A Passion for Birth

by Sheila Kitzinger

  I was keen to draw in professional health and birth activist organisations and star journalists for advice right at the beginning. Dee Remington, who had been Assistant Editor of Woman’s Own, and Davina Lloyd, Features Editor of Woman, advised us on how to reach a target audience. I showed them the material that had been handed over to me. They commented that the writing style talked down to readers, at the same time as going over their heads, using complicated language and terms but failing to explain them. There was no glossary. It did not discuss emotions, dilemmas and challenges in any depth. They pointed out that ‘ease of reading is related to the cadence of sentences and phrases, not just the words used.’ Under the title of each topic there should be a ‘come on’, to draw the readers into the subject. Starting off each with a statement about the learning objectives ‘is like an eighteenth-century novel in which the author tells the plot before you start. It makes it very dull.’ Activities should be fun to do and be realistic. It’s no good telling the reader to spend an hour talking something through with her partner. She won’t. At the end of the running copy salient points should be picked out with bullets. I thought this was all spot on, but my colleagues did not welcome the suggestions.

  It was exciting to get a breath of fresh air from outside when an American researcher, Marjorie Walker, joined the team. Marjorie wrote to me saying that she had a doctorate in the education of young children and wanted to develop TV programmes. She had done research with Kathy Sylva, professor of Educational Psychology at Oxford – who suggested she contact me. (I knew Kathy because she had come to me when she was pregnant). Marjorie had no work permit for the UK so offered to work voluntarily for six months. I grabbed the opportunity, found a new ally, and she took over after I resigned in 1983.

  One reason why I found my role difficult was that I was used to working independently, while drawing on advice on an international scale from a wide circle of friends in the birth movement, and health professionals.

  I was writing a book for Dorling Kindersley called Woman’s Experience of Sex and had a very good photographer, Nancy Durrell McKenna, who also worked with the United Nations and was commissioned by charities such as Save the Children Fund and Oxfam. She submitted a photograph, from a South African Family Planning Clinic, of a mother holding a mirror so that her daughter could see how her genitals looked, and discuss the difference between a child’s and an adult woman’s. Though addressed to the Course Team Secretary, someone opened this package, was deeply shocked, and reported me to the Director of Continuing Education. I was accused of passing on sexually explicit and obscene photographs and this led to my resignation.

  I never worked for a mainstream institution again, remember my stint at that university as an ordeal, and was pleased to get away. I decided that if I was to create change I probably could not do so through any authoritarian organisation.

  The Royal Free Protest

  April 1982. Three days before. The phone rings and I am selecting clothes to wear – my choice a Stetson and a flowing cape – at the Birthrights rally outside the Royal Free hospital in three days’ time. ‘The Chief Constable here. You won’t be able to have your meeting by the hospital – too many people are coming. You will have to march to Parliament Hill Fields. I have arranged for mounted police to escort you.’ I ask how he knows this and how many he reckons will come. ‘Coaches have been ordered and will be arriving from all over the country. There’ll be around five thousand.’

  Five thousand people out on the streets protesting at an obstetrician’s decision that in future, in his hospital, all women must give birth on their backs on the delivery table, ‘until, and unless, it can be proved safe to do otherwise’. Many of Janet Balaskas’s clients had their babies in this hospital and some had been prevented from giving birth actively.

  The day came, and I watched the crowds swell. There turned out to be about 6,000 of them: mothers and babies, couples, single women, women medical students, midwives and students, doctors, feminist activists, home birth supporters – a great tide flowing around the hospital. We walked, (you can’t march with toddlers in pushchairs and it is difficult with a newborn tucked into a carrier against your body), to Parliament Hill Fields, together with Anna Ford, the TV presenter, Michel Odent, who introduced waterbirth to the UK, Janet Balaskas, founder of the Active Birth Movement, who fired us with her organising and publicity skills.

  The band struck up, and we were away!

  5,000 JOIN NATURAL CHILDBIRTH RALLY

  by Annabel Ferriman, Health Services Correspondent, The Independent

  ‘More than 5,000 mothers, fathers and young children marched across Hampstead Heath in north-west London, to demand choice in childbirth and the right for mothers to give birth by natural methods.

  The demonstration was sparked off by a ban on natural childbirth at the Royal Free Hospital, Hampstead, and the hospital’s refusal to allow women to give birth in whatever position they want: squatting, standing up, or on all fours.

  The hospital’s contention, and the belief of many obstetricians, is that the use of high-technology equipment during labour, such as fetal heart monitors attached to the baby’s scalp, improves the safety of childbirth.

  The organizers of the rally claim that such equipment forces women to take a passive role in labour, makes it necessary for them to stay still and consequently slows up labour, making it less safe and less satisfying.

  Banners with slogans such as ‘Squatters Rights’, ‘Stand and Deliver’ and ‘Don’t Take it Lying Down’ were carried by the marchers, who came from all over the country.

  Dr Michel Odent, the French obstetrician whose non-interventionist methods were recently shown on television, told the rally that the day represented the end of an era, a period when human beings had been dominated by technology.

  ‘Today we are awaiting hopefully another human being who might have a different mental picture of the Earth, who will use technology in the service of life’, Dr Odent said.

  Technology itself was not to be feared, but only the glorification of technology. He hoped new methods of monitoring a child’s heartbeat during labour would be developed which would be non-invasive and would make present obstetrics practice obsolete.

  Mrs Sheila Kitzinger, a natural childbirth campaigner, who organised the rally, called for the establishment of alternative birth centres in the National Health Service, which would be staffed and run by midwives.

  Anna Ford, the former Independent Television newsreader, told the rally about the birth of her first baby at the West London Hospital, Hammersmith. She had been allowed to give birth in the squatting position. Other women should not be denied that right she said.’

  This Royal Free protest, was called to demonstrate against an edict by Ian Craft, Professor of Obstetrics at the Royal Free Hospital, that all women must push and deliver lying down, ‘until, and unless, it is proved safe to be in other positions’. The spark that lit the beacon came from the Senior Lecturer in Obstetrics, Yehudi Gordon, who was encouraging women to get into any position that was comfortable for them and keep active. Midwives were developing alternative positions for birth and suggesting that women move around right through labour.

  Mounted police accompanied us on the march, and those who were dads were eager to tell us about the births of their children and what their partners had been allowed, or not allowed, to do, so there was animated discussion throughout the march.

  Following the protest the Professor resigned, left obstetrics and went into embryo research. He said it was nothing to do with the public protest.

  Janet Balaskas

  The joining together of mothers and midwives in the protest marked the rise of the Active Birth Movement.

  Janet Balaskas had studied with me to become an NCT teacher and I realised that she was a special discovery. Like me, she did not toe the line and simply repeat Grantly Dick-Read’s method of relaxation. This brought her into major conflict not only with the medical system but with the NCT
, which threw her out, and there was a split between those who advocated active birth and others who stuck to the standard Dick-Read methods.

  The NCT dreaded further polarisation between professional caregivers and pregnant women making what they saw as excessive demands. But soon NCT teachers started to examine research results and to incorporate pelvic movement, upright postures and spontaneous dance-like activity in their classes, which changed from ‘think positive, flop and breathe deeply’ to what was virtually ‘listen to your body and keep active’. There was a new synthesis.

  Radical midwifery was born. The Association of Radical Midwives, founded in 1976, chose the word ‘radical’ not to suggest violent revolution, but because of its literal meaning of ‘going back to the roots’. This ginger group was concerned to improve the education of midwives and pushed for extension of the three-year direct entry training (so that midwives did not first have to be nurses) to centres all over Britain. They claimed that midwifery was quite distinct from nursing. The leaflets they produced were illustrated with lively cartoons by Polly, my daughter number four.

  Childbirth Is Shaped By Culture

  A common picture of childbirth in primitive life is like that of anthropoid apes. It is wide of the mark. It is always shaped by culture.

  In traditional cultures around the world divination and incantation is widely used. Hawaiian midwives, for instance, use magic spells to take the pain from the woman and an incantation gives it to an animal. In one birth I attended the pain was conveyed to a very lazy brother-in-law.

  In Jamaica a woman who is having a difficult labour can be helped by the midwife if a sweaty undershirt belonging to the father of the child is put near her and she takes some good sniffs. Then the baby is born speedily. Most births are without an acknowledged father, so the sweaty undershirt indicates that there must be a man around. This gives the mother a sense of security because it indicates the man is going to take paternal responsibility.

  In Polynesia there is an incantation that midwives chant over a woman in labour, ‘Now the living child, long cherished by the mother beneath her heart fills the gateway of life. There is room to pass safely through. The child slips downward, becomes visible, bursts forth.’

  Just as there is ritual in traditional societies, there is ritual in modern hospitals.

  In a high tech culture women must go to hospital. Visits are allowed under restricted circumstances. The woman is separated from her partner and he (or she) is in a dependent situation, not allowed to affect the treatment of her or the baby, and often heavily patronised. In fact, a father usually has a humorous role and is supposed to be in a state of confusion and hopelessness.

  In our technological birth culture obstetric incantation is when the doctor says, ‘Don’t bother your head. Leave this to us, woman.’ Or ‘Keep your hands away from my sterile field.’

  The mother tends to be treated as if she were a sardine can and professionals open it to get at the contents. Technical terms are kept from her, and things said over her supine body which she is not supposed to understand. She may not be allowed access to her case records.

  It would be incomprehensible in a traditional society for the baby not to be given to the mother. In a technological culture a woman is not so much a mother as a sick person. She is not responsible for her baby, and the coming together of her and the outcome of pregnancy is regulated by the hospital. In the United States, and throughout the world where American obstetrics have spread their influence responsibility is taken from both the father and the mother. They become virtually non-persons. The ideal patient is passive and trusting – one who doesn’t interfere with hospital routine and is recorded on the case sheet as ‘resting peacefully’.

  Yes, there are women who wish to know very little and who don’t want to make decisions or even be aware of their labour or delivery. I believe they should have the right to that kind of birth if this is what they want. But birth as a pathological disturbance has now become the norm.

  Many women feel the need in and after birth to propitiate those around them. Bowlby suggests that men envy women’s possibilities of creative achievement in and through their bodies.38 Hatred is projected onto women by society at large. How else can we explain ‘routine’ episiotomies and ‘routine’ use of forceps? By cutting the vagina a culture seeks to gain control over women’s sexuality.

  There is evidence that continuity of care and care-giving helps make birth a satisfying experience for mothers. A continuous relationship also contributes to a midwife’s satisfaction with her work. Though shift work and being a member of a large team means that she can plan ahead, know what she will be doing this time next week, next month – even, perhaps next year – it fragments the midwifery experience, and all too often means that she feels trapped in a hierarchical and bureaucratic institution that regulates and controls her life, where she is just a cog in a machine. Because it denies her autonomy, and makes it difficult to give one-to-one care, it leaves her dissatisfied and frustrated.

  Many women struggle to find a way through post-traumatic stress after birth. They suffer nightmares, flashbacks and panic attacks, and describe the birth as a kind of rape, played out over and over in their heads like a video tape that cannot be switched off. It is still not recognised that midwives, too, may suffer from post-traumatic stress. Birth can be emotionally mutilating, for them as well as mothers.

  The essence of midwifery is a close relationship with women and their families as they pass through a major life transition. It is an exciting and awesome journey in which challenges are met, personalities revealed, and values explored. Midwives who have worked for many years in a hospital shift system may grasp the opportunity of switching to case-load practice because they are able to offer personal care. At first doubtful about it, and perhaps low in self-confidence, a new world opens up for them, and they use their midwifery skills with a fresh focus.

  Being a midwife is not just what a caregiver does. It is who this person is. A midwife stands at the crossing-point of generations, embodying fundamental values in societies across the globe.

  Writing About Sex

  ‘Why did you have five children? Was it just so that you had material for your books?’ Celia shouted at me when she was 12.

  When Woman’s Experience of Sex was published in 1983 she said this: ‘I am always accusing Sheila of being heterosexist. Looking back, I really appreciate the fact that she never wanted us to be the same as everyone else. Above all, she expected us to battle to change the world as she had done, and she always said that we should endeavour to put back more than we took out of life.

  ‘It wasn’t difficult to tell her that I had become a lesbian. She found that out from the headmaster of the school I was asked to leave. Although I wasn’t technically “guilty of the offence”, the experience of my mother sweeping in to see him in her flowing cape, and insisting that I be heard and believed, left me with a lasting sense of solidarity. It was clear that, although she would always say, “Fight your own battles”, secretly she was on our side, forever willing us to win.’

  Many mothers make it plain that what they would tell their daughters about sex bears little relation to their own experience. Pregnant women in antenatal classes often confess to a difficult relationship with their mothers. With busy lives of their own, they may have no time to be interested in their daughter’s impending motherhood. They don’t want to get involved.

  Since the birth control pill came on the market women find it hard to say ‘No’. Sex is still used as a way of getting your man – and keeping him. Our sexual experiences are not just something to do with the genitals, but feelings about our bodies and the relationship between these and other people’s bodies, and about ourselves as women and who we are.

  A woman may decide that she doesn’t want intercourse. She may want to be celibate. That is a perfectly viable option. Look at all the women who went into convents in the past. Some were trying to escape men – and live their own
lives.

  Women often apologise for themselves. If things are not good it is their fault. Before I wrote the book I talked to women who had been sexually abused, women who had been beaten, those who had been raped, and almost invariably they asked, ‘Was it my fault?’

  The sex book came about because I was fed up with sex being identified as an object and a vagina. A woman’s warm, tender, passionate, urgent, ecstatic feelings were much more than that. So I decided to research a book about female sexuality, and to include same-sex relationships and women’s feelings about pregnancy, birth and motherhood.

  One of the first things I learned was that many women were dissatisfied with their relationships with men. They were submitting to sex, enduring it in much the same way that we often think Victorian women did.

  The so-called sexual revolution of the 60s did not liberate women. Sex was a common currency so that women’s bodies were more bound to the sexual act than ever before. A great many women thought they were liberated but were in fact caught up in a rat-race to prove that they were sexually successful, and enjoyed the best and most frequent orgasms.

  I felt sure that sex was not just something to do with the genitals, or any one particular organ – clitoris, back of the neck, big toe, or anything else. A woman’s whole body can become an erogenous zone when she is aroused, sexual energy rushing through every pore of her body – her fingers, her toes, her head – everywhere.

  We had built up the idea of orgasm as the heavens opening and angelic choirs playing, so a woman can be quite surprised if it turns out to be quite a little thing for her. Orgasms can be different on different occasions. It depends on your mood and relationship. A purely mechanical orgasm can be unsatisfying. We have become conditioned to think of it as being ‘triggered’ because the language of sex is a male language. I was also learning a lot from my lesbian daughters.