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

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Manchester united: "A minority of absolute idiots are trying to break us apart"

At the vigil, one man's T-shirt read: "The only thing that's allowed to be separated by colour is the laundry."

A day after one of the worst atrocities in the history of the city, Manchester's people were keen to show the world the resilience of the Mancunian spirit.

Dom's, an Italian restaurant, is in walking distance from Manchester Arena, where 22 people lost their lives to a suicide bomber the night before. On Tuesday, the staff were giving out free coffee, tea and pizza to anyone who needed it. On a table outside, there was a condolences book, and teary passersby left RIP messages to those who perished. Under a bright blue sky, the community seemed more united than ever, the goodwill pouring out of everyone I met. But the general mood was sombre. 

"We need to make space for healing and for building up our community again, and just getting people to feel comfortable in their own city," the Dean of Manchester, Rogers Govendor, told me.

The terrorist has been named as Salman Ramadan Abedi, a 22-year-old Mancunian of Libyan descent. But with a population of 600,000, Manchester is a cosmopolitan hub, and proud of it. Throughout the day I encountered people of all skin shades and religions. On one of the roads off Albert Square, a couple of Orthodox Jewish boys set up a little stand, where people could grab a bottle of water and, if they so desired, hold hands and pray.

On the night of the tragedy, Muslim and Sikh cab drivers turned off the meter and made their way to Manchester Arena to offer free rides to anyone - many of them injured - who trying to escape the mayhem and reach safety. "It's what we do around here," my taxi driver said with a thick Arabic accent.

The dissonance between the increasingly frantic debate on social media and what was discussed on the streets was stark. I spoke, on and off the record, with about two dozen residents, eavesdropped on a number of conversations, and not once did I hear anyone speaking out against the cultural melting pot that Manchester is today. If anything, people were more eager than ever to highlight it. 

"Manchester has always been hugely multicultural, and people always pull together at times of trouble and need," said Andrew Hicklin. "They are not going to change our society and who we are as people. We live free lives."

It was also a day where political divisions were put aside. Theresa May and Jeremy Corbyn agreed to suspend their campaigns. For the next few days there will be no Labour vs Tory, no Brexiteer vs Remainer, at least not in this part of the country. This city has closed ranks and nothing will be allowed to come between that cohesion.

"I don't demonise anyone," said Dennis Bolster, who stopped by to sign the condolences book outside Dom's. "I just know a small minority of absolute idiots, driven by whatever they think they are driven by, are the people who are trying to break us apart."

Later in the day, as people were getting off work, thousands flocked to Albert Square to show their respects to the victims. Members of the Sikh community entered the square carrying "I love MCR" signs. The crowd promptly applauded. A middle-aged man wore a T-shirt which said: "The only thing that's allowed to be separated by colour is the laundry." A moment of silent was observed. It was eerie, at times overwhelmingly sad. But it was also moving and inspiring.

Local poet Tony Walsh brought brief respite from the pain when he recited "This is the Place", his ode to the city and its people. The first verse went:

This is the place In the north-west of England. It’s ace, it’s the best

And the songs that we sing from the stands, from our bands

Set the whole planet shaking.

Our inventions are legends. There’s nowt we can’t make, and so we make brilliant music

We make brilliant bands

We make goals that make souls leap from seats in the stands

On stage, everyday political foes became temporary allies. Labour leader Jeremy Corbyn, home secretary Amber Rudd, Lib Dem leader Tim Farron, Mayor of Greater Manchester Andy Burnham and house speaker John Bercow all brushed shoulders. Their message was clear: "we are Manchester too."

The vigil lasted a little over half an hour. On other occasions, a crowd this size in the centre of Manchester would give authorities reason for concern. But not this time. Everyone was in their best behaviour. Only a few were drinking. 

As Mancunians made their way home, I went over to a family that had been standing not far from me during the vigil. The two children, a boy and a girl, both not older than 10, were clutching their parents' hands the whole time. I asked dad if he will give them a few extra hugs and kisses as he tucks them in tonight. "Oh, absolutely," he said. "Some parents whose children went to the concert last night won't ever get to do that again. It's heartbreaking."

Felipe Araujo is a freelance journalist based in London. He writes about race, culture and sports. He covered the Rio Olympics and Paralympics on the ground for the New Statesman. He tweets @felipethejourno.

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