A Passion for Birth

by Sheila Kitzinger

Sometimes a journalist’s questions are formal and routine. Do you believe…? Where do you like to go for your holidays? And so on. Sometimes they are zany: What animal would you like to be? I think I prefer the zany ones. Anyway, Good Housekeeping asked me that one and I said:

  ‘I rather fancy feathers – lovely to stroke and to ruffle, and pretty to preen. For grand occasions I’d like splendid plumage touched with gold, emerald, crimson, ivory and black. I’d never have to think what to wear – only have to spread wide my peacock tail or flamingo wings. I could adapt to changes in the weather, too, without needing to wear heavy clothing – just a shake or two and I’d be wrapped in a soft, air-pocketed feather duvet, which rainwater would just slide off, leaving me glossy, bright and dry.

  ‘Then I could spread and lift my wings and take flight over cities, mountains and the sea. It would be a terrific improvement on transatlantic flights – I’d no longer be locked in a metal tube and forced to inhale other people’s cigarette smoke.

  ‘I’m not sure that I want to lay eggs, though, since the sensations of human birthing are so exciting. Give me a new combination of bird and mammalian physiology and I’ll take off, flapping my wings into the sunset.’

  It is those women journalists who claim to be ‘post feminist’ and who see birth entirely in terms of shopping around, with every option of more or less equal value, who criticise me for apparently dictating how women should have their babies.

  Polly Toynbee writing in the Guardian, came over very strong on this one. She wrote: ‘Natural childbirth, a child of the sixties, was and is largely a nutty fad from a noisy group of lentil-eating earth goddesses.

  ‘How extraordinary that those who call themselves feminists fight for women’s right to suffer and, in the process, inflict so much unnecessary suffering on women. The right to safe local anaesthetics, properly administered by experienced obstetric anaesthetists, should come first. Of course, the right to refuse it is important too. But the earth mothers have lied and lied again about the risks of anaesthesia and as a result they have denied women a genuine right to choose. For if you are led to believe there is a serious risk to yourself or your child, you would probably opt to suffer the pain, however severe.’40

  In my letter back I said: ‘Polly Toynbee claims that I, and other “earth goddesses have lied and lied again about the risks of anaesthesia”. I want to put it on record that I have not lied, and that I object strongly to her unsubstantiated accusation.

  ‘Some women have had traumatic experiences with so-called “natural” birth. (Actually, it’s not a term I use. As a social anthropologist I see birth as always patterned by culture). Often this kind of “natural” labour has been under slap-dash supervision, with no real understanding of how to support physiological processes in childbirth, and sometimes with staff who have attitudes towards the labouring woman which can only be described as punitive. My own research reveals that there are other women who have also had traumatic experiences with epidurals. I am working to make birth better for all women, whether they decide they want an epidural or prefer to avoid all obstetric intervention.

  ‘Instead of polemics and angry denunciations, we need to explore exactly how care, including different methods of pain relief, can be made more effective, and enable women to make informed choices between alternatives.’

  Rowan Pelling did a witty piece on witchcraft and midwives and, thinking I was both, wrote: ‘I made a programme on childbirth earlier in the year and I can state as an unscientific fact that one in three midwives is a practising witch. I knew within one second of meeting Sheila Kitzinger, Britain’s reigning birth guru, that she could turn you into a frog by one clench of her pelvic floor muscles.’ It is rather difficult to live up to this image but I continue doing my pelvic floor kisses, and one day may qualify as a witch.

  Baby Mix-Up

  In 1986 a mix-up in an Irish hospital left two women with each other’s babies, and the blood tests that followed to sort it out seemed to justify the nagging doubts of many mothers – particularly those who gave birth in large hospitals where babies were routinely taken away to the nursery.

  ‘Can I be sure that this really my own baby?’ they often asked themselves as they removed the name tag when they got home and tucked it away as a memento.

  When birth takes place at home it is impossible for babies to be switched by mistake. But when the birth was conducted in a busy ‘production line’ maternity hospital, and babies were whisked away to lie in rows in plastic boxes in the nursery, returned to their mothers only for feeding, it quite possibly happened more than we know. And maybe in some instances where nobody realised, such mix-ups were never detected.

  In the United States all newborns were foot-printed immediately to avoid such confusion and some people pressed for foot-printing to be introduced in the UK, too.

  In the past queens always had to prove a baby was really theirs and Queens of England gave birth surrounded by members of the court and in the presence of the Lord Chamberlain. Marie de Medici, one of the Queens of France, delivered in the presence of 200 people. Today, one of the reasons some mothers insist that their partner is present is to be absolutely certain there are no mix-ups.

  Another fascinating issue raised by the confusion over the babies is the importance and power of mother/baby bonding.

  How can a relationship build up between a mother and somebody else’s baby in such a short space of time so that when the mistake was discovered the mother at first refused to accept that the child was not hers?

  It is well known that adoptive mothers often feel immediate, intense love for babies placed with them. Most women, whether natural or adoptive mothers, are swept into motherhood on a wave of joy.

  There is a definite sequence of events as mother and baby get to know each other and, significantly, it is the same between a mother and an adopted baby. It is the beginning of pre-verbal communication, starting with the woman touching the baby so gently and tentatively, usually with her fingertips only, as if the child is too fragile to approach in any other way.

  She explores the tiny fingers and shell-like ears. All the time she quite spontaneously speaks to the baby in a high-pitched voice, repeating many phrases – a language that a baby can understand and often finds riveting!

  Much was made of one father’s insistence that the baby they were given had his mother’s nose and his uncle’s forehead. But it’s much more likely that the instant, immensely strong bonding that can take place between a woman and a new-born child, even when it’s not hers, convinced them both that this was their baby.

  They each needed uninterrupted time alone with their babies without anyone hovering over them to see whether or not they were bonding. You can’t demand too much of your own feelings – testing to discover if you have the right maternal emotions is like pulling up hyacinth bulbs to see if the roots are growing.

  CHAPTER TEN

  AROUND THE WORLD

  Throughout the 70s, 80s and 90s I lectured around the world and built a web of contacts with individuals and organisations in Austria, Switzerland, the Netherlands, Malta, Malawi, Nigeria, Zambia, South Africa, New Zealand, Australia, Kenya, Mexico, Colombia, Canada, Germany, Poland, Belgium, Greece, Finland, Iceland, Norway, Denmark, Sweden, Italy, Romania, France, Spain, Portugal, Abu Dhabi, India and islands in the Pacific. It demanded a lot of energy and quick change focus of attention. Wherever I was, I asked the organisers to arrange for me to be with women in childbirth, so that I could learn about their birth culture. I had some horrific glimpses into birth management as I was conducted by senior members of staff through proudly exhibited labour and delivery rooms. And I’ve also often been able to learn about and observe traditional practices.

  Dublin

  Invited by the Association for Improvements in Maternity Services and the Dublin Childbirth Trust, in 1981 I lectured for the first time there and appeared on TV in the evening on The Late Late Show with Gay Byrne, who treated me as a dangerous and dotty ra
dical, and a ‘flash-Harry’ obstetrician who cited inaccurate statistics from the Netherlands in an attempt to prove that the Irish rate of home births resulted in death and disaster.

  Attendance at the seminar was so good – around 400 women and a sprinkling of men – that we had to move to a larger hall in order to seat everyone.

  The Master of the Rotunda, Dr Henry, said that for both the mother and baby, all births should take place in hospital. He produced statistics from the Rotunda and compared these with those of the other three largest hospitals, and, in answer to questions said there were no records of epidurals administered, that it was impossible to relate epidurals to forceps deliveries or episiotomy and there was no evidence of any association with postnatal well-being following these two interventions. Nor were there any records of the percentage of mothers breastfeeding on discharge from hospital. He expected that since the members of the audience were asking about these things, they would start to collect such ‘unimportant’ statistics.

  Birth activists in Ireland were facing a major challenge. They drew attention to practice at St James’ Hospital, for public patients only, where still in the 80s it was policy to forbid fathers to attend the birth. A member of staff explained why: ‘Because fathers are a nuisance. They get in the way and the proper place for them is on the far side of the delivery room wall.’

  At the Coombe, the Master, Dr Duignan, was keen to give information. He said that enemas were given routinely on admission, and the perineal area shaved. It was also hospital policy to rupture membranes on admission. This enabled staff to see whether there was meconium staining. The standard dose of drugs was 150mg of Pethilorfan, but women could decline it. Approximately 17 per cent of women had continuous electronic fetal monitoring. Patients were moved to the delivery room for birth, where they had to climb onto the table. Fathers were present if they wished. The cord was always cut immediately. Mother and baby were allowed some time together in the post-labour room, but then were routinely separated for several hours. 33 per cent of mothers breastfed, but were handed glucose to give their babies, too. All babies were taken to the nursery at night unless the mother was in a single room. (Public wards were six bedded but in practice often more crowded than this.)

  Italy

  When I visited hospitals I was escorted through wide expanses of marble halls from the first stage to the delivery wards. Women were wheeled through these cavernous, echoing spaces, on open display. It must have been rather like being conveyed across a London Victorian railway station from platform to platform.

  They laboured alone in small cells in virtual solitary confinement. Every now and then a midwife came to check on them and write something in the notes. Staff talked about the patients in front of them as if they could neither hear, see or speak. They were forced to labour flat on their backs on a hard, narrow bed with one pillow at the head.

  I remember one woman who was moaning and tossing in pain from side to side. ‘The cervix is not dilating. There is no progress’ I was told. I asked if I might stay with her and if I could get her out of bed. The senior midwife looked surprised, but gave her consent.

  Once we were alone I smiled and told the mother, ‘I have had five babies. I will help you.’ I reached out and lifted her up, and then off the bed. Holding her lightly, I started to rock and circle my pelvis. As each contraction ebbed away I gave a long breath out and was still. When I sensed another was coming I breathed out as it began, and danced and breathed my way through the contraction. We did it together. This went on for half an hour or so. A midwife came in to do a pelvic exam. She was fully dilated. We laughed, and the mother and I hugged each other.

  I spoke at conferences in many different parts of Italy in the 80s: Bologna, Rome, Genoa, Milan, Turin and Sicily – helping to form new birth action groups, and to support midwifery and the feminist health movement.

  Professor Miraglia at the University of Milan asked me to speak about the midwife’s role in birth. I described how in the 60s and 70s there were exciting developments in the UK, with the creation of the Association of Radical Midwives, stimulating three year direct entry training across the country, and the Midwives Information and Resource Centre, and finished by saying, ‘Birth is an intense personal experience. Yet it is more than that. The way we give birth is also a political issue. When women are herded into large hospitals like cattle, when their own choices are disregarded, or they do not even realise that there are any choices between alternatives, when the natural rhythms of birth are ignored, when they lie on delivery tables like fish on a slab about to be filleted, and are subjected to the crude assault of routine episiotomy, our Western form of genital mutilation, and when, after birth their babies are taken away from them to be put in plastic boxes while their arms are empty, all women are degraded.’

  Each year in Britain there were now two Research and the Midwife conferences. So research was one major theme contributing to the rediscovery of midwifery. It was a midwife who did research on shaving of the perineum and the use of enemas in labour and discovered that neither practice contributed towards a sterile perineum, shaving caused abrasions through which infection could enter, an enema did not speed up labour, and both routines caused extreme discomfort.

  A midwife, too, who conducted a randomised controlled trial of episiotomy which revealed that episiotomy has no advantages over a second degree laceration, and there is less perineal trauma when episiotomy is restricted to cases in which otherwise a tear into the rectum appears inevitable.

  It was a midwife who analysed the benefits and risks of the managed third stage of labour and discovered that each intervention, even simple early clamping of the cord, made other interventions necessary and introduced risks. A midwife, too, critically examined the relationship between midwives and women in a modern high-tech maternity hospital and showed that women ask questions of the midwives who are with them longest – usually student and junior midwives – who do not know the answers and who say as little as possible, to be on the safe side. Midwives are often inhibited about giving information, especially when other staff are present, and have subtle techniques to block conversation with their patients.

  In Rome I did workshops on posture and movement in childbirth, the rhythmic second stage, and the vitality of the pelvic floor, and lectured on birth pain from an anthropological perspective.

  But it wasn’t only what I said that got the message across. Meetings were often in ancient, very dignified offices of the city’s Mayor and Corporation, a court room or university senate room, with dark panelled walls, massive antique furniture, and oil portraits of ancestors. To demonstrate how ludicrous (and potentially dangerous) directed pushing was I lay flat on my back with my legs in the air on a heavy oak table, huffing and puffing, gasping, desperately holding my breath, hyperventilating, and screaming every now and then. I looked up and between my stretched, wide apart legs could see these worthies staring down at me as I was writhing and straining – with apparent profound disapproval.

  In Rome in 1983 I spoke at the Palazzo Valetini, in the conference on ‘Non-Violent Birth’ organised by the government Social Services Department and helped create an out-of hospital Birth House run and staffed by midwives, and this gained good publicity and was reported in La Repubblica.

  Australia: Midwives And Convicts

  My visits to Australia opened the door for me to learn about the unique history of midwifery there. In 1778 the first convict ships arrived in New South Wales. Most of the female convicts were ‘fingersmiths’ – petty thieves and pickpockets, and the logbook of the Lady Juliana recorded that a baby was born at sea to Mrs Anne Whittle. The boat had stopped on the African coast so that the women could ‘service’ the crew. Mrs Barnsley, a madam, another of the convict passengers, became one of the first midwives in New South Wales, assisting at home births, and often working under very difficult conditions, especially in the disastrous times when crops failed. Rum was used for pain relief and rags for childbirth linen,
and often even these were in short supply. It was the custom to have 10 days lying in, with sometimes an extra day for each previous birth. The birth announcement consisted of placing a cushion on the doorstep with a pink or blue ribbon attached. Everything depended on successful breastfeeding. Sarsparilla was used as a galactalogue and if necessary older women served as wet nurses.

  Most women had home births, but in 1841 the first maternity institution was established – the Female Factory, aptly named because the policy was to get women producing a baby every year in order to build up the population. It didn’t matter who the father was. ‘Lower order’ Irish were sent there and the child was adopted or put into service when five years old. The Female Factory was later renamed the Benevolent Asylum.

  There are records of public meetings about baby deaths and the falling birth rate in 1891 and a Royal Commission of Enquiry was set up. The result was that maternity hospitals were established in Sydney and midwives started to be trained: St Margaret’s and Crown Street, where I was now lecturing, and the Home of Hope for ‘friendless and fallen women’ turned into South Sydney’s Women’s Hospital.

  Working with midwives for change was sometimes tough going. After I came back from Sydney where I lectured in 1983, I learned from Jan Cornfoot, who had organised the speaking tour, that I had left some midwives distressed and angry at the analogy I had made between birth in which women were disempowered and rape. I explained that I could not avoid speaking about this because it was some of the most significant research I had done. Whenever American obstetrics changed care in developing countries, and above all in the USSR and Eastern Europe, terrible things have been done to women. I also suggested that on my next lecture tour I speak about waterbirth on which I had been working over the last two years.