Why We Can’t Call Birth ‘Normal’

We’ve had some really insightful discussions about ‘normal’ birth recently. What’s the right word for it? It’s a complex debate!

My #MatExp colleague Helen articulated the debate in this brilliant, insightful post yesterday. To sum up the extensive discussions, the post proposed calling birth just that…birth.

I thought I’d take a visual approach to explain why that makes sense.

What would you call the object in the image below?

 

apple

It’s not a trick question…it’s an apple. It’s round, red, and has a stalk sticking out of the top. Apples can also be green, come in all sorts of different varieties and sizes, but we can recognise it as an apple. Despite the variations, all apples look pretty much like this one. Some of you might like apples, some of you won’t. No big deal.

…and the object in this image?

car

Again not a trick question – it’s a car. We know it is a car because it looks like what we understand a car to look like in shape. It’s got wheels – we assume in 3D it has two more wheels on the other side, and a steering wheel, engine, and seats inside. While this particular image looks like a VW Beetle, we can agree that generically, it is a car. Further, while the way cars are built and the technology involved in them has evolved massively during the past century or so, they are still recognisable as a car.

One final image…

baby

Yes, a beautiful newborn baby.

I don’t know how this baby was born: whether vaginally, or C-section. If it was vaginal, whether any intervention was needed to get the baby out. Or if it was a C-section whether it was emergency or planned.

We could share images of all these possibilities. For all the diversity of such images, we would recognise each of them as birth, just as we would recognise variations of the images above as an apple, a car, or a baby.

The difference?

Images of birth would create huge debate, and questions. Which was ‘right’, or ‘wrong’? What was that woman feeling at the time? Why were the staff doing/not doing that? Comparisons with our own experiences, expectations, beliefs.

As far as I understand, the concept of ‘normal’ birth is a response to an overmedicalisation of birth. Too many unnecessary interventions have been leading to trauma in women and staff alike, and some women fearing the delivery room.

Most of us would agree that we want the best possible outcomes for women and babies, for women not to have to endure unnecessary intervention during birth, and for the well being of all involved to be protected.

We all, I think, understand that ‘normal’ birth is intended to describe physiological birth – ie vaginal birth. The word ‘physiological’ is a bit of a mouthful and is unlikely to take off. And talking openly about vaginas? Gasp! No thank you, we’re British!

So, ‘normal’ birth has stuck.

The trouble with the word ‘normal’ is that it has so many connotations, as Emma recently pointed out.

Surely there are so many ways a baby can be born it is impossible to say birth can be ‘conforming to a standard, usual, typical, or expected’ as in the dictionary definition of ‘normal’?

Objects such as fruit and vehicles can be identified easily because they conform to a standard, usual, typical or expected shape or form. Normal.

Birth? Not so much.

There is too much emotion, and perception that is coloured by subjective views.

As Helen described in her post, our perceptions of what is ‘normal’ are constantly evolving and shifting. Apples will always be apples, just as birth is birth.

The unintended consequence of such debates is the emotional impact on women. Expectations about what the ‘right’ or ‘wrong’ way and place to give birth is. Judgement – whether inferred or actual – about whether their experience ‘right’ or ‘wrong’.

Women perhaps feeling like they have failed, or did not do well at giving birth to their baby because their experience does not fall under what is defined as ‘normal’.

‘Positive’ birth is another difficulty. Again, it is well-intended, but a positive birth experience is something no one can guarantee with the best will in the world.

My argument as expressed here is by no means perfect. It is intended to provoke thought and further discussion, and a reminder that:

Language matters.

There are so many ways in which a baby can be brought in to the world, so why do we think there can be an ideal that can be summed up in one phrase?

Calling birth ‘birth’ leaves it open to the woman to use any prefix she chooses to describe her experience. Yes, of course the woman will still need advice, information and support. The key is the woman can feel free to use her own words from her own personal experience and expectations – not deriving from judgement, societal expectations, or perceptions (we can’t wipe out the societal judgement, expectations, and perceptions, of course, but promoting the sense there is no such thing as a ‘normal’ birth would surely help.)

Let’s continue these discussions, to make sure we are always striving for the best, safest-possible care experience for women, babies, partners, and staff – in the labour and delivery rooms and beyond.

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15 Comments on Why We Can’t Call Birth ‘Normal’

  1. Wendy
    September 9, 2015 at 11:16 am (2 years ago)

    Would like to add, it troubles me that people take such an egocentric stance in response to the wider debate about the cultural and medical changes/trends in the management of birth and breastfeeding. Maybe it’s something about Western psychology that we so often read these discussions with the mind-set ‘it’s all about me’. I have had births involving a range of interventions but it’s never occurred to me to take discussion of these interventions as a personal insult or comment on my values as an individual or as a mother. I think it’s actually quite unethical to try to stifle debate about the cultural and medical direction of these practices, or undermine clarity by constantly insisting on a heavy handed policing of language in order to save the feelings of individuals who are struggling to come to terms with their own experiences of birth and feeding.

    Reply
    • Leigh
      September 11, 2015 at 11:32 am (2 years ago)

      Thanks for your comment, Wendy. We’re all human beings with our own views and experiences, and all views are valid. It’s great that it’s never occurred to you to take birth interventions as a personal insult or comment on your values. But it doesn’t mean it does not happen with other women. Distress or trauma does not a narcissist make. I consider your view that stifling debate is unethical, unethical. Surely open debate helps all involved – women, partners, staff – have a better experience? It’s a very paternalistic viewpoint. At no time have I suggested a ‘heavy handed policing’ of language, merely to prompt people to think about the words they use and the impact those words can have.

      Reply
  2. Wendy
    September 9, 2015 at 10:57 am (2 years ago)

    If we hadn’t seen a massive decline in breastfeeding and a massive increase in complicated birth, driven primarily by aggressive commercial practices by formula companies, obstetric mismanagement of births and early breastfeeding and cultural ignorance of how breastfeeding works, then there might not be such an imperative to reorientate ourselves to the physiological norm. I appreciate that in thinking about the language we use to discuss birth and breastfeeding many people’s priority will be the emotional comfort of adults. However, as there are concerns about population scale changes in birth and infant feeding practices that may have long term implications for our health and our children’s don’t we also have a responsibility to discuss these things with clarity and with a sensibility which is grounded in an understanding of biological and not just cultural norms?

    Otherwise we risk losing sight of where we have come from, where we are going and why, and how we intend to get there. I absolutely agree that using the term ‘normal’ in relation to birth may now be problematic, given that the social norm in the US and the UK is a birth which involves one or more of the following: caesearean section, instrumental birth, augmentation, induction, episiotomy, managed third stage, and also in relation to infant feeding in cultures where 98% of babies will have infant formula by the end of the first year of life and where only a tiny, tiny fraction of babies will be breastfed for the evolutionary norm of 2 – 4 years. But why not use the word ‘physiological’ in discussions about birth and breastfeeding practices? It’s not a judgement, simply a description, and a very useful one at that when we’re trying to understand or unpick some of the health issues surrounding labour and birth.

    Reply
    • Ashley
      September 11, 2015 at 12:16 am (2 years ago)

      Superbly well said Wendy. Thank you.

      Reply
    • Leigh
      September 11, 2015 at 11:34 am (2 years ago)

      I’m not arguing about the rights and wrongs of modes of birth. I am not a midwife or obstetrician, and am not qualified to do so. What I am qualified in, however, is to talk about language and the impact of it – as the post says, physiological is too much of a mouthful to take off, which is why ‘normal’ has entered the lexicon. Thanks for your extensive comment, Wendy.

      Reply
  3. Sam
    September 8, 2015 at 7:29 pm (2 years ago)

    I guess this kind of equates to the attitudes people come up against in the breastfeeding v. formula feeding debate – either way the baby is getting fed! It just shows that words can be very powerful and we need to be mindful of the connotations of otherwise throwaway labels. Thanks for linking up Leigh, food for thought. X #thetruthabout
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    Reply
    • Leigh
      September 11, 2015 at 11:35 am (2 years ago)

      Couldn’t agree more Sam, thank you xx

      Reply
  4. Julie Dutra
    September 8, 2015 at 5:52 pm (2 years ago)

    I agree that “normal” might not be the best choice, but shouldn’t there be a way to group all non-cesaerean births? I think “natural” is also quite judgemental but can’t think of anything better… Perhaps we just have to get over ourselves and start using the word vagina in everyday conversation 😉

    Reply
    • Leigh
      September 11, 2015 at 11:36 am (2 years ago)

      Haha, yes, we probably need to stop the schoolyard giggles when we mention ‘vagina’ – you’re right, natural is judgemental too because there is the minefield around pain relief too even if the baby is born vaginally. Thanks for commenting xx

      Reply
  5. Sas
    September 8, 2015 at 11:13 am (2 years ago)

    I can tell you exactly what a ‘normal’ birth looks like. One where the baby starts off on the inside of the mother and ends up outside of her.

    Reply
    • Leigh
      September 8, 2015 at 11:19 am (2 years ago)

      Thanks for your comment.

      Reply
  6. Mary Smith
    September 7, 2015 at 8:14 pm (2 years ago)

    Great post and so much to think about. I am continually amazed by all of the great things you are doing to open peoples minds to how hard the birth process and getting a baby can be for people.

    I remember I had an emergency c section with E as my 1st, I went on to suffer with PND for about 6months or so because I didn’t feel normal..everyone asked “did you have a normal delivery or csection?” like I had done something wrong, and like it wasn’t the norm..it was emergency and out of my control, Id panic!!

    No matter how they get here, they are a blessing x
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    Reply
    • Leigh
      September 8, 2015 at 8:52 am (2 years ago)

      That’s really kind Mary, thank you.

      Your experience is exactly the problem – there is no such thing as normal! – and completely right, they are a blessing no matter how they arrive in the world xxx

      Reply
  7. Hannah Budding Smiles
    September 7, 2015 at 8:08 pm (2 years ago)

    Excellent post lovely and very eloquently put across, I’m sure it will get many brains ticking. I was once told by someone who read my birth story that my description of it as ‘positive’ wasn’t correct because I talk about being in a lot of pain and having torn quite badly. Hmmm, I believe I was the one giving birth and I describe it as positive because I felt empowered by my own mind, my husband and my midwives to make my own choices whilst also giving birth at term to a healthy baby. I feel truly blessed to be able to say that. The pain was irrelevant to the outcome yet it shows that words can be so ambiguous depending upon who says, writes or reads them xxx
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    Reply
    • Leigh
      September 8, 2015 at 8:53 am (2 years ago)

      Thank you, Hannah. It really is for no one but you to decide that your experience of birth was positive – or any other adjective for that matter. xxx

      Reply

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