A Passion for Birth

by Sheila Kitzinger

  Anyone who has tried to carry on a normal working and social life accompanied by their children will know how anti-child our society is. There are many places where you cannot take pushchairs, prams, or even babes in arms, and the effort is so great that many women give up and are imprisoned as if in their own barred play-pens, looking out at the world but unable to take any part in it.

  In most of the Third World and in peasant societies, each child is welcomed as a protection against poverty in old age and to strengthen the bonds and enrich the life of the extended family. The child does not belong merely to its own parents but to a whole group of relatives and neighbours.

  Our Western society locks families up in concrete or brick containers, piled high in tower blocks, and tarmacs over the green spaces and woods. It crowds two adults and two children into as limited a space as possible and tells them to love each other and behave nicely, and if they are so profligate as to have more than the correct number of offspring and lumber themselves with grannies and other elderly relatives and ill or handicapped children – who should have been ‘screened out’ in pregnancy – well, they should have known better!

  Children need mud, grass, water and space to explore. Children need the wilderness. We have tidied it all away. It is a thing country children have always had and in Third World societies they still have it around the shacks and pre-fabs that scar the cities like great sores. Even if ‘home’ is a two-room hovel with a corrugated tin roof, a worn out motor-car body or packing case by the harbour, at least outside there is a natural adventure playground. The women, babies in shawls attached to their bodies like limpets, meet at the pump or well as they draw water, scrub clothes on stones by the stream, at the market where they sell and haggle, and on the ramshackle bus rattling its way stuffed with grown-ups, children, hens, ducks – and perhaps a goat or two.

  It is not, perhaps, the life we’d choose. But, Germaine asks, ‘What is our civilisation that we should so blithely propagate its discontents? How can we teach due care for children when we do not care for our own? Why should we erect the model of recreational sex in the public places of the world? Who are we to invade the marriage bed of veiled women? Do we dare to drive off the matriarch and exterminate the peasantry? Why should we labour to increase life expectancy when we have no time or use for the old? Why should we care more about curbing the increase in the numbers of the poor than they do themselves? Who are we to decide the fate of the earth?’

  I’ve seen stickers on cars in the United States which announce ‘Pollution – Your Baby!’ Perhaps it’s all very well for us to lecture each other about the world population, but to foist our solutions and our philosophies on the rest of the world is another matter. Multi-national companies are making large profits producing pills, injections and intra-uterine devices with which, even while we are becoming more and more aware of their danger to our own health, we are flooding the developing countries.

  Enthusiasm for controlling the breeding of the unfit and the unfortunate is, of course, not new. In 1915 Margaret Sanger, the American pioneer of birth control, chose several down-and-outs and sent them into the most crowded streets of New York, displaying the warning: ‘I am a burden to myself and the state. Should I be allowed to propagate? I have no opportunity to educate or feed my children. They may become criminals. Would the prisons and asylums be filled if my kind had no children? Are you willing to have me bring my children into the world? I must drink alcohol to sustain life. Shall I transfer the craving to others?’

  In England Marie Stopes wrote an article in the Daily Mail called ‘Mrs Jones does her worst’: ‘Are these puny-faced, gaunt, blotchy, ill-balanced, feeble, ungainly, withered children the young of the imperial race? Why has Mrs Jones had nine children, when six died, and one was defective? … Isn’t it for the leisured, the wise, to go and tell her what to do? … Mrs Jones is destroying the race!’ When Marie Stopes’s own son wanted to marry a woman who wore glasses, she wrote to a friend: ‘She has an inherited disease of the eyes which not only makes her wear hideous glasses so that it is horrid to look at her, but the awful curse will carry on and I have a horror of our line being so contaminated and little children with the misery of glasses … Mary and Harry are quite callous about the wrong to their children, the wrong to my family and the eugenic crime.’

  Germaine pointed out that, even though we had stopped talking to each other like that, much of what was being said to parents in the Third World countries was on the same level and denied our own responsibility for ‘the sudden exponential increase in the global human population as a result of an ecological disaster which happened about five hundred years ago, namely the explosion of Europe.’ Europeans founded their empires, finding stable populations living in circumscribed communities with reproductive strategies some of which had been effective for hundreds of years. ‘After the initial shocks, and systematic annihilation by guns, disease and poison, especially alcohol,’ survivors began to expand in a population explosion which spread like a virus. ‘When we see the hopelessness of the slums … we see the latest stages of an epidemic disease … It was the scourge of colonialism that cheapened human life, that made human dignity a nonsense, that showed the people in the hot lands that their destiny was not theirs to command. They may wish to escape the pangs of childbirth, for they will not wish to be fewer. There is all the difference in the world between family limitation undertaken for positive reasons and family limitation accepted out of despair. If the second becomes the rule, the world will not be worth living in, however few people are in it.’

  Germaine also discovered the joy of withdrawal – coitus interruptus. What had those of us who have been messing about with chemicals and bits of rubber been missing all these years? Far from being a sub-standard, risky and thoroughly awkward method of birth control, Germaine claimed that it held delights which most of us have forgotten as we have stumbled on, experimenting with yet more complicated and costly methods with dangerous side-effects.

  The trouble with coitus interruptus is that there is no money to be made out of it. No international pharmaceutical company is going to market it as a great new technique or arrange jamborees for doctors to discuss its benefits. Yet withdrawal is probably used more than any other method in the world and is associated with some of the lowest birth rates on record. It is how whole populations have been ready to respond to poverty, famine and other economic pressures long before the days of contraceptive clinics and the invention of rubber, and explains why in Europe birth rates went down dramatically the instant that couples decided they wanted to delay having children, or already had enough.

  It is generally assumed by doctors that it is both ineffective and harmful. One nineteenth-century writer claimed that it resulted in ‘general nervous prostration, mental decay, loss of memory, intense cardiac palpitations, mania and conditions which lead to suicide.’ More recent writers warn about marriage breakdown, anxiety and neurosis and suggest that men have heart attacks because of it!

  Whether or not a woman finds sexual intercourse satisfying has little or nothing to do with when or where a man ejaculates and everything to do with what he does before and after ejaculating. It is very hard for men to understand this because they think that the be-all and end-all of sex is penetration and ejaculation. And all the other delights of love-making are to them merely hors d’oeuvres to the main meal, or after-dinner mints! Women enjoy other kinds of touches and closeness, other caresses.

  Coitus interruptus is certainly not incompatible with skilled and considerate love-making. And because it demands care and self-control it may even draw out the best in a man. When women have talked to me about memories of adolescent sex, it is this aspect of it which they speak of with nostalgia. The quick screw in the marital bed is a far cry from this earlier long drawn out love-making that was spiced with danger.

  In peasant Italy the idea of ‘serving’ the woman entails prolonged intercourse with frequent withdrawal, and men pride themselves on
their ability to keep going ‘all night’. A man has no intention of getting married and having children until he can afford a house, so couples may be engaged for 12 years or more. The practice of coitus interruptus is part of the courtship. The woman who thinks it is about time they got married uses all her wiles to break down the man’s control so that, once pregnant, she goes to the altar, as Germaine says, ‘dressed in white as a testimony of the chastity of her relationship with the only man with whom she has ever been intimate.’

  Conception in this context is not seen as a disgrace, but as a blessing on the union and evidence of its rightness. After the birth of the first child, coitus interruptus will be used again until the couple want a second child, and so on. A good lover is one who can reserve and control ejaculation and who is considerate; a bad one is a man who just grabs a condom and uses the woman for his pleasure.

  In colder climates the practice of ‘bundling’ has allowed for the same extended love-making. The betrothed couple were tucked up in bed together, made snug and warm, with a large bolster between them to preserve the girl’s chastity. A man needs considerable flair in sexual technique to make love to a woman on the other side of a bolster! And it created a pattern of prolonged love-making and consideration for the woman’s feelings which lasted well after the eventual removal of the bolster and the right to lie in their own marriage bed.

  Germaine’s fireworks about sex and fertility are more than just a dazzling display. They spark off questions which, though uncomfortable, demand to be answered. They challenge the assumptions of those of us who live in the privileged and economically powerful parts of the world and which come from ignorance of values of women in Asia, the Middle East and Africa. We need to think in a new idiom, taking into account and trying to understand the bonds of commitment that tie human beings together over most of the world.

  Until now feminism has been a movement mainly for Western women. If it is also to be an expression of the hopes and longings of women in the Third World it is bound to change and may end up looking very different from Western-style feminism. Let’s hope that Germaine’s particular brand of shock-treatment helps us to understand this and adapt.

  My Teaching

  I have been accused of viewing birth through rose-tinted glasses and failing to acknowledge the agony and pain that most women experience. The argument is that women should have the right, without any special medical reason, to anaesthesia and be knocked out and wake up after it is all over.

  On TV and radio I have always stressed that there is no recipe for childbirth. Choices have to be made and they must be based on knowledge, not ignorance, or on wishful thinking.

  In an interview in 1986 I said: ‘Birth is absolutely rotten for many women. It’s sometimes made rotten because of the environment in which they give birth. The kind of professional help they have sometimes involves intervention which makes them feel trapped and disempowered. I had four home births and they were terrific. There are lots of other women who won’t have ecstatic experiences. I fully acknowledge that. But that’s why it’s so important for women to be educated about what is possible: to learn how to talk to their doctors, how to say what they want and stick to it and learn how to negotiate the kind of birth which is right for them.’

  Woman’s Hour

  From the 70s on I made quite a few appearances on Woman’s Hour, first with Sue MacGregor and later with Jenni Murray – both superb presenters – with whom I enjoyed discussing birth.

  In an interview in 1986 Jenni Murray drew on the Woman’s Hour archives to discuss the work I started in the 1960s she said: ‘Thousands of women in Britain have had greater control over the way they give birth thanks to Sheila Kitzinger. At a time in the 1960s when childbirth was almost exclusively in the hands of the, usually male, medical establishment she wrote her first book “The Experience of Childbirth” to “give women a voice”. She introduced to them the idea of fathers being present, if the couple wished it, at the birth; the birthing stool, moving around during labour and squatting for delivery, and the birthing pool. Her advice has sometimes been misunderstood as a demand for “natural childbirth” for everybody, causing women dangerously to refuse medical interference in their labours, or to expect an ecstatic experience when, for some, it could be anything but.’

  In one of the earlier programmes I had explained how I became enthused about childbirth: ‘It was my training as a social anthropologist that led me to my work with pregnancy and childbirth. When I first became pregnant myself, I discovered that we really didn’t know much about how women felt and behaved in different countries. All the anthropological work had been done almost exclusively by men, and they hadn’t asked questions about birth; there was a big literature on what was done to the placenta, because they had stood outside the birth huts of primitive tribes and had seen that happening, but they didn’t really know what went on inside. So I became very interested in what it felt like to be a woman giving birth in different societies, which of course included our own.’

  I said, ‘We have now discovered – and there’s plenty of evidence to support this – that it is much safer for a woman to have at least the upper part of her body well raised, even to be standing, for much of the labour. The uterus contracts better, the woman feels less pain, and the baby is better oxygenated. First of all this was looked at in terms of the first stage of labour, and then also in terms of the second stage. No woman in her right mind would choose to lie down on her back with her legs in the air to push a baby out, because she has to push uphill. Most women, if allowed to do what they want to do, and what comes naturally, will adopt a modified squatting position, crouch or kneel forward, or even get on all fours. Hospitals are now beginning to see that they achieve more effective second stages if they encourage women to adopt any position which is comfortable for them. I think this is marvellous – it means we have to do away with the old-fashioned delivery room beds, and put mattresses on the floor and provide lots of pillows, and something more like the medieval birthing stool – a very low, horseshoe shaped kind of milking stool – which women right through history used to sit on to have babies.

  ‘All this, of course, challenges the current preference in hospitals generally for mechanised, monitored birth. But what is the point of rupturing the membranes, inserting an electrode and putting a clip on to a baby’s scalp, and having a woman lying down and monitoring every heartbeat, if you are thereby producing a dip in the fetal heartbeat? There is also plenty of evidence to suggest that having a woman immobile, and rupturing the membranes artificially, thus taking away the protective bubble of water in which the baby is lying, actually produce the conditions which we then go on to monitor.

  ‘Sometimes I hear a doctor say that the one thing that matters is a live and healthy baby. For most families it isn’t the only thing that matters. The way one feels about that baby, and the bonds that link you with it, are important too, and there’s really no point in producing a perfect, well-oxygenated, healthy little animal unless the relationship between the baby and its parents is a going concern. That’s why I think we have to look at the whole culture of childbirth in our society and see what we can do to make it a celebration, a joyous occasion.’

  My own approach to giving birth I described as ‘psycho-sexual’, a term I used because I believe birth is essentially a sexual activity. ‘By this I mean not only that sex starts the baby off, but that the rhythms of birth are essentially sexual, if we allow them to be. I suspect that most of our hospitals don’t let women do this, but treat birth as a medical crisis. If a woman is really listening to her body, however, and in tune with it, the rhythms come in waves – both the rhythms of contractions right through the first stage, and the bearing down urges in the second stage. Often there is a team of people standing over the mother and saying, “Come on, mother, take a deep breath and push. Come on, push … push … push … Come on, you can do better than that … Hold your breath … and push …push …” There she is with her eyes po
pping out of her head, little blood vessels breaking in her cheeks and eyes, straining and groaning. In fact it’s an awful waste of energy, and she’s not helping the baby get born. Moreover her prolonged breath-holding may well be cutting down the oxygen reaching the baby. She looks quite obviously in distress, which can reduce the amount of oxygenated blood flowing through the placenta to the baby. Studies have shown that if a mother holds her breath for longer than six seconds there is a risk that she may cut down the oxygen reaching the baby, and yet people in hospitals still coax, cajole and command women to push.’

  Nigella Lawson

  Shortly after Nigella Lawson gave birth to her last child she and I did a Woman’s Hour discussion together. It was a meeting of minds. Nigella had had a home birth. She was still fresh from the experience, scented with breast milk, luminous, dewy eyed, touched with the extra beauty and gentleness of new motherhood. She spoke about the importance for her of giving birth in her own space, having those she loved around her, being free to move and make the sounds she wanted. It was clear that she was not just a ‘celebrity’. She was a highly committed woman with a strong mind and determination to do what she believed was right, and birth was for her an outpouring of love.

  Journalists And Me

  I usually enjoy working with journalists, though many assume I’m a midwife. Others cling to the ‘earth mother’ stereotype, and I must often try to dissuade them from using the term ‘guru’. They tend to write about natural childbirth without defining it, and imply that this is what I teach. It is a bit like ‘natural’ eating, clothing, or for that matter, parenting and education. The way we give birth is an expression of culture. It can be spontaneous and instinctual, but it is still patterned by the society in which we live.