A Passion for Birth

by Sheila Kitzinger

  Ina May Gaskin in the United States rejected the emphasis on techniques to ‘control’ behaviour in labour.69 The Farm midwives of Tennessee believe that feeling is more important than control. This expresses my own view that birth is potentially a profound psycho-sexual experience – not just for the mother, but for both parents. Birth Centres reflect this emphasis on emotional and relational aspects of birth and parenting.

  Ina May writes: ‘When birth first began to be shown on US television during the nineties, decisions were made in broadcaster’s boardrooms that it would be acceptable for people to see an incision made in a woman’s abdomen and uterus and a baby’s head emerge through that incision, but not to clearly see a baby emerge from a woman’s capable body, from her vagina.’

  She says she ‘never made the obvious connection between sexual feelings and birth until I witnessed a laboring woman whose husband was sitting at her side pull him closer and passionately kiss him during a long contraction. Her relaxation during this intense part of labor was instant and impressive: I could feel it in my own body. A feeling of calm confidence pervaded the birth room. This was an “aha” moment for me, because I realised just then that my own social conditioning had prevented me from imagining how much a little making out might help not only to augment labor but to numb pain at the same time. The ecstatic and beautiful birth that resulted from this woman pulling her husband to her for a kiss – a real consciousness-changing kiss, mind you, not just a peck.’70

  Psychology To Promote Compliance And Persuasion

  For some psychologists working in the field of childbirth exploring emotions in terms of an unfolding psycho-physical process throughout pregnancy, birth and after is primarily problem-oriented. The key to effective communication and counselling skills is to offer information, allay anxiety, promote ‘compliance’ and ‘persuade’.71 ‘Persuasion’, Sherr writes, ‘may be necessary at many stages: from the first decision about where to have the baby, to pain management, alcohol reduction, smoking cessation’. This statement set off alarm bells for me. Are women to be ‘persuaded’ not to have a home birth, to agree to induction or to an epidural that they did not want! The terms ‘compliance’ and ‘non-compliance’ pepper the pages: ‘The skilled performance of the initial contact interview is the factor which determines information flow, satisfaction and often compliance.’72

  Where there is ‘communication proficiency’ this author claims that ‘compliance and informed consent can be increased’. Insufficient time for communication is ‘false economy’ because ‘dissatisfied clients often return and in the long term take up more time’, and other effects are ‘missed diagnosis, increased legal action, litigation or suing, poor knowledge transfer, limited future health education, non-compliance and failing to seek medical care’.73

  She argues that women must really like antenatal care or they would not turn up for it: ‘The actual behaviour of most women demonstrates their respect for and belief in a system in their overwhelming attendance at antenatal clinics’,74 ignoring evidence that women fear that if they do not attend the baby may be harmed.

  So psychologists don’t seem to have all the answers. In fact, psychological counselling may be as dangerous as an intervention when unevaluated screening procedures and obstetric interventions are assumed to be beneficial. Just as PSYOP – that is propaganda by another name – is used in warfare, so psychology – again propaganda by another name – is used in hospitals to enhance patient satisfaction with the care already provided and to increase compliance. If this is really what clinical psychology is all about, it manipulates, exploits and traps women in a medical system dominated and controlled by professionals and reinforces the power of the professionals, rather than serving the needs of the women for whom the service is supposed to exist.

  Couples need information to ask further questions, understand the answers, and be in satisfying partnership with caregivers. This aspect of childbirth education is vital as obstetrics gets more technically complex.

  Some obstetricians feel uncomfortable about it, because they see all the decision-making as their responsibility alone. But whose baby is it? Pregnancy is a tremendous opportunity to prepare the couple for the responsibilities and decision-making of parenthood.

  CHAPTER FOURTEEN

  BECOMING A GRANDMOTHER

  When Tess made me a grandmother I faced a major life transition without any understanding of what it entailed and what the challenges might be, or what my daughter wanted. I had a picture of what I did not want to be – interfering, know-it-all, bossy or sentimental, and neither Uwe nor I saw ourselves as what Stephen Spender called in one of his poems, ‘Cardboard cut-outs of grandparents’, eagerly waiting for grandchildren to visit, but peripheral and largely irrelevant to their lives, with the real action taking place elsewhere. I wanted to go on being me and not have to fit a stereotype. I did not need, even particularly want, my daughters to have babies. Partly because I had committed myself to motherhood with gusto, and had gone on from there to do research and be involved everyday with mothers and babies, my life was richly satisfying and I was unlikely to romanticise grandmotherhood.

  When I visited Tess in the United States where she was living with her husband and working as an electronic engineer she quietly announced, ‘I’m pregnant.’ It was all very low-key. So low-key that I asked her whether she wanted the baby. She did. And then she said, ‘I didn’t think you would approve.’ That was a shock. She said I was so approving of her academic sisters that when she chose motherhood she feared that I might think it was second best, a waste of her potential. I felt rather ashamed about that.

  The truth was that I was thrilled that this was something – becoming a mother, with all its joy and problems – that had been an important life passage for me and one that I could share with her now.

  Daughters make all sorts of assumptions about how their mothers will respond to being told that they are pregnant. The same goes for daughters-in-law and mothers-in-law. It is worth asking, ‘Why does she expect that reaction of me? What is she telling me about what I have said and done, and also the unspoken messages I have sent her?’ I think Tess’s doubts about my reaction to her pregnancy pointed to the struggle I had experienced as the wife of an Oxford don and the mother of five to make space for myself and to be able to achieve anything apart from motherhood. I used to write in the early mornings before the children were awake. There were many times when a child came into the room and I said, ‘Wait a moment. Let me finish this sentence.’ We communicate to our children the things that matter the most to us, often without even knowing that we are doing so. It is not only a matter of struggling to build a career while at the same time being a homemaker and mother, but helping people outside the family as well as inside it, from personal moral commitment, and in my case, wanting my children to grow up ready in their turn to challenge social injustice, inequality and the abuse of power. But we may also be saying that everything must be clean and tidy in the house, that children should always be polite and well-behaved, putting particular stress on religion or politics, on keeping up with the neighbours, or our grandchildren’s academic achievement, social skills or being good at sport.

  For me, having grandchildren was a bonus. My identity was not encased in the grandmother model. In this research I discovered women who were exuberant in their role as grandmother. But many others were troubled. Some felt burdened with all the problems and none of the joys. Becoming a grandmother can reveal new aspects of the self, bring opportunities to develop and learn as a person, and see the world with freshness and vitality through the eyes of a child.

  Though there are classes to prepare for birth, grandmothers are left to cope on their own. Occasionally you come across newsletters with titles like ‘Creative Grandparenting’ containing articles describing how ‘hugging can improve your health’, and text books used in adult education classes ‘on achieving grandparent potential’. But in general grandmothers have to pick up ideas of how t
hey should be, what they ought to do, and what it is normal to feel, by sheer chance from other women who have been through the same astonishing, bewildering transition.

  For many women becoming a grandmother is something more. It is a symbol of ageing, of being ‘past it’, just a spectator on the touch-line, the invisible older woman.

  Grandmother care is under-valued and often despised. But to become a grandmother gives us the chance to rediscover ourselves as mothers. When I was in New York I sat in a playground in Central Park for an interview with the New York Times journalist who wanted children to be in the scene. You don’t see children in the streets of New York. The only place to go is where kids are corralled. There were few mothers with their children, only one granny, and the other dozen or so children were being supervised by nannies. There are many warm and wonderful nannies but these were bored, detached, their faces slack and expressionless. Childcare was obviously a tedious chore that somehow had to be endured. They did not talk to the children. They just gave orders. They often did not even look at them. When children cried, they did not comfort them. When a child did something that made him happy – reached the top of a climbing-frame, for instance – they did not join in this or even acknowledge it. A two-year-old was distressed and had been crying non-stop for half an hour. I learned later that he was one of twins and had never been separated from his twin before. He had been plonked in a swing, and screamed until I thought he was going to vomit. The woman in charge of him stood at the side of the swing, pushing it back and forwards, ignoring him while she continued a desultory conversation with friends. Meanwhile the single granny was running around bright-eyed and sharing in the excitement of her grandchild’s discoveries and achievements. Here was one-to-one child-centred care given by a woman who was enjoying it. It provided a dramatic contrast.

  As I’ve watched babies and small children with nannies and au pairs, with minders and day-care providers in many countries I have come to the conclusion that grandmother care is often among the best kinds of childcare, even if that is only possible for a few hours at a time and mothers at work must rely on other people to be the primary care providers.

  A book came out of this – Becoming a Grandmother, and was published by Simon and Schuster in 1997.

  Grandchildren

  When Tess had Sam, her first baby, I was impressed by her strength and had utter confidence in her. She chose to give birth at home relaxing in a pool of water until the baby was about to pop out, when she moved to dry land. They lived at the end of the Manor garden in a bungalow built for them in 1993 and we were an extended family. The children were an integral part of my life. A new baby was often plonked on my bed in the morning as Tess had to get Sam dressed for school or do a school run. I was more relaxed about being a grandmother than I was about motherhood, especially the first time round. The first baby is highly experimental. You wonder whether you can possibly do it and if the child will survive. When I saw little Laura, nearly a year old, picking up beads and carefully putting them in her mouth, I didn’t get alarmed. She was not going to choke on them, because she knew she must not swallow beads. The important thing was not to startle her or trigger conflict.

  For Becoming a Grandmother, I did research in Australia and the UK, with further material about women’s experiences of their own grandmothers from Israel and Poland, for example. There have been marked changes in the lives of grandmothers over the last 100 years – and the last 50 years- and many feel alienated from daughters and daughters-in-law, especially daughters-in-law, because the whole culture of child-rearing has altered, and they don’t know what they can say that will be relevant. They told me, ‘I bite my tongue’, ‘I’ve learned to keep quiet’ and ‘I never give advice’.

  My personal experience witnessing Tess giving birth in water inspired me to work with other birth activists to organise the first International Water Birth Conference. I was amazed watching her, the way pain melted away when her body was submerged, and how she moved so easily. She could almost somersault. She was spreadeagled like a frog, on her back, semi-squatting, and got in all sorts of positions, without any difficulty. When she stood up she was uncomfortable and sank down into the water again. I gave a birth pool to the John Radcliffe hospital in thanksgiving for Sam’s birth.

  Then we had the International Water Birth Conference in 1987. Four of us got together and hired the Wembley Conference Centre, which seats 2,000. It was crowded. It was important to find out what was happening around the world. There were many questions to be answered. People were doing research who were completely out of touch with other researchers, and I was surprised as the abstracts came in at the number of randomised controlled trials that were being undertaken. We also wanted to hear from the practitioners of water birth, midwives – usually midwives because most doctors didn’t like sitting on the floor waiting – and other researchers and parents. We needed to form a network and put them in touch with each other.

  Diary Of A Week In 1996: An Appetite For Life

  Sunday

  Enjoy craft fair with daughter Tess (electronic engineer and website specialist), Laura (the baby), Sam (six) and Polly (sailing and youth worker daughter). Meet up first with Celia (psychologist daughter) and Sue (her partner) for lunch at restaurant in Kenilworth with gorgeous vegetarian food, where disposable nappies are produced when Tess runs out. She cradles Laura at the breast, wrapped in a capacious shawl knotted over her shoulder. Wish more restaurants were baby-friendly. Laura slurps and smacks her lips to show what a delight breastfeeding is, but table of business men behind us don’t notice, thank heavens!

  Monday

  Work on my new book, Becoming a Grandmother, to chorus of morning bird-song which livens it up no end. Editorial comments have been faxed for chapter I’ve written for American anthropological book – most tedious part of writing academic paper: further citations, counter-arguments, explanations, clarifications.

  Early morning is my best writing time – an oasis of peace. I often start around 5.00 a.m. If I work through the evening, especially if it entails writing, I can’t sleep at night. So I must chill out.

  It could be some quick crosswords or reading a detective story. I soak up Morse, in his familiar Oxford setting. Even Poirot, who dates from 1920 – a gentle contrast to the crazy violence and sadism of contemporary sleuths like Montalbano. They probably improve my writing style, too, making it snappier and steering me away from academic jargon. Certainly if I read a lot of foreign research I get to the point where I can no longer produce a simple sentence. If this happens in my memoirs, I apologise. I have worked too hard.

  Today I start later and slog away from 6 a.m. till mid-afternoon.

  Whenever I get down to writing concentration is punctuated by a ringing phone, including Birth Crisis Network calls. Today a woman still not completely continent, and with no clitoral sensation, after botched episiotomy and catastrophic repair. Then another, from Germany, who had failed prostaglandin induction for ‘fetal growth retardation’ over three days followed by emergency Caesarean section, and 3.6 kilo brain-damaged baby. She says birth was like rape. It sounds as if medical-surgical management was disastrous. It is vital that these women have a warm and immediate response. They have had to sum up a lot of courage in order to ring me.

  Then I find time to read The Enchanted Horse to Sam and give Laura lavender oil massage. Admire his painting of a Shetland pony and himself in ‘pooey field’.

  Tuesday

  Masses of stuff on dictation machine for my secretary to put on the computer. I get on with painting old school desk for Sam. Hen with chicks, owl, goose, rabbits, frogs on chair, and underwater scene inside. We go through second and third drafts.

  Acrylics dry out while I deal with umpteen phone calls about publicity for my new book, The Year After Childbirth. Woman’s Hour, breakfast TV and arrangements for lecture tour in United States September/October when it’s published there. Mix fresh yellow, scarlet, pink for sun.

  U
we, still in Harvard, phones to fix holiday dates and his sailing trips, so we have a diary session. Thinking of Bali holiday on my way back round world in autumn. Mix paints again. Phone rings – woman considering home birth and wants help getting it. Then another who wants elective Caesarean section. Listen – discuss. Mention that occasionally when a woman has been sexually abused as a child this may seem only way she can give birth that she can tolerate. Then flood-gates open and her distress pours out. She describes the abuse which she has never told anyone about. She has been blaming herself and believes that she must have been responsible for causing it. Tell her she is being reasonable and I’ll support her any way I can. She is happy for me to ring obstetrician, whom I know and admire, as she can’t put it into words to him.

  At lunch-time committee meeting to plan International Water Birth Conference next April. We’ve hired Wembley Conference Centre – big commitment. We lunch in conservatory on salads and daughter Nell’s tasty tomato and olive bread. She enjoys cooking and turns out everyday dishes with a special touch: stuffed potatoes with mushrooms and cheese, sweet and savoury scones and pizzas.

  Vine is flourishing at last, and has overtaken one I stencilled on wall to encourage it while it was sickly. How many of water birth research projects on risks and benefits will be at the stage where there can be at least preliminary reports? Janet Balaskas is organising posters, as she did for Active Birth Conference.

  Plan small exhibition crafts – garden statues, pots, painted children’s furniture – by Creative Women in the Manor for September and wine evening to open it. That will be fun. To London overnight because TV early morning. They put me up in Forte Crest Hotel – never again! Public rooms flashy but bedroom grubby and falling to bits, and food inedible.

  Wednesday

  TV chat show am. Then meet Celia to choose vivid peacock de Morgan tiles for her fireplace and ship tiles for Uwe’s (late) birthday present. Free hour, and buy beautifully cut and sewn Japanese swinging loose linen coat at Egg.