Sarah Buckley talks Birth.

By Home Birth Aotearoa
May 2015

Sarah Buckley, author of Gentle Birth, Gentle Mothering, is the mother of four home-born children. She is also a New Zealand trained General Practitioner with training in family obstetrics and family planning. Her work critiques current practices in pregnancy, birth, and parenting from the widest possible perspectives, including scientific, anthropological, cross-cultural, psychological, and personal. She encourages us to be fully informed in our decision-making; to listen to our hearts and our intuition; and to claim our rightful role as the real experts in our bodies and our children. She has taken time out of her very busy schedule to answer our questions and we thank her for gifting these words.

What are the most significant changes you have seen in birth culture in the medical profession in your time practicing and writing?

I would say it’s the advent of evidence-based medicine (EBM), which began with the 1989 publication of Effective Care in Pregnancy and Childbirth, the first publication in obstetrics from the Cochrane Collaboration. The EBM approach was revolutionary, providing an authoritative, accessible, evidence-based, perspective that generally has supported low-technology approaches in childbirth. The Cochrane Collaboration continues to produce reviews of topics in childbearing that are recognized as the highest standard in evidence-based health care.

After 25 years, I think that we are now over the honeymoon period with EBM and some of the limitations are becoming evident. In particular, EBM is based on a “reductionist” scientific approach that focuses on one outcome. This has lead, for example, to decades of early cord clamping (with what are now being recognized as harmful consequences for babies) because this was part of a package that supposedly reduced postpartum haemorrhage risk, which was the only outcome considered in the EBM reviews.   In addition, the “systematic reviews” of EBM are only as good as the studies that are included, which reflect the questions that researchers are asking.

Up until now, there has been very little interest in longer-term outcomes in relation to childbearing and interventions, which I believe is a very concerning limitation, especially with our expanding understanding of epigenetics and the potential for long term effects from interventions in early life. See my 2015 report Hormonal Physiology of Childbearing for more discussion.   The good news is that we are beginning to think more broadly and to appreciate the complexity of biological systems, including mothers, babies, and childbearing. I intend that my work with hormonal physiology is a contribution to these more sophisticated, systems-based approaches.

In your opinion, what is the key thing that needs to happen to change the fear culture in birth?

I think we need many approaches to counter this. Some of the fear is actually based in reality, as many women do have a frightening time giving birth. (I think that this reflects the low priority that modern maternity care gives to women’s emotional wellbeing in labour and birth. In contrast traditional systems of birth care make the labouring woman’s mental and emotional state a top priority.)

Fear can also be used, whether deliberate or not, as a tool to maintain the status quo. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) statement on homebirth is a good example of this. These types of statements and opinions are out of step with the best evidence (including the Cochrane Collaboration) and with practices on other places- for example, the United Kingdom Royal College of Obstetricians and Gynaecologists encourages homebirth.

I believe that the current escalation in this type of propaganda is a good sign that the movement for physiologic birth is gaining power. This is particularly evident in the US, where homebirth rates are rising, and the backlash against this includes publication of many of the poor-quality studies quoted by RANZCOG.   In the end, I think that Womanpower–our collective voices, energy and passion for our children and families- is the most powerful force on the planet. Adding in the paternal passion and protectiveness that can be evoked when fathers are present in physiologic childbearing creates an unstoppable movement.   Voting with our feet- and wombs- for gentle, physiologic birth and maintaining a public position to counter the misinformation are important. It can also be as easy—and powerful–as sharing our stories with family and friends and supporting others to make these choices.

We are a national organisation, speaking for homebirth. What is the most valuable thing you think we could do to protect and promote physiological birth in New Zealand?

As above- you are doing a great job! I also acknowledge homebirth as the model that currently most supports physiologic childbearing. From a HPOC perspective, this is likely to give the best long-term outcomes for mothers and babies, both by avoiding unneeded interventions, which have impacts on hormonal physiology, and by optimizing physiologic processes including breastfeeding and attachment- see “biological bonding” in HPOC.

On your wish list for birthing women, what sits at the top?

I intend that women wake up to the power and pleasure of their childbearing bodies and to their innate capabilities–what I call “Mother Nature’s superb design.” I also intend, with HPOC, that we appreciate this from a scientific perspective so that we can protect, support, and promote physiologic childbearing.  

Your recent publication “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” is a comprehensive guideline to the importance of physiological birth. How would you like to see this inform our medical birth professionals?

It is obvious that much needs to change to support physiologic birth, but the good news is that shifts are happening, especially in the last few years. When I began writing Hormonal Physiology of Childbearing (HPOC) in 2006, there was very little research and understanding about hormonal physiology, but now we have much more interest and engagement among clinicians, researchers, and parents.

In addition, we have a better grasp of concepts like physiologic birth, salutogenesis, and epigenetics, which underlie HPOC. The intentions of myself and my colleagues at Childbirth Connection, who worked with me over these years, and the National Partnership for Women and Families, who sponsored the report, are to have this information as core learning for all maternity-care professionals, and informing clinical decision-making for professionals and for parents. We have now begun publishing papers in peer-reviewed journals to bring this perspective into mainstream maternity care.

Your work in birth has been inspiring and tireless, the birth community owes a huge debt of gratitude to the work you do. What inspires you to bring this information to our birth community?

My own beautiful experiences of giving birth to my four children at home are the gifts that keep on giving. Even through the teenage years and beyond, I can still connect with the pleasure of their births and of early mothering, and the ease it gave me in those intense years.   Out of this deep embodied knowledge, along with the intellectual understandings I’ve gained through my research and writing, comes my intention is that every mother, baby, father, and family get the best possible start, which in my world means optimizing hormonal physiology in every childbearing situation.

Sarah Buckley and her family.

Header photo generously gifted for use by Jerusha Sutton who is a photographer and doula working in Australia. Her work recorded the Home Birth Australia Conference of 2014 including the beautiful picture of Sarah Buckley that graces our header image.