Manifesto: Freedom and Physiology

According to a joint statement by the three professional midwifery organizations (ACNM, MANA, and NACPM) in the U.S.:

A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus.

To expand on this definition and explain further, let’s think of birth as something the body is designed to do. Birth is powered by strong muscle contractions of the uterus, facilitated by complex hormonal processes, and assisted by gravity and movement.

98% of births in the United States are happening in hospitals. Unfortunately, for many reasons, birth physiology is not well-supported in our maternity care system.

Women and birthing people often do not have the freedom to birth in a way that respects the science behind how our bodies work. Women and birthing people are often not given the freedom to be fully autonomous decision makers at their own birth and about their own bodies.

My manifesto in support of freedom and physiology consists of four pillars:

• Intuitive
• Intentional
• Informed
• In-Charge

Intuitive

The space and freedom to labor intuitively is foundational and non-negotiable. Those in attendance should not interfere unnecessarily. 

As physiologic labor progresses, birthing people enter into a hormone-fueled altered state of consciousness. Focus turns inward and behavior becomes very instinctual. Intuitive movement and coping strategies are valuable labor management tools.

This state can be difficult to attain and maintain in an unsupportive, distracting environment. Those in attendance can provide support in ways that respect birth physiology and the birthing person’s specific needs at any given time during the process. And often that might mean just being present and holding space.

Intentional

When additional support is wanted or needed, non-medical strategies can be implemented with intention.

If the woman or person in labor is struggling to cope with pain, what additional comfort measures could be helpful? Is there a birth plan that lists specific preferences?

If a more proactive approach to labor progress is wanted or needed, which labor positions would be best to try? What are some options based on where the baby is in the pelvis? Does the mother or person in labor need to rest or are more active positions appropriate? Are there any other strategies or techniques could be used?

It’s important to understand that even non-medical strategies can have a negative impact if not used appropriately. Here are some examples:

• Suggesting a labor position that reduces space in the pelvic inlet when the baby is not yet engaged
• Suggesting a pushing position that limits movement in the sacrum
• Using massage techniques that are irritating to the person in labor

Informed

It is a birthing person’s right to be fully informed, with evidence-based information, about the benefits and risks of all available options.

We need evidence-based information to properly inform our decisions. It’s important to understand that this information should not be presented in a way as to persuade or convince.

Note: Other factors can absolutely be considered in the process and what we ultimately decide does not have to be based solely on what the evidence says.

Here are some examples of what it can look like when pregnant and birthing people aren’t being properly informed about their options:

• “Vaginal birth after cesarean (VBAC) is unsafe.”
• ”Continuous electronic fetal monitoring is necessary for a safe birth.”
• “Don’t get the epidural.”
• ”The Vitamin K shot is dangerous for your baby.”

In the above examples, the decision-maker isn’t being given the whole picture or an accurate assessment of risk.

In-Charge

The ability to say yes or no to medical interventions is a basic human right. The birthing person is ultimately in charge of their own body.

To put this simply, no one should be doing anything to you without your permission. This includes:

• Cervical exams
• IVs
• Medications
• Episiotomy
• Cesarean surgery
• And more

Medical interventions can be invasive and have the potential to disrupt birth physiology, so they should only be used after informed consent has been given. And informed consent has no meaning if there is no true ability to say no (informed refusal).

It’s also important to recognize that medical interventions are valuable tools when wanted or needed. In the event of a complication, they can prevent further disruption to physiologic birth and can even be life-saving.