Musings of a Midwife: Instinctive birth – getting out of Mother Nature’s way

Published on: April 09, 2021

With the theme of nature this month, Midwife Emma explores instinctive birth, a philosophy in which labor and birth is respected as a natural physiological process with a delicate physical, hormonal and emotional balance for the birthing woman, her partner, and their baby.

By Emma McNerlin

There is a well-known saying in my profession: “Midwives have skilled hands, and they know how to sit on them”, meaning that at its heart, midwifery is a profession of watchful observation and trust in birth as a natural process, and intervention only happens when absolutely necessary. By contrast, in obstetrics, pregnancies are labelled as ‘high or low risk’ with pre-set care pathways that defer to the doctor as the expert rather than placing the woman at the center of her care.  There is no doubt that medical advances in recent decades have saved the lives of mothers and their  babies, but in viewing all births through the prism of risk, are we undermining a woman’s ability to follow her biological instincts? 

Pregnancy in the information age consists of content from many sources seeking to inform your pregnancy care decisions – often without any evidence base. From marketing campaigns to promote the latest baby gadget, to the pregnancy app that declares your baby is the size of a cantaloupe, or even TV shows that depict labour and birth as dramatic, comedic, or even dangerous. This culture of treating birth as a commodity bombards women with opinions and judgements, and it can introduce fear and doubt about her ability to birth. 

Language used to explain risk can also be frightening and misleading. For example, you could be given the very alarming statistic that your risk of a complication doubles by not having a medical intervention. However, if you were told your risk would go from one in 200 to one in 100, in real terms, you still have 99% chance of not experiencing any complication. It is crucial to ask your care provider to explain your percentage risk of any options for a clearer picture. Additionally, attitudes to risk are subjective and personal. Some will believe that they would be that unlucky one in the 100, whereas others would calculate that the risk is minimal. Everyone should be given the information in unbiased terms and supported in making the decisions for them and their baby. 

Traditionally, a pregnant woman was mentored and prepared for birth by her own mother, and birth stories of others from within her extended family helped build her confidence. Working in partnership with her midwife, birth was a rite-of-passage, and it usually took place within the home environment. Living internationally, away from extended family, and in an era of increased medicalization, traditional ties can be eroded. In Bangkok, there is an obstetric model of care, meaning obstetricians are the primary care providers for pregnancy. Birth outside the hospital is not supported by the medical establishment, which can make listening to her instincts for birth all the more challenging for a woman wishing to birth naturally.

For a woman with an uncomplicated pregnancy looking for an instinctive birth experience, choosing a doctor experienced in natural birth and grounded in evidence-based birth is vital to developing a partnership of care. In such partnerships, you are central to any plan of care and are provided with the means to make informed decisions. It is your right to question anything that is suggested, and many women invite a doula to join their care team for additional physical and emotional support.  

Commitment to an instinctive birth also requires you to be informed about how your body changes and accommodates pregnancy. Armed with this knowledge plus a supportive environment and care team, you develop trust in your body to birth your baby. Ina May Gaskin once observed that humans are the only mammals who doubt their ability to birth their offspring. Comprehensive birth preparation for you and your birth partner that covers the physical, hormonal, and emotional symphony that drives labour and birth will help to remove fear and doubt. 

Fear is the biggest enemy to instinctive birth. Fear engages your neocortex to release noradrenaline, which disrupts production of your birthing hormones and, in turn, stalls your labour. Women seeking to birth with minimal or no medical intervention need to avoid negative birth stories throughout their pregnancy, and immerse themselves in positive affirmations. By tuning into the partnership you are creating with your baby, you will become confident in the knowledge that you will grow a baby that your body is built to birth. Hypnobirthing, relaxation, and breathing exercises can all contribute to allowing you to feel calm, relaxed, and in-control. 

When approaching birth, anticipation and excitement are to be expected. Having trust in your body to prepare for labour and patience to wait for your baby to be ready is key. Use the final weeks of your pregnancy to rest and nurture yourself in preparation to meet your baby. A balanced body will labour more efficiently, so regular pregnancy-specific yoga, pilates, or stretching can help to balance your muscles and ligaments to encourage baby into a good position for birth. 

All this preparation will put you in a positive position for instinctive birth. A supportive birth partner and care team will help to encourage you, normalize the sensations you are feeling, and hold space for you to be present in your labour. Freely moving throughout labour, an instinctive birther will naturally find positions that provide comfort and help the cervix to open and the baby to descend. The sensations of labour and birth can feel overwhelming, but trusting the physiological process will bring you ever closer to your baby. 

From the moment you receive the positive pregnancy test, your thoughts will naturally drift to the birth. What is great is that women now have a choice in how they have their baby. C-section, vaginal birth with epidural, and instinctive, unmedicated births are all valid and safe options as long as they are fully informed. For those opting for instinctive, unmedicated birth, approaching it prepared and with confidence that you and your baby are working in partnership will allow you to surrender the rest to Mother Nature. 


Val Clark (2005) Instinctive Birthing: Heeding Your Inner Voice

Ina May Gaskin (2011) Ina May’s Guide to Childbirth 

Milli Hill (2018) The Positive Birth Book 

Tamara Cianfini (2020) The Birth Path


Photos from Unsplash and Canva

About the Author

Emma McNerlin is a UK trained and registered Midwife, First Aid Instructor and owner of Bumpsy Daisy Café and Community; a cafe and parenting community centre for new and expecting parents offering birthing classes, hypnobirthing, First Aid workshops and baby classes. Emma has been the BAMBI Bumps and Babies Coordinator since 2015. Prior to coming to Bangkok in 2014, Emma worked as a clinical midwife in a busy London hospital with 6,000 births per year. Emma lives with her husband and teenage son and when she is not working she enjoys baking, aqua-aerobics and singing badly at karaoke.

The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects.

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