Squaring The Circle
The book ‘Squaring The Circle’ is informative and a thought-provoking read. The opening line of the foreword that ‘families want more from childbirth than simply emerging from the process unscathed’ highlights how pregnancy and childbirth are being anticipated for. Over the past decade, there has been a dramatic increase in technological advances when it comes to childbirth and this book seeks to open the conversation and challenges current practice in many different ways.
Perhaps the most pivotal chapter that resonated with me the most, having just given birth myself, was ‘nature and consequences of oxytocin, and other neuro-hormones during the perinatal period’. Synthetic oxytocin is used so widely in childbirth for a variety of reasons, but the differences between that and natural oxytocin are vast. Whilst they are chemically the same, the effects on our bodies and minds could not be more different. Synthetic oxytocin does not cross the blood-brain barrier and so the women receiving it for induction of labour do not benefit from the positives, such as reducing fear and stress, pain relief, and feelings of calm and relaxation.
Further on in the book, the chapter on ‘Risk, Safety, Fear and Trust in Childbirth’ discusses in-depth how maternity risk investigations are viewed by practitioners and following adverse incidences, the development of defensive practice to prevent reoccurrence. The authors' proposition of moving to a culture of trust within maternity systems is well-known yet still poorly implemented. The authors have highlighted the importance of continuity of care and how this affects all aspects of maternity care. Most poignant, however, are the relationships between midwives and obstetricians when based in trust, overwhelmingly transforms the experiences of women and in turn, reduces the risk to that woman. We know that effective communication minimises errors and loss of information thereby decreasing a woman's risk, no matter what complications may be present in her pregnancy. Reinforced in this chapter is that all maternity professionals have the knowledge, skills and values to ‘rebalance the scales of risk, so that respect, autonomy, evidence-based care, trust and physiological birth can all be seen as equally important components of safe, positive maternity care provision’. The care of maternity staff is a very current issue. The revisited ‘Why Midwives Leave’ (Royal College of Midwives, 2016) continues to highlight the same issues of overwork, low morale, bullying and risk-averse cultures. The authors discuss this chapter in detail and essentially conclude with what we already know—that if maternity staff are looked after from a top-down approach, they deliver more compassionate care.
In a concluding chapter, one of the most profound statements – and something that I fiercely believe – is that obstetricians should be exposed to as much ‘physiological birth’ as possible, otherwise how can they trust the process, especially when they are exposed to emergencies and high-risk groups. Sadly, the increase in patients and complexities mean that our amazing obstetricians are already pushed to the limit and rarely have time to see or facilitate these births.
Overall, this book has been an eye-opening read. A lot of what we already know is discussed but in such sharp detail that it makes you completely re-think even the basic concepts. Whilst it is very academically focused, the research is current and the book is easy to read. This is an incredibly useful resource for any maternity worker who wants to challenge the status quo and positively drive change, and it has certainly made me reflect on my practice.
The many decorated authors have challenged the current ideology of midwifery versus what happens in practice and the consequences for women and their families, set firmly on a very sound evidence base. This book should be read by all healthcare professionals who work in the maternity system and continue the inspiring conversations and work that it has provoked.