A Passion for Birth

by Sheila Kitzinger

  How To Grow A Baby Right

  Women talked to me about how the baby grows from a stalk. Its feet are embedded in the small of the mother’s back, like a statue modelled out of clay which is ripped out at birth, leaving a wound where it was torn off. The baby is curled round so that the head, too, is normally in the small of the back, above the level of its feet. It breathes inside her, and gets either milk through the ‘soft spot’ or anterior fontanelle, ‘the mole’, or – other women told me – blood from the mother through its mouth. The great danger was that a baby may ‘come up in the chest’ and to avoid this, and ensure that it did not grow too big, the mother wore a tight string below her breasts. Modern girls in the towns simply did up their bras very tight to prevent this happening. Women feared that if the baby went ‘up’ it may never come ‘down’, and in labour could choke them.

  The baby’s sex could be foretold. A boy lies on the left side. When ‘the belly round it is a girl, but if it have a point, it is a boy’. Fetal movements could also foretell sex: ‘To the movement of the child I know whether it is a boy or a girl. The boy doan’ move as often as the girl, bit it move more stronger than the girl’. And from Claribel, pregnant with her twelfth child: ‘I cannot keep up my urine every time I having a girl child cause my urine pass thin, and it is more like down there (touching her pubis) and the boy he doan’ give me any pain like what the girl give me, but this one I can hardly sit down’.

  The womb should be nourished by sex so that the birth canal is kept open and delivery easy. Maud said she told her man that she ‘didn’t want to feel much pains to bring the baby into the world’, and if he loved her ‘he must continue nourishing the womb by constant sex dealings’.

  One woman told me that when she gave birth to her first baby the midwife remarked that she had not had enough sex during pregnancy, so the vagina was closed. She was careful with the second baby to ‘have sex up to the last minute’.

  Midwives And Mothers

  Birth was not a dramatic event. Pregnancy, labour, breastfeeding, sex, were part of the inevitable and rhythmic flow of life, and bearing or feeding a baby was a normal state of existence. The abnormal would be to stop for any prolonged period.

  A woman got up a few hours after giving birth to cook the family porridge or do other household tasks. She carried on with jobs like these as long as she could during the first stage, too, and reckoned the length of labour from when she took to her bed. Usually it merged imperceptibly with pregnancy. She was not used to thinking in terms of set times and routines and rationing out her daily existence, so would be hard put to say when labour started. Her attitude to the start of labour was usually unhurried, casual and almost nonchalant.

  Midwives were skilled at adapting simple equipment. They made do with one or two jugs of boiled water, might work by the light of burning wood, candles, or a Tilley lamp if they had one, and used newspapers for sheets, boiled rags for swabs and lemonade bottles for glass utensils. Boiled empty condensed milk tins were used for sterilising scissors and hypodermic syringes. The main hygienic equipment was a bar of soap and a small bottle of Dettol. Sanitary pads were hemmed rags, boiled and ironed, since commercial products were too expensive.

  Like the Obeah man or woman and the religious cult leaders, a good midwife was a counsellor, both in practical, economic terms and in spiritual matters. She reprimanded a man for wife-beating, arranged to go to see the employer of another for failing to support his wife and 13 children so that the money could be docked at source, gave advice on morality and child psychology, and exchanged banter with those calling to her in the street. She may have been the only social worker in the area, and was the agency through whom the people communicated with bureaucracy – government offices, and welfare and health departments.

  I went with district midwives on home visits. The front of the houses gave a deceptive appearance of respectability to the district. But behind almost every one was a mud yard in which the occupiers had built perhaps a handful, perhaps several dozen, one room shacks, constructed of packing cases and tin sheets. There was no drainage, no equipment, other than old oil drums, for storing water, nothing but minimal privacy for anyone, young or old, ill or healthy, dying, making love, or in childbirth. Small children were for the most part unclothed, and played ‘dutty potty’ with old cans in mud or danced to the blaring music or half a dozen radios all going at once turned on full. Enormous lizards scuttled like small battleships fighting and chasing each other, starving dogs, bitches and puppies nosed among the huge piles of rubbish and excreta, women scrubbed clothes in the hot sun, and in every alley-way, walled by tightly knotted dusty cactus, littered with broken bottles, shit, cigarette cartons and other waste, squatted groups of unemployed young men playing cards or dominoes for money, sometimes smoking ganja at the same time.

  Taking place in the one-room hut, birth could not be allowed to disrupt the day-to-day life of the family. Children still had to be fed and washed and the rent paid. They might sleep in the same bed as the mother. If they could not be sent across the yard or out to play, they were separated from her by a strip of cloth hung over a clothes line suspended vertically down the length of the bed. The midwife would tell them to lie still and be good children and soon they would have a new brother or sister, and they would lie in breathless silence, sharing in their mother’s labour, listening to the midwife’s instructions and encouragement, hearing the first cry of the newborn baby, and seeing it as it was lifted damp from its mother’s body.

  Hospital Birth

  In the hospital there were two eight-bedded first stage rooms which were not only for those in the first stage, but also women well advanced in the second stage and those who had been returned to this ward shortly after delivery. Babies were frequently born in the first stage rooms, sometimes in the lavatories, or were dropped as the woman rushed into the delivery room. Thirty-five to forty patients gave birth in each of these wards every twenty-four hours.

  The midwives had a very different and much more limited function from that filled by those working on the district. It was mainly concerned with efficiency and speed of delivery or the patient, cleanliness, hospital routines relating to hygiene and orderliness, and the control and limitation of emotional factors in labour and the first 48 postpartum hours so that the greatest number of patients could be effectively treated in the shortest possible time without disruption of hospital organisation.

  They confronted almost insuperable obstacles. Equipment was always in short supply, even basic things like cotton wool, which was allowed to run out before it was re-ordered. The clock on one delivery room wall had not been repaired for two months, the emergency lighting supply had been out of order for one month, and for six months there was no tape for tying name labels on babies’ wrists, so that midwives had to spend time cutting up gauze. Sterilisation of swabs took 48 hours, liquid soap containers had been broken and not replaced so that everyone had to wash with odd bits of soap. There was no hot water after early morning, and midwives had to walk across the length of the delivery room to get water in chipped enamel jugs from the sluice. There was no isolation ward. And with no staff meetings or suggestion boxes, or any means of regularly and effectively communicating up the staff hierarchy, the midwives were dissatisfied and frustrated.

  Women came long distances to the hospital to give birth. To avoid delivering on the way it was the custom to balance a brick or other heavy weight on the head. This was said to have the effect of pressing on the baby and preventing its birth. The mechanism of this brick technique is probably fairly simple. The first effect is psychosomatic; the mother does not become anxious that the baby may be born on the way to the hospital, so continues to breathe rhythmically and does not hold her breath and bear down. The second effect is postural. To balance a weight on the head, the pelvis is tilted forward and the pelvic floor musculature has the effect of delaying delivery. Some women removed the brick on reaching the hospital and promptly delivered in the admission
room.

  It was in keeping with the mood of the labour wards that someone stuck up at the entrance of the hospital a card bearing the words – ‘Death is sure. Sin the cause. Christ the cure’.

  Birth in hospital was completely different from home birth. In hospital, it was a dramatic, physical experience, and the cries coming from the labour wards are those of pain and fear. At first sight the drama of suffering is almost overwhelming, and it was only as I observed the behaviour of women individually that a pattern emerged of women going through the same physiological experience, who were led by a few who were specially active, moving with repetitive cries.

  These women tended to have large families. Young first time mothers watched them in spellbound fascination, a fact which midwives frequently deplored. Throughout labour they danced and uttered cries which were typical of behaviour in revivalist cult groups, particularly that of spirit possession. They sparked off similar reactions in newcomers to the ward, and kept each other at high tension all the time.

  This might be reinforced by the administration of the ‘Jubilee cocktail’, an analgesic and sedative mixture which, called ‘knock-out drops’ or a ‘Mickey Finn’, is well known in the underworld. Thirty grains of chloral hydrate were given in one ounce or more of rum and shaken up with an ounce of sugar syrup.

  Listening to my tape recordings of Zionist church services with dance, prayer, chanting and cries to Jesus – and the largest proportion of worshippers and the most fervent are women – and comparing these with tapes of women in labour in this hospital, it was not easy to determine which was which.

  Hospital midwives told me that a woman cried, ‘Jesus! Jesus! Jesus!’ throughout contractions of the first stage, and they knew when she was in the second stage because it changed to, ‘Jesus Christ! Jesus Christ! Jesus Christ!’

  There was close physical contact between women. They bled over each other. Their waters broke over one another. They had contractions leaning against each other, flinging out their arms to hold on to the next body, and shared in a common sense of salvation when they were delivered. I did not meet one woman who said anything which suggested that she felt that she was being denied privacy in the hospital. Even when two women were on one delivery table, neither flinched from the mingled blood, urine, faeces and liquor of the other.

  Immediately after the birth hospitalised Jamaican mothers were in a state of emotional withdrawal, in spite of the fact that they had quick and easy second stages. This contrasted strongly with the woman’s delighted bonding with the baby when born at home. They seemed to leave the matter of the child’s life or death, health or ill-health to people who know better, resigned themselves to the hands of experts and often lay back wearily moaning, apparently too exhausted to look at their babies. Often too, the arrival of the baby forced home to them their economic condition and after the efforts of labour they felt unable to cope with the sheer problems of survival, of feeding, clothing and caring for their now enlarged family. The custom of showing only the baby’s sex to the mother, and not its face, and of rapidly moving the baby away before the she had had a chance to handle her baby, emphasised this trauma. At home the midwife rested the baby in the mother’s arms while she prepared to wash the child. The number of knots in the umbilical cord indicated the number of children the mother still had to bear. Many women took this very seriously, and trained midwives sometimes did this, if only in fun. If a hospital midwife commented on the number her verdict was accepted in all earnestness, since given the added mystique of hospital routines her every word had special significance.

  This counting of knots comes from West African placental divination. Sometimes I saw a mother’s satisfaction at birth turn to despair on seeing these ‘knots’, but, I have seen a mother beam with delight after I explained that they were just bumps, not knots, that she had had her ‘lot’, and suggested that she should now register with the birth control clinic.

  Babies And The Breast

  Jamaican babies were breastfed as a matter of course. Probably few would have survived if bottle feeding had been the norm.

  In the 50s the Government introduced dried milk (Semilko) for distribution from welfare clinics. Till then feeding on cow’s milk meant a teaspoon of condensed milk in a large jug of hot water; in lean times the milk was stretched further. When I was there new cheap (or if need be free) dried milk could be obtained, and in the towns much advertised American dried milks, some of them expensive, but all containing the same ingredients, had become very popular. Women skimped on protein for the older children so that the baby could be give SMA, Lactogen or Ostermilk.

  Babies were fed on demand, and it usually worked out at around two-hourly intervals. A sleeping baby was never wakened. After night feeds, and there may have been three or four at first, mother and baby fell asleep with the breast still available to the baby, often with the nipple still in its mouth. Night feeds continued for as long as the baby wanted them.

  The pattern of night feeding was based on a system evolved under slavery. While mothers worked in the fields during the day their babies stayed with an old woman who fed them on a pap of bread flour and water. So most breast feeds were given at night.

  A woman carried on doing domestic work, combing the toddler’s hair, or eating, and other things while she fed.

  Since there was no embarrassment about exposing breasts, nipples dried in warm air. Women rarely wore bras and when worn they were invariably of cotton. This meant that air circulated easily around the nipple. The mother did not mind if her dress or blouse was wet with milk, and made no attempt to wash it off, and never wore pads, so her nipples did not lie in a container of stale, congealed milk. Sore and cracked nipples were rare.

  Every mother expected to be able to breastfeed, and did not anticipate difficulty. I only met two women who failed to breastfeed satisfactorily out of approximately 200 with whom I discussed the subject. One was in the hills and one in Kingston. One woman persisted for three months, using complementary bottle feeds. She told me with evident surprise that her baby was flourishing and said she knew a mother who did not want to breastfeed in Kingston. The baby was ‘fat and well nourished’ in spite of being on a bottle.

  A Jamaican baby was fed casually – its head was not always supported – without concentration of purpose or attention, and without anxiety. An English mother would often try to prop the baby into exactly the right position, to feed for the set number of minutes, and for only so long at each breast. She was often in a quandary about not only how she could get the baby on to the breast if it was unwilling when the clock said it was time, but how to get if off again, once its jaws were clamped round the nipple, since the book said she should get its wind up at this point, or terminate the feed.

  I watched mothers breastfeeding, sitting in the shade of a tree or house and chatting to everyone who passed by. Other women broke off doing their washing, husking coffee beans, or plaiting straw, to stroll over and join her. Far from being a solitary activity, it was a social occasion in which gossip and local news could be exchanged.

  A mother had no idea of the time spent at the breast, or how long it was since the last feed. The baby usually fell asleep at the breast and when it dropped off she continued to chat, moving her whole body in a gentle rocking motion, then put the baby down on some rags indoors, or in the shade outside in the yard.

  When I asked when they stopped giving the baby a feed – and how they knew when to stop – mothers looked at me with amazement and I added, ‘Mothers do different things in different parts of the world’. They then said, ‘When I put it into her mouth and she draw back’. ‘When him leave the breast; he just sleeps.’ ‘When him take enough him spit out the breast out of him mouth.’ ‘When him seem bellyful, him burps and stops.’

  A baby wore little clothing – only a short cotton vest and a cotton napkin; or buttocks could be left bare and the baby be put lying on some rags. Frequently the only bedding the mother had for her baby was her own best dres
s, which, carefully washed and ironed, was put down as a sheet for it to lie on. Arms and legs were left unrestricted and the baby’s movements were free. Its life alternated between periods of marked freedom when it could wave its arms and legs about and periods of restraint provided by the close juxtaposition of other bodies as they crowded together for the night. The physical boundary the baby was meeting was not one of fabric or plastic, wood or shawl, but the flesh of another member of the family, most often that of his mother.

  At the breast the baby was held loosely. This freedom of movement and freedom for exploration was in marked contrast to the cocoon-like shawl or blanket-enveloped European baby, and it was encouraged to touch the mother’s breast and stroke and squeeze her.

  When I asked them what their babies did after feeds they all said, ‘Him sleep’, as if this were a surprising question. Asked what they did when their babies cried, mothers explained that this was when the baby was hungry or wanted a bit of ‘hushing’ (to hush a baby a mother takes her in her arms and rocks her, meanwhile talking or singing): ‘When this baby cries I know that the baby is hungry,’ but (this mother added) mostly because he was hungry, and then of course she fed him. ‘I take him up and feed him, but sometimes him want a little bit handling.’

  But when I was talking to women in the presence of a nurse, they were often apologetic and said things like – ‘I can’t stand crying’ to explain why they picked the baby up.

  When a baby at the breast had a bowel motion or passes urine a mother simply parted her legs.

  Volunteer assistants from the local high school, who hoped to become nurses, attended the infant welfare clinics to help out. These girls of 15 or 16, in blue and white school uniform, copied the nurses in everything, including their manner of dealing with patients, and were sometimes addressed as ‘nurse’ though it was well known that they came from local families. The way in which these girls tapped a mother on the shoulder and commented curtly, ‘Come!’ or lifted a protesting baby as if it were a sack of potatoes, without speaking or attempting to soothe it, faces impassive, hands strong, firm and unyielding, was almost a caricature of the nurses’ way of dealing with patients.