Q: My friends tell me that birth is nothing like you see in the movies or on TV. Why not?

A: Yes, your friends are generally quite right.

There are some conventions of birth representation that are so pervasive they permeate virtually every depiction of birth in all forms of media. Some of these conceits derive from practices that were accurate at some point in history, or may be still happening in some places now, but there are many aspects of the standard representation of birth that we, here in Vancouver, are very unlikely to encounter today. Since these elements feature prominently in almost every birth image to which we are exposed, they have assumed the status of perceived truth. The inundation of such misleading images clouds our understanding of birth, and interferes with our acceptance of accurate information. The myths are so familiar to us they have become comfortable and trusted, even as they misinform us, and undermine our very ability to perceive birth without bias.

 

I will refer to some of the most common myths.

 

Movie Myth: Most Women Give Birth On Their Backs

This particular trope is so common that I hear people asking if they are even “allowed” to give birth in other positions. Even in movies that take place in pre-history, or in the jungle, or on other planets, women are virtually always shown lying on their backs when they give birth. In fact, women throughout history would have given birth in just about any position other than supine. The flat-on-the-back position for birth was introduced sometime in the 17th century purely for physician convenience, as everything was accessible and visible this way. But the practice didn’t become global until, well, ever. Even though the sight of women birthing on their backs is omnipresent, the World Health Organization advises against it because “it is often harder on birthing mothers as use of the lithotomy position can narrow the birth canal by up to a third” (Wikipedia). Here in Vancouver, most women are encouraged to adopt any position for pushing that is comfortable and effective. So if supine is out, what positions are in? Anything that feels right, such as squatting, side-lying, all fours, standing, sitting, kneeling, or anything in between.

 

Movie Myth: Labour Begins With A Bang

In the movies, mom feels a pain, announces “This is it!” followed by a mad race to the hospital during which everyone freaks out completely. By the time they arrive, mom is shrieking in pain. Her labour started with sudden, intense contractions, and then escalated at roller-coaster speed. I think this storyline is generic because showing the way most births actually unfold would be too boring to endure. In real life, labour usually starts very slowly, with mild contractions that very gradually get stronger. It can take hours, or days, before the contractions are at all intense. And even then, the stretches between contractions are usually quiet and restful, with everyone silently waiting while the mom relaxes or even dozes. Labour is usually very long, and mostly uneventful. It is characterized by dim lights, stillness, and long intervals of just waiting while nothing much happens except very gentle, imperceptible progress. But who would watch a movie like that? Although there are exceptions (fast labours, sudden labours, intense labours), the high-drama birth you see on TV is the minority.

 

Movie Myth: Your Doctor Will Be There The Whole Time

It is easy to get the impression that after your frantic race to the hospital (see previous myth) you will be received by your doctor who will focus on you from the moment you arrive. In reality? Not so much. Doctors don’t usually arrive until you are in second stage labour: the pushing stage. Most mothers will be monitored by a nurse for many hours, throughout all of first stage labour before a doctor will join the scene. And then, it might be your own familiar doctor, but more likely a member of their call group. (Unless you have a midwife, who will indeed be with you for the duration).

 

Movie Myth: Most of Labour Is Pushing

We might reasonably think that pushing the baby out is the majority of labour, from what we see on TV. Most shows include only one or two first stage contractions, and then proceed right to second stage (pushing), where the camera dwells forever on the mom’s sweaty grimaces. However, most of labour actually happens during the first stage, which is when the cervix slowly softens, shortens, opens, and moves forward, and baby descends into a “ready” position: only then can the pushing begin. Typically, first stage takes many hours, whereas pushing the baby out takes a fraction of that time. Think 12 hours versus 1/2 hour, although every labour is unique.

 

Movie Myth: Birth Is Highly Risky With Innumerable Disasters Just Waiting To Happen

This is unquestionably what we see in all the reality TV shows. This view of birth as fraught with risk and imminent danger is so ingrained that it has bypassed myth and entered the territory of superstition. There is a long history of this complicated construct in which we pathologize birth itself and see it as a minefield of potential emergencies, rather than a healthy and normal biological process. In real life, birth usually works just fine, especially when the mother’s cascade of hormones is undisrupted. Sure, things can go wrong –as in any aspect of life—but many of the problems we routinely encounter are arguably iatragenic, and even then, the majority of births are uncomplicated and uneventful: not at all worthy of televised drama.

 

These are only a few of the movie myths that hugely affect how we think of birth. This ersatz version of birth is so ubiquitous that it dominates our imaginations and maintains its own paradigm. It is hard to even accept that birth can be calm, slow, mostly take place at home, and that the baby can be born while mom is kneeling. But in at least one way the movies don’t lie: the moment that you meet your baby can be heady, emotional, powerful, and amazing. Just like in the movies.

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