A Passion for Birth

by Sheila Kitzinger

  Briefing of parliamentarians and a media campaign were necessary and a group of us in childbirth organisations started to work together to free women from their chains. Beverley Lawrence Beech, Chair of the Association for Improvements in the Maternity Services (AIMS), was fitted with a secret camera by Channel 4 News, and filmed a new mother in hospital manacled. The result of our campaign was that the Government announced a change in policy and practice: chains must come off. Until January 1996, women in British prisons were still giving birth shackled.

  Chains stayed on, however, when women went to and from hospital, and even in hospital until ‘treatment’ started. Prisoners with loops of chains clanking beneath their coats, handcuffed to prison officers, were still a common sight in some antenatal clinics in 2008.

  A great deal remained to be done. I explored the possibilities with National Childbirth Trust teachers in the area of Holloway of setting up a doula scheme, to offer woman-to woman support in late pregnancy, during birth and afterwards. There was already an NCT breastfeeding counsellor working in the prison and she became one of our doula group, who were renamed ‘Birth Companions’. They help women handle birth physiologically by moving around, breathing and being massaged, and to breastfeed. They also support a woman who opts for an epidural or is having a Caesarean section.

  One problem is that a woman cannot know until the last five or six weeks of pregnancy whether she will be permitted to keep the baby. She may not allow herself to bond with it. Women sometimes tell their families, ‘Don’t buy any clothes for the baby.’ They are in an emotional limbo. This is because towards the end of pregnancy the Admissions Board of the Mother and Baby Unit decides whether a woman will be allowed in the unit. If she does not get a place she is separated from her child, who then goes into the care of the social services and is fostered or looked after by relatives (most often the woman’s mother).

  Women were rejected for the Mother and Baby Unit if they talked back to prison officers, were in conflict with other prisoners, or did not obey orders.

  Holloway is the largest women’s prison in Europe. A 24-year-old psychology student whom I shall call ‘J’, in prison on a five year sentence for slashing a friend’s face with a craft knife in an argument over a man, was told that her baby would be taken away at birth. She decided to challenge the decision. I learned about this soon after the Admissions Board meeting, obtained the minutes of the meeting from the solicitor, contacted the woman’s mother and the woman herself, and determined to fight this to the end. (I had already tried to help seven other prison mothers and only been successful with one, a 17-year-old from whom a judge had ordered her baby to be removed for two weeks after her due date in order ‘to punish her’.)

  A decision of the Admissions Board had never been challenged before. Most of the accusations against ‘J’ were unsubstantiated and petty: she took a carton of milk that was not hers; she had made ‘snide remarks’ to a woman who was reduced to tears; she picked quarrels; she did not get up in the morning. (This happened after she had been told that her AFP level – Alpha-fetaprotein, screened with a blood test – suggested she had a Down’s Syndrome baby, and then that amniocentesis revealed the baby had an extra chromosome, though not Down’s.) One board member complained that she did not seem to be looking forward to her baby, implying that it should be removed from her for this reason. Another, a health visitor, said that to care for a baby ‘you need to be able to co-operate with everyone. She didn’t’.

  I started to work with ‘J’s’ solicitors. I asked John Davis, Emeritus Professor of Paediatrics at Cambridge University, to be an expert witness, and he readily agreed. With a statement from him they went to the Crown Court and were granted leave to appeal. I was concerned that there had been no independent psychological assessment. I asked Dr Suzie Orbach if she would do one free of charge and she did so immediately, pointing out in her report that ‘J’ was suffering from both shock and depression.

  ‘J’ had given birth on the day that the first appeal was turned down. She learned that the case had failed just after she delivered her baby daughter. She told me, ‘If they take my baby away from me they might as well kill me.’

  I rang journalists and there was lively interest. At the Independent, Jack O’Sullivan was magnificent and seemed the ideal person to interview ‘J’. She gave me permission to let him have the number of the phone at her hospital bedside. As far as her guards were concerned she was talking to a friend, though, of course, they listened to every word. The legal correspondents of the Guardian and the Independent were hot on the trail, too, and Andrew Marr wrote up the story in the Express. I kept in close touch with the press and TV, and Frances Crook of The Howard League threw her energy and detailed knowledge of the prison system into the campaign. The Maternity Alliance also became involved and, because ‘J’ was breastfeeding, I solicited help from breastfeeding organisations. Mothers, fathers and babies turned up outside the Crown Court when the appeal was heard with big notices saying, ‘Remember the child’.

  On the first day of the appeal ‘J’s’ barrister focused on the rights of the child. Counsel for Holloway asked for more time to prepare his case. When one of the three judges asked, ‘Are you going to tear this baby from her mother’s breast?’ those of us who were determined to keep mother and baby together felt the first flush of success.

  The judges asked whether, if he was given the week for which he asked, he could assure the Court that the mother and baby would be kept together during that time. The barrister wheeled round and asked the representatives of Holloway whether that could be arranged. There was an awkward pause. He turned back, with obvious embarrassment, ‘No, my Lord.’ The judges’ eyebrows shot up into their wigs, and one said, ‘You can’t? Goodness me!’ They allowed him the weekend to get his act together, but insisted that mother and baby were not separated.

  Over that weekend the solicitors for Holloway contacted ‘J’s’ solicitors to try and arrange a settlement. When the court assembled on Monday morning it was agreed that the Admissions Board of the Mother and Baby Unit should sit again. It had to consist of different people, be chaired by someone from outside the prison, and none of the previous charges about her behaviour were to be considered, because none had been proved.

  The judges ruled that in future, primary consideration must be given to the rights of the child.

  This case created what the judges called a ‘practical precedent’, meaning that others should refer to this judgement when fighting similar court battles. Holloway had to honour the rules of the European Human Rights Convention and the United Nations Convention on the Rights of the Child. Holloway had neglected to comply with prison service regulations and in future the Board should be properly constituted, the correct protocols observed, and a prisoner should have the right to a legal representative.

  Following this successful appeal, J was admitted to the Mother and Baby Unit at Styal prison, where she found the atmosphere surprisingly different from Holloway. She could keep her baby with her there for 18 months. She planned to resume her psychology studies in prison.

  The Governor of Holloway resigned the day after the Appeal. A week later Richard Tilt, the Director General of the Prison Service, announced a review of principles, policies and procedures for mothers and babies and setting up of a working group to include professionals from health, social services, probation and relevant interest groups.

  It is easy to remain ignorant of conditions in prisons. At that time in 1998 there were more than 3,000 women in British prisons, and 61 per cent were mothers of children under 18 or pregnant. There were only 64 places in Mother and Baby units throughout Britain. Between 1993 and 1997 the number of women in prison leapt by 76 per cent. I believe that any commitment to help childbearing women must extend to speaking out for the most vulnerable and voiceless in our own society. Women in prison are often the least educated, and victims of violence and sexual abuse. 33 per cent are first-time offenders, over half had their firs
t child when they were teenagers, 27 per cent are single mothers and 34 per cent of prisoners in Holloway are black. Pregnancy can be an opportunity for development and change.86

  CHAPTER SIXTEEN

  IN THIS CENTURY

  Romance Distorts Everything that is Real in Human Experience

  An organisation called Family and Youth Concern produced a film for schools and youth clubs which was supposed to teach girls how to say ‘No’ to sex and wait for their prince to come.

  June, a good-time girl, gets pregnant, fails her exams, has an abortion and goes into a dead-end job. Linda, on the other hand, says ‘No’, goes to college and has a white wedding with all the trimmings, while June watches, envious and miserable. The message is clear – good girls wait, virginity intact, until a ring is on their finger. Bad girls enjoy themselves, have abortions, and end up unloved and without a man.

  The film was welcomed by some Fleet Street journalists who seemed to be missing out on romance in their own lives. ‘I’m enraptured by the idea,’ breathed the Daily Express. ‘Remember those wonderful ages we spent nibbling crisps and each other’s ears … making plans for a thrilling virginal honeymoon?’ And the Daily Mail announced, ‘The word “No” is the best contraceptive, the only true preventive of VD and a recipe for happy married life.’

  It was part of a backlash to the sexual revolution of the Sixties. It took its most exaggerated form in the United States, where a new Puritanism denounced all who did not conform to a rigid, restricted morality which claimed to be based on the Bible. My book on breastfeeding published in Britain with a lovely photograph of a mother and baby during a pause in breastfeeding, with her breast and nipple exposed, had to be changed in the United States to one with invisible nipples. Before many radio and TV shows I was warned not to be ‘explicit’ and never, ever refer to the male member. On a popular Mid-West chat show the presenter, quivering with rage, denounced me for my ‘disgusting’ beliefs about sexual relationships. Revivalist preachers in crowded stadiums whipped up hysteria against homosexuals and the mob roared for blood. These puritans, instead of lopping heads from religious statues and smashing stained glass windows, burned down abortion clinics and feminist book stores. This was the creed of the ‘moral majority’, often obscene in its hatred, always bigoted and, in spite of its lip-service to the ‘right of life’ – life-denying.

  As for sex education, the idea seemed to be that if you dangle a frothy white wedding gown and a three-tiered cake in front of girls, they don’t need any. Girls under 16 certainly would not require birth control, nor the abortion that, in practice, follows society’s refusal to permit them contraceptive advice and counselling.

  Teenage girls were offered once more a glittering fantasy, the tinsel and stardust of romance, and it was implied that once they’ve got their man everything will be happy ever after. Girls growing up are not short of this candy-floss, even without having lessons about it in school. There is a whole industry based on it. Publishing houses like Mills and Boon turn out titles like Cinderella SRN, offering a lotus land of romance in place of the boredom of life as an office junior or on the dole.

  While women were reading romantic fiction, men read pornography. Neither romanticism nor pornography treats sex realistically, and neither acknowledges a woman as a person.

  What bothers me about romance is not only that it conditions girls to be exploited by the first man who convinces them he’s Prince Charming, but that it snuffs out a girl’s potential to be herself and do what she wants. Self-worth becomes something that is conferred on a woman by a man and lasts only as long as he wants her.

  Equally harmful was the romantic theme that a man ‘awakens’ sex in a woman. Yet we are sexual beings from birth. You only have to watch a baby at the breast, little hands and feet curling in delight. Adults find it difficult to acknowledge that a girl is capable of having sexual experience with her own body and within herself. Passionate friendships with other girls or older women are treated as trivial and silly, because women aren’t supposed to love other women, or get strength and support from them. Everything is supposed to come from the man. The candy-floss of romance is substituted for reality and the girls themselves enter into the conspiracy, seduced by its glamour. Teaching girls about romance therefore evades the main issue, which is that each of us needs to accept responsibility for the way in which we use our sexual energies.

  Teenage girls are under enormous pressure to be sexually active. Many are very unsure of themselves and use sex to obtain some proof that they are of value and that somebody wants them. Teenage girls risk pregnancy because they think that at least a baby will be someone to love who in return will love them. They look to the baby to give them the sense of worth that’s lacking in their lives.

  There are all sorts of teenage myths about conception: it can’t happen if you do it standing up, if the girl doesn’t have an orgasm, or if the boy was drunk – and it certainly can’t happen the first time. Even when contraception is available to boys in the form of condoms, girls often don’t check whether a boy has them because they feel less guilt if sex if unpremeditated. It’s the romantic image again. If you’re carried away it’s forgivable. Doing it with forethought is wrong.

  The romantic nonsense with which society stuffs the heads of teenage girls is directly responsible for many unwanted pregnancies. If we really want to help young women avoid pregnancy and exposure to sexually transmitted diseases, teachers would do better to run assertiveness-training for girls and courses in how to respect girls for boys. When it comes to it, it’s confidence in her own worth that enables a young woman to think through what she really wants, choose between alternatives with knowledge of the consequences, and make a decision that is right for her. And young men need to recognise and respect those decisions.

  Marketing Pregnancy Ultrasound

  A personal ultrasound scan that showed the moving fetus came on the market in 2002. It was advertised as promoting bonding between fathers and babies. The US company recommended that if a man invested in one of these machines he not only would get to see the baby for himself, but for the first time could touch its virtual image. A representative of the firm said that parents ‘get a sense of security that you don’t get without having an ultrasound … It’s as if you were playing a video right through the womb’.

  BBC Woman’s Hour interviewed me and Jim Thornton, Professor of Obstetrics and Gynaecology at the University of Nottingham. Jim was really keen on it, while I was highly critical. I said, ‘It’s good advertising. It’s another way men have found of invading and usurping women’s bodies: “Anything you can do I can do better”. There’s a pregnancy belly around, too, a big silicone thing a man can strap onto himself so that he feels what it is like to be pregnant. And perhaps you could have silicone breasts filled with milk!’

  The presenter of the programme, Jenni Murray, protested, ‘Hold on! Do you think this is more for fathers than mothers? Maybe mothers would like to be in touch with the baby, too.’ I replied, ‘Mothers are in direct touch with the baby inside them and in an intimate relationship. They can feel the movements of the different parts.’ Jenni said, ‘It seems to be a rather wonderful and lovely thing to have to at least pretend to touch your baby. There was an experiment in which pregnant women were divided into groups when they were having their ultrasound examination. With half they turned the screen away from the woman, and with half they turned it toward her. Just seeing her baby made parents less anxious and more happy, and helped them bond. It lasted through the pregnancy.’

  My reaction was, ‘There are other ways of bonding with a baby. It’s as if the baby is “out there”, almost like an astronaut in space. It actually divides the mother and baby in their intimate relationship. In all our experiences in life we seek pictures, take snaps, record videos, but I think we need to evaluate what is happening with the introduction of this new technology.’

  I was also concerned that we did not know if there might be risks with the ind
iscriminate use of ultrasound. ‘Pelvic x-rays were used for 50 years without recognition that they increased the rate of cancer in children under 10 years of age, and even after the research was published that demonstrated this pelvic x-rays continued to be performed.’

  Jim said, ‘Sheila is right. You cannot absolutely prove that anything is safe. We have been using ultrasound in pregnancy for 30 years. It has been studied very closely and so far, there is no evidence of any adverse effects.’ Jenni Murray commented that ‘Once the technology is there it may be you can’t put that genie back in the bottle.’

  I concluded, ‘This idea of obstetricians taking over bonding and companies producing technology to promote paternal bonding – I don’t know – what is the evidence? I think the real question is, “Do these guys change more nappies?” That would be a wonderful randomised controlled trial.’ Jim said it would be a lovely trial and he would like to undertake it. I don’t think he ever did!

  Conversation analysis

  In workshops for women preparing themselves for Birth Crisis counseling Celia and I used recordings (made with women’s permission) of real interactions I’ve had with women calling me for help with trauma after childbirth.

  A recording of one of my conversations with a woman suffering from post-traumatic stress disorder:

  FIONA: ‘I just thought, oh I was just being – hysterical’.

  CALL-TAKER: ‘Well … You … it’s a pity you blame yourself then.’