Podcast: Physiological Birth & The Maternity System with Guest, Midwife Dr Sheena Byrom OBE

Physiological Birth & The Maternity System with Guest, Midwife Dr Sheena Byrom OBE

Season 1, Episode 4

Last year in the UK only 52% of women went into spontaneous labour. An even smaller number ended up having the physiological birth the vast majority of women want and expect when it comes to meeting their babies. In a highly technological era, what does physiological birth look like for the modern woman? And how does this fit in to the current maternity system?

This week I am joined by the incredibly inspiring Sheena Byrom OBE; Independent Midwifery Consultant, Midwife of over 35 years, Author & Speaker; to unpick all of this! Sheena works tirelessly across the world, transforming maternity systems with a focus on supporting physiological birth.

Regardless of what kind of birth you are planning, expecting or hoping for, this episode delves into how normal physiological processes in pregnancy, birth and postnatally can be supported in all environments, for all women and babies.

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TRANSCRIPT

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Welcome to The birth-ed podcast, where we open up conversations about all aspects of pregnancy, birth, and parenthood, so you feel fully informed, confident, and positive about what this journey might entail.

I'm Megan Rossiter, founder of Birthed, and your host here at The Birthed podcast.

Birthed offers comprehensive, positively presented antenatal and hypnobirthing classes, both in person and online.

So if you like what you hear, be sure to come check us out on our website or social media.

Don't forget to hit subscribe so you don't miss any of our upcoming episodes.

Believe me when I say we will leave no stone unturned when it comes to preparing you for your pregnancy, birth, and the postnatal period.

So welcome to The Birthed podcast.

Today, I am honored and excited to be joined by a very inspiring guest, Sheena Byrom OBE, who is an independent midwifery consultant, a midwife of over 35 years, an author, a speaker, and co-owner of the Practicing Midwife Journal, and importantly, also a mum to four and a grandmother to nine.

So Sheena, welcome.

Thanks so much for joining me.

Oh, thank you, Megan.

It's really an honor to be invited to join you.

So yeah, I'm delighted.

Good.

Thank you very much.

So this episode is, we're going to kind of focus on physiological birth, which kind of sounds either like a potentially broad topic or kind of quite a weird thing to potentially just focus a whole episode on, particularly because this is something that the vast majority of women, I think around 80 percent want from their births, and generally quite rightly assume that this is the norm when it comes to giving birth.

However, in 2018, actually only 52 percent of women went into labor spontaneously.

And I think the estimate is that around only 20 percent of women ended up with a birth that didn't have some kind of intervention in it.

And these statistics are quite generally for most people quite surprising, quite staggering.

So Sheena, to kind of kick us off, I basically want to start by taking it right, right, right back to basics.

And before we can start talking about kind of the ins and outs of it all, what do we need to understand kind of as women, as humans, as mammals, about the process of birth?

What is going on inside our bodies in labour essentially?

Well, I think actually, Megan, it would take me a whole session just to talk about that in itself.

And really, it's best to I think rather than me explaining it here, it would be really good to for mums and fathers and expectant parents really to have a look at Sarah Buckley's website or to take some form of program of education to really kind of help them to understand it.

Because it's just not sorted in one sentence.

You can't describe it.

But basically, physiological childbirth is in a nutshell is really a basic science.

So it's the oldest research evidence that we have.

It's the oldest knowledge that we have as women, as humans, as mammals, as whatever we want to call ourselves.

And really, it's the process of a woman's body spontaneously going into labor.

Actually, in the antenatal period, her body is getting ready for the moment of birth all the way through.

There are subtle changes happening to her body all the time.

For example, her hormones get ready for milk production, and they also get ready for the softening of the cervix, and they get the uterus ready to contract.

So all the way through pregnancy, this is happening.

But it's such a finely tuned, detailed orchestra of happenings that it's worth really looking into.

It's quite exciting, and sometimes health professionals actually don't really understand the nitty-gritty of it because they do it maybe at the beginning of the training, if at all, and then they might not cover it at all after that.

So it's something that I think that we forget very easily.

But when you're having a baby, it's worth really having a look at it because there are things that you can do to maximize the potential of your body working in a way that really it's designed to do.

So the physiology of pregnancy, labor and birth and the postnatal period is a huge topic, but it's a very exciting topic.

And it's just really all about your body working as it was designed to do.

And that includes the moment of birth and the period after the birth.

So the postpartum period where a mother and baby are getting to know each other.

Again, there's physiological processes that if you do certain things, you will benefit those processes.

So you'll make those processes happen in a better way than you would if you didn't know.

It might not happen in the same way if you didn't know about it.

So things like skin-to-skin contact at birth, zero separation from your baby, having nurturing around you, having people to care for you so that you can focus on your baby.

All these things help the mother-baby relationship, and that's really important for not only that family, but for future generations.

So I've tried to put that into a short sentence, but it's sort of...

I do think that it's just something very, very worth...

For all of us, we really...

You know, just as you would doing exercise, and knowing what the best exercise for you is, or knowing what the best food to eat for your body is, when you're having a baby, it's really worth looking at how your body usually works.

Yeah, and I think this is always the bit, whenever I sort of teach this to parents, particularly dads always find this part very interesting, is once you kind of understand the hormones that are involved in birth, the kind of the muscles that are involved in birth, it kind of makes everything else click into place, and the reasons why you want to do certain things and not do other things, kind of, yeah, it makes it all make a little bit more sense, I guess.

Exactly, exactly.

It really does.

And we've, because I'm sure that we're going to chat about this later, Megan, but, you know, as we move into a highly technological age, and, you know, I love technology, I love my phone, I love kind of gadgets and things, but I think when it comes to the birth of a baby or the journey that a woman has and the parents have from the beginning to the end of their sort of pregnancy right up until the postnatal period, I think that the less technology we use and the more connected we become to nature, the more connected we become to that physiology and respecting it, then I, you know, I do think that we're optimising, optimising opportunities, and that's all we can do is optimise opportunities all the time.

Yeah, absolutely.

And so can you just give a couple, I don't know, we'll probably go into all of this in more depth, but a couple of examples of things that you can do in labour, simple things to kind of promote the physiology of birth.

Oh, yes, there's lots of things.

And, you know, I think just, well, first of all, being prepared.

I know, so you're asking me in labour, right?

Okay, so that's all right, in labour.

Well, I would say create your space.

So the first thing would be to make sure that you take in with you things that make you feel happy, things that make you feel comfortable, that you know that you can associate with.

It might be your something that you have at home.

It might be your favourite smells, music, favourite music, whatever.

Take it with you and try to create a space.

So even if you're in a highly medicalised environment, then you can maybe just create your own tiny area or large area if you can, where you feel safe in that and you've got things that are familiar to you.

And just kind of try to prepare for that maybe beforehand, thinking about what you could take.

But whilst you're there in that space, just keep those things around you, and that can help because actually your brain really does affect the way your body works.

So the more you can keep association with things that you kind of have in your mind for being positive, then it will help you to get through it.

I also think that having someone near to you, someone that's within your circle of support.

So when I talk about circles of support, it's really people that you really trust to help you to get through and to really kind of achieve what you want to achieve from your birth.

So whatever you've got in your mind for however you want your birth to be, then those people will be the ones that try to hold that space for you.

So they know all about those things that you take with you.

They know that that's important to you, and they know how to kind of advocate for you if you're feeling tired or you're sleeping or you may be in another place.

They're there for you.

And so those two things, really, they're associated with each other, but they're kind of the things that I would really focus on.

And that partner who is with you to hold yours, to help you to hold your space is really, it couldn't be anyone.

It can be a family member.

It can be a doula.

It could be an independent midwife.

Do you know, it's just really anyone who you absolutely trust.

So I would say that those two things are really, really important.

Am I allowed to say a third thing?

Yes, of course you can.

I suppose trying to keep us upright and mobile as possible, which is another kind of, you know, really, in all the years that I've been a midwife, I think one of the striking things is how wrong it is that we assume that women should go on the bed.

And for all of my career, perhaps at the beginning of it, in the 1970s and 80s, I didn't realize how wrong it was because that was in my training that women just led on the bed.

But as I've learned more and more, and as I've seen women birthing for decades, I can see that there's an absolute difference between someone who is a midwife mobile and free to move into any position she wants to.

So she might want to lie on the bed.

That's absolutely fine.

When I had my last two in a birth center, I actually wanted to lie down, and that's fine.

I just led on my side, and I was absolutely fine.

And I loved it because I rested a lot.

But what I've seen other women giving birth, the majority of women that are in the space where they've created, whether that's in hospital or at home, when they've been free to move around, they've moved into positions that actually have been the best to allow the baby to descend in an appropriate way.

So most women, for example, when I've helped women to give birth at home, will get up out of the bed, stand up, move forwards, lean forwards, rotate, rock their hips, backwards, forwards, from side to side, turn their feet inwards, create positions that actually, physiologically, they're making the space, they're opening up the brim of the pelvis and the outlet of the pelvis so that the baby has the maximized space to get through.

So they do that sort of spontaneously, without direction.

They just do it.

I was just recently in Bulgaria and doing some talks with midwives there.

And I was absolutely horrified because women there always give birth in lithotomy.

100% of women give birth in lithotomy.

So lithotomy is laying on your back with your legs?

Yes, with their legs strapped into stirrups, legs flat on their backs.

There's always a doctor and a pediatrician in the room, and their babies are more or less managed out of the birth canal by pulling and tugging and pushing.

And it's actually horrifying.

And yet the midwives cannot see that another way would be possible.

Even when we've spoken to them about another way, they really find it difficult to understand that.

And I was in Africa before that, and some of the midwives were telling me there that women in Africa, in this particular part of Africa, I think it was Namibia, they were telling me that when women got to the second stage, they started to get violent.

And when I asked the midwife, why did women get violent?

Why did she think that happened?

Because I had never seen that in my career.

She said that women wanted to get off the bed, but they weren't allowed to get off the bed for various reasons.

But they were trying to get off the bed, and when the midwives weren't letting them get off, they got really angry.

So I suppose what I'm trying to say here is that if physiology is facilitated, so if we support women to understand and respect how their body works, if we help them to do that, they will naturally do it.

They will automatically go into those positions and those spaces.

So I gave you three things there, but they're all interlinked.

Yeah, absolutely.

And I suppose I probably should have pointed this out at the beginning because this is probably where the physiology of birth comes from, is that actually the things you've just been saying about women being on a bed and things, even for the vast majority of women in the UK at the moment, I do an exercise at the beginning of our classes where I get everybody to draw a picture of what they think it will look like when they give birth.

And 90% of the time, before anyone's done a course, they draw a woman on a bed because this is what we think birth looks like.

And I think like a helpful comparison and something for some reason we just don't have it with, I suppose, a system that is inherently female maybe.

But we don't generally doubt our ability to breathe.

We get up in the morning confident that we've breathed all night, happy to kind of go away breathing without questioning whether or not we're going to do it.

We don't tend to doubt our ability to eat and digest food.

And I suppose the reproductive system or the birthing system is a physiological system in the same as any system that is in our body.

But we kind of have a lot more doubt over that system than we do in any of the other normal physiological systems in our body.

Absolutely spot on there.

And I'd like to say that I always talk about this when people say to me, we shouldn't be talking about normal birth.

So basically, when we think about the term normal birth, I understand that for some women, it feels like there's a judgment call here and that we're talking about then if they didn't have this physiological birth, then it's abnormal.

I don't think we should ever refer to any birth as abnormal.

But we do know that there are some births that need intervention and that there are complications.

Some of my daughters and my daughters-in-law had complications and that we're absolutely so lucky that we've got immediate responses to when there is a problem.

But talking about normal birth isn't a judgment call.

It's like talking about normal breathing, normal walking, normal bowel movement.

When we talk about public health, we refer to these things.

So for example, encouraging someone not to smoke, we'd say it can change your pattern of breathing when you're older.

So we know what the normal limits are of breathing, like you mentioned.

So we can talk about that, but we can't talk about normal birth, normal physiological birth, because it seems to be this judgment call, which is a shame really because it's never intended to do that.

We're basically describing actually what should happen to a woman's body when she goes into labour.

Sometimes it doesn't happen, but we have to remember that it's there anyway.

So it's just something that's there since time began.

I listened to a really interesting interview with Maisie Hill, who wrote Period Power recently, and she commented about, somebody asked her a question about language, and she just basically replied saying, to be honest, I don't want to get caught up in the semantics of language because the minute we start debating which word to use, we stop debating what the actual issue is.

Exactly.

If we are arguing between physiological and normal and natural, then we're not talking about birth, we're talking about words, and then you end up kind of losing the focus of what I guess you were supposed to be talking about in the first place.

I absolutely agree.

I absolutely agree.

But what we have to be mindful of here, Megan, is that, you know, this isn't about trying to get into some kind of movie, film of wonderful, blissful things happening.

It's about just having what really we're entitled to do.

So it's just having that respect for how our body works.

So just really taking care of that.

And it isn't rocket science.

It's just getting right back to basics, trying to take out all the layers and just get back to the fundamentals of how a baby is born.

And it's interesting because I've just done an interview.

I don't know whether you know, but I started doing podcasts about, well, a few months ago.

And the last but one interview that I did was with my old boss, my old head of midwifery.

And she's called Pauline Quinn.

And I asked her if I could interview her for a podcast.

And I asked her about when she was a pupil midwife.

We used to call them pupils in the 1960s.

So she was working around the time of call the midwife.

And she said, as a student midwife, she only did 12 months training because she was already a nurse.

Six months she did in the hospital, six months in the community, a part two.

And when she said, I've heard this before so many times, and I've read about it, when you were a student pupil midwife, you had to go out to births in the community on your own.

This is after six months' education.

You had to go out into people's homes.

She couldn't ride a bike, so she had to catch a bus.

She didn't have a car.

And there were no phones, no phones in the houses many of the time.

And she said sometimes she got there, and the man of the house would have been out somewhere doing things or taking his children somewhere.

So she was totally alone, sometimes with the neighbour hanging around just to make sure everything was okay.

And so she said she helped women to have babies in their home as a student midwife, pupil midwife for six months like that on her own.

And she rarely contacted the midwife.

A, sometimes she couldn't get hold of them because there was no phone.

And B, she said by the time they got there, the baby would have been born anyway.

So I asked her the question, so during that six months time, how many transfers did you do and how many emergencies did you have?

And she said, well, to be honest Sheena, I didn't have any.

I didn't have any.

And she said, and none of my friends did either.

She said, we heard of a few transfers, you know, we'd learn about them, that it happened.

But she looked at me in the eye because she knew why I was asking her that question.

And she said, it really is quite remarkable, isn't it?

And so I just think that, you know, what are we doing now?

What are we doing?

We've moved women out of their homes for giving birth and made them believe that actually giving birth is safer in hospital.

Yet we know that when women give birth at home and or in mid-refill ed centers, not only are they as safe in most circumstances and their babies are as safe in most circumstances, but actually women prefer it.

They like it.

When I say they prefer it, I mean the satisfaction rates are higher and there's less medical intervention.

So we're still trying to grapple with that.

And we know that we've got that evidence and it's very, very clear.

And yet women still most of the time don't get the choice to give birth in that way.

And nor do most women want to do that because they still feel that it's safer to go to hospital.

So I think that birth should be equally as empowering and as wonderful whether you give birth in hospital or at home.

I do believe, truly believe that, that it should be the same.

But unfortunately, it isn't.

And we're a long way off making it so.

And I think we should keep striving to do that.

And one of my absolute passions is to try to get hospitals to work in a way that we know women prefer.

But it's almost, you know, it is a huge challenge.

But we have to keep working that way.

Yeah, and your sort of newest book kind of touches on that.

It's aimed at health care professionals, isn't it?

The squaring the circle book.

And that's kind of about how something that I think is quite interesting that you kind of already touched on is how birth is not simply a physiological event, but it's a psychological event, an emotional event.

And until we consider all three every single time we think about birth, we're never going to be able to fully support or understand physiological birth, really.

Exactly.

And that's it.

It's just about considering all those things.

I don't know whether you heard yesterday on the radio, Millie Hill was talking about giving birth like a feminist.

She was talking about her new book.

She was on the Jeremy Vine Show, and the other person was Dr.

Sarah...

Is it Sarah Davis?

Jarvis, I think.

Jarvis.

Sarah Jarvis, that's right.

And there was this huge debate about safety and about women wanting a birth and feeling like failures, wanting a particular kind of birth.

And there was a confusion, I felt, between the issue of experience and safety.

And so we should stop this confusion.

And I think the questioning and the answers from this GP were completely wrong in that they were sort of fed particular statements.

And then the responses were almost like it had been scripted in that you had to have one or the other.

You couldn't have both.

And we have to stop thinking in these dichotomies and think, right, we can actually have both.

We can actually be safe and have a good experience.

And in fact, experience is actually part of the safe birth agenda.

So we haven't to think of it as separate.

If a woman doesn't feel comfortable, if she's not having her needs met, like you say, psychologically, physically and physiologically, then she's not going to be in the safest place.

Because if her mind isn't connected, if her mind isn't in the space with whoever's in the room and with the baby that she's going to connect with when the baby's born, then that's not safe either.

Are we supposed to leave damaged women and just make sure that we have a healthy baby?

Absolutely not.

So I felt quite sad listening to it, because I just sometimes as well, I feel that there's a huge hierarchy between a doctor saying something and a mother saying something.

And I felt that that just wasn't balanced at all.

It was almost like the doctor was saying, Oh, no, I know best.

And, you know, don't even consider it.

Listen to me, everybody.

You know, I just felt so frustrated with the whole thing.

As did I.

And I think something that kind of comes into that is that we sometimes, well, I say we, I don't, often you see women's expertise kind of diminished or not thought, you know, women are experts in their body and in their baby.

And that goes in both ways.

Women can say, actually, everything seems fine and healthy and kind of happy as I am.

And sometimes women go, something doesn't just something doesn't feel quite right.

I don't know what it is, but it doesn't feel quite right.

And that is, you know, even more important than what research on a bit of paper says sometimes, because intuition is something that we definitely shouldn't underestimate.

Absolutely.

Yeah, absolutely.

And I totally agree with you.

In this circumstance, however, there were two women.

And so I always say when I talk about women having babies, I always talk about me as one of those women, because, you know, health professionals aren't separate to women.

If they're women, you know, we are women.

And so, you know, sometimes I hear my colleagues say, oh, the women I care for.

And I say, we're one of those women.

Just remember that, that we are them.

So I totally agree with you.

But I kind of like to add on to that is that being a health care professional and, you know, sort of being a midwife for, you know, for such a long time, I have seen sort of all the way through my work, I've seen this hierarchy of kind of, you know, first, it's at the top, it's the doctor.

The second, it's the midwife.

And third, it's the woman who's having the baby.

And it's almost like you could draw it like that.

And I've tried to really, really hard to change that.

Certainly in my practice, I've, you know, I've kind of moved away from that.

I moved away from it many years ago, but it's still there.

And I thought, I think that what that interview did yesterday was highlight exactly, highlighted the patriarchal system.

So even if you're a woman and you're a healthcare professional, you can still be in that shocking position where you think that your knowledge, that your positional power is much more, you know, you're sort of throwing it out there and saying, oh, no, no, no, this isn't, this isn't so.

I just feel really sad about that.

And that's why books like Millie's and your work that you're doing, your education program that you're running are so important because what you're doing is you're counter, you're counterbalancing, you're counteracting that kind of pressure that's everywhere.

And you're saying, no, hold on a minute.

We know as much as you do in that we know about our bodies more than you do.

Your expertise lies in when things go wrong or potentially go wrong.

And we kind of, we just want to stay as safe as possible in that we know about our bodies and potentially our babies.

So I think that's what you were getting at, really.

Yeah, and I think it was worth pointing out that this is by no means every obstetrician.

I was looked after by four obstetricians throughout my pregnancy, and actually they were all on exactly the same side that I was.

They were incredibly supportive of my choices and presented everything in a very balanced way.

But again, I don't know how much of that was because I kind of knew what questions to ask and knew that I could be involved in these decisions.

And it's sometimes very easy to end up just kind of nodding along if you don't realize that actually you get to be involved in decision making.

I agree with you.

And so my point isn't to diminish or demonize doctors at all.

In fact, I was just explaining the hierarchies that exist within healthcare settings.

But some of my best friends are doctors, some of my closest allies, actually, were obstetricians.

And so I'd like to really kind of reiterate what you said here, Megan, because sometimes it's midwives that kind of put the pressure on and are kind of in that model of hierarchy.

And sometimes women prefer that.

So we've also got to remember that, you know, there are some women and some families that actually prefer to be directed and told what to do by a doctor.

And that's fine, too.

So, you know, this is only about if you don't want to do that.

And it's about, do you know, kind of learning about really what happens out there?

Because I talk to many of my children's friends, and they'll ask me about what I do when I talk to them about it.

This is, you know, sort of friends from all around the world, actually.

And some of my family live in America, and they say, oh, gosh, we didn't know that.

So, for example, they'd ask about, my nieces in America were asking me about epidural.

And when I talked to them about epidural, they said, well, we didn't know that.

We didn't know that that happened, and we didn't know that it changed the physiology of our bodies.

Nobody told us that.

We just knew that it took all the pain away.

Yeah.

So this is why your education programs and what we do, me and my daughter, running the Practicing Midwife, this is what we hope to do, is really try to get as much knowledge out there as possible so that women can make those decisions around.

If you do want to go to see your midwife or doctor and be told exactly what to do, that's fine.

You know, there's no problem with that, but do understand that there's other things out there that you may not know about.

So I think this leads us on probably quite nicely to, I think it's quite important to note that for some women, a small number of women, but certainly for some women, pregnancy and birth can become a more complex event.

And I always talk about these situations as the moment that physiology and pathology kind of bump shoulders.

So kind of like illness and wellness kind of jumble together a little bit.

And for some women in these situations, closer monitoring and maybe a little more intervention can be incredibly helpful.

But I think the World Health Organization states that when we see kind of worldwide Caesarean figures going beyond about 15%, we aren't actually seeing any improved outcomes for women and babies kind of overall.

And I've got a bit of a theory here that I'd love to kind of hear your thoughts on.

And for first of all, it seems to me that more and more women that I'm working with are getting this kind of high risk label attached to them.

And in some ways, I wonder if this becomes a bit of a self-fulfilling prophecy.

Because for starters, when you have this kind of label high risk, it kind of makes you feel more likely that you're going to need help and then probably more likely to therefore accept it.

And the second thing that this kind of label does or this kind of care package often does is that it drives women into giving birth on labour wards, which essentially are in no way designed to facilitate physiological birth.

And we know when we look at kind of all of the big studies looking at the births of low risk women or people with uncomplicated pregnancies, we know that being on a labour ward increases the chance of intervention.

And that's probably transferable to anybody that's on a labour ward, even if they're there for potentially a better reason.

And so I always feel like women who do have more complex pregnancies end up with a bit of a raw deal, because even if initially they are likely to need support from a multidisciplinary team in their pregnancies, in their birth, then quite frustratingly, bright lights, beeping machines, the kind of becoming the role of a patient becomes par for the course of getting this label.

Would you say that's kind of true?

What are your thoughts on that?

Right, well, you've covered a lot of ground there.

You've actually covered quite a few issues, but I agree with everything you say, and I think that there is so much truth in all the points you made there.

But there's more to it than that, I think, even.

I think there also comes into it the fear of the healthcare professionals that transfers to women, and the fear is a huge topic in itself because that has many dimensions.

And the high-risk labeling is probably one of the most shocking things that has happened in my career, that we use the word risk more than we use the word relationship.

And it's just become the focus of everything.

And we need to stop using the word risk, in my opinion.

That doesn't mean we have to stop risk assessing, because we should be doing that all the time.

Just as when I, because I've got a problem walking at the moment, because I've got something wrong with my back.

And I have to risk assess the path, as I'm going along it.

In all my life now, I have to risk assess.

So, do you know, I think that as a midwife, we should be doing that.

It should be absolutely part and parcel of every single connection we make with women.

But it doesn't mean we have to give women names and labels and stick things on their notes, because it makes it easier for us, and it makes us stop, you know, sort of reduces error.

You know, if we had more relationships, sort of focus on relationships, then we would be diminishing that potential of error.

But, yeah, so going back to your quote from the World Health Organization, what they say is that any caesarean section that's above 15 to 20 percent, I think it's 15, it doesn't come with any benefit to mother and baby.

They don't say that it's wise to have a target to reach, that that's not the way forward.

So the latest evidence is that you shouldn't be working towards a target, but we should be trying to reduce unnecessary intervention.

What we're seeing is that we're pathologizing women that don't need to be having it because of this risk label.

So we're moving all the time towards monitoring, monitoring, monitoring.

And wherever you look, there's kind of a focus on this, what could go wrong all the time.

So women are starting to, I believe, over decades have stopped losing faith in their bodies.

They think that there's potentially something going to go wrong any minute now because of it.

And yes, you're right, so women who don't have any chance of complications, who are having a straightforward pregnancy, are very often sort of diverted towards that risk label through their journey.

But women who do need, genuinely do need, for example, a woman with preeclampsia or a woman with diabetes, and needing that extra care, that extra support during pregnancy, what happens is then, like you say, she seems to get a really raw deal because everything lands on her lap.

She has all the extra visits to make, which is really important.

But then she seems to be forgotten in that her experience doesn't seem to matter as much.

And that's what we should be really trying to change, as well as supporting women to give birth in different environments.

So, for example, one of my daughters, my youngest daughter, had a tumour when she was pregnant with her second baby, and she didn't know she had a tumour, but it made her blood pressure sky high.

So when she was first pregnant, she booked to be in a birth centre.

And then as her pregnancy advanced and her blood pressure was going up, going higher and higher, because the tumour was enlarging and it was secreting adrenaline, she had to then go to the...

So she was going to go to an alongside birth centre, so she had to go into the main labour ward, the obstetric unit.

And one of the things she said to me, so she went in for...

when she went into labour, she went into the obstetric unit and she said to me, it's really sad in here mum, because there are no butterflies.

And that's because when she had been going to be checked over, she had gone into the birth centre and seen all the beautiful decorations.

But as soon as she moved into the obstetric unit, that was different.

So she was then in a different environment and she really noticed it.

So we have to try to make the rooms different and try to change the environment, because we know that the environment absolutely impacts, potentially impacts on the outcome, on the woman's experience, on the way she births a baby.

And even if she does need intervention, and she, like my daughter, really she needed a serine section, but what she did was she stayed in control of her physiology as much as she could.

So she didn't close the door.

She didn't say, oh, that's it now.

I can't have anything.

I may as well just give up.

We chatted to the obstetrician and said, so that she has choices, and so that the baby can have the best possible start in these circumstances, and so that the mother can have the best possible start with her baby, let's do these certain things.

Can we have these things?

And so that's when the physiology comes back into it and respecting it, such as optimal cord clamping, mother-to-baby, skin-to-skin contact, uninterrupted, zero separation, creating that space.

You know when I talked about creating a space in the labour ward to optimize physiology right at the beginning of the podcast, Megan?

Well, we have to think about this for Cesarean section as well.

And I've got an amazing photograph that was given to me by a mum and dad who did exactly this.

They created, and the healthcare professionals, they created it with the blue towels.

And so they had their own little cocoon at the top.

So when the baby was born, they went into this little cocoon that was just theirs.

And it's an incredible image.

And it's just full of love, you know.

The whole area is just full of it.

So that should happen as well.

And if that can't happen because your baby is sick and your baby has to go to the neonatal unit, then there are other ways that you can maximise physiology by going to be with your baby as much as possible, right next to your baby, holding your baby, touching your baby.

And if you can't be with your baby because you're sick and the baby is sick, then you can do it later.

So you can actually reconnect to get back to those moments when your baby is well and you're well.

You can do all the skin to skin then.

You can do all that absolute attachment then.

And there's ways of doing it.

It takes a little bit longer, but it's important that you know about it.

And there's fantastic YouTube clips by Nils Bergman.

I don't know whether you've seen them.

It would be great to direct your parents to this.

Nils Bergman.

It's spelt N-I-L-S.

And then I think it's B-E-R-G-M-A-N.

And he's a...

I think he might be a Kiwi.

I'm not sure.

Or a South African pediatrician or neonatologist.

And he does these beautiful clips about how to respect and support physiology in any circumstance.

So that's my kind of message, really.

So whilst I'm...

Much of the time I focus on supporting normal physiological birth is because it's diminishing, because the number of women that are able to give birth without any intervention, like you've quite rightly highlighted, is diminishing.

And that is an absolute crisis.

So it's a public health issue, and we are heading towards a birth crisis, in my opinion.

And I would argue that if we continue on this trajectory where more and more women are having interventions that don't need it, they're having routine medical interventions when they're not necessary, then we are sort of going towards a time when perhaps midwives may not be needed because we'll have doulas who can provide the nurturing support and we'll have obstetric nurses who help the doctors to perform the interventions.

But midwives, you know, if we don't look after and support physiology, then our absolute key element of our role as midwives is, and it's there in our scope of practice on the International Confederation of Midwives website, is to support and promote normal physiological birth.

That's where our autonomy lies and that's where our skills lie.

So I know that this podcast is for parents, but hopefully some midwives will be listening too because that's your job, guys.

And we need to be supporting and helping women to have the maximum opportunities.

Fantastic.

Well, that's probably quite a good place.

I mean, I think we could probably talk about this all day, but that's probably quite a good place to kind of wrap us up and just understanding that physiology is, you know, the physiology of birth is not just one day.

And it goes, you know, throughout pregnancy, throughout labour and birth, the postnatal period and kind of right on through your child's life.

And there's the opportunity to kind of promote that and the kind of all of the benefits that that brings is totally an ongoing thing.

And I think that was a really nice thing to kind of highlight for all women to kind of take away from this, hopefully.

So the kind of the very, very final question that we ask all of our podcast guests is if you could give pregnant or birthing women one thing, what would it be?

I would give them a midwife that they knew and liked and trusted.

So that's what I would definitely, whenever you get, we get continuity of carer, whenever midwives know the woman and the woman knows the midwife, it is a different experience.

But if she can't have that, so if there isn't that facility in her area to have continuity of carer, I would give her a happy midwife who was nurtured and supported in practice and someone who really wanted to be there at that moment caring for that woman and to build a relationship with her to make sure that she gets the best possible experience and outcome as possible.

Lovely, perfect.

Thank you so much for joining me, Sheena.

You're welcome.

If people want to kind of follow your work, either mums to be, parents to be, midwives, where can they find you?

Well, I do have a website which is just my name, Sheena Byrom, and they can get me via that.

I am on social media, so I use Instagram, Twitter, Facebook and LinkedIn.

So I'm kind of everywhere, really.

And me and my daughter own something called All for Maternity, which is a learning platform for health care professionals.

And it includes two journals, the Practicing Midwife Journal and the Student Midwife Journal.

But very soon, next year, we're going to be collaborating with Waleeda, and we're developing an area on our website for parents to access evidence-based information.

We started it.

It's called All for Birth.

So it's there already.

You can Google All for Birth.

And there's lots of information on there already.

We're going to have lots of different elements on there for women and parents to be, to access, and already parents who have already got their babies.

So it's going to be mainly evidence-based, but we'll also have other kind of resources on there, too, like films and guidelines.

So they can go there already.

It's free to access.

Perfect.

Thank you so much.

Thank you, Megan.

And it's been really nice chatting to you.

I hope you have a great day.

Thank you.

Thank you so much for listening to this week's episode.

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