BIRTH: Countdown to Optimal

This is a how-to guide for women who want to make birth as good as possible, written by a mother and researcher who has experienced 'optimal' birth three times. The book includes personal accounts, comments, photographs and advice from other families and professionals. The concept of optimality initially seems an extremely subjective one. However, the World Health Organization associates optimal birth outcomes with lowest possible amounts of intervention and drug use and the American College of Nurse-Midwives has developed an Index of Optimality, linking best outcomes with minimal (or zero) use of pain relief and interventions. Both organisations clearly accept the many research studies which conclude that entirely physiological birth is associated with best outcomes in terms of maternal and fetal (or infant) morbidity and mortality. On a subjective level, optimality has long been associated with natural birth by women and families who have experienced successful physiological births. However, by women who have tried but 'failed' to have a natural birth, 'natural' is no longer seen as being optimal. Women who are afraid of things going wrong or of experiencing pain in labour also assert that 'optimal' means the use of every kind of intervention to induce, monitor, 'control' and anaesthetise labour and birth; many even prefer elective caesareans. Some professionals share these interventionist views, perhaps because of a desire to control the physiological processes, pre-empt problems or gather evidence to avoid litigation. Considering these views in terms of both safety and experience, Sylvie Donna has researched the concept of optimality. This book for pregnant women is the first outcome of her work. (An edition for midwives - called 'Optimal Birth: The What, The Why & The How' - is now also available.) She concludes that 'optimal' does indeed mean 'natural', provided this term is redefined substantially. Surprisingly, she also concludes that physiological birth (i.e. birth with no drugs or interventions) usually means far less pain overall than any interventionist alternatives. Sylvie Donna's work has the support of many professionals and several have contributed first-hand accounts, comments or testimonials.