Is it time to ditch the term ‘normal birth’?

The language used around childbirth should be more personal and less judgmental, a study by the Royal College of Midwives has found.

Terms such as 'normal birth' can cause upset to women and should be avoided, the Re:Birth report advised.

Midwives are recommended to speak to pregnant women and ask what language feels right for them.

The RCM worked with a number of different organisations to survey 8,000 people – including women, their partners, doctors and midwives – from across the UK to develop "a shared language for pregnancy, labour and birth".

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About 1,500 women who had given birth in the past five years gave their views.

Most preferred the term "spontaneous vaginal birth" to "normal birth", "natural birth" or "unassisted birth".

Words suggesting "failure", "incompetence" or "lack of maternal effort" should also be avoided, they said.

They wanted labour and birth to be a positive experience and for the language used to be non-judgemental, accurate and clear.

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“The relationship between a midwife and the women in her care is an incredibly intimate one," says Gill Walton, Chief Executive of the RCM.

"The role of the midwife is to advise and support women, to listen to them and to advocate on their behalf. To do that successfully, we have to share a language. That is why Re:Birth is so important. It puts women’s choices at its heart, so that they are in the driving seat when it comes to how their labour and birth are described.

“We know that, particularly in England, there has been an increasingly heated debate around the term ‘normal birth’. Whatever your personal perspectives, it’s clear that when describing labour and birth, the term means many different things to different people, which has caused misunderstanding, confusion and upset.

"These public conversations have raised questions about all the terms we use to describe different types of birth. How can we ensure that the language we use helps support safe and high quality care? Which terms serve our maternity community best? Many of us involved in maternity care, including the Royal College of Midwives, believe that this language needs to be reviewed and, in a sense, reborn. Hence, Re:Birth.”

Mum of two sets of twins, Nina Spencer, welcomed the report as she felt like a failure after being unable to have what people term a 'normal birth'.

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"With my first pregnancy I had no chance to have a vaginal birth as my babies were both breech," she explains. "I really felt like I had failed due to not having the “normal” birth. It affected me so much. To the point where I felt I couldn’t talk about my birth because I’d failed.

"My second birth I was adamant I’d have the normal birth but again failed. Thankfully I took charge the second time. However ended up with a caesarian hysterectomy as I had a life threatening pregnancy complication.

"I still get on my soapbox about calling a vaginal birth 'normal' because it disempowers mums. But I am able to feel the strength in knowing my caesarians were life saving. Both of them."

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Mum Ivana Poku agrees. She has had three babies by C-section, due to complications, and believes the wrong language used around birth could contribute to post-natal depression.

"I believe that the term 'normal birth' is offensive and incredibly triggering," she says. "Back in the day, many mums lost their children because a c-section was not available, so we should celebrate it for allowing more healthy children to come to this world and not perceive it as something abnormal.

"Being a postnatal depression survivor, I also believe these types of comments can contribute to postnatal depression or other postnatal mental health issues."

But mum Rhian Kivits, who has had one waterbirth, one ventouse with an episiotomy, one c-section after a failed induction and also lost a baby at 23 weeks, is not offended by the term 'normal birth'.

"I see ‘normal birth’ as a term that describes a delivery without interventions," she explains. "I didn’t feel like my children were any less important or loved as a result of the way they were delivered but I certainly don’t normalise the pain and trauma of the interventions I received.

"My personal preference would always be to recognise that interventions are not ‘normal’ and to acknowledge just how painful, intrusive, scary and complex they can be."

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In the project, midwives were advised to follow five guidelines:

If the woman has had a previous birth, acknowledge this as a birth (independently of mode of birth), or if this is her first time. If she has had a previous loss, that should also be acknowledged.

Ask how would the woman describe a birth she has had or would like to have? Her feelings are just as important as the technical description, so listen to how she talks about that experience.

Check with the woman the language used in your notes to describe any previous birth. Does that description feel right to her? Is there another term she would prefer to describe it?

Try not to make assumptions about her choices – for example, if there was a previous caesarean birth. Don’t make your own interpretation of what you think her experience might have been, or impose terminology on her.

Record the woman’s own description of her previous experience of birth as fully as possible, and her preferences on language and terminology.

Maternity care has come under the spotlight after the recent Ockenden review of baby deaths at Shrewsbury and Telford NHS Trust suggested there was too much focus on promoting "normal" or vaginal births to the point they were valued above all other types of births.

And this meant women's concerns were at risk of being ignored.

The term "normal birth" is used by organisations including the International Confederation of Midwives and the World Health Organization.

But it has "often taken on negative connotations in the UK, and particularly in England", the RCM report says. The new guidelines should make positive strides in addressing the issue.