A review on Dr Sarah Buckley’s ‘Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices’
Written by Tina Kokott
Many women, myself included, start educating themselves about pregnancy and childbirth when they are already pregnant. High school sex education is usually of little help when it comes to the multitude of decisions new parents have to make. Not knowing where to start, I crammed as many books into those nine months trying to get as much information as I could. ‘Gentle Birth, Gentle Mothering’ is the one book I wish I read. It is evidence-based, easy to read, authentic, and factual. You will learn what our current birth culture is like, how that affects you and your baby, and what your choices are. No matter what kind of birth you are planning for, what care provider you are choosing, and if this is your first or fifth baby, this is the book you want to read. If you can, do so before you conceive.
About Sarah Buckley
Sarah is a New-Zealand-trained General Practitioner and family physician with qualifications in obstetrics and family planning. She has four children, all of whom were born at home.
‘Dr Buckley’s work critiques current practices in pregnancy, birth, and parenting from the widest possible perspectives, including scientific, anthropological, cross-cultural, psychological, and personal. She encourages us to be fully informed in our decision-making; to listen to our hearts and our intuition; and to claim our rightful role as the real experts in our bodies and our children.’
What is the book all about?
As the title suggests the book consists of two parts. Part one is about pregnancy and birth and includes in-depth reflections on the most common screenings, tests, and interventions. The second part elaborates on the life of parents after their baby is born and compares modern recommendations with evolutionary science. Most resources stop educating at the point where the child is born or shortly thereafter. A lot of parents might feel confident about childbirth but don’t know what to expect after that. Because of that, they might be more receptive to influences that may be more detrimental than beneficial. ‘Gentle Birth, Gentle Mothering’ empowers parents to be confident before, during, and after the birth of their child.
Included in the book are not only the four birth stories of Sarah’s children but also the story of the lotus birth of her son Jacob. She writes about the significance of the baby’s placenta from an angle that is commonly overlooked. By sharing her personal breastfeeding career, she gives an honest insight into the ups and downs of sixteen years of nursing her children. Sharing her personal experiences and the fact that her own choices don’t reflect what women are usually told by doctors, makes the content of the book authentic and accessible. She doesn’t use medical jargon or judgement, but rather evidence-based information in simple language combined with the experience of a mother.
There is no need to read the whole book to gain an understanding. Parents can pick out information that is important at a certain point and use the book as a reference to look back on.
Birth is a feminist issue
I wish every mother-to-be would take the first few pages of the book to heart and feel empowered by them. Birth in modern society is a feminist issue. Unfortunately, it is at the bottom of the list. Our current practices give the impression that women need to be saved during birth. That their bodies are failing. Instead of celebrating how incredible the female body is, women and society generally shame it. Sarah urges us to reclaim our innate strength. To feel empowered about our bodies and its unique ability to give birth. And to recognize that this is what we are made for, exactly how nature intended.
The BRAN model – helping you make the right choice, and what actually is ‘risk’?
The book offers many practical tools parents can use throughout their pregnancy and labour journey. One of them is the BRAN model, which is useful to ease various decision-making processes. Although its use is not limited to medical decisions, it is especially beneficial for people having their first major encounter with medical professionals. The acronym stands for Benefits, Risks, Alternatives, and doing Nothing. Sarah encourages parents to make sure their caregiver discloses and explains all relevant benefits, risks, and alternatives that come with a recommended test, treatment or intervention. ‘Doing nothing’ should also be acknowledged as a reasonable course of action. Yet, it is important to recognize that medical professionals usually don’t disclose all risks and that many risks are yet unknown. Thus, it is crucial to do independent research to make an informed decision.
But what does risk even mean? The risk pregnant women hear about is the obstetric concept of risk, which is based on perinatal outcome. That means your doctor focuses on specific threats to your and your baby’s health immediately before and after birth. While that is of great importance, it does not consider any long-term effects such as the mental or physical health of you or your baby, the establishment of breastfeeding, or emotional attachment.
You can find practical examples of how to use the BRAN model and are guided through the decision-making process around testing for Gestational Diabetes, screening for and treating Group B Strep and being induced for “Going Overdue”, decisions that nearly all Australian parents face.
Ultrasound – isn’t that totally safe?
The short answer is, we don’t know. The last large population ultrasound study was produced in 1990. Since then ultrasound technology has changed a lot. Many studies since suggest negative biological effects. Yet, these are usually not talked about. As the majority of pregnant women receive not only one, but multiple ultrasounds throughout pregnancy, we need further research. Until then caution should be exercised. Especially when it comes to non-medical ultrasounds, the ‘keepsakes’. There is of course a time and place for an ultrasound. For those occasions, the book provides a form to be filled in by the doctor/midwife and sonographer. This way parents have a record of the baby’s exposure and will raise the technician’s awareness at the same time. Your care provider might tell you otherwise, but you don’t actually need to have an ultrasound scan at all!
Nature vs Obstetrics
Growing up I somehow got the idea that the hormones my body produces are a bad thing. They are responsible for my period, my mood swings and so on. Only after falling pregnant I started to appreciate the amazing work our hormones do if we let them. Sarah talks about the ‘hormonal orchestration of birth’. A cocktail of hormones working in sync during pregnancy, birth and postpartum to ensure safety for mother and baby. Modern obstetrics doesn’t need to rely on that natural release of hormones though. They have their own synthetic version. Why would that be an issue?
Induction – not just a quick way to get the baby out
One in three Australian women is induced rather than going into labour spontaneously. Induction is one of the most common obstetric interventions. And it seems like it is also one that many women perceive as not problematic, safe, and even convenient. My personal encounter with induction was luckily limited to an obstetrician urging me to have one and me declining. I have since learned a lot about associated risks and benefits (thanks to this book), none of which I was told by the obstetrician by the way.
Sarah talks about how natural oxytocin (the ‘labour’ hormone) is different from synthetic oxytocin (usually administered as syntocinon to start or speed up labour). She elaborates on the major risks that are associated with induction, such as abnormal fetal heart rate patterns, fetal distress, or even uterine rupture as well as an increased risk for postpartum hemorrhage and lower breastfeeding rates. She clarifies that contrary to common belief, syntocinon doesn’t actually affect dilation and can often lead to a so-called ‘failed induction’ and thus cesarean section. Would equally as many women consent to an induction if they would be fully informed about all this?
Just get the epidural!
An induction is often followed by some sort of pain relief. Sarah explains that reduced pain is not the only effect they have. She gives a detailed overview of the benefits and risks of various drugs, focusing mainly on epidurals. When considering an epidural, women are rarely educated about the risks and concerns that arise for themselves and their babies. Increased chances for instrumental delivery, severe perineal tear, and cesarean section are only a few of them. The increased risk of early mother-baby separation can negatively impact the evolving mother-infant relationship. Interesting to note is that although epidurals offer the most effective pain relief, their use does not increase the mother’s satisfaction with the birth experience.
Does it really matter what happens after the baby is born?
The birth of the placenta is often seen as the ugly, inconvenient part of birth. Sarah’s personal experience of her son’s lotus birth gives the reader a whole new perspective on this life-sustaining organ. We have to acknowledge that the hormonal situation right after birth is unique and will never occur again for the mother and baby.
Hence, this time should be used for attachment and breastfeeding establishment. Yet, current obstetric practices like to see an active management of the placenta. This involves clamping the umbilical cord straight away as the baby is born, which is a major intervention in itself. It requires an oxytocin injection into the mother’s thigh to help the placenta to detach. Although very effective, associated risks are yet again unknown to most parents.
Clamping the cord deprives newborns of about a third of their blood volume, which has a multitude of detrimental impacts. If you consider early cord clamping to collect cord blood, the presented research evidence might surprise you. Requesting a natural placenta birth is usually met with resistance by most hospital staff. The book includes a valuable checklist for mother and caregiver to enable a natural third stage.
I can choose my baby’s birthday!
Cesarean births, elective or not, have been on the rise for a while. Statistics of cesarean rates in developed countries give the impression that there can’t be any major risks associated with that procedure. Otherwise, women wouldn’t opt for it, right? Sarah elaborates how this major abdominal surgery affects mother, baby, and future births. We are lucky having the option of a cesarean section if it is needed. However, the risks outweigh the benefits if there is no medical indication. Needing to have a cesarean section was one of my biggest fears leading up to my birth. I would have definitely not been prepared for it. I love that Sarah gives ideas on how to have a positive cesarean birth if it becomes necessary. That way mothers can prepare for all possible outcomes and feel strong and empowered.
Homebirth – isn’t that dangerous?
Homebirth was common all around the world until recently. Why did it start changing? You will read about the reasons why people started to give birth in the hospital rather than at home. That in itself is food for thought. Choosing the right birthplace is a very individual decision. Yet, it is often led by fear and lack of knowledge. If you are curious about homebirth, how to set it up, and what to ask your potential midwife, you will find great advice in this book.
Birth is not an isolated event
Reading ‘Gentle Birth, Gentle Mothering’ I once again realized the importance of birth as part of the feminine cycle. The choices we make for us as mothers and for our family should ensure that this cycle stays intact. Sarah encourages mothers to start trusting their bodies again. To reclaim their power and autonomy and hopefully their desire for an undisturbed birth. This is paramount in order for the birth experience to be positive. Labour is not dysfunctional. It does not need to be disrupted and corrected by obstetrics. However, it is on us to make the choices that prevent that interference. And it is on us enjoy giving birth, for it being so similar to making love.
‘Is he a good sleeper?’
…is the question I get asked all the time since the birth of my son. There seems to be a slight obsession with infant sleep nowadays. In the second part of her book, Sarah talks about how expectations around sleep in our culture are not realistic from a developmental point of view. And how our need to make babies independent sleepers is harmful and stressful for baby and parents. She looks at natural mother-infant sleep form an evolutionary perspective. The benefits, concerns, and safety of cosleeping are addressed as well.
Apart from sleep deprivation, the life of a new mother is also ruled by her newborn’s constant need to feed. Western cultures have high rates of formula feeding. Often parents are not properly informed about the benefits of breastfeeding. Or what their children miss out on if they opt for formula. There is only a small percentage of women that don’t have a choice and can’t breastfeed. The vast majority of women are able to and should inform themselves before choosing to substitute. Sarah also touches on ‘extended’ breastfeeding and its benefits. Unfortunately, it is still not widely accepted in our society.
The research presented in the book recommends the opposite of current parenting literature. Practices such as “cry it out” are critically looked at from a neuroscientific perspective. Sarah urges parents to ease mothering and enhance baby’s development by promoting continuous body contact, ongoing breastfeeding, and cosleeping. Remaining calm and physically close to our children will help them during unavoidable stress.
Love is all
As per epilogue, we should “… [take] the time to think and feel, [use] instinct and intelligence, heart and mind” to make the best choices for our children, our family and ourselves. It is important to also acknowledge birth and parenting trauma and to recognize any feelings towards our birth experience. Just because society perceives our birth as ‘normal’, ‘positive’, or ‘lucky’ doesn’t mean we have to feel good about it. Sarah reminds us that as parents we make mistakes, we are not perfect, but we are all doing the best we can. And with love, connection, and nurture we can contribute to making this world a better place.
Written by Tina Kokott