As part of my Birth Doula training with the Doula Training Academy, I am reviewing Gentle Birth, Gentle Mothering. This book is not new to me – I have read it several times in preparation for my second baby’s birth, as well as for professional purposes. It was written by Sarah Buckley, a family GP who is specialised in obstetrics and family planning.
Gentle Birth, Gentle Mothering is different!
This book is one of the most significant ones there is when it comes to educating expecting and new parents about (natural) birthing and parenting options and is therefore recommended by doulas, midwives, childbirth educators and parents all over the world. To me it is the most important one, and I encourage every pregnant woman to read it.
What is so outstanding about this particular book is that Sarah Buckley is a mum of four children born at home and a family GP. She is also an advocate for and believer in the natural process of childbirth. It is very obvious throughout the book that she “knows her stuff”, both from a personal and from a professional perspective. Being a medical specialist, Sarah knows how to read and interpret the studies incorporated and cited in her book. That way, she allows everyone that is interested to access latest, very relevant research about birth, particularly common tests, procedures and interventions. Her language is not loaded with medical terms, and therefore can easily be understood. In addition, the birth stories of Sarah Buckley’s own children form part of the book, which are just beautiful. This book would have helped thousands of parents already, and will surely continue to do so for many years to come.
Feminism, history and the BRAN method
At the beginning of the book, Sarah writes about feminism (which somehow hasn’t really reached birth and motherhood yet – I think most women agree with that!), and the general situation for birthing mothers in most industrial nations at present – which is a highly medicalised process, that is viewed as possibly high risk.
What I really admire is the statement that her intention is not to advocate a certain type of birth, or birth without interventions, but she wants women to be more involved in their birth choices, and to be able to make informed decisions. This should in my opinion be the ultimate goal for every medical professional or support person that works with pregnant women and their families.
This chapter also explains the very important and well-known BRAN method for making decisions, something that every pregnant woman should know about:
Benefits: Positive impact on my labour, my baby and myself?
Risks: Negative impact on my labour, my baby and myself?
Alternatives: Other options that might achieve similar results?
Nothing: What will happen if I do nothing?
This method is also known as the BRAIN method (with I standing for Intuition).
Possible outcomes, and how to use the the BRAN method are explained using three common scenarios (being testing for gestational diabetes, screening for Group B strep and induction when pregnancy is “overdue”). This it is done to help future parents to get into the habit of looking into possible outcomes more deeply, and how to read and understand the numbers provided in studies. Often times, facts stated by health professionals during appointments can be misunderstood or misinterpreted, as such it is a valuable tool to learn to put these into perspective. A good example from the book is taken from the part about inductions when pregnancies are “overdue”: “One large Danish study that compared uninduced post-term pregnancies […] to term pregnancies (between thirty-seven and forty-two weeks) found an overall PNM rate of four per thousand (289 babies out of 77,956) for post-term babies compared with three per thousand (92 babies out of 34,140) for term babies.” If a mother is in this situation, she might be told by her caregiver that she has an increased risk of stillbirth as her pregnancy has progressed past 42 weeks, and might be recommended to have an induction. This might of course worry her and sound alarming. If you look at these numbers however, you can see that the risk is higher, but still very low, actually only increasing by 1 per thousand, which equals 0.1%. Putting things into perspective like that helps when important decisions have to be made, especially when it comes to interventions like induction, cesarean, but also common tests and treatments that are offered to pregnant women in industrialised nations by default.
Another fabulous content of this book is the information it provides in terms of the different care models during pregnancy, how parents chose the right one for their situation and how their choice can influence the outcomes.
There is also a chapter about ultrasound scans, which are on the rise as a diagnostic tool, but also for “keepsake pictures” of the growing baby (especially using 3D and 4D). Sarah explains that they are not only costly, but they have also not been proven to provide better outcomes (at least for low risk pregnancies, she also explaines that they are indicated in some cases). But what is worse is that there is no proof that they are actually safe for the developing baby. It is known that ultrasound waves create a rise in temperature, which may or may not be harmful to the baby, especially when using vaginal ultrasound early in pregnancy, as there is little tissue between the transducer and the baby to protect it.
Undisturbed Birth = easy birth?
The next part of the book is about undisturbed birth, which means a birth where a woman feels safe, private and unobserved, free of unneccessary equipment and monitoring that could otherwise make labouring and birthing painful, uncomfortable or even frightening. Sarah explains how the process of giving birth has evolved and refined over hundred thousand generations, and caregivers’ views should be based on trusting this natural process, rather than feeling there is a need to correct “dysfunctional labour” by intervening, and how unnecessary many common medical interventions are. She makes clear though that undisturbed neither equals unsupported birth, nor will it be pain-free, or easy.
The hormones of birth
My favourite part of the book is the one about the hormones of birth, how common interventions alter their release, and the consequences. There is clearly a lot more research needed to understand the whole process, but the facts that are known already are quite remarkable! The reader learns about how hormones like oxytocin, beta endorphin, catecholamines and prolactin help to establish contractions, provide pain relief, and are needed for a smooth birthing process. They also help establish breastfeeding and bonding between mother and baby. This is what Sarah Buckley calls “the hormonal orchestration of birth”. I could read this part over and over again, as I am so amazed how wonderfully designed our bodies are, and how this system of releasing hormones at the right time has evolved to ensure safe and relatively pleasurable and easy births for us (as easy as a birth can get, those who have had a baby before will know what I mean!).
TENS machines for labour can be a great form of pain relief, as they stimulate endorphine release.
For more info: https://evidencebasedbirth.com/transcutaneous-electrical-nerve-stimulation-tens-for-pain-relief-during-labor/
There is also a lot of information about common interventions, being the induction and augmentation with synthetic oxytocin, the use of opiate painkillers in labour, and epidural and spinal drugs. This is a helpful summary for expecting parents: Most people might know or at least think that these medications can cause side effects, but what Sarah describes in her book is beyond the information you would find on a package insert, and is linked to earlier explanations in the book. She explains how these interventions interfere with the orchestration of hormones, can create abnormal labours that are potentially painful and dangerous for both mother and baby, how much pain relief they actually offer and what the risks are. It is quite interesting to see studies about what actually happens once the hormone production (especially oxytocin) during labour is inhibited , not just during labour and birth, but also longer term (including breastfeeding problems). There is also information about more interventions that can become necessary as a result, and what outcomes all of this creates for mothers and their babies.
After reading this, everyone should understand that the majority of women would in fact be able to birth their babies healthily and safely, if only we let them. Sarah also stresses it is vital for caregivers to keep in mind that all the important birthing hormones are produced in the middle brain, aka the emotional brain. As such, the more a woman is using her emotional brain, rather than her higher brain, the easier her body can create the cocktail of hormones she will need to birth her baby. This can be achieved by avoiding bright lights and loud noises, conversation and everything else that will need women to be rational. There is a useful list of suggestions for women and caregivers to facilitate an undisturbed birth.
Caesareans and epidurals
The percentage of caesareans in industrial nations has been on the rise for a number of years now. According to Sarah, this is because somehow many care providers and parents believe this might be the safest way of birthing babies, despite the fact that there is no evidence supporting this view. Looking at maternal deaths, caesareans are definitely more dangerous for mothers than vaginal births. But there are also more studies that look into the long-term outcomes for babies that were born by caesarean, and the findings show that they have a weaker immune system, and an altered gut flora, which can obviously lead to all sorts of short- and long-term problems. There is a whole chapter about caesareans, including information about all the risks (to mother, baby, and future pregnancies), and in which cases the benefits actually outweight the risks and a caesarean birth is the safest option. There is also whole chapter about epidurals, their effect on labour hormones, the process of labour, side effects for mother and baby and the impact it can have on breastfeeding. I would encourage every pregnant woman to read this chapter,, given that having an epidural almost seems to be standard these days, and very little information is provided about it.
Placenta – natural or active management?
This is a question that every mum-to-be should be asked during antenatal appointments, however active management is nowadays the standard in most maternity hospitals without much explanation. Unfortunately, more often than not, side effects of the active management are not mentioned. Sarah explains the process, benefits and risks of both options, which hormones are needed to achieve a natural birth of the placenta, and how beneficial it is for the baby to cut the cord only once it has stopped pulsating (optimal cord clamping). She also writes that the active management might actually be needed because there have been interventions during the birth (such as the use of synthetic oxytocin, epidurals, instrumental births and episiotomies), which have disturbed the natural process (including the third stage) and can increase the risk of postpartum hemmorhage. Sarah has also created a useful list of suggestions for the mother and caregiver to facilitate a natural third stage in the book.
Homebirth – safer than you might think…
There is a whole chapter that contains studies about the safety of homebirth, which for many women is safer than a hospital birth, because they can avoid many of the unneccessary interventions that can negatively alter the birth process (as discussed earlier in the book). It also includes ideas and suggestions on how to set up a homebirth.
The last part of the book is about parenting choices that are based on natural attachment parenting, that has become more popular in the last couple of years, including information about breastfeeding and co-sleeping. While I feel the birth part of the book would be interesting and beneficial to every pregnant woman and her partner, the parenting part is probably more important for those that have an interest in gentle parenting, and might not sit well with every parent. I really like the suggestions and personal stories included in this part, but I understand they might not resonate with everyone.
In summary, this book provides a great amount of knowledge on common tests, procedures, the natural birthing process and possible birth outcomes. The information included is balanced, relatively easy to understand, profound, and backed up by studies. The book is written without bias, rather with the mission to inform parents about their options. If you haven’t read it yet, do yourself a favour and buy it – it could change your life!
Written by Kristina Fuderer
Birth & Postpartum Doula