I’ve written extensively about the misogynistic views of Grantly Dick-Read, the father of natural childbirth. Dick-Read was deeply concerned that white women of the “better classes” were forsaking childbearing for political and economic rights. He viewed childbirth pain as one of the reasons, and strove to convince women that the pain of childbirth was in their heads, arguing that “primitive” women have painless births, an utter lie.
The philosophy of Lamaze birth began in the postwar Soviet Union when leaders tried to make a virtue of necessity. As Paula A. Michaels relates in her excellent book Lamaze: An International History, they could not afford to purchase the pain relieving mediciations available in the West, so they conjured a method of abolish the pain of childbirth by psychological conditioning. Soviet obstetricians believed that women were weak and had been “conditioned” to believe that childbirth was painful. Therefore, through patterned breathing and other exercises, they could be conditioned in Pavlovian fashion to have no pain at all. Lamaze was imported into France for political reasons. It was first used at hospitals run by the Communist Party of France as an example of the superiority of Soviet science over American science.
Therefore, both major forms of natural childbirth were based on deeply sexist and retrograde views of women, and scientific claims that were never true. They also shared another important characteristic, one that is rarely acknowledged among contemporary natural childbirth advocates. The practice of natural childbirth was deeply and deliberately paternalistic. It explicitly depended on the laboring mother trusting the doctor to take charge of childbirth. By convincing the mother that the pain of childbirth was in her head, doctors hoped to shame women into being more docile patients. Indeed, Lamaze and his Soviet and French colleagues graded women on their performance in labor. Women could be given and were given failing grades for exhibiting signs of pain.
Interestingly, neither Dick-Read nor Lamaze opposed the use of pain relief in labor. However, it was the doctor who decided, based on a woman’s performance, whether or not she needed or deserved pain relief. At no point were laboring women asked about their preferences or needs.
As Michaels notes:
… American obstetrician shared the value that European doctors put on psychoprophylaxis as a means to impart — as Soviet obstetricians liked to put it — discipline. The laboring woman who willingly and quietly relinquished control of the process to her obstetrician, while playing an active roll in assisting him to deliver her baby, was characterized as successful.
So the philosophy of natural childbirth is and has always been deeply sexist, unscientific, and patriarchal. How, then, did it come to be seen as feminist? The primary reason is that in contemporary incarnations, women, in the form of midwives, doulas and childbirth educators, replaced men as the people who manipulated women into behaving in ways that were convenient for them.
Simply put, natural childbirth has exchanged the matriarchy for the patriarchy.
That doesn’t mean that contemporary female arbiters don’t believe completely in their view of childbirth. Grantly Dick-Read, Lamaze and the other male originators of natural childbirth philosophy also deeply believed that what was convenient for them, a docile patient who refused pharmacological pain relief, was in the best interests of women. But natural childbirth, in its current incarnation, is still about convincing women that what’s actually in the provider’s best interest is in the woman’s best interest.
It is in the interest of midwives, doulas and childbirth educators to convince women not merely that they can control the pain of childbirth by preparation, but that experiencing the pain of childbirth is in itself a necessary, valuable and healthier choice. Contemporary natural childbirth is, in large part, about what midwives can and cannot do. If a midwife can do it, it is an acceptable practice. If a midwife can’t do it, it is an “intervention.” Hence epidurals, fetal monitoring and inductions are “interventions,” while waterbirth, cranio-sacral therapy, and herbal supplements are not.
But most importantly, and most apparent in countries where midwives are gate keepers of maternity care, it is the midwife who determines whether a patient needs pain relief and whether she gets it, not the patient. It is the midwife who determines whether a woman’s performance in labor is successful, not the patient. Both midwives and doulas appear to view pharmacologic pain relief as evidence of “giving in” and failure on the part of the mother. Both midwives and doulas appear to believe that they are more capable of judging whether a laboring woman “needs” pain relief than the woman herself. They have perfected delaying tactics (“You don’t really need it.””You’re doing great.” “You’re almost there.”), shaming tactics, and don’t hesitate to resort to simple obstruction by refusing to call for an anesthesiologist when the patient requests it.
The mantra of natural childbirth is “choice” but the meaning of choice within the world of natural childbirth is deeply circumscribed. When midwives, doulas and childbirth educators use the word choice, they don’t mean all possible choices that a woman might make. They mean one choice and one choice only, the choice to have a “normal” birth.
Midwives have replaced the obstetric patriarchy with the matriarchy. Some wield their power for the mother’s benefit, but more often that power is wielded for the midwife’s benefit. Midwives want to have complete control over childbirth and to that end, they lie to women about the risks of interventions, the dangers of refusing interventions, and the purported value of forgoing pain relief. Midwives do exactly what they abhorred about obstetricians, insisting that they know better than the patient herself what’s good for her.
Natural childbirth advocates have not overthrown the “authoritative knowledge” of obstetricians, they’ve simply promoted themselves to the role of the authorities.