The Dumbarton Oaks birthing figure is believed by some scholars to be Aztec in origin. It is a small statue of a crouching woman in labour. Her baby is emerging between her legs and her face is fixed in a rictus grin, with the muscles in her neck corded and her eyes popping wide. She’s looking up to the sky. The war photographer Don McCullin has observed that people do have a tendency to look heavenwards when experiencing anguish, and this figure offers an ancient representation of what anguish really looks like.
The British obstetrician Grantly Dick-Read, author of the best-selling book Childbirth Without Fear, first published in 1942, may not have been aware of the Dumbarton Oaks birthing figure. But he must surely have read Genesis (“in pain shall you bear children”, God promises the disobedient Eve). And he must have seen plenty of anguished women in labour while practising in Britain and South Africa from the 1920s to the 1950s.
Nevertheless, in his popular writings, Dick-Read put forward an idea that proved to be unexpectedly influential in the development of the so-called “natural childbirth movement”: that “primitive” women did not experience pain during childbirth. To his mind, a return to a more “natural” form of childbirth — by foregoing medical interventions such as analgesics and caesarean section — would effectively break the vicious cycle of fear-tension-pain suffered needlessly by Western women.
Dick-Read’s teachings continue to reverberate. On 6 March the head of the Royal College of Midwives, Gill Walton, apologised for the college’s role in promoting “normal” births as part of a campaign that lasted from 2008 to 2017 and is believed to have contributed to the deaths of mothers and babies who would probably have survived if c-section had been attempted earlier in labour. Walton acknowledged that parts of the normal birth campaign were “not as evidence-based as we would have wanted” and that a minority of British midwives were influenced by the ideology that can be traced back to the faulty reasoning of practitioners like Dick-Read.
I do recognise that there is truth to some of the claims made by natural childbirth proponents. Giving birth in familiar surroundings, rather than in hospital, can often reduce a woman’s fear, which can in turn also reduce her pain. And one medical intervention can produce complications that demand many more interventions, producing a cascade that can sometimes result in an unnecessarily medicalised and distressing birth. Most mothers and babies do just fine without the full panoply of 21st-century obstetrical technology.
But when birth goes wrong, it goes very wrong indeed. In the pre-modern era about 1 per cent of women died while giving birth. “Natural” birth is not only agonising, even for supposedly “primitive” women (as the Dumbarton Oaks figure shows us); it is also dangerous — not always, but often. My mother in law, a paediatrician, likes to tell her patients that “you can predict a low risk birth, but you cannot predict a zero risk birth”.
Anecdotally, my impression is that some NHS midwives are still working hard to steer their patients towards “natural” childbirth, despite the failures of the campaign that ended in 2017. I had my first baby last year and, because of my medical history, I knew from the beginning of my pregnancy that I would need to have a planned c-section. Nevertheless, whenever I met with a new midwife (which was often, since I never saw the same one twice), she’d typically begin our appointment by asking if I was planning a natural birth in the midwife-led centre, where interventions like epidural anaesthesia are not available. The upward lilt to the question made it clear that the answer I was expected to give was “yes”.
Some senior midwives, including Walton, concede that ideology is at play here. Yet, cynically, I suspect that part of the push for “natural” births was also about cutting costs. One student midwife detailed for the Guardian in 2014 that while giving birth on an obstetric ward overseen by doctors costs the NHS £1,631, a “natural” birth in a midwife-led birth centre costs £1,450, and a home birth £1,066. The fewer health professionals you have around you, the cheaper it is.
These figures are slightly misleading, however, because they do not take account of the costs to the NHS of compensation awarded to patients who suffer from avoidable complications. One study from 2019 found that, when these costs are included, planned c-sections turn out to be the cheapest option, given the huge sums paid to parents of babies who suffer brain damage during vaginal births that go wrong. That doesn’t mean, of course, that every baby should be delivered by c-section, but it should encourage us to resist fetishising the “natural”.
If I’m honest, there is a small part of me that envies the mothers I know who have experienced unmedicated vaginal birth and have found it to be, as the writer Milli Hill puts it in her book Give Birth Like a Feminist, “spiritual, ecstatic, empowering, and full of health and strength”. It’s an experience that I’ll never have.
But I wonder if this envy of mine is rather like the envy that a teenage boy feels when he reads battle stories written by victorious soldiers. According to Plutarch, the only exceptions to the rule against naming the dead on Spartan tombstones were men who died in battle and women who died in childbirth. The two ordeals have often been understood as feminine and masculine counterparts, to be bravely endured. We might envy, in fantasy, the men and women who come through such ordeals triumphant. We’re far less likely to envy those who don’t.
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