Monday, 23 August 2010

Natural Childbirth Mistrust

Queen Victoria, notwithstanding her nine children, was no enthusiast for pregnancy and childbirth, and, at the first possible moment and although that moment only arrived for the birth of her eighth child, availed herself of the benefits of chloroform as a pain relief during labour. This was much to the outrage of various interest groups of the time, and in particular of church leaders who held the view that God would not have made childbirth painful if it were not meant to be so and if the pain were not necessary to the production of healthy infants and devoted mothers. Even Victoria was unconvinced by this argument, and today it will seem to many one very weak indeed. And yet, much of the substance of the mid-nineteenth century church's view is sustained by the notion of "natural" that continues to emerge as the dominant contemporary ideology surrounding labour and birth. Today, a woman often finds herself with feelings of guilt and inadequacy at opting for one of the pain relief methods available to her - most usually, the epidural - because of the tacit assumption that a birth without pain relief is a "natural" birth, and therefore a more successful birth, a healthier birth, a more autonomous birth, an easier birth, a better birth.

Now, given the fact that most women who have the option open to them do continue to avail of pain relief in labour, we might conclude that, much as the church's argument in the nineteenth century that the pain of labour is in some sense necessary failed to produce its effect, the "natural" position has not gained its point. But this would be to move too quickly. For, it is actually crucial to the "natural" position that most women do not opt for a "natural" birth; its effectiveness lies not in its increasing the number of labours and births that take place in pain but rather in the dissemination of a view that there is a way of giving birth "naturally" and that not to do so is to have fallen short of our "natural" potential. Why should this be? Why should it be essential to the "natural" position that most women do not opt for a "natural" birth? Well, much of the rhetoric of the "natural" position focuses on the lack of autonomy available to a woman under epidural (she will have delivered herself into the hands of the medics, will no longer be able to move about as she chooses, and will have all key decisions in the birthing process removed from her jurisdiction) and on her inevitable retreat from the experience of her own body, so that the only person who can really know what is happening is taken out of the equation (the woman can no longer feel when and how to push). These two effects are also said to attach to other, less complete, forms of pain relief; diamorphine, for example, tends to make a woman feel detached from her physical existence, and gives rise to a demotivation that can make her more malleable in the hands of professionals. In short, then, the "natural" position argues that reason and experience are bracketed by pain relief during labour and birth; a woman sacrifices both her freedom to judge and her capacity to feel. Implied in this argument, of course, is that reason and experience, autonomy and feeling, would, if allowed to operate, function during labour and birth; without epidural, a woman would, it is claimed, judge for and feel for herself...

...which is why it is important to the "naturalist" that women do not generally undergo labour and birth without some form of pain relief: for, one of the most startling aspects of labour and birth that is undergone without pain relief is its revelation of the very limited nature of the human capacity to reason and experience. Once in the throes of labour pains, a woman unmedicated will often, and very quickly, have reached the limits of her ability to conduct herself, will often, and very quickly, cast about for some person in whom to place all of her trust and who will subsequently work, more or less well, to be the woman's judgment for her. Herein lies the challenge to the midwife, who must - although he or she is not always able to do this - exercise the woman's supposed autonomy on her behalf. And herein lies the rage for "birth-coaching," which the "natural" position recommends as facilitating a "natural" birth and which conceals the fact that a woman in labour will often outsource her supposed capacity to judge for herself as soon as ever she can; if this fact has been buried in a previously worked out "birth plan," it is less likely to strike us as an abdication of reason. So much for the rational birth. Even more surprising is the extent to which a labour and birth without pain relief, far from revealing the woman as a "natural" child bearer, shows up the extent to which we are alienated from our most basic of phsyical experiences. Without numbing, it is said, the woman can judge for herself when to push, can report to the midwife the nature of her experience, can shift her position so that the baby's passage is easier, and so on and so on. What is never said is that it is very unlikely that a woman who has never experienced the need to expel a baby from her body will recognise the need to do so. The what-it-is-like of needing to push is something with which she is not familiar, is something not "natural" to her, and therefore something that she is not necessarily the best person in the room to be the judge of. In fact, it is most likely to feel to her like the desire to defecate, which, given the strength of the taboo against public defecation, is likely to make the woman not want to push just at those times when she ought to push; seen in this light, the person supposedly experiencing what it is like to give birth is the last person in the room whose experience should be given priority.

What a labour and birth without pain relief reveals, then, is that the autonomy and rational judgment that we often regard as definitive of humanity is but a thin and fragile layer atop a deepseated irrationality that is no longer that of the animal (we have, in many ways, been alienated from our animal capacities) but much more like that of the child, and that our ownership of our bodily experiences is very very tenuous, subject, like our ownership of the more intellectual, less supposedly immediate, aspects of our lives, to habit and convention. What a labour and birth without pain relief reveals, in short, is that there is very little "natural" about us - we are neither naturally thinkers, nor naturally feelers; which is why, together (but this is another story) with its implicit disciplining of women by feelings of guilt and inadequacy, it is essential to the "natural" childbirth camp that relatively few women live up to its expectations.

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