20 Margaret Jowitt
Channel: Virtual Midwives
Date: 2023-05-15

Baby led birthing

Facilitator: Adetoro Adegoke

In ancient times Hippocrates considered that at the appointed hour the fetus put its feet against the fundus of the uterus and pushed but for the last 500 years the baby has been relegated to being a passenger in the story of birth. In the 21st century it is time to consider how material and structural remodelling of the uterus and cervix in the last four weeks of pregnancy unleash the body’s ability to help the birthing baby find the best way through the pelvis. At crowning, the fetus activates his mother’s fetal ejection reflex to release oxytocin and complete his journey. The mother and fetus need to move instinctively to enable each to act on the other to effect a straightforward birth.  

Being with women throughout labour, midwives are ideally placed to advance scientific knowledge of how birth works. They observe the evolving hormonal milieu as labour progresses, they see how the mother’s mind and body work in concert with her fetus to provide a smooth passage. They recognise the importance of the social, emotional and physical environment in facilitating or impeding birth. A better understanding of the mechanobiology of birth will avoid aggressive medical and surgical intervention which can disrupt the transition to confident motherhood. 

The art of midwifery is to educate and inspire the mother to trust the power of her body and her baby to work together in birth, and also to recognise when more help is needed to achieve a safe birth.