Tell her the truth
- Lamaze: An International History by Paula Michaels
Oxford, 240 pp, £19.99, February 2014, ISBN 978 0 19 973864 9
My NCT classes gave the impression that childbirth in Britain is dominated by doctors who foist painkillers on women against their better instincts, leading to a ‘cascade of intervention’ that may be damaging for ‘baby’. But when I went into labour and arrived at hospital, late on a Sunday night and in serious pain, a midwife told me to go home and come back when labour was properly ‘established’. There were no doctors to be seen. When I came back and it became clear something was wrong, there were suddenly doctors everywhere. Doctors are in charge of the medical management of labour but they’re not around to push pain relief on women with more straightforward deliveries than mine. Instead, midwives are keen that women should give birth ‘naturally’, without pain relief. Their message is reinforced by the media: ‘11 hours’ labour and all natural!’ ran the Daily Mail headline following the arrival of Prince George. The same plan was in place for the birth of Princess Charlotte, the Mail reported, ‘no drugs unless absolutely necessary’. But why should women experience pain when the medical risks of painkillers and epidurals are negligible (caesareans, like all operations, have some risks)?
As the phrase ‘too posh to push’ implies, women – particularly well-off women – are made to feel like failures if they have epidurals or caesareans. The subtext is: your education or professional status won’t help you now. Embrace your new role as a servant to your baby. Feel the pain. Growl like the base animal you really are. The women who ‘do’ NCT are mostly middle class, but they are encouraged through anecdotes and videos to believe that the model to emulate is that of working-class or ‘ethnic’ women, who supposedly give birth more easily; they take a break from scrubbing the floor or herding goats to slip a baby out like a bar of soap.
In the wake of heavy population losses in the First and Second World Wars, many countries launched campaigns to boost their birth rate. In the West, they were explicitly eugenicist: directed at women of the ‘better sort’. The obvious question here is why it seemed a bad idea to give women drugs that would enable them to experience pain-free childbirth. In the case of the Soviet Union, they were too expensive. In the UK and America, pharmacological quick fixes were frowned on (this is what lies behind the disciplinary, moralistic tone of the NCT). The American movement was led by an organisation called Lamaze, which is now an international company. The extraordinary thing, as Paula Michaels documents in her fascinating book, is that the Lamaze craze, so redolent of American self-determinism, originated in mind-control techniques developed in the Soviet Union.
Ivan Pavlov’s discovery of the conditioned reflex earned him a Nobel Prize in 1904. In the following decades, Soviet doctors used the idea to train women to relax during contractions and to practise breathing patterns which they believed would interfere with the transmission of pain signals to the brain. Advocates of psychoprophylaxis, as this technique was called, believed that tales passed from mother to daughter – folk wisdom and gory literary depictions of childbirth, such as in War and Peace – had created a powerful cultural illusion; what one contemporary of Pavlov called a ‘collective reflex’. These doctors aimed at the ‘re-education and reshaping of a mental attitude’. As the obstetrician Anatoly Nikolaev put it, ‘if the head is in any way responsible for labour pain, it is not the head of the foetus but that of the mother.’ In 1951, the Soviet authorities decreed that the method was to be used in every maternity unit in the USSR.
In June that year, Nikolaev gave a lecture on psychoprophylaxis in Paris. In the audience was Fernand Lamaze, an obstetrician who was running the maternity unit at the clinic for members of the metalworkers’ union. Lamaze, inspired, joined a delegation of doctors on a tour of the USSR intended to demonstrate advances in Soviet medicine. According to his account of the trip, he had to beg his guides to let him witness a birth; two days before he had to leave for Paris they relented. He visited Nikolaev’s clinic in Leningrad, and wept with joy at seeing a 35-year-old typist give birth to her first child ‘without pain and with joy … There was not the least agony in her eyes, not one cry, not one drop of sweat beaded on her brow, not one grimace appeared on her face.’
Extraordinary accounts of ordinary painless birth, combining the celebration of a rare miracle with a subtle prescription for all women, form the canon of the natural childbirth movement. In an early anecdote, told by the 17th-century French doctor Guillaume Mauquest de La Motte, a woman, ‘surprised by childbirth pains one day … wanted to call to one of her neighbours through the window; there she gave birth and the child dropped to the floor; to this accident she added a second … without either mother or child suffering the slightest inconvenience.’
The founding parable of the natural childbirth movement in Britain took place in the East End of London. An obstetrician and trainee male midwife called Grantly Dick-Read is attending the labour of a young working-class woman. Everything is proceeding without ‘fuss or noise’. When the baby’s head appears, Dick-Read offers the woman chloroform, but she turns it down. After all, she tells him afterwards, ‘it didn’t hurt. It wasn’t meant to, was it, doctor?’ Dick-Read told this story throughout his life to women who – like their Russian counterparts – had somehow got it into their heads that childbirth was painful. He claimed that for women who had attended his training sessions, pain became ‘almost negligible in over 95 per cent of normal deliveries’. In fact, ‘for the perfect labour, anaesthesia is unnecessary because there is no pain.’ ‘You have been marvellously lucky in finding all the “animal” women in pregnancy,’ one mother wrote to him, ‘the “animal” woman who has her child born while cooking a dinner – in a bus – etc – painlessly.’
Many women, however, welcomed the encouragement and guided autonomy provided by Dick-Read’s method. It didn’t prevent them from feeling pain, but Dick-Read’s authority and charisma prompted women to keep their expressions of it to a minimum. One obstetrician said that ‘patients wouldn’t hurt just to please him.’ In 1957, a phonograph album featuring Dick-Read presiding over a natural birth was released, which is still available on CD. You have to turn the volume up to hear the woman’s discreet sighs.
In the Soviet Union, the popularity of psychoprophylaxis waned rather rapidly in part because of doubts about its efficacy. But Lamaze had considerable success promoting the method in France, where it resonated with existing debates about Cartesian dualism. It also became a battleground for political ideologies. French leftists’ enthusiasm for the technique signalled their rejection of Anglo-American consumerism: this form of pain control was available to all women, not just those who could afford it.
In 1958, Marjorie Karmel, an American ex-actress, enjoyed an ecstatic birth at Lamaze’s clinic in Paris and wrote a book about her experience called Thank You, Dr Lamaze. It made Lamaze a household name in the US. One mother said it captured the thrill of Paris in the 1950s; it was ‘as evocative of its era as, say, On the Road’. But in its passage across the Atlantic, the Lamaze method had to be purged of its association with the Soviet Union. By the mid-1960s, Pavlov wasn’t mentioned on the letterhead of the American Society for Psychoprophylaxis in Obstetrics (now Lamaze International), removing links, as Michaels notes, not only to the Soviet Union but also to salivating dogs.
Dick-Read was rattled by the similarities between his own approach and psychoprophylaxis, insisting that his had come first (his bestselling Revelation of Childbirth was published in 1942), and denouncing Lamaze as Communist bunk, the product, he wrote dismissively, of ‘the ideological indoctrination he received in Moscow and Leningrad’.
Paradoxical ideas about conscious control and animal instinct pervade the history of natural childbirth. An idea about the psychological nature of pain, derived from experiments on animals, and applied to a cognitive training technique designed to encourage women to be more like animals, was adopted by opposite sides in an ideological war. Although Dick-Read praised the natural ease of working-class and tribal women during labour, his ideal was ‘civilised’ reproduction. He nevertheless disapproved of women pursuing careers: in Motherhood in the Postwar World (1944),he wrote that a woman’s ‘true emancipation lies in freedom to fulfil her biological purposes’.
Lamaze emphasised the virtues of preparation: this was what placed humans above primates. But he didn’t believe in giving women pain relief that allowed them to remain conscious and not be in agony. ‘I would have preferred an epidural,’ as one Lamaze mother put it, ‘because I have not chosen to be a masochist.’ But in order for childbirth to be instinctive, it had to be learned. As one sceptical doctor wrote of Dick-Read’s method: ‘Does childbearing require special training to be natural?’
Dick-Read sometimes seemed to think pain in childbirth was a good thing. In an article in the Sunday Pictorial magazine he advised doctors to remind women that childbirth ‘is Nature’s first hard lesson in the two greatest assets of good motherhood. Children will always mean hard work and self-control. Tell her the truth: motherhood is not fun, it is not a hobby.’ It is a view that persists. In 2008, Belinda Phipps, then chief executive of the NCT, said: ‘If we just dropped babies like eggs without noticing, what would that say about the responsibilities we’re taking on for the next twenty years? Birth marks you out as a mother and a carer for a very long time.’
In the 1960s and 1970s, doctor-directed docility gave way to the earth mother version of natural childbirth. Different breathing patterns were championed, not that they necessarily had any effect on labour. The British birth activist Sheila Kitzinger wrote in 1977 that when she lectured on either side of the Atlantic, students often asked if she advocated ‘“huff and puff”, “slump and blow”, “choo-choo breathing”, “the sigh”, “levels A, B, C and D”, “H out, H out, Hoo-hoo”, “sss-sss”, “tune-tapping” or whatever. I do not know if the mothers were as confused as I was. Certainly it all tended to be very noisy.’ Lamaze became part of a reaction to modernity and mechanisation. American feminists embraced perinatal preparation with the intention not of eliminating pain, but of ‘owning’ it. ‘Pain’s valorisation among middle-class, educated, white women in the United States,’ Michaels writes, ‘elevated the rejection of pharmacological relief to a rite of passage.’ In Painless Childbirth, published in 1970, Lamaze recorded the testimony of one devotee: ‘When friends say to me, “Well, did you feel nothing?” I reply, “Quite the opposite, I felt everything, and that is the wonderful part of it.”’
One new mother wrote to Ms magazine in 1978 to say she was ‘sick and tired of laments about the Terror of Technology v. The Joy of the Natural Earth Mother Way. I would rather lie on a metal table attended by doctors and machines than deliver a dead or defective baby in a cosy four-poster at home.’ In general, however, natural childbirth has come to be regarded as ‘woman-centred’ and ‘empowering’. Since the 1990s in Britain, it has been included – somewhat awkwardly – in the medical mainstream. Along the corridor from the labour ward is the ‘birth centre’, where you can have your baby in a pool as you listen to music or inhale aromatherapy oils, but you can’t have an epidural. This is the kind of birth most midwives suggest to women with low-risk pregnancies. If medically unnecessary ‘interventions’ occur in this country, it’s more likely to be a consequence of staff and resource shortages than of over-zealous obstetricians. As I discovered, they’re not generally seen until something goes wrong.
As Michaels points out, the fact that an almost identical form of preparation for childbirth emerged in Britain, the Soviet Union, France and the US, makes clear that these practices are determined by prevailing attitudes. But if the role of the individual woman in making decisions about the birth of her child is overstated, what has been thoroughly individualised is her accountability for what happens. As Lamaze put it: ‘A woman must be imbued with the thought that she is essentially responsible for the success or failure of her own childbirth.’ The transition to capitalist culture was complete.