‘Putting the Baby Back in the Body’: How Midwives Construct Safe Birth at a Birth Centre in Germany

Abstract

Background: In maternal healthcare, safety is commonly understood as risk prevention. To avoid risk, surveillance technologies are routinely implemented antenatally and at birth, even for women who don’t need these. The negative effects that this unnecessary use can have on women and babies is often dismissed. Birth centres offer women with low risk pregnancies the opportunity to receive care that is not heavily reliant on the routine use of surveillance technology. However, despite studies showing that, for low risk women, outcomes of births at birth centres are good for mother and baby, the notion that it is risky to give birth at a birth centre permeates the discourse concerning birthplace. Alternative ways to create safety, perhaps because these are not thoroughly understood, are disregarded. This thesis explores how midwives at a birth centre in Germany, together with their clients, perceive and create safety antenatally and at birth.
Methods: Data collection occurred over a period of nine months. The methods utilized included participant observation throughout the birth centre, conversational interviews, and semi-structured interviews. Interviews were conducted with 17 midwives, 1 external midwife responsible for quality management, 27 women in pregnancy and postnatally, and 1 woman only in the postnatal period. 7 births were also observed during the data collection period.
Findings: Before the pregnant women sensed fetal movements, ultrasound scans reified the pregnancy for almost all of the women, creating a need for regular scans to check up on the baby. After quickening, at antenatal appointments at the birth centre, the midwives used palpation of the abdomen to connect the women with their moving, vital fetus/baby, thereby ‘putting the baby back in the body’. Midwife participants believed that this stimulated a deeper level of perception between mother and fetus, seen as an essential aspect of safety. This re-embodiment improved subtle communication between the mother and the baby, with a consequently enhanced capacity in the mother to perceive and manifest emergent symptoms of pathology, before these were detectable through standard surveillance technology.
Conclusion: Midwives believed that embodied communication between mother and baby was crucial for safety during pregnancy, labour and birth. This profound connection between mother and baby, in addition to helping women feel safer, supported the perception that the mother-baby dyad was the unit for the focus of care.
Implications: Re-establishing the mother as the expert on her baby by ‘putting the baby back in the body’ provides a new critique of the silencing effect of technologically visualized and captured data during pregnancy, labour, and birth. Further, it opens up a new dimension of ‘safety’ that engages with the somatic, embodied experience of pregnancy and birth, providing an opportunity to extend the kind of care expressed in this study to childbearing women and their babies in other settings in future.