Book Review: Birth in Focus by Becky Reed

Hats off to Becky Reed for writing this book. It’s an invaluable resource for anyone who is passionate about supporting autonomy and continuity in birth. From 1998 to 2009, Becky was part of the Albany Midwifery Practice based in South East London.Becky starts the book off detailing her own birth experience that led her on her path to become a midwife and doula. From there, readers are invited into a series of birth stories, accompanied by intimate, photo-album-style images captured by Becky (and occasionally by older siblings). Each vignette  is uniquely told from three perspectives: Becky’s, the birthing person’s, and a partner or family member’s.

The Power of Continuity and Relational Care

Birth in Focus highlights why a midwifery model based on continuity and relational care is a key tenet that’s missing from maternity services in the UK. Through the stories, it becomes evident just how much Becky cared for the women she supported. She knows what’s most important to them, their fears, their past experiences and has built a level of trust with them that is often absent in today’s maternity culture. These midwives had a sense of autonomy and felt rewarded in terms of their high level of skill in supporting complex birth in a home setting. They were also able to build lasting relationships with the women they supported, being asked to care for some of them through multiple pregnancies.

A critical takeaway is that the Albany Practice was not a homebirth service, despite its 40% homebirth rate. Women weren’t pressured to decide their birthing location before labor. Unless someone explicitly chose a hospital birth, an Albany midwife would attend them at home when labour began, allowing the birthing person to decide whether to stay or transfer to the hospital. Unsurprisingly, in a safe and supportive home environment with a midwife they respected and trusted, most people opted to remain there rather than travel to an unfamiliar, clinical setting.

Another important element was that the midwives got to choose their own way of working, so rather than working a couple of set hours a week, which is how most NHS home birth services are staffed, Albany midwives worked in pairs and adopted an on-call model akin to doulas. This enabled them to provide consistent, personalised care—a rewarding approach for both midwives and the families they served.

Accessibility of services for marginalised groups

There have been various reports over the years showing that maternity care services are not accessible to several groups of people. Despite efforts to move away from blaming these communities as "hard to reach," systemic barriers persist, leaving people from marginalised groups to navigate and advocate for themselves in a complex healthcare system. The Albany Practice stood out for its accessibility, serving a population of many Black and teenage mothers—populations often overlooked in the maternity care system. Today, the kind of personalised, high-quality care that Albany provided is largely reserved for those who can afford independent midwifery. Reflecting on a time when teenage and Black mothers received this level of individualised perinatal care feels both inspiring and bittersweet.

Challenging the Over-medicalisation of Birth

Personally, I struggled with the language of ‘normal birth’ as I know there’s a lot of stigma around how women and pregnant people choose to birth. In my experience, one of the many issues is the fact that for a long time, the medical profession has viewed physiological birth as something that is ‘abnormal’, dangerous and needs to be controlled.

The portrayals of birth in this book are in stark contrast to a medical system that often pathologizes birth, viewing it as inherently risky. Defensive practices, driven by fear of litigation and lack of support, often strip midwives of their autonomy and pregnant people of their agency.

Albany midwives flipped this paradigm. Their model empowered midwives to fully utilise their skills, which in turn deepened their expertise in supporting less medicalised births. The result was a cycle of trust: midwives gained confidence, families felt supported, and complex births could often be supported at home. This model wasn’t about rigid ideology—it was about relationships and respect.

In Birth in Focus, Becky avoids the sometimes alienating rhetoric that suggests physiological birth should always be the goal. Instead, the Albany model focused on building trust and honouring each individual’s birth preferences, which translated into a large number of people feeling safe enough to birth physiologically if they wanted to. There were also stories in the book of gentle elective caesareans and people transferring into hospital for additional monitoring and medical intervention.

Notions of safety

At the moment, we know that more and more women and birthing people are choosing to freebirth. This can be a decision that stems from empowerment but often arises from fear—fear of inadequate homebirth services, past trauma with healthcare professionals, discrimination, or coercion. The Albany model countered these fears by providing continuity with a trusted midwife. Women were more willing to accept medical recommendations, including transfers to the hospital when needed, because they knew their choices would be respected.

A Glimpse Into the Intimacy of Birth

The photographs in Birth in Focus are strikingly different from the polished, curated images often portrayed in media. They are raw and authentic, capturing the ordinary yet profound nature of physiological birth. These aren’t moments staged for perfection; they are real, intimate snapshots of trust and transformation.

Some of the most memorable images highlight the Albany midwives’ calm and unobtrusive presence. One photo shows Becky knitting in the next room as a labour slows in the second stage—a testament to her trust in the process and her patience. There are several other instances where Becky uses her experience to gauge a birthing person’s progress without invasive vaginal exams, relying instead on observation and connection.

One particularly moving story is that of Ayeshea, who, despite a complex medical history, found support for her homebirth with Becky after being told by several other professionals that it wasn’t an option. Becky’s reassurance and respect gave Ayeshea the space to make the choice that was right for her.

A Portal Into Tender Moments

Birth in Focus is a treasure for doulas, birthworkers, expectant families and anyone interested in the power of continuity in care. Becky Reed has created a portal into moments of tenderness, trust, and resilience. Through her words and images, she invites readers to dream of what birth truly could be.

Thank you, Becky, for this beautiful and inspiring work.