The place of birth

This chapter focuses on the power of the place of birth to influence the behaviour of women and their midwives during childbirth. We propose that neither the type of care provider nor the model of care delivery alone is able to affect outcomes without sufficient attention paid to the physical and psychological environment for birth. Through exploring the complex nature of modern maternity care, with its focus on hospital birth, we discover that the influence of ‘environment’ may be so pervasive that the full, potential benefits of ‘new’ systems or models, such as continuity of midwifery care, in this setting fail to be easily realised. Important insights into why this might occur are provided through the lens of one New Zealand study comparing the practices of midwives who move between small and large birthing units. The midwives’ own words will be used to illustrate clearly what they have come to know as ‘real midwifery’. The chapter begins with a reminder that childbirth hasn’t always occurred in hospitals and that the move to hospital that accompanied the medicalisation of childbirth was not based on evidence demonstrating the superiority of hospital care. We then consider what has been lost in the process of medicalising
childbirth and how the modern birth environment affects outcomes for women and babies, as well as midwives. This chapter aims to reveal what midwives can do to ensure that the potential benefits of midwifery-led care are optimised, no matter where the place of birth.