Janet Balaskas is credited with starting the Active Birth Movement; a women’s movement that led to fundamental change in British Obstetrics and childbirth preparation. The South African mother of four, who originally trained as an NCT teacher, founded Active Birth in response to the oppressive active management of obstetrics during the 80s and 90s. She is the author of many books on active birth and set up the Active Birth centre in north London; a dedicated hot spot of antenatal female empowerment. Active Birth was the first approach to childbirth preparation that brought the principles of yoga to childbirth preparation.
The Active Birth approach was a body-centred approach? How does that body-centred approach look now after 30 years?
The principles of AB are universal. They are ancient. They are the way women have given birth throughout history and they are the way hopefully more women will give birth in the future.
The principles are multidimensional. The way women give birth has not changed. It is intrinsically the same. What has changed is culture. AB feels to me like seeds that have been sown but there is still long way to go until we have the harvest.
I think the seeds have brought about a great deal of change. Birth Centres have come out of the AB movement, birthing environments are becoming more conducive for women to give birth physiologically. There’s better understanding about the physiology of birth, but these are early days.
In many ways there is no method to Active Birth. In fact, the words Active Birth were initially coined as a pun on Active Management of birth.
All the subsequent approaches to childbirth like Ecstatic Birthing and Hypnobirthing offer different gateways to the same place. They offer a way for a woman to discover her instinct.
I think the principles of AB are fundamental to everything.
The way in which women relate to their bodies is a constantly evolving process. Culturally speaking there has been so much growing awareness around bodies, sexuality etc here in the UK in the last four decades. How do women take on the principles of AB in some of the other countries you are working in — for example Dubai and Brazil where women have a different cultural relationship to their bodies?
I was really surprised by the women I met in Dubai where I was invited to go and teach. I found a group of amazing and empowered women underneath their hijabs.
They have incredible traditions of birthing; the Moroccan traditions are so strong. They are very woman centred and their response to AB was wonderful.
Likewise, in Brazil, where there is a huge high rate of CS – the highest in the world – 80 per cent in Rio and around 50 per cent nationwide. The woman who are interested in natural childbirth are interested in AB. Because AB explains to them what their bodies can do; what instinct means and what birth physiology is all about.
There’s a great hunger in all these places for knowledge and understanding.
Even though the movement of change is slow, and we are competing against a rapidly growing hard-edged dominating obstetric model, there are examples everywhere that childbirth is becoming moderated to facilitate women who want to have a more natural approach. Here in England, it’s greater than anywhere else. It’s been embraced by the NHS where birthing pools are now quite widely available. That’s unique. Nowhere has this approach been accommodated so widely as it has here. But at the same time if you watch One Born Every Minute you are not going to see a high percentage of active births!
What are your thoughts on pain and pleasure in childbirth? Ecstatic birthing, the Hypnobirthing approach to pain-free birthing etc? How does AB seek to navigate between these two polarities?
The way women experience birth is a very broad spectrum Sure, we have the innate physiology that provides us with ecstatic hormones so that, if we are in the right environment, pain can be transformed into pleasure, that’s the physiology of birth. We release floods of endorphins in labour — endorphin means ‘inner morphine’. We produce our own natural painkillers. Birth hormones are identical to those women produce when we make love.
So, if you have floods of the so-called love hormones your birth is going to be a different experience from that of the woman who is feeling terrified, feeling tense; who is producing lots of stress hormones which inhibit the flow of the love hormones. In every individual birth it depends a lot on the environment and on how the woman has worked and prepared herself to create the inner atmosphere for an ecstatic birth.
I have experienced pain in labour but I never so much as thought of having an epidural. It was just ok to go there. I was deep in whatever the pain was. It’s a very deep meditation going through labour and I think the pain or intense sensation pulls you in. If you are equipped with yoga practice, meditation or mindfulness you will be able to embrace the intensity of what you are feeling in your body and relax into it.…
The more you understand birth physiology, the more you understand how the body softens as the baby creates space and moves along the birth path, I do believe yoga dissolves the fear of pain. Fear is the greatest inhibiting factor. Its fear that dominates well-intentioned obstetric care. They are afraid of letting you go past the due date; they are afraid the baby will die. Even though the stats are so small. I look at it as well-intentioned, but not always well informed.
Where do you get your deep confidence in natural birth from?
If we understand the miracle of the physiology of labour and birth, that’s what gives us trust and faith. I’ve felt instinctively and intuitively when I was having my first baby that I must know how to do this. I thought ‘I’m a mammal like all the other mammals.’ I don’t know why I’ve always had such confidence in birth but I have. Actually, I had a grandmother who had 13 natural births. That’s probably why. My mother gave birth naturally to me. It felt like I was going to know how to give birth. I’ve always felt a lot of trust in my body. That’s why Yoga resonates with me so deeply.
Tell me about your journey into Yoga? How did you find the idea to bring this into your pregnancy and work?
There was s synchronicity of three different things. On the one hand I got interested in Yoga. I started attending class with a man called Arthur Balaskas. who, as you can guess from my surname, I ended up marrying.
After I had my first baby in South Africa, I was determined to become a birth educator, so I went to the NCT and found Sheila Kitzinger and I trained to become a childbirth educator.
In those days the NCT were very sceptical about yoga as preparation for childbirth. They were skeptical about my body-centred approach — so I left the NCT and decided to do my own thing.
In looking for a name for it one night, I got the idea of coining the phrase Active Birth. Because it implied being actively in charge of your own birthing experience and gave the power of birth back to the woman.
I was also doing yoga at the time and researching the history of birth. There was nothing around at that time that taught the history of birth. You always need to know the history of something so I went and looked into it. I discovered that all around the world, throughout history, women were giving birth in all sorts of upright positions for millennia in all cultures everywhere.
At the same time, I had a plastic model of a pelvis, which I used in my NCT classes. One day, I was playing with a baby doll and trying to see how the doll might fit through the pelvis. So, I turned it up the other way and hey! I discovered it got through much more easily. My husband and I played around with this and looked at all the other positions and we soon realised the importance of gravity in childbirth.
Now, I know it is totally crucial for the baby, the uterus and the mother to be in harmony with the force of gravity. Yoga, birth history, the mechanics and shape of the pelvis — it was synchronicity
When I was pregnant with my second baby, I invited the women I was teaching to come to my house once a week and practice yoga. I’d noticed that many of the yoga postures were identical or similar to the most common birth positions. I realised that certain yoga postures were going to help widen the pelvis and prepare women for an active birth much better than sitting in a classroom and learning about hospital procedures.
Although useful to be well informed, it’s more empowering to feel with your own body that the squat can be a position for birth, child’s pose can open the pelvis up wide. I realised how essential it is for western women, who sit at computers all day, who don’t squat down to do their washing in the river, to prepare their bodies in this way. We don’t use our bodies as women used to. Yoga offers us an alternative and healthy way to engage with our bodies.
For me it’s never been about the asanas. They are vehicles. They are useful. But essentially, for me, it’s about the experience of the positions combined with breathing that relates with the force of gravity.
I always teach women exhalations that travel down to the earth. The Earth and the Breath are the two great allies for a woman going through labour.
Just yesterday I heard of a woman who, after a section, ended up giving birth in the back of a taxi on all fours and her partner caught the baby!. She said the breathing helped her so much She said “I just breathed and exhaled. Those still moments at the end of the breath were my anchors.” Despite the context, she experienced a completely peaceful birth in the back of a taxi.
In my experience there has been a steady flow of women who have given birth calmly, joyfully, naturally for four decades. And now I’m starting to see women whose mothers came to my classes. It’s been going on for a few years. I feel like we are recovering the tradition of mother to daughter transmission of birth wisdom.
The yoga that is specifically helpful to pregnant women needs to go deep. It needs to go inside and take her on a deep journey into her own body — that journey needs to be recreated, ideally, weekly through the whole of her pregnancy. Most women who’ve done yoga before have a great advantage over other women — unless they’ve done a practice like Astanga. In which case pregnancy yoga is a very different kind of practice for them. They have to learn a new much softer way of moving.
My main inspiration has been Vanda Scaravelli. I met her personally and had some lessons with her. But I’ve studied for years with her closest student Sandra Sabatini who is like a font of inspiration for me. I work slowly and gently, but she works mega-slowly and deeply with such detail. When I feel I’ve given a good class it’s because I’ve succeeded in drawing those women to a deep place inside themselves. If I’ve been able to do that, they feel great, and they want to come back and do more. The practice and the way of moving and being that they are embodying is also sinking into their body memory. They are learning without trying. That’s really important. All they have to do is pitch up and let go. The rest happens because the body memory kicks in and the body memory meets instinct very naturally if the teacher is teaching in that way.
I feel quite passionate that it’s this approach to how we teach pregnant women that makes our classes so empowering. I am sure Lolly will agree with me on this, because we share a similar approach.
We need to help the woman to go deep rather than learning a big wide range of wonderful postures.
How do you think AB and Pregnancy Yoga have influenced, supported and inspired each other?
Well, you know I’ve never really seen them as separate. That’s the main thing. I thought that Yoga was an amazing way to prepare for an active birth and an active birth was what a woman’s body is designed for. So if you are doing work like yoga, then you are discovering and enjoying your body, inevitably it will influence the way you give birth.
The first book I ever wrote was called New Life. On the cover was Lolly (Stirk) pregnant with her daughter demonstrating the squat. At that time there were no upright births. It’s not even about standing, it’s about the freedom to move — and sometimes standing is part of that.
AB grew along with yoga for me. They grew together. They come from one well. And it’s a feminist well. AB is not anything far-fetched, its something women are designed for.
You said practicing yoga and AB makes women assertive. How does Yoga make you assertive?
It brings you to your inner core in a deep way and there you find your truth and your voice. You can speak more easily about what you really want when you are in touch with yourself like this. I see it all as going together.
Tell me about the build up to AB Movement and the famous demonstration on Hampstead Heath?
It was clearly an incredible time.
I think there was a huge synchronicity happening at that time. Michel Odent was happening in France; there were people making headway with natural birth traditions in Brazil, Sheila Kitzinger once said it was like a volcano erupting in lots of different places.
I didn’t know what was happening to me. It was just happening and it was driven by my experiences of being pregnant and doing yoga.
How have things changed since then?
Women at that time were so motivated. The early Active Birth mothers would practice their yoga and squatting all the time. Now there’s a different atmosphere. People are already convinced; they know it works well — there isn’t quite the same motivation.…
At the moment we are in a time where we don’t know what the new normal is going to be? I think this whole Covid pandemic is going to have an interesting impact for people. I’m sorry that so many people had to become ill and die, but I think we may emerge from this with a little more awareness about the world we live in; the people we live with; and how we want to live on the planet.
Maybe one day people will begin to understand why birth is so important. It’s wonderful to have climate change and everything that David Attenborough has been campaigning for. A better more sustainable world.
But what about Birth Change? I have a feeling there’s another movement coming. People need to know how a child is born and raised makes a difference to their life and to the world.
What are your wishes for a happier healthier maternity service that serves women better?
One is the end of the induction policies. Honesty, this really needs a rethink. The second is that I wish the doctors and midwives who create these protocols and run the maternity system knew more about birth physiology. Maybe then they would know that the baby starts the labour when the baby’s lungs are ready to breath. When the baby has got to the end of pregnancy, the baby actually ends the pregnancy by releasing specific hormones. That release of hormones also prepares the uterus and that happens just days before the birth. During that time the uterus becomes populated with a lot more receptors for oxytocin. That means more oxytocin enters the muscle fibres, resulting in more efficient contractions and a better birth.
Being upright also means a better blood flow to the uterus. And the hormones travel in the blood stream. Most people don’t seem to know that. Oxygen travels in the blood stream, we all know that, but so does oxytocin, iI comes from the pituitary gland, through the blood stream to the uterus. It is essential for all birth professionals involved with pregnant women, from yoga teachers to doulas, and obstetricians to midwives, to have a thorough background in the physiology of birth.
I think there’s no one better to learn from than the great Michel Odent who I think of as the David Attenborough of the birth world. Dr Sarah Buckley too! — The brilliant Australian GP whose writings about birth physiology are so easy to understand at whatever level you are. I don’t see how we can go around blindfolded against the truth of this physiology; of how birth is meant to be; how nature has designed birth to be?
I’m not ‘anti-obstetrics’ but I’m wanting birth professionals to learn about birth physiology. That’s what I teach now in all my courses and in all the travels that I do.
The problem is that the medical establishment does not want to listen. I know Michel Odent has travelled the world speaking at medical conferences. Sarah Buckley has also been writing and travelling and teaching — the information is out there.
I often wonder why some medical professionals are so stuck in their ways? I think it’s because they are on the front line where life and death is real. I have great respect and regard for that.
But I’ve also seen what happens when doctors do understand birth physiology and they can then apply their obstetric techniques in a more discriminating way.
However to say to every single women who hasn’t gone into labour by 41 weeks that she is going to have to be induced because there is a study that shows there is a greater risk of stillbirth over a certain age or length of pregnancy is an emotive argument. It’s a tiny percentage of increased risk anyway and when women are told that the risk doubles after a certain threshold, they become fearful of the baby dying and agree to the induction. Yet it’s the doubling of a tiny number. But they only emphasise the doubling, not the tiny number.
Where does the pregnancy teachers remit as a community guides for women start and end?
Your choice of word ‘guide’ is very good. Because what we want to do is empower women to find the strength to question and get information themselves. We can’t tell them what they should do. Every week that I’m teaching, somebody comes to me asking questions such as whether I think they should be induced. Or, they’ll say’ I’ve got group B strep. Do you think I should go on an anti-biotic drip? What do you think?
It’s not my place to say what I think. I’m never going to say what I think. Because I have too much influence and I want each woman to make the choice from her own research and her own inner guidance. I really trust women to know what they need. And if they are doing yoga, they’ve got a much greater sense of feeling that, because yoga is so centring. But I will point them in the direction of information so that they can make their decisions from an informed place and discuss their options with them.
What about with Induction which you said you feel strongly about?
I deal with the subject of induction in detail in all my workshops. I think women really need empowerment around this issue. They need to know what they can do if they go past their due date and labour has not started. I tell them that it’s the baby that starts the labour. I also find that once I can get the couples to understand the physiology, they find they own way. And I also can refer to an obstetrician I know whom they can go to for a second opinion.
But we do need to be careful about what is in our remit. And our personal opinion is not part of our remit. We need to make sure that we don’t have an agenda they have to live up to.
When you look to the future what would you like to see? You’ve spoken about the changes in the NHS but what about at community level and for individual mothers?
I’d really love to see women of the future losing their fear of birth and being less under the spell of medical experts; being informed — yes — and interested — yes — but less convinced that they need medical support when there is no indication of a problem.
I’d also like to see more women giving birth in their own homes. My experience is that the best births are usually home births. Even though I do think birth centres are a great alternative to hospital and lots of wonderful births happen in birth centres, and great midwifery too, but I’d like to see more of a balance and better services for homebirth. I’d like to see more encouragement for those who have healthy pregnancies to have a homebirth.
I’ve got five grandchildren. I caught one of them, and was the first person to touch my oldest grandson. One of my daughters had a c-section because of a positional problem that occurred during the labour at a homebirth. We had to transfer into hospital, when we spotted some meconium, but it was a beautiful calm c-section. My granddaughter was born in a pool in my home. It has been a great adventure becoming a mother and a grandmother.
One good thing about this time that we are in right now, in the midst of the pandemic is that more women have chosen to give birth at home — and usually to good effect. Homebirth is truly a wonderful experience.
Janet Balaskas is launching a film called Active Birth – Your Guide to Nature’s Plan early in 2021 and a new book called Active Birth – The History and Philosophy of a Revolution.
For information about Janet’s new film and book plus her class and workshop schedule please visit www.activebirthcentre.com