Prenatal classes in 1968 at the hospital in Margate, Kent. Photo: Hulton Archive/Getty
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Don't call the midwife: why we're obsessed with “natural” childbirth

A new history of the Lamaze technique is balanced and impressive, but, like almost everything connected to childbirth, it is not entirely neutral or impassive.

This article first appeared on newrepublic.com

The typical birth narrative that you read online is a tale of harrowing disappointment. The mother had “spent months – if not years – dreaming” about her baby and her pain-medication-free birth. Often, it’s at home, where the mother fantasises that she will be “surrounded by my family, in an environment where I was free to walk around.” Ideally, the mother would even be able to reach down and pull her baby into the world herself. But, by dint of fate and unhappy circumstance, these moms are forced by medical professionals – sometimes even midwives or doulas – to have C-sections or epidurals. They are “treated disrespectfully or without compassion at that most vulnerable time.”

Read enough of these narratives and you’ll be convinced that the baby-industrial complex is a cold and harsh machine, where epidurals are pushed like marijuana from an aggressive street vendor and individual agency is dismissed.

But the reality is quite different. A new book, Lamaze: An International History by the historian Paula A Michaels, explains that the vast majority of modern American women are satisfied with their birth experiences. She doesn’t get into specifics on this particular matter, but she notes that according to a 2013 national survey of women’s childbearing experiences, “Mothers generally rated the quality of the United States maternity care system very positively.” 47 per cent said it was good, and 36 per cent said it was excellent.

Indeed, it’s my experience that even at big, impersonal city hospitals, the language and protocol surrounding maternity care is sensitive and catered to a woman’s desires. I recall the birthing plan that I was encouraged to fill out before I delivered at NYU Hospital. Would I like to move around during labour? Did I want pain medication offered to me immediately, or never? Did I want to delay umbilical cord clamping? (Studies show that this has benefits for the baby.) I remember looking at the crisp white sheet of paper with its cheerful check boxes and being mystified. Before receiving it, my “birth plan” consisted of going into the hospital when I started having contractions and leaving, at some point, with a baby in arms.

“We invite you to participate in the planning of your birth,” the NYU hospital’s website warmly announces. “We ask you to consider your preferences and beliefs that will make your birth experience meaningful to you and your family.” That’s a long way from the birthing gulag conjured up by disappointed new moms, and it’s a result, in part, of the adoption of Lamaze techniques in the US in the 1970s.

Michaels’s book offers a fascinating and detailed history of childbirth over the past century-plus and how what we refer to as Lamaze, but what is more technically known as “psychoprophylaxis,” fits into it. Michaels defines psychoprophylaxis as “a way of giving birth that attempts to manage labour pain primarily through psychological conditioning and without reliance on drugs.” The patterned “hee hee hoo hoo” breathing that is a staple of sitcom depictions of a Lamaze birth is intended to relax and distract a woman from the pain signals in her brain.

Though Lamaze was spread widely in the late ’60s and early ’70s by American feminists who were pushing back against a medical establishment that they saw as paternalistic, its roots go back to the 1930s, when a British physician named Grantly Dick-Read published a book called Natural Childbirth. Dick-Read’s Natural Childbirth was itself a kind of reaction to the established norms for middle- and upper-class birth. In the late nineteenth and early twentieth century, new state regulations about who could attend a woman during childbirth placed the majority of pregnant women in hospitals when they gave birth. Once birth became a formal, medical process, middle- and upper-middle-class women began asking for pharmacological pain relief. In 1915, Michaels notes, first-wave feminists were not agitating for a return to the home birth; they were arguing for twilight sleep during labour, because they thought it would liberate women from the discomforts of childbirth.

In Natural Childbirth, however, Dick-Read stated that childbirth is not inherently painful. “Women’s minds, not their bodies, were at the root of pain in childbirth and fear was ‘the greatest evil,’” Michaels writes of Dick-Read’s beliefs. The way to help women get out of their heads was through childbirth-education classes and greater support from husbands. Dick-Read promoted some insanely retrograde ideas – that birth pain is psychological; that women of the upper classes should be the ones having lots of babies – but other parts of his philosophy sound like they could have been cribbed from crunchy mommy blogs. Birth, Dick-Read wrote, is “an ecstasy of accomplishment that only women who have babies naturally [i.e., without anesthesia] appreciate.”

While Dick-Read’s methods were proliferating in the US and the UK in the ’40s and ’50s (though they never defined the dominant approach), a similar technique was devised in the Soviet Union. But there the impetus was different: a shortage of pain meds and a concomitant, statewide push for fecundity in devastated post-war Russia. There, psychoprophylaxis was developed and encouraged to improve the experience of the working classes. Like Dick-Read’s methods, psychoprophylaxis also relied on education for expectant mothers as a way to cut down on pain, which was, of course, all in their heads.

A French obstetrician named Ferdinand Lamaze picked up psychoprophylaxis when it was presented by Russian doctors at the 1951 International Congress of Obstetrics and Gynecology. Lamaze promoted, on an international scale, the trained muscular relaxation and patterned breathing he learned from observing women giving birth in Russia.

When Lamaze was first imported to the US, it wasn’t synonymous with zero medication. In the mid-’60s, “a little Demerol or morphine to take the edge off pain and tension did not stand in the way of claiming success in achieving a ‘natural’ birth,” Michaels writes. It was only when countercultural ’60s values, which prized authentic experience above all else, took over Lamaze methods that pain medication was eschewed completely.

Also gone was the notion that childbirth pain was all in a woman’s head. Pharmacology-free childbirth was framed as empowering because the male medical establishment pushed drugs, and those drugs “desensitised women’s bodies and clouded their minds” during an experience that should be wholly natural. Despite the shift in framing, the language of Lamaze moms in the early ’70s was curiously similar to the language of Dick-Read. They wanted an experience that was “near ecstasy”.

Exclusive use of Lamaze without pharmacological pain relief fell out of fashion in the early ’80s as epidural anesthesia became widely available, and as scientific literature began showing that those complex breathing patterns didn’t really help mitigate pain. But Lamaze helped usher in a lot of birth practices that we now think of as commonplace, including childbirth-preparation classes, allowing the birthing mother to have a supportive partner of her choosing in the room with her, and the rise of hospital birthing centers, which provide things like hydrotherapy tubs and homey furnishings along with access to the regular maternity ward should anything go wrong.

Michaels's book is balanced and impressive, but, like almost everything connected to childbirth, it is not entirely neutral or impassive. Even as she admits that most women are happy with their childbirth experiences, she still pushes for systemic change in her conclusion. She believes that maternity coverage should be ordered by the “logic of care” instead of the “logic of choice”. Care is an open-ended process without boundaries, Michaels says, while choice is a matter of assessing the limited products on offer. The latter, she argues, gives women a false sense of empowerment. According to a “logic of care,” women would be able to have a doctor or midwife with whom they’d developed a rapport deliver their baby, instead of whoever is on call; doulas, a kind of birthing assistant, would also be available to whoever wanted them, instead of just to women wealthy enough to afford them. Doula rates vary depending on geographic location and level of experience, but range from a few hundred to a few thousand dollars.

I don’t know that those measures are practical, or that they would even prevent the blogosphere from being “perennially abuzz with chatter of disappointing childbirth experiences,” as Michaels puts it. How do you guarantee that a certain obstetrician is available for every woman in labour? What if two women covered by the same doctor go into labour simultaneously at different hospitals? Isn’t a midwife allowed to have her own family emergencies that might supersede her job? What if your doula disagrees with your choices? Or the doula fights with the midwife? Will you still feel cared for and empowered?

I don’t mean to discount the bad experiences that women have during childbirth – those experiences are real and painful. But perhaps those are individual issues, rather than national ones, stemming, in part, from the unreasonably high expectations that we’ve put on the birth process. Our expectations are high because we choose to have children, and we have fewer of them. Before the pill and the sexual revolution, having children was socially expected and more difficult to prevent. As Jennifer Senior says in her new book, All Joy and No Fun: The Paradox of Modern Parenthood, “Adults often view children as one of life's crowning achievements, and they approach child-rearing with the same bold sense of independence and individuality that they would any other life project.”

But the other part of our high expectations may have to do with all of the new information we have about pregnancy and how our actions and environment could influence our fetuses. In her wonderful book, Origins, Annie Murphy Paul discusses the burgeoning scientific field of “fetal origins”. Paul writes that the discoveries of these researchers “have been cast as one long ringing alarm bell, one long line of doctors in white lab coats, shaking their fingers at pregnant women: No, Don't, Stop!” Your diet, your stress level, the air you breathe, and yes, how you give birth, can all affect your child. No wonder we are so concerned with how our children come into the world; we're told we could be screwing it all up just as they take their first breath.

As a result, we now emphasise our preparation in the run-up to the birth – all those birth classes to take and cord-clamping decisions to make – and yet, we leave the hospital almost entirely clueless about the mewling, fragile little bundles we’re spiriting home. Just like parenthood itself, birth is not always going to be something “ecstatic” or something that you can control, no matter how many boxes you’re allowed to check on your birth plan.

This article first appeared on newrepublic.com

Photo: Getty
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In focusing on the famous few, we risk doing a disservice to all victims of child sexual abuse

There is a danger that we make it harder, not easier, for victims to come forward in future. 

Back in the 1970s when relations between journalists and police were somewhat different to today a simple ritual would be carried out around the country at various times throughout the week.

Reporters, eager for information for their regional newspaper, would take a trip to the local station and there would be met by a desk sergeant who would helpfully skim through details in the crime Incident Book.

Among the entries about petty thefts, burglaries and road accidents there would occasionally be a reference to an allegation of incest. And at this point the sergeant and journalist might well screw-up their faces, shake their heads and swiftly move on to the next log. The subject was basically taboo, seen as something ‘a bit mucky,’ not what was wanted in a family newspaper.

And that’s really the way things stayed until 1986 when ChildLine was set up by Dame Esther Rantzen in the wake of a BBC programme about child abuse. For the first time children felt able to speak out about being sexually assaulted by the very adults whose role in life was to protect them.

And for the first time the picture became clear about what incest really meant in many cases. It wasn’t simply a low level crime to be swept under the carpet in case it scratched people’s sensitivities. It frequently involved children being abused by members of their close family, repeatedly, over many years.

Slowly but surely as the years rolled on the NSPCC continued to press the message about the prevalence of child sexual abuse, while encouraging victims to come forward. During this time the corrosive effects of this most insidious crime have been painfully detailed by many of those whose lives have been derailed by it. And of course the details of the hundreds of opportunistic sexual assaults committed by Jimmy Savile have been indelibly branded onto the nation’s consciousness.

It’s been a long road - particularly for those who were raped or otherwise abused as children and are now well into their later years - to bring society around to accepting that this is not to be treated as a dark secret that we really don’t want to expose to daylight. Many of those who called our helpline during the early days of the Savile investigation had never told anyone about the traumatic events of their childhoods despite the fact they had reached retirement age.

So, having buried the taboo, we seem to be in danger of giving it the kiss of life with the way some cases of alleged abuse are now being perceived.

It’s quite right that all claims of sexual assault should be investigated, tested and, where there is a case, pursued through the judicial system. No one is above the law, whether a ‘celebrity’ or a lord.

But we seem to have lost a sense of perspective when it comes to these crimes with vast resources being allocated to a handful of cases while many thousands of reported incidents are virtually on hold.

The police should never have to apologise for investigating crimes and following leads. However, if allegations are false or cannot be substantiated they should say so. This would be a strength not a weakness.

It is, of course, difficult that in many of the high-profile cases of recent times the identities of those under investigation have not been officially released by the police but have come to light through other means. Yet we have to deal with the world as it is not as we wish it would be and once names are common knowledge the results of the investigations centring on them should be made public.

When it emerges that someone in the public eye is being investigated for non-recent child abuse it obviously stirs the interest of the media whose appetite can be insatiable. This puts pressure on the police who don’t want to repeat the mistakes of the past by allowing offenders to slip through their hands.  And so there is a danger, as has been seen in recent cases, that officers lack confidence in declaring there is a lack of evidence or the allegations are not true. 

The disproportionate weight of media attention given to say, Sir Edward Heath, as opposed to the Bradford grooming gang sentenced this week, shows there is a danger the pendulum is swinging too far the other way. This threatens the painstaking work invested in ensuring the public and our institutions recognise child abuse as a very real danger. 

Whilst high profile cases have helped the cause there is now a real risk that the all-encompassing focus on them does both victims of abuse and those advocating on their behalf a fundamental disservice.

As the public watches high -profile cases collapsing amidst a media fanfare genuine convictions made across the country week in week out go virtually unannounced. If this trend continues they may start to believe that child sexual abuse isn’t the prolific problem we know it to be.

So, while detectives peer into the mists of time, searching for long lost clues, we have to face the unpalatable possibility that offences being committed today will in turn only be investigated fully in years or decades' time because there is not the manpower to deal with them right now.

So, now the Goddard Inquiry is in full swing, taking evidence about allegations of child sex crimes involving ‘well known people’ as well as institutional abuse, how do we ensure we don’t fail today’s victims?

If they start to think their stories are going to be diminished by the continuing furore over how some senior public figures have been treated by the police they will stay silent. Therefore we have to continue to encourage them to come forward, to give them the confidence of knowing they will be listened to.

If we don’t we will find ourselves back in those incestuous days where people conspired to say and do nothing to prevent child abuse.

Peter Wanless is Chief Executive of the NSPCC.