Man-Midwifery and the Romanticization of Labor Pain

A few days ago, a friend of mine who’s expecting her first baby emailed me, wondering if she should plan for a “natural” birth or give in to the “temptation” of an epidural. I don’t know what she’ll decide (and honestly, both are reasonable choices, in my view), but I pointed out that she was using the language of moralistic judgment. She’s a very smart and reflective person, and yet the words she used already condemned one choice as illicit. It’s telling, I think, that these words are the available ones, particularly for educated women concerned about doing everything right.

Hard on the heels of our conversation comes this British professor of midwifery, Denis Walsh, who’s been getting lots of attention for claiming that experiencing labor pain makes you a better mother. Here’s how the Guardian laid out his position:

More women should endure the agony of labour because pain-relieving drugs, including epidural injections, carry serious medical risks, diminish childbirth as a rite of passage and undermine the mother’s bond with her child.

These claims from Dr Denis Walsh, one of the country’s most influential midwives, have prompted a furious reaction, with other experts saying he has exaggerated the risks of having an epidural. Official figures show that the number of mothers-to-be who receive an epidural, general or spinal anaesthetic has soared in recent years to 36.5%. [Note that these are British statistics; U.S. figures are likely higher.]

Walsh, a senior midwife and associate professor in midwifery at Nottingham University, argues that many women avoid experiencing the discomfort of childbirth because hospital maternity staff are too quick to offer an epidural or agree to a woman in labour’s request for a pain-killing injection in her back to ease her suffering.

“A large number of women want to avoid pain. Some just don’t fancy the pain [of childbirth]. More women should be prepared to withstand pain,” he told the Observer. “Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.” …

“Over recent decades there has been a loss of ‘rites of passage’ meaning to childbirth, so that pain and stress are viewed negatively,” said Walsh. Patients should be told that labour pain is a timeless component of the “rites of passage” transition to motherhood, he added.

While Walsh has found some support among feminist bloggers for challenging the medicalization of birth, he’s also been roundly criticized: Anna N. at Jezebel says he’s setting new mothers up for a lifetime of being judged. The bloggers at Broadsheet, to a woman, chose epidurals and have no regrets; the reject the idea that those who don’t suffer birth pangs (like, say, fathers!) will be better parents, and Amy Benfer suggests that Walsh’s position “smacks of sadism.” Figleaf points out that the curse of Genesis applied to Adam, too, yet men aren’t considered morally superior if they avoid “painful toil.” Dr. Amy Tuteur at The Skeptical OB notes that “the claim about endorphins and bonding is entirely fabricated; it was made up by Michel Odent.”

Yep. That’s all true. Tuteur’s reference to Odent is particularly telling, because he’s one of the fathers of  “natural” childbirth, along with Grantly Dick-Read and Fernand Lamaze. While female midwives picked up the idea of natural childbirth and ran with it, and many mothers enthusiastically embraced it, it was originally the brainchild of male physicians.

But the original promise of natural childbirth was not to create better mothers through suffering. Quite the contrary; it was to greatly reduce or eliminate pain. Dick-Read believed that labor pain was largely due to fear and tension. His theory relied heavily on what we’d now see as racist distinctions between “primitive”African women, who allegedly gave birth painlessly because of their closeness to nature, and “civilized” European women. The original Lamaze technique used Pavlovian conditioning to train women to relax and ideally eliminate pain. Ina Mae Gaskin, who’s probably America’s most famous midwife, redefined contractions as rushes and contended that women could learn to transmute the pain into productive effort. (I don’t know if she still makes the claim that women can achieve a pain-free birth through the power of their minds, but that’s what she originally contended in her book, Spiritual Midwifery.)

So Walsh’s position is actually much closer to Odent’s and quite far from Dick-Read and Lamaze. What changed between the early 1960s, when natural childbirth was first popularized, and today? Well, women no longer need to choose between consciousness and pain relief. Epidurals offer both, unlike Twilight Sleep or other opiate-based techniques. Culturally, motherhood has optional. We’ve mostly left Freudian mother-blaming behind us, but in its place has arisen a standard of intensive mothering that no woman can ever perfectly meet.

It’s ironic that the attempt to sell natural childbirth by equating pain with better mothering is occurring in Anglo-American discourse. Originally, it was American women who most vocally demanded better obstetric pain relief in the early 1900s, following the invention of Twilight Sleep. They were far more organized and vociferous than their counterparts in Germany, where the technique originated. Although strong religious objections against relieving labor pain persisted into the late 1800s in the United States, ether and chloroform had been commonly used since early in the post-Civil War era. British, women, too, embraced pain relief fairly zealously after Queen Victoria quelled the controversy over chloroform by choosing for her eight delivery in 1853, though working-class women remained more skeptical into the twentieth century.

The historical adoption of pain relief in labor both reflected and helped to constitute new ideals of motherhood as less about suffering and more about love. Motherhood became less identified with complete self-sacrifice and more compatible with legal and social personhood. Where backlash against this trend occurred – such as in Germany – it was often tangled up with militarism and bellicose nationalism. One German obstetrician who opposed pain relief in labor wrote in 1932 that “humanity must become tougher and more manly again. Learn to suffer without complaining.” He was one of many physicians who worried that women were becoming soft, sentimental, and degenerate, with dire consequences for national health and military fitness. The apparent contradiction of calling for laboring women to become “more manly” is a little less nonsensical in light of the demand for a virile military, which required virile mothers.

I’m not suggesting that women who reject pain relief are complicit with militarism. Not at all. But arguments equating suffering with good motherhood have a very regressive history. Those who would shame women for relieving their pain are part of that tradition.

Which brings me back to my friend, who’s expecting at the end of the summer. I don’t know what choices she’ll finally make. It would be equally bad if she felt pressured to choose an epidural; that happens, too, thanks to medicalization and our idolization of technology. I just hope that whatever she does, she’ll feel free of judgment.

(This post ought to have about 20 footnotes. Anyone who’s really curious can email me: sungold85 [at] gmail [dot] com, or start with Judith Walzer Leavitt’s groundbreaking study, Brought to Bed: Childbearing in America, 1750-1950. On Grantly Dick-Read and the genesis of natural childbirth, see Tess Cosslett, Women Writing Childbirth: Modern Discourses of Motherhood.)