After that, I always invited women to bring all the female members of the family to classes if they wished. A one-to-one relationship helped a great deal, but drawing on the sisterly relationship of Muslim women in the extended family was even better. A group of four or five accompanied one woman to my classes – sisters-in-law, a cousin, and an aunt I think they were. They were enthusiastic participants and when we got down to acting through different kinds of birth, massage, holding, supported positions and movements, joined in with relish, drawing on their own experience. Seeing the lively companionship and shared female knowledge in that group may have made the male-female couples in the class feel rather deprived. The emphasis on the isolated husband-wife relationship in North American and European industrial birth culture misses out on the emotional support and life experience that women can bring each other. Having a group of women from one culture infuses confidence and gives realism in a class. There is a case for making women-only classes available. These may appeal especially to Muslim women and others from minority religious and cultural groups where involvement of men in pregnancy and childbirth is considered inappropriate. It is worse than useless to try to prepare a devout Muslim woman for childbirth without taking into account the religious convictions in her community. This entails, wherever possible, drawing in other significant women in their lives, learning from them and approaching childbirth together, instead of teaching a pregnant woman in isolation. Birth education is not just about techniques. It should also involve discussion of memories of birth in the family, social and personal values, and may entail exploring deeply held religious beliefs.
The Five Pillars of Islam are the oneness of God (kalmia), prayer five times a day (salat), giving alms (zakaat), fasting during Ramadan (sawm) and making a pilgrimage to Mecca (hajj). Concepts of modesty (hiya) and seclusion (purda) are central, and wearing a head scarf or completely covering the head (hijab) is the visual symbol of modesty. Hiya is important for Muslim men too, and entails respecting women’s space, and not intruding on it. Food allowed under Islamic Law is called halal. When a Muslim woman is in hospital she wants to keep her modesty and privacy, eat only halal food, and have a quiet place in which to pray regularly. A Muslim midwife bathes herself before attending a birth and prays to the Creator. If the birth is complicated she recites a special chapter from the Koran.
I learned that every child has the right to be breastfed, ideally for two years. There are symbolic rites around birth. It may be important for Muslim parents to enact these in privacy. The father, or a respected member of the family, whispers a prayer, the adhan, into the baby’s ear as soon as possible after birth. It includes the pronouncement: ‘There is no God but Allah and Muhammad is the Messenger of Allah.’ A member of the family, often the father, places a small piece of date or a spot of honey in the baby’s mouth. If other family members are not allowed in the birth room this ceremony cannot be performed at the right time. It symbolises introducing the baby to the sweet things of life. Muslims on the Indian sub-continent tie with black string a small pouch containing a prayer to the baby’s wrist or neck, as protection against illness. This should always be handled with respect.
I have always used masses of verbal imagery and visual demonstrations of organs and physical functions in childbirth. My body is the canvas for this expression. Rather than issuing instructions to make the rib cage expand and force the diaphragm up to inhale and down to breathe out, for example, I suggested imagining it as like a jellyfish that could surge and spread out and downwards, allowing the lungs to fill with air. A rather odd image perhaps, but it works!
This all came from Stanislavski acting training. Our senses are important aids to understanding how we might feel in pregnancy, labour, and afterwards, too. I thought there was great danger in intellectualising birth and turning it into something our brains try to analyse and manage, but which is really an overwhelming experience when it comes to be lived, and surrender to the ocean and the roaring tempest. After a birth in which a woman has struggled to keep her brain in control and found it impossible, she is likely to feel an utter failure.
Some Stanislavski exercises I invented included squeezing stiff egg white through a syringe to make meringues, carrying a heavy tray, ironing, putting on a bra two sizes too small, struggling into jeans two sizes too small; driving – about to overtake – and a car coming in the opposite direction sweeps round the corner at speed, making a cake in the kitchen and a visitor comes in and asks if she can help, buttering toast and suddenly seeing that the milk is about to boil over; lying in bed at night feeling very unhappy and trying not to cry or to let your partner see you are crying, waiting at the station booking office for a ticket with the train just about to leave – it is desperately important that you catch it – the doors are being closed, people are saying goodbye and the clerk still hasn’t given you the ticket, and then recreating in your imagination an actual situation that has caused you great distress personally. Each exercise was followed by complete relaxation and a few minutes peace before embarking on the next so that residual tension was not carried over from one to another.
If I had gone straight from school to university and slotted smoothly into the higher education system I couldn’t have had my acting training and got to know Stanislavski’s method. Failing a Greek exam opened the door for me to create a way of approaching relaxation and body awareness to help women prepare for birth. What at the time seemed a set-back turned out to be a success.
I took failures and used them constructively. My Stanislavski-based exercises made a bridge with real-life situations. There might be a simple task based, for example, on domestic or office activities – then more complicated ones done under some pressure. Finally there were situations involving great stress, both general ones which could be shared, and other personal and private ones, which might be the subject of recurrent fears or dreams – things that the woman herself knew worried her.
She began to understand what happened to her body when she reacted to stress with tension, and found that she could let it slip away with active relaxation, a skill useful for stress situations in everyday life as well as for birth.
I found that it was a good idea to get members of the group to act and move. Then they learnt that static muscle contractions could re-enact these events in the same way without entailing movement. It is these static muscle contractions which encase our bodies and form each individual’s own ‘body armour’.
Instead of saying to yourself, ‘I must relax!’, ‘I must release all muscle tension’, or, as in psychoprophylaxis training, ‘I must hold the muscles in one arm tight when relaxing those in my left arm’, the contact from a partner’s hand gave the message of release, and eventually just thinking about it could stimulate instant relaxation. Then, when labour started, the pressure of contractions themselves inspired the same response.
I wanted to present the experience of birth vividly and prepare women for the intense physical sensations and turmoil of often conflicting emotions they might feel. Birth is psycho-sexual. I acted the thrilling and irresistible sensation of the urge to push building up in a powerful wave-like orgasm. My breathing speeded up, my eyes shone, and at the peak of desire I held my breath and opened up. Then I could breathe again and a second and a third wave of longing came.
When I did this journalists sometimes described it as ‘faking orgasm’. Far from it. It was a way of expressing the passion and fulfilment of spontaneous action in the second stage of labour. I wanted to convey the thrill of childbirth, contraction following contraction like waves in a mounting storm, the energy that pours through your body, pressure building up to the next roller-coaster, and the peace of the blessed lull between contractions.
When beautiful births are described or photographed, however placid the mother looks, and though there is a tranquil atmosphere, for her the earth is moving. I thought it was important to capture the passion of birth-giving.
I acted birth-giving and the different
phases of pregnancy and labour. My torso became the uterus, my arms fallopian tubes, and fingers the sea-weed-like tentacles that hover over the ovaries to catch a ripe egg and sweep it into the tube.
I invented a foam-rubber vagina – a hollow plastic kitchen container big enough for a birthday cake with two layers of soft sponge and a slit in the middle to represent the pelvic outlet and the perineum, and used a flexible baby doll that looked as nearly as possible like a real baby to act giving birth energetically. The baby’s head rotated and crowned, slid through the opening folds of tissue, the shoulders turned, I pushed in response to a passionate urge to do so, waited with a relaxed, open mouth and breathed gently, gave another little push, breathed rapidly, paused and pressed down once more, and when the baby’s body slipped out, reached down to lift the newborn up into my arms.
Instead of the language of text books and chunks of information from them, I combined vivid visual images with gestures and movement. To understand the uterus at conception, for example: ‘It’s a muscle about this size,’ and I’d clench a fist in front of me as I said this, ‘a bit like an avocado pear – only hollow, the baby floating inside in its own warm amniotic fluid, protected from bumps and bangs, with sound passing easily through the liquid.
‘As pregnancy progresses the walls of the uterus stretch, and grow new tissues as well. The cervix projects like the stem end of the pear or the neck of a bottle (I let my thumb stick out from the fist). That’s the bit that opens up in labour to let the baby out. A plug of mucus, like the cork in a bottle, seals it from the outside world, and from infection, and slips out before labour really gets going. At the end of pregnancy hormones soften your cervix, more blood flows through it, it gets puffy and begins to be drawn up into the uterus, so it’s shorter. That’s called “effacement”, and it’s a good sign. If you squat over a magnifying mirror with legs apart, you can see your cervix when the baby is pressing down against it. Part your labia and feel and look between the fleshy folds.
‘It’s like a plump Victorian button cushion with the mucus plug the button in the middle. When your cervix is ready for labour it is said to be “ripe”.’
Though it helps to know obstetric terms and a woman can ask, for example, how many centimetres her cervix is dilated, and realise what the answer meant, the vital thing was to visualise what was happening to her body.
Small boys experiment with controlling and cutting off the flow of urine, and use their pelvic floor muscles to do so. Small girls don’t seem to have any kind of game like this. But children often know that they can play with their pelvic floor muscles in one way or another. As one of my own daughters said, ‘Us can talk wiv our bottoms.’
Pelvic floor exercises were all the vogue in the 70s – rigidly tightening pelvic muscles to tone them. They were called ‘Kegels’, and still are in the United States. Dr Kegel was an obstetrician who directed attention to the importance of strengthening these muscles after childbirth, and even before, because of the strain that would be put on them. As a result women religiously practised ‘Kegels’ and stuck notices to their fridge doors reminding them to exercise. They bashed away at them – attacked them actually – and felt good about doing them, and bad when they couldn’t be bothered.
I preferred a more subtle approach, using the imagination. I suggested thinking of a circle of muscle halfway up inside the vagina that was like a lift in a five storey building. Get into the lift. The doors close. Now gradually tighten the muscle as you move from the ground to the next floor – pause – go higher – and so on till you reach the top. Then slowly, carefully, descend one floor at a time, and when you finish, go up one floor again. That way you keep the muscles springy and firm. This exercise has become standard in much antenatal teaching now.
But there is another way of thinking about it too. It is a kiss inside when making love. Then the exercise becomes sensual and intimate.
As an unintended goddess of pelvic floor exercises I must have made a lot of women feel guilty and inadequate. Journalist Deborah Ross interviewed Pam Ayres and wrote a poem in her style, ‘Oh, I Wish I’d Looked After Me Pelvic Floor’.
Oh, I wish I’d looked after me pelvic floor
And done them post-natal work-outs
I wish I’d been wise and I wish I had said:
‘I’ll do ‘em, and do ‘em times four!
Oh, I wish I’d looked after me pelvic floor,
But what did I do? I did snicker
So now when I sneeze, or laugh quite hard,
I wet a bit of me knicker.
The Twins
When Celia was nine months old, I discovered I was pregnant again, sooner than planned and I intended to have another home birth with a midwife. One day, six weeks before my baby was due, my GP was carefully palpating my abdomen and commented, ‘I think I feel two heads.’ My first thought was that I was having a two-headed baby, but then I realised what she was saying. I definitely did not want twins. It took a week or so to get over the shock and begin to look forward to them. Now, of course, I would have to visit the big teaching hospital, and not be allowed to give birth at home. Or would I? This was my body, my birth, my babies. I was already teaching childbirth classes for what later became the National Childbirth Trust. If I did not organise my own setting for birth, how could I expect other women to do so?
The antenatal clinic at the teaching hospital was like a cattle market. Women were sitting on rows of chairs and waiting hour after hour, holding their bottles of urine. Each woman, as she was called, went into a boxlike cubicle where a notice exhorted: ‘Take off all your clothes and put on the cotton gown.’ The air was thick with sweat and the smell of fear. Through the flimsy door I could hear everything the doctor was saying to the woman before me as well as the glup-glop of his gloved fingers as he stuck them into her vagina, probed, and then withdrew them with a plop.
I climbed onto the examining table, lay down, and realised that this was a three-sided cubicle. At my feet was an open hall where the obstetrician, registrars and students walked about, talking to one another, as they stared at each woman’s perineum, gave the bulging abdomen a quick shove, and then passed on to the next woman. We were laid out in rows like carcasses of meat.
At my next visit, Margaret, a friend who was studying medicine happened to walk by as I was waiting. She had given birth to twins in that hospital and they had not survived. ‘My God, you’re not coming here!’ she exclaimed. That decided me. I was not going to have my babies there if I could help it. I continued my antenatal clinic visits, however, because I wanted to know that my babies were a good size, their hearts were beating strongly, and their heads were presenting. They were. After one pelvic exam, when I came home and found myself bleeding, I made up my mind not to return. The babies were almost due.
Nuffield College, Oxford, where Uwe was a don, was planning its Charter ceremony the day before my due date; the ball was to be attended by the Duke of Edinburgh. I bought an attractive midnight blue dress speckled with bright Botticelli-type flowers, put a towel in the car, and danced all evening. Later that night, I woke from a dream in which I was having a period on a double-decker London bus. While wondering what the dream meant, I got up, walked out of the room, and suddenly realised that the balloon of unruptured membranes was hanging down between my legs. I poked it, swung it to one side, tucked it back in, and waddled back to the bedroom. As we got things ready, I became aware of easy, rhythmic tightenings like ocean waves.
We called the local midwife, who came and told me to go back to sleep. Uwe persuaded her to examine me, whereupon she exclaimed, ‘Oh, a head!’ I opened up, pressed down, and let out the first baby. She caught her in a roll of cotton wool, as she did not have time to get out her maternity pack. I lifted the baby straight to my breast. Then I felt a thud in the small of my back as the next baby dropped down. I asked the midwife to hold the first baby while I had the second, and with one push the second twin was born, inside the unruptured membranes. Their fused placentas c
ame with her. It had been an hour and a half since I had woken up.
Me with my new twins and Ceila with her twin dolls
If I had attempted to get to hospital the babies would probably have been born in a lay-by on the A40. Uwe photographed everything: me dancing (on a table for some reason) before it all started, smiling down as a head was born, and babies suckling – this at a time when women in birth photographs were commonly shown with their faces blacked out, or wearing masks.
Celia, our firstborn, came in and was presented with twin dolls. In a party atmosphere, we ate chocolate, laughed and cuddled. I did not tear and had minimal bleeding. Both babies suckled enthusiastically.
The twins, Tess and Nell were born on a Sunday, and on Thursday my class turned up to find the bump gone and two babies waiting to greet them! I joined the NCT national committee and used to travel by train to London with the babies head-to-toe in one carry-cot.
‘The Experience Of Childbirth’ – My First Book
Two years later Polly was born, another home birth. It was January, my room was full of hyacinths in bloom, and this flower still symbolises for me the heady scent of birth. Polly’s was a painful, tumultuous, triumphant 40-minute labour. I dilated gently during the week or two before birth, so that the actual labour was the final flourish to a process that had been going on quietly beforehand. The other children tumbled in to share the excitement and hold their new sister.
I was in a state of post-natal euphoria. I hadn’t wanted my mother around because I didn’t want to have my babies in the way she might have hoped. I wanted to do my own thing – I suppose I was still going though adolescent rebellion, a bit late in the day! Afterwards she said to me, ‘Darling, I knew you must be in labour. I felt every pain you had’, and I said – it was very cruel – ‘That’s odd, Mother, because I didn’t have any pain.’ I wish I hadn’t said that.
A Passion for Birth Page 10