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Posted: 06 April 2006

Public Lecture in Midwifery - ‘Promoting Normal Birth: Research, Evidence and Storytelling’

3rd May 2006, School of Nursing, Midwifery & Health Systems, University College Dublin

Professor Soo Downe, BA(Hons) RM, MSc, PhD
Director of Research in Childbearing and Health (ReaCH) unit
University of Central Lancashire, Preston, Lancashire, England

Modern midwifery in most countries of the world claims to offer expertise in, and guardianship of, ‘normal’ childbirth. In the UK, official documents such as the recent maternity element of the Children’s National Service Framework (DH & DES 2004) have repeatedly supported normal childbirth, and the role of the midwife. Changes in the UK midwifery education system have continued to promote midwifery as an autonomous profession. Official publications from the World Health Organisation and the International Confederation of Midwives are equally supportive of the midwifes’ role, specifically in the context of normal childbirth (WHO 1997, International Confederation of Midwives 2005).

Close examination of intrapartum practices indicates that many women experiencing so-called ‘normal’ birth in centralised hospital settings in fact experience a wide range of technical or pharmacological interventions (Downe et al 2001), even in innovatory childbirth contexts, such as New Zealand (Crabtree 2004,). This raises questions about the nature of normal childbirth in a hospital setting, and about its relevance in a late capitalist world of risk-averse ‘consumers’. Indeed, it is hard to make a case for normal birth, since existing research offers very few data where physiological birth without intervention takes place. This is despite the fact that the majority of obstetricians and midwives state that they would prefer to experience a normal birth (Al Mufti et al 1997, Dickson and Willett 1999, Jacquemyn et al 2003). Women maintain this stance even in Brazil, the country with the highest rates of caesarean section in the world (Faundes et al 2004).

Perhaps as a consequence of dissatisfaction with this situation, the demise of normal birth has suddenly become a topic of discussion across the world, with normal birth standards being written, and normal birth conferences being held in a number of countries. Questions about the reasons for the increased intervention in birth have been raised in these contexts. I suggest that the underlying problem is not hospitalisation, or lack of leadership, or medicalisation, or women’s fear of childbirth, though all of these may have some impact. At root, I believe that modernist health provision which is founded in pathogenesis, certainty and simplicity has resulted in a loss of faith in childbirth, which does not fit into this dominant paradigm.

The solution to this situation may be a change in thinking, towards concepts of wellbeing (salutogenesis), uncertainty and complexity (Downe 2004). This depends on a re-engagement with values such as courage, trust, and mutual respect between professional groups and childbearing women and families. This seminar will present national and international initiatives designed to maximise the potential for normal birth, and discuss the role of storytelling, communities of practice, and research into ‘unique normality’ in taking this agenda forward.


Professor Soo Downe, BA(hons), RM, MSc, PhD - Biography

Soo qualified as a midwife in 1985, having trained as a direct entrant (non-nurse) student. She then spent 15 years working in various clinical, research, and project development roles at Derby City General Hospital. During this time, she served on both the English National Board for Nursing Midwifery and Health Visiting and on the midwifery committee of the United Kingdom Central Council for Nursing Midwifery and Health Visiting. From January 2001 Soo has worked at the University of Central Lancashire in England, where she is now the Professor of Midwifery Studies. She set up the UCLan midwifery studies research unit, now known as the Women Infant and Sexual Health (or WISH) research unit, which was launched in October 2002. She is the unit director. She currently chairs the UK Royal College Midwives Campaign for Birth steering committee, and in March 2006 she was appointed as the Francine Gooris International Chair of Midwifery at the Artevelde Hogeschool, Ghent, Belgium. She has been a member of the RCM, and of the UK Association of Radical Midwives, since 1983, and she was appointed as a member of the MRC College of Experts in 2006. Her main research focus at present is the nature of, and culture around, normal birth.

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