Childbirth, like war, is hell.

Soldier in his helmet with hands covering face

Civil War General William Tecumseh Sherman famously said, “War is hell.” It’s an accurate description, so it’s surprising that very few people said it before the 19th Century. War is about maiming, gutting, killing other human beings. and potentially being killed oneself. It is horrifying in every possible way, yet that is not how it has traditionally been portrayed. Young men were (and in some places still are) taught that war is about courage and honor, that it is the highest pursuit of “real” men and that success in battle is the ultimate achievement.

The philosophy of natural childbirth bears as much relationship to childbirth as army recruiting posters bear to the reality of war.

For most women, childbirth is hell, replete with agonizing pain, blood and bodily fluids. Traditionally it has been portrayed as excruciating, life threatening and a punishment administered to women by God. But in the mid 20th Century, natural childbirth advocates decided to romanticize it. They romanticize the pain by minimizing it, attaching spiritual significance to it, or by claiming that it is “good” for mothers and babies. They romanticize the dangers by pretending they don’t exist, and they romanticize the death toll by ignoring it altogether. Natural childbirth advocates go so far as to appropriate the classic exhortations of war mongers. Indeed, they refer to women as “birth warriors.”

What’s the worst thing that a man can be in society that values war? A coward. There is nothing worse than refusing to fight, particularly if it is because of the fear of being killed. Cowards are vilified in societies that value prowess in war and brave men receive medals. Natural childbirth advocates have appropriated the same reasoning, even if they express it slightly differently. What’s the worst thing that a pregnant woman can be in a subculture that romanticizes birth? Someone who does not “trust” birth, but “fears” it, i.e. a coward. Natural childbirth advocates teach women that birth is about courage and honor, that it is the highest pursuit of “real” women and that “success” in birth is the ultimate achievement.

The natural childbirth literature is filled with claims about the pernicious nature of fear in childbirth. It is considered the ultimate put down of doctors, who supposedly have created a “culture of fear” around birth. Fearing pain, and abolishing it with pain relief is derided as the province of weak women who are unwilling to fulfill their true function in life. Being alert for complications is asserted to cause complications. Most importantly, just as men who fear war are shamed with the appellation ‘coward,’ women who do not subscribe to the romantic idealization of birth asserted by NCB advocates are also shamed. They are portrayed not merely as cowardly, which is bad enough, but as bad mothers who care more about themselves than the well being of their babies.

Why did generations of men romanticize war? They did so for a very simple reason, to get other men to follow them into battle. Who would want to go to war if they knew what it was really like. Why do natural childbirth advocates romanticize birth? To get other women to validate them by following them and mirroring their choices.

The most important thing that every women needs to know about the philosophy of natural childbirth is that it bears as much relationship to childbirth as army recruiting posters bear to the reality of war. Both are all about hiding the grim and painful reality because very few people would willingly choose either war or natural childbirth if they knew the truth.

  • shay simmons

    OK, technically he wrote “war is all hell.”

  • susannunes

    Heck, the psychology profession even labels women who have legitimate concerns about childbirth and justifiable fear of it as having “tokophobia.” A phobia is an irrational fear. Being afraid of dying in childbirth or having one’s body damaged or destroyed in it is not irrational.

  • Erin

    I am a CNM student, and I hear the “trust birth” mantra everywhere. But I don’t trust birth, not one iota. I have not seen nor experienced anything that makes me trust it. Birth is a force of nature, not some benevolent deity you can appease by singing its praises. It can be as temperamental as the weather. Nurse-midwives are like meteorologists: we read patterns of pregnancy and labor to predict the outcomes. Often it’s blue skies, and that’s where we’re comfortable, but when a storm rears, we collaborate/refer to the disaster response team: the obstetricians and specialists. Failure to accurately predict a storm brewing can leave OBs unprepared with a mess to handle (like homebirths gone South) and a bad outcome for our mothers and babies.

    This can happen even with low-risk patients. I should know; my first pregnancy ended in a stillbirth. No one can tell me to “trust birth” when I’ve held my own dead infant in my arms. “Trust” has nothing to do with it.

    • Spamamander, pro fun ruiner

      I am very sorry for your loss, but thank you for channeling it into helping ensure other women have the safest births you can assist them to have.

    • The Bofa on the Sofa

      I am very sorry about your loss. And agree, thank you for channeling your efforts.

      I can imagine that you hear a lot of things that are pretty insulting when you come down to it. I know it can’t be easy, but I hope that when you do hear crap like that (“you have to have good thoughts!” or worse, attempts to blame bad outcomes on the mother), that you remind everyone that they are talking about YOU. Are they saying it’s your fault?

      They’ll come back with, “Oh, we didn’t mean you” but you need to remind them, when they are talking about loss, they ARE talking about you. Maybe they will realize that they are insulting real people.

      • Erin

        Yes. I swear, even among (some) CNMs, there’s such a woo-woo echo chamber. The most insulting thing to me is when I read professional midwifery literature and they list c-sections and epidurals as “poor outcomes”.

        Yeah…no. Process =/= outcome. Needing a c-section or pain medication does not constitute a failure of any kind. It is so paternalistic and condescending for midwives to push their agenda under the guise of female empowerment. Is the mother okay and healthy? Yes? Is the baby alive and healthy? Yes. Maybe the delivery didn’t go the way the mother or the provider wanted, but if the mom gets to walk out of the hospital with a healthy baby, then it was a successful birth. The only way to “fail” at birth is if mother and/or baby don’t get to go home…

        • LaMont

          C-sections might indicate something medically interesting at least, but epidurals? Like, wow, a universally-known-to-be-painful experience *required pain relief*? How is that a poor outcome? What is to be done about that? C-sections might indicate some sort of problem with labor that OBs might be interested in working on in the future, but what is to be done about the pain beyond *offering pain relief*??? Good god.

          • Erin

            I couldn’t begin to tell you. That is where I disconnect from many of my fellow CNMs. I don’t see epidurals or pain relief as any kind of undesirable thing. I don’t know where it became feminist and empowering to convince women they *should* feel the full pain of childbirth, and that there is some sort of morality to their suffering. I decided to become a midwife to advocate for my patients choice and preferences (provided they are safe, sound, and the baby cooperates), not my own birth preferences and agenda. Forcing what I consider to be the best way to give birth on a woman is paternalistic, and replaces that historical patriarchal structure of obstetrics that midwifery pushed back against with a new condescending matriarchy; it’s no better, really. I’m an aspiring midwife to promote patient autonomy, which is not inherently synonymous with natural childbirth–this is something many midwives have lost along the way.

          • LaMont

            I’d go so far as to say that I *advocate* for use of pain relief. Not if a woman is determined not to use it, but the fact that many/most women who go in with a “no pain relief” plan end up using it anyway says that we should start speaking up for the positives in pain relief. We need to stop setting up women to fail because they are in pain. We need to start putting “go without pain relief” in the same “stupid/insane” bucket with the JW’s “let yourself die if you need a transfusion” belief.

        • The Bofa on the Sofa

          The only way to “fail” at birth is if mother and/or baby don’t get to go home…

          That is definitely a bad outcome, but I find the description “failed at birth” to be pretty insulting. The birth attempt may have been a “failure” but no one failed.

          • Erin Williams

            I understand what you mean. I didn’t phrase that well. I certainly don’t view a stillbirth or maternal death as anyone’s failure (unless there was provider negligence involved). I don’t think that losing my baby makes me a failure, which is why I put “fail” in quotations. That’s not reflective of my personal feelings. I was trying to express that there is a big difference between c-sections and epidurals being considered a bad outcome and a dead mother and/or baby being a bad outcome. Firstly, one is truly an outcome while the other is just a mode of birth/intervention. Secondly, and most importantly, the death of a mother or baby is a far greater tragedy than a deviation from a birth plan or preference.

          • The Bofa on the Sofa

            The problem is, Erin, that some people WOULD consider it to be a personal failure. They have to believe that, because it is a consequence of the “nature is perfect, trust birth” philosophy.

          • Erin

            I agree with you…but I am confused…you said you found what I said insulting. Even after I clarified, do you find issue with what I said, specifically, or more the idea out there that some people legitimately would feel that way?

    • Tara Coombs Lohman

      Me too, Erin. Nothing makes you a believer in the “childbirth is deadly” philosophy like spending hours giving birth to a child who has already died. Many of us had to learn the hard way that you absolutely cannot trust birth. But I absolutely trust the medical science that allowed me to survive that birth, and that allowed me to monitor my next two children so they did not end up following their older brother to the grave.

      • Erin

        Tara, I’m so sorry that you are also among the ranks of loss moms. I wish no one else knew that pain, but alas, here we are. Rose-tinted glasses shattered.

  • Gæst

    Sing the praises of the epidural!

  • MaineJen

    Amen.

  • Anna

    Interesting analogy. I think when everyone comes out alive and in one piece from birth we forget that not everyone does. I can’t imagine a veteran that comes home and says “well I survived a helicopter crash so that means theyre safe” or “we need to stop looking at mortality as the only measure of outcome”. I wonder if a vet who lost his legs would go on the we love war FB page and be talked over by a bunch of lay people that have never seen action. Told to shut up and stop trying to ruin it for others? Or ignored while people talk about the trauma of having surgery to save their lives or being bullied into wearing a helmet.

  • Athene

    Ooooh! I get to finally use my history degrees!

    Fun fact: Throughout most of pre-christian Northern Europe, women who died in childbirth were given the same burial rites as men who died courageously on the battlefield. It was believed that the very act of carrying a child and attempting to birth it was on par with running headlong into the frontlines of combat. It gained a woman special favor with her ancestors and the gods of her tribes – especially the gods of war. In labor, she was considered a warrior – although her fight was against natural forces considered hostile and unpredictable, not other people. Wounds suffered in childbirth were referred to as battle scars. Childbirth was described in terms of great violence, and not sugarcoated.

    We still see this echoes of this in the sagas of the later Viking cultures where it was said that women who die in childbirth have a straight ticket to Valhalla and are feted even above the male dead of the battlefield, for their foe was more terrifying and the bravery required of them was considered greater.

    I specialized in European history, so those are the cases I know of in detail. I’ve heard of similar examples from the Levant and East Africa, and it wouldn’t surprise me if temporarily equating pregnant and laboring women with a warrior caste was common worldwide, at one time or another.

    I’m not trying to glorify warfare, or “natural” childbirth here. I am trying to show that the link between warfare and childbirth in our cultural consciousness is a very old one.

    One final note: Keep in mind, these practices and beliefs come from very close-knit tribal cultures. The concept of “unassisted childbirth”, as we know it today, was unheard of. A woman in labor would be surrounded by every able-bodied person who might be able to assist her. There are actually examples of midwives and birth assistants being executed or exiled for abandoning a woman in labor.

    The woman in labor cannot run away, and also cannot fail her test of bravery. Either she survives – and wins the battle – or she dies, and is still celebrated for her efforts to gift another child to the tribe. There are no qualifiers there. How she manages to bring that child into the world – or fails to – is not important. Only the fact that her body and life was put on the line to do so.

    The test of courage, then, was in the people who stood by the laboring woman and supported her. I think that is an important lesson for us today. Are we brave enough to face the unpredictable, dangerous side of childbirth so that we can be fully present with laboring women, and help them any way we can?
    Alternately, we could bury our heads in the sand and pretend their sacrifice is not much, critique their efforts, and tell them that positive thinking will fix all their problems. Would we dare to do that with someone serving in a military combat zone? I think not.

    • The Bofa on the Sofa

      OK, I know that Pablo’s First Law of Internet Discussion is to always assume that someone participating knows more about the topic than you do. In this case, I think we can say that Athene IS that person who know more about the topic than we do 🙂

      Thanks for that information!

    • Empress of the Iguana People

      I think I love you

  • StephanieJR

    Isn’t it an oft repeated fact (that I have no idea the accuracy of), that in ancient Sparta, the only people to get headstones were soldiers and women who died in childbirth?

    This doesn’t mean that war and birth are glorious events to be proud of; all this means is that war and birth are both hell.

    Also, there is something super squicky about ‘birth warriors’ being so proud of their fannies. Like, I’m pretty sure you’re more than just your reproductive parts, so please stop bragging about them.

    • Athene

      well said. 🙂

  • LaMont

    Oh! Today I crunched some numbers. Apparently, risk of dying by gun in the US each year is about half as high as the risk of childbirth. Idk if that makes me feel better or worse about having kids one day, but it does make me think that all my “gun control now” friends should stop being “nachural or bust” about women’s stuff.

    • Heidi

      Everyday something makes me feel bad that I decided to bring life into this world. If I’d held off childbearing another couple of years (got pregnant early 2015), I guarantee I’d have decided to not have a child. Of course, I love my child, but I love him so much, I really worry what kind of world I brought him into.

      • MaineJen

        Both my kids were born during the Obama years, too.

        Those were more innocent times…

        • Gæst

          I voted for Obama while pregnant.

        • LaMont

          sweet summer children…

      • guest

        I definitely have been feeling this way about my two kids as well.

      • Gæst

        Someone told me that having a child is the ultimate expression of optimism. When I have similar feelings about having brought a child into the world today, I think about people from past eras where things looked much worse. Sure, pregnancy was less of a choice in the past, but times that looked like the absolute worst did eventually turn around many times. And got worse again. And better again. Etc.

        • Merrie

          Yeah, this always gets me down too. I try not to think about it. My dad told me they were worried about nuclear war when I was born, and it’s always something.

      • Maybe a better one for having your child in it. Who knows?

    • fiftyfifty1

      Risk of childbirth to whom? The baby I am assuming. Certainly not maternal mortality.

      • LaMont

        Maternal mortality is what I was using, deaths per-100,000 births (as compared to gun deaths per 100,000 Americans annually).

        • fiftyfifty1

          Wow, this surprised me! I had thought that when you added it all up (homicides, suicides, accidents) that the total gun death rate would be higher than the maternal mortality rate, but no. (Gun death is ~12 per 100,000 total population vs. maternal mortality is ~26 per 100,000 births.) I guess my perception is skewed by the fact that total gun deaths are so much higher than maternal deaths.

          • Toni35

            Gun deaths get more press.

          • Wren

            Well, some of them do. Mass shootings or police shootings do. Suicides and single gun deaths often do not. I’m pretty sure if 26 women all died from maternal mortality in one place at one time, that would get a lot of press too.

          • fiftyfifty1

            “Gun deaths get more press.”

            Which makes sense. It’s ~14,000 gun deaths per year vs ~700 maternal deaths. If we cut maternal deaths in half (as some have estimated we could) it would save ~350. Cutting gun deaths in half would save thousands.

        • Tigger_the_Wing

          Isn’t that a mistaken comparison, though? Everyone in the US is at risk of gun violence, thanks to outrageously lax gun control, but by no means do all women give birth each year – and no men. So a woman can reduce her risk of dying in childbirth to nil by not getting pregnant (or reduce it to nearly nil by not carrying a pregnancy long enough to have to give birth) but there is nothing she can do to protect herself from death by firearm except by leaving the country.

      • OrionsMom

        It’s definitely the Maternal death rate IF one is assuming the USA. For a terrible reason the US isn’t doing a good job of taking care of postpone Mama’s. It’s ridiculously high for a developed country. I mean part of the problem is hospitals try to push mom’s and babies out of the hospital after 24-48hrs after delivery! They focus completely on baby and they don’t educate mother’s on her healing complications.

  • The Bofa on the Sofa

    It is considered the ultimate put down of doctors, who supposedly have created a “culture of fear” around birth

    Mind-boggling.

    It was doctors who wrote the book of Genesis 3000 years ago?

  • Empress of the Iguana People

    Posthumous glory doesn’t do much for a person, and usually that renown is fairly short-lived, a few generations maybe, unless you did something remarkable in life. Who fell with King Richard when Henry Tudor seized the throne? Even the other nobles are largely forgotten.

  • OT: There was another mass shooting yesterday. It was a small town in Texas; there are 26 dead and 24 wounded last I checked.

    The shooter checks all the usual suspect boxes. White, male, domestic abuser. This was probably a “domestic dispute” according to the latest updates. Are we going to take domestic abuse seriously now, now that unrelated innocent bystanders are increasingly at risk because of men’s entitlement and misogyny? I don’t have high hopes.

    • LaMont

      I feel weird about this, as a NYCer. When we are attacked by foreigners, red-staters try to tell us our business and how afraid we should be of immigrants (because as much as they fantasize, ISIS isn’t coming to THEIR rural middle-of-freaking-nowhere neck of the woods). It’s gross and absurd when they talk to us. So who am I to tell a town of god-fearing people, who believe that earthly life is inferior to the next life and far less important, who believe that women should not have reproductive/personhood rights, who believe that the second amendment is all but literally sacred, what to care about? If this is the “Freedom” issue they care most about, fine. And we’ll keep our immigration doors open here in Blue America.

      TLDR: This whole situation is eroding my ability to care about people who tirelessly vote to get themselves killed.

      • Well, as someone living in Texas, please believe some of us are trying to make it better! You wouldn’t know it from the news, but Texas is actually about 40% Democrat-voting (gerrymandering ensures we have less than that impact on state and national politics). Don’t write us off yet!

        • The Bofa on the Sofa

          Actually, Texas is even trending higher democrat than that. It is probably the southern state that is closest to tipping, and if that happens, it is a HUGE impact on the EC. If you get Texas, California and NY, you don’t need a lot more.

          • LaMont

            Oh I’m aware that Texas is split. But super-small-town Texas where the entire town can fit into one small church (and really does all go to church)? I’m guessing this is as red-blooded of a red-state situation as you can get.

          • Gene

            They are. I’m Texan and my parents currently live in that kind of small town. My mom jokes she knows all of the five other Democrats in the county by name.

            I can’t even get into the mental gymnastics there, but it tends to be xenophobia plus nationalism mixed with prolife and bootstrapism. A close friend is in a biracial relationship (married with kids) and her brother is gay (married to his partner), but she is a rabid trump supporter and thinks he can do no wrong and isn’t going far enough.

    • MI Dawn

      But, but, but TEXAS! The home of open carry and men and women who can kill a shooter with their eyes closed, right? How did this man kill 26 and injure 24 with all those brave people with guns around? (sarcasm, for those who miss it).

      • The Bofa on the Sofa

        The gun-loons are praising the neighbor who came with his gun to scare off the shooter….after the shooter killed 26 and wounded everyone else in the church.

        Like having the police show up wouldn’t have gotten the same result…

        • FormerPhysicist

          I think this is called closing the barn door after the horses have bolted. Sigh.
          He was brave, and good, and deserves props for trying to help, but we’ll never know if that neighbor actually made any difference at all. The shooter may not have had any plans to go anywhere else.

          • The Bofa on the Sofa

            According to NPR, he quit shooting because he used up all his ammo. He didn’t stand down in response to the other guy with the weapon.

            The neighbor may have helped chase him down in pursuit, but he certainly did not save any lives at the church.

          • MaineJen

            Someone commented at me that the bystander “stopped the shooting,” and thank goodness he was there.

            My reply? “NO ONE stopped the shooting. 26 people died.”

          • The Bofa on the Sofa

            I have heard that it was a small congregation, only around 50 people.

            26 dead, and 25 more injured, right? He pretty much shot everyone. What did anyone stop? Stop him shooting them again while they are lying on the floor bleeding?

          • Platos_Redhaired_Stepchild

            In a town of 300 people, everyone knows or is related to someone dead or injured. Jesus Goddamn Christ. Gun control needs to happen before this happens again.

    • The Bofa on the Sofa

      I almost think this is going to the case that sheds the light on the domestic abuser common thread.

      I mean, how many times do we have to hear that it is someone who is having a domestic spat and taking that out on the masses?

      • Or even if not, that they have a history of domestic violence? Because the Pulse shooter wasn’t taking things out on anyone per se, but he still had that history.

        • The Bofa on the Sofa

          Yep.

          It really is something that creates that common thread, doesn’t it?

          • Yep.

          • guest

            I heard on the news today that 50% of mass shooter have a history of domestic violence.

        • MaineJen

          They have Kelley’s court martial papers published now. They’re horrific. This man beat and strangled his wife, beat his child, and threatened them both with a loaded firearm before he was finally jailed. And yet, the air force did not report him to the national database, and he was still able to go and purchase an AR15.

    • MaineJen

      It’s okay! Dear Leader has assured us that this was a mental health problem. The guns are, again, blameless. /sarc

      As someone with an *actual* mental health problem, I’m getting REAL TIRED of hearing that the real problem is mental health.

      • Especially because this guy wasn’t mentally ill. He was an abusive asshole, but that doesn’t mean he had a mental illness. Most abusive assholes are legally and clinically sane.

        • LaMont

          Yeah, we should look at a history of violence. If certain mental health conditions are related to certain instances of that history, whatever. We’ll capture the *real* problem if we look at domestic violence, but let’s be real, the politicians who fetishize guns also believe that women are property.

    • EmbraceYourInnerCrone

      Mass shootings while horrific are a tiny part of the problem with guns in the U.S.:
      https://splinternews.com/more-children-are-shot-every-day-in-america-than-the-nu-1820188019

      “According to a study on children and firearm injuries, published in the journal Pediatrics in June by researchers from the U.S. Centers for Disease Control and Prevention and the University of Texas, approximately 19 children a day die or receive emergency treatment for a gunshot wound in the United States. The study, which is one of the most comprehensive of its kind, found that in total, between 2012 and 2014, an average of nearly 1,300 children died and 5,790 were treated for gunshot wounds every year.”

      http://pediatrics.aappublications.org/content/pediatrics/early/2017/06/15/peds.2016-3486.full.pdf

      • Oh yeah, well aware of that. But if the deluge of shootings spread out over time and place doesn’t do it, we’re stuck with mass shootings to bring attention to a public health issue that kills as many people as car accidents.

  • Heidi

    I was pondering the other day if sex was negatively viewed back in the day because the consequences could be so dire? I was thinking how scary something I consider a lot of fun would be if I was likely to become pregnant and on top of that, absolutely none of the reassurances I had giving birth with great prenatal care at a modern, well-equipped hospital. I can’t even imagine what it would be like to know you could easily die during childbirth, you had no way to prevent the pain, no way to know if your baby was doing okay in there, no way to get an endangered baby out, no way to really prevent a hemorrhage, no way to guarantee your baby had safe nutrition if you couldn’t breastfeed. I had a fairly straightforward labor, but I tore. When did they even start suturing tears? If I hadn’t gotten my second degree tears sewn up, would I be facing incontinence or excruciatingly painful sex forever? My baby and I probably wouldn’t have died during childbirth myself, but I think there’s a very good chance my child wouldn’t have survived after the birth. He’d probably be fed bacteria-laden, nutritionally inappropriate goat or cow’s milk out of desperation.

    Thinking about this, I can’t really blame people for not being sex positive. Women paid a heck of a price to have sex. I’m not sure how anyone can claim natural childbirth philosophy is feminist or pro-woman.

    • Sheven

      Sadly, you have it the wrong way around. People have had condoms since Roman times–they were made from sheep intestines and reused, but they did work and people did know about them. Moralists argued that if unmarried girls were told about them, and had access to them, they’d have sex before marriage instead of being chaste. And if married women knew about them they’d refuse to have babies because who would want the pain, work, and danger?

      There were some decent moralists who argued for birth control. Even religious people did, because they didn’t like the idea of young mothers dying in childbirth on their fourth kid, or families becoming poverty-stricken because they had too many mouths to feed. But for a lot of people, the pain of childbirth was punishment for unchaste behavior and a lesson to girls to keep chaste.

      • Sarah

        It’s interesting because we’ve also had ways to achieve mutual orgasm that don’t involve risk of pregnancy for a very long time.

    • attitude devant

      In answer to your question: YES. Read Freud’s case histories. There are several references to men who had a morbid fear of having sex with their wives because it could quite literally kill them, either by spreading disease or by causing pregnancy-related death.

    • OrionsMom

      Good question, when did they sew mom’s up after birth?

      • Didn’t. You stayed in bed 40 days with your legs together and hoped for the best. My private theory is that was really why virginity was so prized by men, not the idea that because a man had her first he could be sure of paternity. After repeated unsutured lacerations the vagina was slack.

        • Roadstergal

          Oh man. :/ When did suturing start being a Thing?

    • Merrie

      Yeah. It was bad enough being in college and using birth control but getting worried that it would fail and I’d have to have an abortion which I wouldn’t be able to access because there were few providers in my state who were far away and I didn’t have a car or a credit card and my parents would not approve.

      In the era you describe I probably would have become a nun.

  • Sheven

    The worst thing you can be as a mother is “selfish.” Meaning at any time you put your own needs ahead of your child’s. And since the person calling you selfish is the one who decides what your child’s best interests are . . .

  • Daleth

    Great analogy.