Challenging the biomedical model of childbirth
Challenging the biomedical model of childbirth

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Challenging the biomedical model of childbirth

4 Personal experiences of childbirth

In this activity, you consider whether official policies on the need for increased choice for women during childbirth have become a reality for women having their babies.

Activity 4

Allow about 1 hour.

Listen to the audio tracks below, where you will hear three contrasting reports of women’s experiences of pregnancy and childbirth. After each audio track, make brief notes on whether you think each of them felt they had a choice in:

  1. who cared for them during their pregnancy
  2. where they received their care
  3. the place and type of delivery.

After listening to all three audio tracks, consider:

  1. What were the constraining factors that influenced whether or not those women had a choice?
  2. Whose voices were heard and whose views were not listened to?

Audio 1

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Transcript: Audio clip one

Faye
My name’s Faye. Me and my husband got married a year and a half ago, and I fell pregnant on the honeymoon. I live in a little village, so there wasn’t somewhere I could go all the time I had to make an appointment four weeks in advance to see somebody, and we didn’t have any like drop-in centre where you can just go with your children or go and speak to a health adviser, so I did feel … I did feel quite alone. I thought there was almost somebody gonna be there with me as as the pregnancy went on, but that wasn’t the case.
I had placenta previa, which looked up on the internet will really scare you if you just type in them words and read about them, so the advice on that wasn’t very clear after I had my 20 week scan. I was just told I had it and to come back at 36 weeks to see if that was still the case. At 36 weeks the placenta was still lying low, and then at 38 weeks it had moved by 4cm and they said I could have a natural birth.
I was frightened, I was also frightened of having the C-section, both options seemed pretty scary. And walked out quite chuffed that we were going to have a natural birth but quite stunned as well. Again it was like they said OK, and off I went on my own again.
I wanted a water birth, I’d really looked into the birth side of things and as a woman having periods, I did use a bath at home every time I had the upset tummy or didn’t feel right, a bath would really relax me. So I thought the best option for me would be a water birth.
Interviewer
And what happened in the event? Tell us the story.
Faye
[laugh] I didn’t go into natural birth. I was induced two weeks after my due date. As my contractions started I did go down the hall and run a bath at the hospital, which wasn’t as comfortable as I imagined it to be when I had a contraction I just wanted to get out! So after that I used the TENS machine which I really did enjoy it gave me some control over the whole situation, every time I had a contraction I pressed the button. And I was slightly more in control of something that you’re not really in control of at all.
On the way to the labour ward I asked about the water birth and was told at this point that I would not be allowed one because I would need to be monitored the whole time as I’d been induced.
I was then given a delivery room in the labour ward and put on a bed and strapped to some monitors. It wasn’t very comfortable having to lay down. So we did try again the birthing ball by the side, but still strapped to the machine. At this point I was checked again to see how far dilated I was, and I was seven and a half centimetres. At this stage I was given an epidural, which had been requested when I arrived at 8 o’clock, so it took a good few hours, to get the epidural.
As soon as the epidural had been given (laugh) the relief was lovely. I still felt my contractions, but they weren’t painful. And I could still feel the pushing sensation that started, and once I had that feeling I did let the nurses know, but again they said I couldn’t be checked to see how far dilated I was because I’d only been checked an hour ago, or two hours ago, they wanted to wait. So they told me I was not allowed to push.
The sensation overwhelms you and, no matter how hard I tried to fight it, at the peak of every contraction, it did push slightly, I couldn’t stop it.
As the epidural went on, I lost more and more sensation: when the sensation had finished, they then said I was allowed to start pushing.
So every time they could see me having a contraction on the computer, they then allowed me to push. We pushed, we, I pushed for about an hour and a half until they decided that the contractions were slowing too much and I needed to be put on a drip to speed the contractions up.
At this stage I’d been pushing for nearly three hours, and a doctor finally came to see me. He examined me quite roughly, and said “give her fifteen more minutes”. I pushed for fifteen more minutes and then they came back to see me, and then they decided that they would do a forceps delivery in twenty minutes time.
I was still quite calm. I think my mum and my husband were more anxious, than I was, and I was trying to keep a very calm face, and reassure everybody that I loved that was there, seeing me go through it, that I was OK.
They - they used the forceps to get the baby out. I was aware that they would have to pull, when using forceps, I wasn’t aware of the force behind it. I was being held onto the bed as they were pulling me because I was being pulled off the end of the bed. And my legs were in the stirrups.
They got the head out, and then said that they were going to have to get the baby out immediately, without a contraction, I just had to push and they would carry on pulling with the forceps. And then my baby was born.
He was then taken away quite quickly for resuscitation. And while he was being resuscitated I haemorrhaged. And I remember lots of people in the room, and somebody massaging my tummy to stop the flow of blood, he was telling me what he was doing. He was the only person really talking to me at this point, everybody else was quite busy.
I had a man running round trying to put a needle in me to get a drip, but my veins were collapsing, and it was very loud, lots of shouting.
And still nobody was really talking to me: they were all really busy, they’d got lots of things to do. And they were counting. They were counting things on tables, and looking in bins. And they told me that they’d lost a swab, and I’d need to go and have an X-ray to see if the swab could be found inside me.
It’s very surreal. I was really not sure what was going on apart from they had a problem with the lost swab. And I wasn’t aware of if I was still in any danger of dying from haemorrhaging. Nobody reassured me that it’s OK, it’s stopped you’ll be fine. They just carried on with their jobs.
The X-ray results came back clear, which I assumed they would. Yeah, the swab’s never been found.
I didn’t feel I was given any decisions, on the actual birth. I wasn’t given an option of a C-section, whereas I was just told what was going to happen. I wasn’t aware I could say “Stop, I don’t want this”. I just wanted my baby safe, and out in the fastest way possible. Looking back, I think a C-section probably would have been better as I did have a very large baby, at 9.8 pound.
I didn’t scream, I didn’t shout, I think maybe if I’d have screamed and shout, I might have been listened to a little bit more,
But I think it’s a shame that the beginning of my life with my baby and my baby’s life, for the first three or four months, I was in shock and upset quite a lot of the time, even though I was so happy and I loved being a mum.
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Audio 2

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Kate Taylor
My name’s Kate Taylor, um Ruby is just over a year old.
And yeah I had a very good pregnancy, I’m a dancer, that’s my profession so I’m a trained dancer um, and I really believe that helped, I went in to my pregnancy very fit, um I also kept doing Pilates classes, but very much antenatal focused.
There was definite choice in terms of um what hospital I wanted to be based at, for the labour, and also the tests that are offered to you, throughout your pregnancy in terms of seeing whether your baby might be at risk of having Downs Syndrome or spinal defects, that again was a choice and I didn’t have to take it. So lots of things for discussion.
And then in terms of your type of delivery, there was lots of choices there, for example, C-section, or do you want an active birth? And also where, I was at a place where I could if I'd wanted to have done, had a home delivery.
I did have to have a separate scan because when I went for my twenty-week scan, my placenta was low lying. So to check that the placenta's going to be in the correct place for me to have a normal delivery I did actually go back at week 35. It was fine, it had moved, and I was able to proceed and hopefully have a normal delivery.
I definitely wanted an active birth if I could, and I think that also came a lot from reading this particular book that really kind of connected with me and I think being a dancer, and being physical. And also fortunately learning a lot about the anatomy, learning that if you’re sat down you’re actually sat on your coccyx which is going to be really difficult, I guess I had quite a knowledge of internally what’s happening in terms of the body and the delivery. So I felt like if I could be in control, then an active birth would be the best for me.
Interviewer
What actually happened?
Kate
[(Laugh] Well. It’s funny because especially not having a baby, you don’t know what to expect so you’re forever listening out for little kind of twinges, and I kept asking my mum, “What will it feel like?” and my mum kept saying, “Well it might feel a bit like a period pain kind of thing to begin with.” So that began about 4 in the morning.
And then I think by 9 o’clock I actually phoned and said “I’m getting some discomfort, I’m pretty much sure I’m in labour.” But I was managing it. They could tell that I was managing the pain. And everything felt like it was coming together as in the book that I’d read I was like “Right, let’s utilise these distraction methods”, I was pacing up and down the room, focusing on objects, focusing on wallpaper patterns, anything to distract myself. And then by 11, things were happening every three minutes, and I was kind of thinking “I think we better kind of try to get in”. And what I mean by “try” is I couldn’t sit down. So I’m thinking how are we going to get there in the car, because it’s a good 20-25 minute journey.
And when we got there, at about I don’t know it was roughly about 1, examined me and I knew what the case would be, I was only about 2cm. “Can you give me anything?” They gave me a paracetamol, and said you’re best to go home. So. We were going to drive to a nearby park. But I just couldn’t physically sit down. So we were walking round the hospital, and then, um, my waters broke: it was this relief of ‘aaaaah, we can go back in’.
So within the space of an hour, when I went back in I’d gone from 2 cm to 10.
So then when the next midwife came in and examined me she said “You’re ready to go”. So I was like “Right”. And for the whole time, I’m saying this like I was full of energy but I was in my own zone completely.
You know I didn’t need any distractions, I needed to keep this kind of little zone, this bubble for myself. And we found out that Ruby’d poo’ed inside, which can be a sign of distress so they had to monitor the baby’s heartbeat throughout the whole delivery.
And I remember I sort of sat on the bed, and I was there for maybe, it felt like a long time but possibly an hour, hour and a half. Midwives swapped over, I was in no risk whatsoever, and the baby wasn’t so it was very, it felt very informal, you know very relaxed.
In comes the next one, and she said “Do you want to be sat down?” And of course then, I was like “Active Birth! No, I don’t want to be sat down.”
So the fact that I was sat static for that first initial hour, because I was in such a zone, it’s almost like I needed that other midwife that had that different energy, to go “Do you want to try something else?” I’m not saying the other midwife wouldn’t have done but it needed me to almost kind of wake me out of that zone, to make me think about “Let's Kate think back to what you wanted, in terms of you know the positions that are going to be good for easier [laugh] delivery”.
And I’d managed an Active Birth up to then which I believe brought on the labour very quickly, and so I ended up delivering Ruby on my hands and knees, which was fantastic because I could feel her coming down the birth canal, I could, had that vision in my head, and kept using the breathing that I’d done throughout all of my pregnancy and, It was 17:48, she came, and I remember saying, looking at Richard and I just looked at him and said “We’ve done it!” You know.
So I did have to have stitches after, which was probably the most uncomfortable thing of the whole situation, after managing the whole labour without any pain relief apart from a paracetamol, I got gas and air for that, and then I think we managed to get back onto the ward at about 9 o’clock.
I’d say, probably, eighty percent of me feels like I definitely had the birth that I’d envisaged and wanted. I think for me because it happened very quickly it was a quick labour, I almost didn’t have much time to think.
And I think there’s possibly elements of possibly sort of shock, like a long time after.
I think the fact that I only had to have one paracetamol, I still look back with a slight little cheeky grin. I do get very empowered by that and the fact that I was able to manage the delivery on my own, you just feel, well I did, feel such elation. And I remember that sensation as Ruby came out of the birth canal and she was delivered, this ‘aaah…’ you know this real kind of a sense of relief and just really proud that you’ve actually done that. You know you’ve brought this little person into the world.
And I think I remember … I’m sure I punched the air as if to say “Yes, you’ve done it!”, you know to myself in the toilet, you know. And I got through it. You know I can walk around. And I’m OK!
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Audio 3

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Maddie
My name’s Maddie and this is Amelia. I became pregnant age thirty-nine and have a long-term thyroid imbalance. I was under local community midwives, attached to the doctor’s surgery, and I was also under consultant care, just to check that the thyroid antibodies didn’t cross the placenta. The care was done in conjunction with each other throughout the pregnancy and the green notes were passed from pillar to post. And I didn’t have any complications but they were very attentive.
It was always commented when I went to see medical professionals that I was well-informed. Had I been less informed myself, before I went to see the medical professionals I may not have been aware of the choices that were there because they weren’t always offered to me. But when I asked they said “Of course, yes.”
For example, because of my thyroid disorder, when it came to the end of my pregnancy, I was told that they would induce me on 40 weeks exactly, plus no days. And I asked them what the reason for that was and they said, “We can leave it later if you want”, because medical standards are I believe that you can go to 40 plus ten days or 40 plus 2 weeks. And so eventually the induction was booked in for 40 plus 10 because I questioned them, and as it happened she came at 40 plus 5 days, so I would have had to be induced if I’d gone with their original recommendation.
I had wanted to have a completely natural birth: I had on top of my antenatal classes gone to a hypno-birthing course, and was fully intent on a hypno-birthing experience, however, I had been informed enough that I knew that that may not be possible. And so when I wrote my birth plan it was a birth preference, but without the attachment to that being the only route, because I knew that I may have to deviate from my plan. And I did (laughs).
When I arrived at hospital, I was 4cm dilated which thankfully meant I didn’t have to go home which would have been terrible. The midwife was very keen to adhere to my birth preferences, and honoured the fact that I wanted to go into a birthing pool which I stayed for some amount of time, not as long as I would have liked because it was getting a bit sore and also because of intermittent bleeding and she thought I should get out at 5cm.
I did react strongly to being asked to get out of the bath, because I had set my heart on having it, but actually it was for the best and in trying to become comfortable and relax into the birth, my contractions were so great that I was starting to pull my muscles, so it probably was the best thing and it was the only time when I felt disappointed.
But it wasn’t getting any easier and actually it became clear to me that the way that I was going to best deal with the situation actually not just for me but for the baby was to have an epidural because I was starting to stress so much because it was sorer than I ever anticipated, and how much hypno-birthing practice I’d done, after 5cm it stopped being effective for me.
The rest of the dilation happened when I was on the epidural, and I slept a little, and I talked, and it was quite OK and quite pain free.
I don’t think my birth preferences were unrealistic, and I was happy to deviate as and when was necessary like I hadn’t said in it: “Do not give me an epidural whatever I say”. It was an “If I need an epidural I would like it to be done in this way, and after consultation”. I also had specified that I wouldn’t have a canula in the back of my hand, but in my arm, and they completely respected that, and everything that was done was asked.
During the time when I was dilating from 5 to 10 cm I had a temperature which they weren’t sure was caused by an infection or not, so they gave me paracetamol but when it came to 10 cm the baby wasn’t ready to come out and they didn’t want to leave her for three hours till she naturally came out because she was lying back to back, without testing her oxygen levels. And they couldn’t do that because they felt that they might introduce an infection into her head. So they suggested that I went for a forceps delivery and if that didn’t work after a certain amount of time that they would go for a C-section.
We went into theatre, and the registrar used the forceps to turn the baby in the right direction so she was no longer back-to-back, and then when they were all ready the midwife felt for when the contractions were because I couldn’t feel when they were, and then an assistant nurse and my partner, when they were instructed to, lifted up my head and shoulders and I pushed, and pushed for my life. And. She didn’t move for the first about four pushes and then after that she came out in another four pushes. Squiggled out into this world, and we didn’t know it was a girl until she came out and it was the best surprise ever.
I cannot fault my birth story at all, I mean it wasn’t as my birth preferences had hoped, but before you have a baby you have a set of preconceived ideas which are not completely wrong, they’re the most informed you can be, but when it comes to it, I think you just have to go with it. And we had a calm birth and my greatest fear was that I didn’t know when it came from dilating to having the baby, whether the pain relief would be maintained, and so I had a little bit of fear going on, but they said oh of course it will be, you’re not going to feel that either, and then I relaxed completely and it was amazing.
But if I had been so adamant to stay on my hypno-birthing route, I think the stress levels for me, my partner and the child as a result would have been extraordinary, and it would have been much more traumatic than deviating from my birth plan.
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Discussion

You have heard three quite different stories of childbirth from three women who had different levels of knowledge and who experienced positive and negative relationships with the practitioners involved in their care. You may have found Faye’s story quite distressing; thankfully she and her son are fully recovered and enjoying life. These stories demonstrate that choice in childbirth is not always a reality and can be constrained by a number of factors.

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