What does contemporary midwifery have in common with Stalinist Russia?


Jessica Grose, writing in this week’s edition of The New Republic, reviews a new book about the history of the Lamaze movement. The piece, entitled Why We’re So Obsessed with ‘Natural’ Childbirth; A new history of Lamaze explains the origins of the mythology reviews the book Lamaze: An International History by medical historian Paula A. Michaels.

Grose’s review explores many of the themes I have written about over the past few years:

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… 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.”

As Grose notes, however, reality is quite different from the dystopian fantasies of natural childbirth advocates.

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.

Grose also notes the pernicious influence of the father of the natural childbirth philosophy, Grantly Dick-Read:

… 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.”

In other words, NCB was created by a misogynist eugenicist as a way of convincing women of the “better” classes to have more children. NCB is not feminist, no matter how much its contemporary avatars, midwives and doulas, try to pretend that it is.

The leading exponent of contemporary natural childbirth philosophy is Lamaze International, and the history of the Lamaze movement is also surprisingly retrograde. Before it was popularized by a French obstetrician, the philosophy of Lamaze natural childbirth was created with the encouragement of the Stalinist government to paper over the horrific quality of Russian maternity services. Simply put, the Russian government couldn’t afford obstetric anesthesia, so they set out to convince women that non-pharmacologic methods of pain relief were both equally effective (which they knew was a spectacular lie) and “better,” a value judgment they felt compelled to promote rather than acknowledge the dire state of Russian medical care.

What is most striking to me is that the Lamaze method, just like Dick-Read’s philosophy, was a deliberate attempt to manipulate women into accepting the future that men wanted for them, or in the case of the Russian government, the only future they could afford to provide.

And in a nearly seamless transition, the philosophy of Lamaze has been adopted by midwives, doulas and childbirth educators for the same cynical reason is was invented in the first place. What does contemporary midwifery have in common with Stalinist Russia? Neither can provide effective pain relief for childbirth, so both resorted to hoodwinking women into thinking that pain relief is unnecessary, and that unmedicated childbirth is an accomplishment.

In other words, contemporary midwifery and Stalinist Russia tried to make a virtue of necessity. They couldn’t (in the case of the Russians) and still can’t (in the case of contemporary midwifery) provide effective pain relief. The Russians couldn’t afford it and the midwives don’t know how to do it and can’t bill for it. In both cases, women are manipulated into making a virtue out of necessity, literally.

There is nothing inherently better, healthier or safer in any way about giving birth without pain relief and there never was. The Russians made it up because they couldn’t provide pain relief, and contemporary midwives promote it because they can’t provide pain relief, either.

Effective pain relief for severe pain is a basic human right. Those who make a virtue of denying women pain relief or shaming them for wanting it and enjoying it should be recognized for what they are: selfish and manipulative individuals who praise what they can profit from and demonize anything they can’t.