A Passion for Birth

by Sheila Kitzinger

  In England instruction was at first based on the teachings of Grantly Dick-Read, the forerunner of all education for childbirth, who believed that fear caused a great deal of the pain that many women felt in labour. Through the centuries they had grown up to expect pain. The instant they felt uterine contractions they tensed up and resisted them, which resulted in more pain, which made them more afraid, and they reacted to this by getting more and more tense, which produced yet more severe pain. This he called ‘the fear-tension-pain syndrome’. The basis of re-education of the mother was to give her accurate information about what was going on in her body, reassurance and self-confidence and teach the art of complete relaxation. Many women benefitted enormously from this teaching. To others the reality of labour still came as a shock and they felt let down and deceived.

  Dick-Read intrigued Russian obstetricians already working in Pavlovian psychology founded on the conviction that pregnant women could be ‘de-conditioned’ from their environmental influences and ‘re-conditioned’ in such a way that they could adapt themselves to the stresses of labour. They aimed at setting up a series of conditioned reflexes both to verbal stimuli and to those coming direct from the dilating cervix, so that a woman could respond with behaviour which ‘blocked’ pain and she did not notice it.

  Lamaze, a French obstetrician in a Communist trade union clinic in Paris, visited the Soviet Union and was impressed by the quietness of maternity hospitals practicing these methods and the calm of the labouring women. He invented techniques by which the woman could adjust herself to labour – notably the ‘panting like a dog’ method of riding over contractions. Labour was transformed into an athletic activity for which one trained as if for a race

  In Britain meanwhile, the Natural Childbirth Association, together with the first obstetric physiotherapists and a handful of midwives, had been influencing more women; they met much opposition along the way, but persevered. Organisers and helpers used to have cups of coffee with nervous expectant mothers, reassure them and show them simple breathing techniques (breath-holding for bearing-down and quick panting for delivery) and relaxation ‘until you feel you are floating on clouds’. Some midwives and obstetricians, pleased with the results, became interested and started to send patients for help – but on the whole were tongue-in-cheek. Gradually hospitals began their own classes, gave morale-boosting talks, instruction in the use of the gas-and-air machine, and encouraged women to lie on the floor and relax while the midwives made a refreshing cup of tea. But the results of this hospital based training were unimpressive.

  The Natural Childbirth Association

  I had got to know Dick-Read towards the end of the 1950s and invited him to speak at a meeting. He came with Jess, his elegant and adoring wife, to stay at our cottage Toby House in Freeland, Oxfordshire, where we’d moved in 1956.

  It was tricky organising all the children, the publicity, the meeting, looking after my guests and still taking the opportunity to learn something from him. At breakfast time, with the children playing around, we were discussing the side-effects of birth on the mother’s self-confidence and interaction with her baby. I suggested that it would be interesting to do research on this. He paused in slicing the top off his egg, looked at me sternly and said, ‘Research? I have done all the research that is necessary.’

  We discussed natural childbirth, of course, and he told me about his experiences with women in the East End of London and during the Second World War. He was never an elitist and praised women’s courage and confidence. He had watched them working with their bodies giving birth in the slums or outside in the fields. He died in 1959 and I spoke about this on Woman’s Hour.

  ‘He didn’t believe for one moment that you shouldn’t use pain-relieving drugs in birth, but thought they were often used in place of good, emotional, loving support. When Dick-Read died he was very bitter and isolated. It was a time when technology was being introduced in a big way into British obstetrics. Dick-Read was way ahead of his time, but it isn’t so much that we’ve gone back to his ideas, as drawn on the wealth of his experience, the way he listened to women and respected them and considered birth a celebration of life.’

  Dick-Read, like many other gurus, saw those who supported him, as well as those who questioned his teachings, as hangers-on, and if they advocated research he might even regard them as traitors. As far as he was concerned he had revealed the truth. Their role was to accept it uncritically and enthusiastically and propagate his message.

  In 1959 the Natural Childbirth Association, seeking to broaden its base, changed itself into the National Childbirth Trust (NCT), not just advocating one method of preparation but becoming a sort of consumers’ council of childbirth. One year it elected as its chairman a specialist in hypnosis; another year a consultant who believed that previous instruction about what to expect often led women to behave unnaturally and to interfere with physiological processes which ought to be smooth and unstrained. The Trust started to vet its teachers more carefully. Many were midwives, physiotherapists, school teachers or social workers who brought special skills into their work and the sympathetic understanding without which obstetric information, however detailed, is never enough.

  With the fresh stimulus coming from the Continent – under the name of ‘psychoprophylaxis’ – antenatal education in Britain changed dramatically. At first claims made for the ‘new’ method were excessive and a woman who felt pain was made to feel as if there were something wrong with her and one who needed the help of a forceps delivery or a Caesarean section suffered desperate feelings of failure.

  While Prunella Briance was in the United States in 1959 and the Natural Childbirth Association became the National Childbirth Trust, the organisation changed its objectives and eradicated any mention of Dick-Read. Lamaze was substituted as the method of childbirth – the system he had based on Russian psychoprophylaxis. This reflected bitter conflict in the childbirth movement.

  I started to run groups (the first ‘couples’ classes) in our cottage outside Oxford, with discussion about emotions and changing relationships. From my background in social anthropology, I wanted to look at the values in our birth culture. I never did believe in just doing breathing and relaxation exercises – or, at least, I didn’t think that was sufficient to make birth joyful. These groups became very popular. People went to great efforts to attend. I remember one man bringing his very pregnant partner wheeled in a huge retro pram, trundling it five miles from a neighbouring village. He took a liking to another very attractive woman in the class. I don’t know whether it came to anything after their babies were born. But there were rumours of him being seen sitting on a ladder below her bedroom window when her partner was away one night – climbing up to help with changing a nappy perhaps!

  I had good friends in the NCT – remarkable women like Gwen Rankin, a tower of strength and wisdom, Philippa Micklethwait, peacemaker extraordinaire, who became President, the lively Joan Gibson who made us all mind our Ps and Qs, Ruth Forbes, who introduced a mix of yoga and encounter groups, and Betty Parsons who taught duchesses, and became antenatal teacher to Princess Diana and Prince Charles. These women brought a range of skills and distinctive personalities.

  I was increasingly fascinated by emotional aspects of birth. I was more interested in minds than muscles and in personal experience than exercises.

  Central to this was a woman’s relationship with the unborn baby growing inside her. The uterus isn’t a dark, soft cave, a retreat from sensation. Or a piece of anatomical equipment we might be just as well without. It is the place where the fetus has its first sensations, the environment for a person who is coming into being. The baby hears the throbbing of the mother’s aorta and other blood vessels magnified by the amniotic fluid in which it floats. The uterus isn’t a secluded, silent place, after all.

  When I started to work in childbirth doctors tended to refer to emotions as if they were merely trimmings, gilt on the gingerbread of reproductive physiology, and the
obstetric manoeuvres they conducted. Things have changed. We are beginning to learn that mind and body are inseparable. In childbirth education, too, labour used to be talked about as if it were an athletic event for which a woman trained as if for the 100 metres, or an ordeal for which she had to be brainwashed so that though it hurt, she didn’t realise it hurt.

  Giving birth is a psycho-sexual experience. Many women are swept up in these rhythms in spite of themselves, and regardless of techniques taught in antenatal classes. Each contraction follows on another like the waves of the sea, and every one brings nearer the birth of the baby.

  A midwife friend who loves doing home births rang me after a birth in which the mother had music during labour that they had selected together – Brahms’ String Sextet No.1 in B-Flat Major. And this midwife, called by one of her mothers ‘the shepherdess of birth’, exclaimed, ‘Oh, it was lovely! The baby was born at just the right point in the music!’

  This was a great time in the NCT because we were developing teacher training. With Ann Proctor, I devised an educational programme based on the Oxford tutorial system: individuals and small groups meeting with a tutor in a one-to-one continuing relationship. I was a tutor and taught study days and workshops as well as antenatal classes at the NCT office in Bayswater, London.

  For many of us the NCT served as a source for canalising energy, exploring ideas with other women and working for change. For me, it was never about coffee mornings. It was about women striving to reclaim childbirth as an exultant personal experience, rather than a medical event – and, in the process, creating a social revolution! Childbirth is a political issue.

  In my work as an NCT Tutor some remarkable students shared my enthusiasm. One was Janet Balaskas, who created the Active Birth Movement and has trained teachers from all over the UK and in other countries. Another was Janette Brandt, who started the Swedish Childbirth Association. Like me, Jan had Stanislavski drama training and took to the teaching methods I was developing like a duck to water.

  Many of these students went to live and work in other countries – Australia, New Zealand, the United States and Eastern Europe. It has been exciting to have had close contact with these adventurous women and be invited to lecture in places around the world in which I worked with them to develop a new kind of birth education. Others became writers, midwives, childbirth researchers and university teachers. I gained a great deal from those I have taught and am grateful to them.

  Birth Classes Were Fun

  Running classes was an opportunity to meet a wide range of fascinating people from all kinds of backgrounds: actresses, academics, artists and authors, dress designers, doctors and film directors, potters, poets, policewomen, priests and TV presenters. There was a group of Muslim women who came en famille – aunts, cousins and sisters – to support a young pregnant woman in their traditional style, and who contributed a lot about their cultural traditions in childbirth. There were lesbian couples following self-insemination. I remember one couple for whom it was very hard for a partner to support the other, because she had recently miscarried, and had to work through the grief she was feeling while at the same time rejoicing for the pregnant woman. There was a surrogate mother and the woman who was going to be the social mother who came to this group together to be as close as possible through the experience of pregnancy. An elegant model was on a strict diet – and effectively starved herself – to keep her figure. She was concerned that the bedroom into which she was going to take her new baby was painted completely black, with black hangings round the bed, and that this was going to be bad for the baby. Her partner was a well known photographer – obviously with a great sense of style – and their baby is now an artist. Ronnie Laing, the psychoanalyst, came with Jutta, and we discussed the significance of birth for the baby as well as the mother, and the ideas he had developed about how birth ought to be.

  One of the loveliest people was Felicity Kendal who attended with her husband, the theatre director, Michael Rudman. She was very like the character in her role in The Good Life, excited, bright-eyed and shining, and wanted birth to be as natural as possible. She was a committed member of the group, and missed only one meeting when she was on holiday. I loved having her there. In fact, at the end of her pregnancy, she switched from her private specialist obstetrician when she couldn’t get answers to her searching questions, and was told she would not be allowed to move freely in labour or use water, and opted for midwife care. She had a joyful and triumphant birth, in her own space, able to be upright and do whatever she felt like doing. Later she helped me launch my book Freedom and Choice in Childbirth.5 Many years later, in an interview for the Independent, she said that my writing had changed her life; ‘She gave me the courage to do what I wanted to do, in the face of doctors trying to shout me down.’

  In every class there was a buzz of conversation, laughter, and sometimes – as at the best parties – debate, but always vitality, reflection, honesty and celebration of pregnancy. Occasionally there were tears. If a woman was traumatised because an experience cast its shadow onto this birth there was always someone there to reach out. If she was deaf or disabled in some way, or didn’t have much English, others were ready and eager to help. The groups were lively and exciting because of this vital mix. They certainly didn’t just sit and listen or get down to a lot of exercises. They swapped ideas, explored feelings, shared experiences in ways that were much more stimulating for them than if I had only been advising and teaching. It was in dramatic contrast to antenatal classes that were mainly about acquiring information and being instructed. I described this in one of my early books, Education and Counselling for Childbirth, the one I wrote sitting beside my mother’s bed as she was dying.

  Psychoprophylaxis developed still more exercises based on the Pavlovian discovery of conditioning and deconditioning in experimental animals. In France practitioners of psychoprophylaxis talked about ‘verbal asepsis’ in childbirth. That is not surprising given what they inherited from Russian psychoprophylaxis. Velvosky, who introduced the method, opened one of his lectures with the announcement: ‘If you make a sagittal section of the corpse of a woman who died in childbirth you will see …’6 He warned women, ‘Your vagina, which will have been greatly stretched during the birth, will never again return to its prebirth dimension’ and advised against having baths at the end of pregnancy ‘as this may damage the vagina’. They called relaxation by a new name – ‘decontraction’ – and invented new types of breathing rates and levels for different phases of labour. Under the impact of psychoprophylaxis breathing exercises proliferated, so that wherever classes were taught there seemed to be some new variation or complication of exercises, and as I travelled on lecture tours across the United States, Canada and the UK, I was often asked if I taught, ‘huff and puff’, ‘slump and blow’, ‘choo-choo breathing’, ‘the sigh’, ‘levels A,B,C and D’, ‘H out, H out Hoo-hoo’, ‘SSSS’, ‘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, and labour wards hummed with activity as women busily breathed their way through contractions, often to the consternation and dismay of midwives, who sometimes saw these exercises as rites which were exhausting for mothers and midwives alike.

  That teaching method and the way of talking about bodies and birth was quite different from my approach. For one thing, I explored feelings in a way that some of my colleagues in the NCT found disturbing. One told me that she didn’t need to discuss feelings because ‘All my girls are normal!’

  I talked about how strong emotions can overtake you at different phases of pregnancy, too. Between six and four weeks before the birth a woman often has a sudden failure of nerve, focused for example either on labour or on being a good-enough mother. Around half the women in classes said that they lay awake in the night thinking like this. One woman said, ‘Tom doesn’t want to be at the birth.’ So I asked, ‘Why not?’ ‘Because of the blood.’ Tom said, ‘No, it’s not blood.’ She sa
id aggressively, ‘You wouldn’t want to see a road accident!’ Tom turned to me and said, ‘I am desperately disappointed that she doesn’t want me there’, and at last Sarah could say quite simply, ‘I am awfully scared!’ Another couple were discussing breastfeeding, and the woman said, ‘He has always advocated breastfeeding. It is a passion of his. He would make a much better mother than me!’ A pregnant woman is like an actress before the curtain goes up on the opening night, and may be afraid that she will forget all she has learned. It is, in one woman’s words, ‘an abrupt breakthrough of cold reality. It is like living in a warm, cosily lit house where a door is blown open onto the dark night outside. Suddenly the bump is a baby – a baby which, somehow, someday, has to get born. Whether by the birth canal or a Caesarean, whether it lives or dies, it is in and must come out.’ For each woman pregnancy has its private meaning.

  Muslim Birth Culture

  It was one of the most imposing houses near Buckingham Palace. I had been summoned to teach a young pregnant woman from one of the Gulf States about childbirth. She was not allowed to attend classes, so it had to be one-to-one and I was expected to do it in a single meeting. She spoke no English. It all had to be enacted with my flexible baby doll, plastic pelvis and foam rubber vagina and a dramatic performance by me. I breathed my way through contractions, sighed, relaxed, tackled a difficult late first stage with a torrent of powerful contractions, pushed, groaned, breathed, gasped, pushed, panted, and – gently, gently – smiling and shiny-eyed, gave birth to a gorgeous baby whom I lifted straight to my breast. But the only thing the older woman – her mother-in-law, or a senior wife (I never found out which) – who was in charge of the proceedings was concerned about was that I should show her young pupil how to push, long and hard. That was what she had to be taught. The mother was a little slip of a girl and the older woman feared she wouldn’t have the stamina or will-power to do it.