, or have enough faith, I will have a physiological birth.”

That is where I think we can unintentionally place a huge burden on Christian women. And create another version of the same problem.

What happens to the woman who prayed, prepared, trusted God for a physiological birth and then had the caesarean?

What happens to the woman whose baby needed help?

What happens when birth doesn't unfold according to the picture she had in her mind?

This concept deserves a lot more unpacking, so look out for my next blog.

In the meantime...

Maybe the problem isn't wanting a particular birth

I don't think the solution to all of this is telling women not to have hopes for their births.

Women should go into labour knowing what they want. We should understand our bodies. It is vital to know your options, ask questions, make informed decisions and feel confident in your ability to birth.

And if you desperately want a homebirth, an epidural, a waterbirth, a VBAC or a planned caesarean, I don't think we need to diminish that desire in the name of avoiding disappointment.

Hope is not the problem. Preference is not the problem. Preparation is not the problem.

The problem comes when preference becomes expectation. When preparation becomes a promise. When somebody else's birth becomes the standard against which we measure our own. Or when one route of birth becomes evidence that we have somehow done birth “properly”.

Perhaps good preparation for birth isn't about convincing ourselves that we can control the outcome.

Perhaps it is about understanding what we can influence, knowing what matters to us, being equipped to make decisions if the path changes and recognising that our worth was never dependent on how our baby entered the world.