A Passion for Birth

by Sheila Kitzinger

  Back home, write lecture notes on sexuality and breast feeding for Vienna conference. Organisers want everything in advance. Midwife on our MA course at Thames Valley University and Queen Charlotte’s – the only midwifery MA – has written to ask me to be her supervisor for dissertation, so I read work she’s already done on mother goddesses and midwifery arts compared with medical management. Propose that, since she is moving to New Zealand, she interviews Maori women. I can help with fieldwork I have already done there and my discussions with Maori women aged 80–104 about tribal birth traditions and their personal experiences.

  Thursday

  Sun blazing – try to turn courtyard into scene more suited to house that was modernised in 1492 (when they put in ceilings and fireplaces). Heave old bricks around and make base for pots of lavender, rosemary and lilies, and plant herbs. Nell guides me. She was trained as a gardener at Pershore College. Looks like elaborate oriental grave. What do I do about exposed plastic drains? Have another go.

  Swedish midwives’ workshop here tomorrow. I always offer a buffet lunch. I roast some vegetables, enjoying their different shapes, colour and aroma. Sandwich this work in kitchen with reading some research papers in garden. Earth warm in sun, leaves a singing green, wild flowers starring the paddock – the England of John Clare.

  Mr Lay, macho village elder who is our gardener, is on ride-on mower on a search and destroy mission. He is wonderful at training roses and fruit trees, stone walling, and disciplining nature, but this is supposed to be our wild flower garden. I rush up, wave my arms like windmills above roar of machinery, ‘Please don’t cut down the flowers!’ He thinks I’m mad, mutters, ‘Blumin weeds! What do you want them for?’

  Into kitchen to chill Somerset cider. Fridge over-crowded. Full milk bottle crashes to tiled floor. Phone rings. Breathe out, drop shoulders and relax! Good! Jenny, social anthropologist daughter, is lecturing in London on sexual abuse and the media and will stay Friday night. I clear up mess in kitchen, then go to farm shop and pick luscious strawberries. Buy their home-grown wonderful mauve and pale green asparagus. I mix hollandaise with orange juice to make a sauce Maltaise for tomorrow.

  Friday

  On dot of 10 a.m. coach releases 30 midwives from hospitals and universities all over Sweden, armed with cameras, and I stand at door shaking hands and smiling, while Jean – stalwart National Childbirth Trust colleague from long ago who has come to live near – serves coffee and cake. They want to take pictures first, and I present a little patter about history of house. Then down to hard work. I’m lecturing on god-sibs – the women who came to support a woman in childbirth in medieval Europe, ‘turnabout’ care by North American pioneers, nurturing women in birth in diverse cultures, and contrasting this with social isolation and male control over women in techno-childbirth today. They eat an enormous lunch. Not a crumb of apple-almond tart left. Afternoon topic, discussion of language in childbirth: medical – ‘the uterus’ as if it were not part of a woman; engineering elements – ‘birth canal’; woman-blaming – ‘incompetent cervix’, ‘lazy uterus’, ‘failure to progress’. In Swedish and some other northern languages nipples are ‘breast warts’; sado-masochist brutal – ‘fetal head battering perineum’, and in Swedish ‘exploding’ perineum.

  Wave them off to John Radcliffe Hospital where midwife Ethel Burns will tell them about birth pool and midwives’ and women’s experiences of it there. Jenny arrives and we relax in garden over champagne cocktails. Laura lies under sunshade on grass, kicking, cooing and laughing. We indulge in asparagus, artichoke and strawberry feast.

  Children At Birth

  At age five, my grandson, Sam was invited to witness the birth of his sister. Tess had decided on a home birth in a pool. Sam made it clear that his place was right where the action was going to be. He knew more about birth than many pregnant women do. He had seen his own birth photographs, and all his questions had been answered candidly. He had recently pressed the button on the slide projector as I spoke to one of my groups of midwives and doctors who regularly visit my house for workshops. He had heard Tess talk to them about her physical and emotional feelings at each phase of labour.

  During Tess’s pregnancy, my picture book, Being Born, was Sam’s favourite during quiet times together. He knew how the baby developed in the uterus and what it could do at each stage of pregnancy. Equally important, he had seen and held babies and knew that they couldn’t play with him, though they could communicate through gaze and the sounds they made. He realised that they needed to be handled with consideration and gentleness. Sam was present at each antenatal exam, which took place in the familiar environment of home. He watched the midwife palpate Tess’s uterus, heard the baby’s heartbeat with the hand-held Doppler ultrasound, and felt the baby’s movements.

  Tess talked with Sam about her birth plan and suggested that he might make a birth plan, too, listing the things that were important to him. So, with help, he wrote carefully:

  If Tess has to go to hospital, I want to go, too.

  I want to take the birth photographs.

  I want to cut the cord.

  If she needs a Caesarean operation, I want to see it.

  Tess can hold the baby first, then Sheila, then me.

  When the great day came, Sam and his father, Jon, settled in the kitchen with felt-tips and paper, while Tess floated in the pool set up in the sitting room. Sam wandered in and out, obviously aware that something momentous was happening but not anxious about it.

  He was in the room as the baby was born, sharing his mother’s excitement and anticipation as she pushed. Afterwards, he sat on the rug by the log fire, cradling his baby sister tenderly in his arms. She looked up into his eyes, and he spoke softly to her. They were friends already.

  When Tess had Josh in 1996 there were three midwives and me as well. It was like a party. Jon and Sam popped in and out and Laura slept until she woke just as the baby’s head crowned. We laughed a lot and Tess was enjoying herself! Sam made a chocolate cake to go with the champagne to celebrate the new baby. He burned the first attempt and Tess had to labour through the awful smell of burnt chocolate. He made a second cake, and waited until Tess had finished a push before coming in and announcing that he had made this cake 15 minutes ago. ‘Where was the baby?’ he demanded. That spurred her on and with two more pushes Joshua tumbled out.

  Victorian children – at least, members of the middle classes – believed the doctor brought the baby in his little black bag, or that it had been picked from under a gooseberry bush. Girls grew up utterly ignorant about where babies came from or how they got out.

  Death, however, was considered highly suitable for children and morally uplifting. Children joined the mourning circle around a death bed, viewed the corpse and made mourning cards. However, shielding them from any knowledge about birth was a sign of social status. While the poor lived in crowded hovels, where death and birth were open to everybody, those who had more money could shroud birth in secrecy.

  It wasn’t always like that. In the Middle Ages, Florentine and Siennese painting of the birth of Mary, the mother of Jesus, and of St John sometimes showed children present, either playing or helping the god-sibs, the women friends who attended birth to care for the mother and baby. There are German woodcuts from the sixteenth century which show children at birth, too.

  Until the time when most births in Britain took place in hospital, following the Second World War, children were often quite naturally around when a baby was born. They were sometimes sent off to Granny when delivery was imminent but often Granny would come to care for them in their own home. They were always involved with the preparations, and often had a cuddle from Mummy during labour. Sometimes children just happened to be present at the birth, although their parents did not necessarily plan this, and they climbed onto the bed to hold the new baby when only a few minutes old. They did not get much education or preparation for what to expect during the birth, but it was a normal part of life.

&nb
sp; In many cultures it is not only considered natural for children to be present at a family birth, but an important part of their education. When I was learning about traditional ways of birth in South Africa, a Zulu chief told me how young girls would prepare the birth hut and make it beautiful with wood carvings and beads. Children attended both birth and death, he said, ‘because it teaches them to respect life.’

  In most peasant societies in southern and far Eastern countries, women have always given birth surrounded by female friends who offer practical help and emotional support, often bringing small children with them. When birth is moved to hospital, the woman becomes a patient and birth is rarely an experience for the whole family.

  In Britain today most babies are born in hospital and children learn about birth from TV. They see a woman suddenly doubling over in pain, and then there is a mad dash to hospital. It is often a drama in which the baby’s life is at risk and, sometimes, the mother’s too, and they are saved by a high-powered medical team performing an emergency Caesarean in the nick of time.

  We condition our children to think of birth as a medical emergency, like a road accident or a heart attack. It is scary. It is not surprising that many mothers (especially first-timers) are afraid of birth and want to make sure they have an epidural as soon as they step through the hospital doors. But having your children there for the birth can have positive benefits for the mother, because it demedicalises birth.

  In my research with parents and children in Britain, Australia and the United States, children who were there often communicated a sense of awe and wonder. The children’s pictures for me usually showed Mummy smiling. Sometimes she was even a Queen wearing a crown. There was often a big cake and it looked like a party. They are pictures of Happy Birthdays!

  Carcassonne Ramparts

  Laura was five months old and Tess flew out to Carcassonne with Sam and Laura to meet us for a short break. We went up into the old city for supper and then wandered round the alleyways up to the ramparts. We found a puppeteer there with a marionette exactly the same size as Laura. The stars were sparkling in the night sky, he was playing rollicking music, and a group had collected to watch. So that the children could see, we went up close until Laura was right in front of the dancing puppet. She was entranced. She became restless and pushed away from Tess’s arms. Then, intently observing, she started to dance too, keeping every movement identical. Marionette and child moved in unison. In mirror image, she copied each gesture, each step, minutely, in time with the lively music. I had not realised that at that age such a young child could observe, interpret and comment this expertly. I became aware of Laura’s talents in communication and recording and understanding behaviour.

  Episiotomy

  By the 1970s routine episiotomy and forceps to deliver the baby had become standard practice on the grounds that women could not stand the agonising struggle to give birth and this would shorten the second stage of labour. Women were stereotyped as ‘inherently frail’, ‘predisposed to insanity’75 and ‘the nervous inefficient products of modern civilisation’.76 Active Management seemed to solve the problem by making birth the gynaecologist’s responsibility, not the mother’s.

  DeLee compared the stress of delivery to that of falling on a pitchfork that cut through a woman’s perineum and the effect on the baby as like having one’s head crushed in a door. He went on to say: ‘Labour is pathogenic, disease producing, and anything pathogenic is pathologic or abnormal.’ So birth was not, and could not be, a normal human activity.

  Chloe Fisher was a community midwife with whom I have worked closely over the years. In 1980 she pointed out that even in the 1950s Constance Beynon showed that women who were not told to push had a ‘much higher rate of spontaneous deliveries than those who were chivvied’.77 Chloe commented, ‘A major reason for the increase in episiotomies … has been the midwife’s attempt to enable the woman in her care to achieve a spontaneous delivery in the limited time allowed – knowing that otherwise she must hand her delivery over to the obstetrician to be delivered by forceps. Simultaneously, there has been much discussion about the merits of episiotomies as a measure to prevent future pelvic floor problems – though there has been no evidence to support this. We have now reached the stage where a small tear is considered evidence of poor delivery technique but to perform an episiotomy is absolutely acceptable.’78

  Chloe had been the midwife at the birth of my first grandchild, Sam. He was a nine and a half pound baby. Tess did not require an episiotomy and her perineum was intact. As he slid out he looked up at her and smiled.

  CHAPTER FIFTEEN

  WHEN THERE IS NO BIRTHPLACE

  There are women for whom there is no place to give birth.

  In war, ethnic conflict and under military occupation – and wherever any social group is perceived as inferior – mothers and children are the most vulnerable and become victims of the dominant power.

  This happened in rural areas in the ex-Russian republics. My friend Dr Ethel Burns, a midwife, who works with midwives in Vietnam and the ex-Russian republics, described how Nagorno-Karabakh, a self-declared independent state in the early 2000s, faced the bitter aftermath of a war between Armenia and Azerbaijan. Shushi, once the capital of Armenia, and Lachin both lie in what local people call ‘no-man’s land’, and inhabitants have even less access to healthcare resources than in other parts of this impoverished country. With a barely functioning phone system, no railway or civilian airfield, and often no electricity or running water, the only public transport was an erratic bus service, and pregnant women not only had great difficulty in getting to the hospital in the main town, Stepanakert, but were sometimes treated as outcasts if they did manage to get there. They needed money to bribe caregivers for access, and staff and other women might ostracize them.

  Examples could be multiplied from almost every continent. The Gaza Strip is described by the Israeli Information Center for Human Rights in the Occupied Territories, as ‘one gigantic prison’.79 Checkpoint tragedies have occurred when women trying to get to the hospital across the border with Israel from villages in the Occupied Territories were held up by the army. The hospital may be only a few kilometres away, but they were barred from reaching it because of fear that any Palestinian, including a heavily pregnant woman, might be carrying explosives. Between September 2000 and October 2004, 61 women gave birth at checkpoints and 36 of these were stillbirths.80 Amnesty International stated: ‘The practice by Israeli soldiers of delaying or denying passage to women in labour at checkpoints … constitutes cruel, inhuman and degrading treatment’.81

  Fortunately there exists a new spirit where Israeli and Palestinian midwives are trying to work together to integrate members of all religions and ethnic groups into the maternity care system. Wendy Blumfield, who founded the Israel Childbirth Education Centre, says:

  ‘Our organisation is totally apolitical … Every new group starting a training course includes Arabs and Jews, Moslems, Christians, religious, secular and representatives of the many different immigrant groups. So today we can offer our services in Arabic, Hebrew, English, Russian, French and Spanish. We opened up the entire area of the Arab villages in the Galilee because of our connection with the Scottish hospital in Nazareth. We ran courses for their midwives and for the nurses of the well-baby clinics in that rural area. Today Miriam Shibli, a Bedouin midwife who is head of the Nazareth maternity ward, is also the academic co-ordinator of our organisation’.

  She went on to tell me, ‘So much of our national budget is spent on defence that our health and education systems are stretched to the limits and there is more poverty than there has ever been.’

  Pregnant Israeli and Palestinian women suffer from the constant threat of violence. Women in the Gaza Strip know that they may not be able to reach the nearest Israeli hospital if they are haemorrhaging or go into pre-term labour, because of barriers at checkpoints. Home birth rates have gone up, not because women want them, but because there is no safe alter
native. Elective Caesarean section rates have risen for the same reason. Intense anxiety is a powerful element in the experience of pregnancy for the whole family. Mary McNabb, a British midwife, who visited Palestinian communities under military occupation, says, ‘During pregnancy, women live in fear of a variety of threats to themselves and their unborn children: exposure to gunfire; effects of poisonous gases used by security forces; going into labour during prolonged curfews; and getting trapped in a car or ambulance at IDS checkpoints on the way to hospital’.82 Rita Giacaman, Associate Professor and Research and Programs Co-ordinator at the Institute of Community and Public Health of Birzeit University was quoted in the Amnesty report as saying that women are very fearful of childbirth under these circumstances. ‘The result is a tendency towards over-medicalisation of the process of giving birth, which is that women feel that they need to be able to control the time when they go into labour to ensure a safe delivery and see Caesarian and induced delivery as the only way to do so.’83

  Women have given birth in ambulances, hospital elevators, and sometimes on the ground at checkpoints, watched by Israeli soldiers. A woman in labour may be told to strip so that the soldiers can satisfy themselves that she is really pregnant, and is not carrying explosives under her bump. Amnesty International reported a checkpoint tragedy in which a woman, Maysoon Saleh Nayef al-Hayek, was trying to reach the hospital in Nablus from her village 10 miles away. Her husband drove her and her father-in-law to a checkpoint and they were all ordered out of the car.

  ‘We told the soldiers I had to go to hospital to give birth as soon as possible, that I was in severe pain. They first refused, then told me to uncover my belly, so they could see I was telling the truth. All this lasted about an hour and we were told to go ahead. We drove on and after a few hundred meters I heard shots from the front of the car.