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The Theft of Childbirth

Immaculate Deception: A New Look at Women and Childbirth in America

by Suzanne Arms
San Francisco Book Company/Houghton Mifflin, 318 pp., $6.95 (paper)

Birth Without Violence

by Frederick Leboyer
Knopf, 114 pp., $7.95

I

Childbirth has nowhere been regarded merely as one possible event in a woman’s life. The Hebrews saw in women’s travail the working of “Eve’s curse” for tempting Adam to the Fall. The Romans called it poena magna—the great pain. But poena also means punishment, penalty. Whether as a “peak event” or as a torture rack, childbirth has been a charged, discrete happening, mysterious, polluted, often magical; in our current idolatry, a triumph of technology. Thirty years ago, in Male and Female, Margaret Mead noted the violence done by American hospital obstetrics to both infant and mother in the first hours of life.1 Within the last few years, partly within and partly outside the women’s movement, criticism of technologized childbirth has been growing, notably in California, where an important case is under appeal by a group of midwives in Santa Cruz who are charged with practicing medicine without a license.

Two recent books, with differing tones and perspectives, criticize the depersonalizing of hospital birth (American-style, though increasingly faddish in Europe) and recommend alternatives. Frederick Leboyer, a French obstetrician, is Americanized in the sense that he assumes that the mother’s problems have been solved by hospital delivery; for him the radical issue is the handling of the newborn in the delivery room immediately after birth. Suzanne Arms, an American photographic journalist and a mother, is concerned with the warping of childbirth in modern obstetrical practice, its transformation into a “medical event” with consequent physical and psychic damage to both mother and child.

The technology of childbirth began with the forceps, first used in the seventeenth century by surgeons as a means of hastening slow labors, but forbidden to—and criticized by—midwives. The forceps and its monopoly by male practitioners were decisive in annexing childbirth—previously a woman’s event often taboo to men—to the new medical establishment, from which women were barred. The annulment of pain by ether-inhalation was discovered by a Georgia doctor in 1842; both ether and nitrous oxide were shortly after used in dentistry by Horace Wells and W. T. Morton, and the term “anesthesia,” suggested by Oliver Wendell Holmes, soon became accepted. In 1847, using ether in a case of childbirth, James Simpson in Scotland showed that contractions of the uterus would continue even if the woman was unconscious, and proceeded to experiment with and use chloroform to relieve the pains of labor.

A fierce theological opposition was mounted; the clergy attacked anesthesia as a “decoy of Satan, apparently offering itself to bless women; but in the end it will harden society and rob God of the deep earnest cries which arise in time of trouble for help.”2 The lifting of Eve’s curse seemed to threaten the foundations of patriarchal religion; the pain of labor was for the glory of God the Father. Alleviation of female suffering would “harden” society, as if the sole alternative to the mater dolorosa—the suffering and suppliant mother, epitomized by the Virgin—was the fanged blood-goddess, devourer of her children.

This view still finds expression in anti-abortion rhetoric, and has extended beyond any single issue to feminism in general. After the horrible and lingering death of Mary Wollstonecraft from septicemia, the Rev. Richard Polwhele complacently observed that “she had died a death that strongly marked the distinction of the sexes, by pointing out the destiny of women, and the diseases to which they were peculiarly liable.”3

In the nineteenth century the educated woman was seen as a threat to the survival of the species. “Deflecting blood to the brain from the ‘generative organs’…, she had lost touch with the sacred primitive rhythms that bound her to the deepest law of the cosmos.”^4 Patriarchal society would seem to require not only that women shall assume the major burden of pain and self-denial for the continuation of the species, but that a majority of that species—women—shall remain essentially uninformed and unquestioning.

The identification of womanhood with suffering—by women as well as men—has been tied to the concept of woman-as-mother. The idea that a woman’s passive suffering is inevitable has worn many guises in history; not only those of Eve or the Virgin Mary but later masks such as Helene Deutsch’s equation of passivity and masochism with femininity. If the medieval woman saw herself as paying by each childbirth for Eve’s transgression, the nineteenth-century middle-class woman could play the Angel in the House, the martyr, her womanhood affirmed by her agonies in travail. Oliver Wendell Holmes supplies one version of the rhetoric:

The woman about to become a mother, or with her newborn infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law…is arrested in its fall at a word which reveals her transient claim for mercy.5

The value of a woman’s life would appear to be contingent on her being pregnant or newly delivered. Women who refuse to become mothers are not merely emotionally suspect, they are dangerous. Not only do they refuse to continue the species, they also deprive society of its emotional leaven: the suffering of the mother.

It was therefore a radical act—the truly radical act of her entire reign—when Queen Victoria accepted anesthesia by chloroform for the birth of her seventh child in 1853. In so doing, she opposed clerical and patriarchal tradition and its entire view of women; but her influence and prestige were strong enough to open the way for anesthesia as an accepted obstetrical practice.

It was also under Victoria that the female body became more taboo, more mysterious, more suspected of “complaints and disorders,” and the focus of more ignorant speculation, than ever before. Female sexual responsiveness was deemed pathological, and the “myth of female frailty” dominated the existence of middle and upper-class women. Childbirth and gynecology were now increasingly in male hands, and the developing medical profession had no more interest in female self-determination than any other institution. If education was supposed to atrophy the reproductive organs, women’s suffrage was seen as creating “insane asylums in every county, and…a divorce court in every town.”

Clitorectomies and ovariotomies were performed on thousands of women as a form of behavior modification for “troublesomeness,” “attempted suicide,” and “erotic tendencies.” The professed “reverence” for (upper-class) women in Victorian England and America consisted largely in an exaggerated prudery.6 At the onset of labor, the woman was placed in the lithotomy (supine) position, chloroformed, and became the completely passive body on which the obstetrician could perform as on a mannequin. The labor room became an operating theater, childbirth a medical drama, the physician its hero.

In the early twentieth century various forms of anesthesia were developed specifically for labor. “Twilight Sleep,” a compound of morphine and scopolamine, was widely used until it was discovered to have a highly toxic effect on the infant. Sodium amytal and nembutal were found to produce after-amnesia (while only partly blunting pain), and of nembutal Sylvia Plath’s heroine in The Bell Jar bitterly remarks, “I thought it sounded just like the kind of drug a man would invent.”7 The development of caudal or saddle-block anesthesia meant that a woman could remain conscious and see her baby born, though she was paralyzed from the waist down. Speert and Guttmacher, in their textbook Obstetric Practice, admit that the use of caudal or saddle-block anesthesia can prolong the second stage of labor, by producing “uterine inertia…(and) the absence of voluntary expulsive efforts by the mother,” thus rendering a forceps delivery “necessary” where the child might have been born more swiftly and without instruments.

There are certain valid reasons for the prevention of exertion by the mother—such as heart disease, tuberculosis, or a previous Caesarean, 8 but women are now asking what psychic effect a state of semihelplessness has on a healthy mother, awake during the birth yet unable to participate actively, her legs in stirrups, her wrists strapped down, her physical engagement with the birth process minimized by drugs and by her supine position. This “freedom” from pain, like sexual “liberation,” places a woman physically at the disposal of men though still estranged from her body. While in no way altering her subjection, it can be advertised as a progressive development.

In the 1940s, the English obstetrician Grantly Dick-Read related pain sensation to fear and tension and began to train prospective mothers to relax, to breathe correctly, to understand the stages of labor, and to develop muscular control through exercise. Dick-Read placed great emphasis on the role of calm, supportive birth attendants throughout labor, especially the obstetrician, who was to act as a source of confidence and security rather than as a surgeon needlessly interfering with or accelerating the birth process. He held that anesthesia should always be available but never involuntarily imposed on the woman or administered routinely.

Dick-Read’s work was of considerable importance and many of his observations are still interesting. However, his attitude to women is essentially patriarchal. While in genuine awe of the female capacity to give birth, he writes of “the inborn dependence of woman” finding its natural outlet in her dependence on the doctor. “Biologically, motherhood is her desire,” he remarks, and “Varium et mutabile semper femina, but never more so than in childbirth.”9 For him, childbirth is a woman’s peak experience and purpose in life. Remove fear, reinforce ecstasy, and childbirth can be “natural”—that is, virtually without pain. But the male obstetrician remains in control of the situation.

During the Thirties and Forties, Soviet doctors began applying Pavlov’s theories of the conditioned reflex to childbirth. There had been, earlier, successful deliveries in Russia under hypnosis and in post-hypnotic states. This led to increased emphasis on “suggestion,” which was the basis for the first prenatal training: the creation, during pregnancy, of “complex chains of conditioned reflexes which will be applicable at the confinement. The pregnant woman learns to give birth as the child learns to read or swim.” The conditioning toward pain was to be altered and new reflexes set up; the method is described as “verbal analgesia,” using speech as a conditioning stimulus.10

In 1951, Fernand Lamaze, a French doctor, visited maternity clinics in the USSR which used the “psychoprophylactic method,” and introduced the method at the French maternity hospital he directed, one serving the families of the Metallurgists’ Union. Lamaze, far more than Dick-Read, emphasized the active participation of the mother in every stage of labor, and developed a precise and controlled breathing drill to be used during each stage. Where Dick-Read favors a level of “dulled consciousness” in the second stage, Lamaze would have the mother aware and conscious, responding to a series of verbal cues by panting, pushing, and blowing. However, as Suzanne Arms points out, the Lamaze method “has the unfortunate side-effect of greatly altering a woman’s natural experience of birth from one of deep involvement inside her body to a controlled distraction.” In her “militant control over her body,” she is “separate and detached from the sensations, smells, and sights of her body giving birth. She is too involved in…control.”11

  1. 1

    Margaret Mead, Male and Female (William Morrow, 1975), p. 268.

  2. 2

    Walter Radcliffe, Milestones in Midwifery (Bristol, 1967), p. 81; R. P. Finney, The Story of Motherhood (Liveright, 1937), pp. 169-175.

  3. 3

    Claire Tomalin, The Life and Death of Mary Wollstonecraft (Harcourt Brace Jovanovich, 1974), p. 226.

  4. 5

    O. W. Holmes, “The Contagiousness of Puerperal Fever” (1843) in Epoch-Making Contributions to Medicine, Surgery and the Allied Sciences (Philadelphia, 1909).

  5. 6

    B. Ehrenreich and D. English, Complaints and Disorders: The Sexual Politics of Sickness (The Feminist Press, 1973), pp. 26-36.

  6. 7

    Sylvia Plath, The Bell Jar (Bantam Books, 1972), p. 53.

  7. 8

    H. Speert and Alan Guttmacher, Obstetric Practice (McGraw-Hill, 1956), p. 305.

  8. 9

    Grantly Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth (1944; Harper and Row Perennial Library, 1970).

  9. 10

    Pierre Vellay et al., Childbirth Without Pain (Dutton, 1968), pp. 18-21; K. D. Keele, Anatomies of Pain (Oxford, 1957, Blackwell’s Scientific Publications), p. 182.

  10. 11

    Immaculate Deception, pp. 145-146.

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