Wednesday, February 28

Relentlessly pushing the idea of ​​’natural’ childbirth is an affront to pregnant women | Catherine Bennett


For Grantly Dick-Read, the Victorian originator of the UK’s natural childbirth movement, birthing women in Britain should emulate those, as he phrased it, “of more primitive types”. In Natural Childbirth1933, he pictured one of these individuals disappearing into a “thicket” – it sounded plausible enough from Woking – to await her pain-free labour.

“Natural birth is all that she looks for; there are no fears in her mind about her; no midwives spoiling the natural process; she has no knowledge of the tragedies of sepsis, infection and haemorrhage.”

The “modern cultured girl” had, he theorized, lost the knack of childbirth. But she might regain it if she delivered according to her own system, excluding “meddlesome” medical intervention.

Even as Dick-Read, an adroit self-publicist, managed to promulgate his fantasy, there were contemporaries who disputed all of it, noting his lack of evidence. “Meddling”, it was pointed out, had saved countless lives, maternal and infant. Another doctor asked, in 1955: “Does childbearing require special training to be natural?” As for women, the unenlightened were still clamoring for pain relief, like the Queen got for Prince Charles.

But Read’s thicket could still sound, as it has continued so advantageously to do, a lot nicer than submission in a scary or unkind hospital. In 1956, it inspired Prunella Briance, a survivor of traumatic deliveries, to create the Natural Childbirth Association, teaching Dick-Reid methods. Renamed the National Childbirth Trust, or NCT, this organization remained true to its creators’ vision to a point that has inevitably, given the frequent refusal of female biology to comply with thicket-worthy deliveries, attracted attention.

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Item has been reportedfor instance, that days before Donna Ockenden’s final report about avoidable deaths at Shrewsbury and Telford NHS trust detailed its sometimes lethal unwillingness to perform caesareans, the NCT website still featured material telling mothers that “natural” labor would leave them more “satisfied”. In fact, Ockenden had deplored the NHS trust’s culture of “normal birth at almost any cost” in 2020, in her interim findings. Hundreds of women had told her they “felt pressure to have a natural birth.”

Responding to Ockenden’s final review, the NCT said it had changed since 1956: “We are not here to promote one way over another.” However, recent alumni report continued exaltation of “natural” birth by some instructors and a parallel aversion to the “cascade of interventions” said to await the unwary. Some have been advised to memorize the acronym Brain, to avoid being diverted from planned transcendence by the descendants of Dick-Read’s “meddlers”. As in: B. What are the Benefits of this course of action? A. What are the Risks? A. What are the Alternatives? I. (disputed) Intuition/What are the Implications? N. What if we do Nothing? Some people add an S, though not apparently for “What about Shrewsbury and Telford?”.

But it would be unfair, given the scale of the childbirth training industry, the variety of campaigning groups and professional doulas, to single out the NCT for encouraging women to fetishise choices and births that will not, for many, be achievable. With “normal” increasingly redefined, thanks to Ockenden, as a potentially dangerous goal, and the catchy but fatuous “natural” finally recognized – though by no means everywhere – as insensitive to women compelled by nature to accept technological assistance, a range of replacement synonyms testifies to the continued market for minimal intervention. Either that or to continued suspicions about NHS provision.

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If there are any anti-pain or pro-science groups out there for the many women who think nature totally fucked up childbirth, they have yet to compete with programs described as positive, relaxed, physiology-informed, active, sacred – and still, pace Ockenden, “natural”. There’s not much you can teach or sell a person who’d prefer to give birth in a nicely lit operating theater. More adventurous participants can be tempted, on the other hand, with everything from birthing balls to, for those who don’t want to make smoothies, placenta jewelery.

So perhaps it’s a bit optimistic to identify, as some are doing, proliferating accounts of the traumatic consequences of ideologically delayed intervention, as natural childbirth’s “MeToo” moment. The history of the movement chronicles a remarkable ability to survive, along with the occasional tragedies, repeated testimony from the mothers it has left, even with healthy infants, feeling like failures. It probably helped that these regrets were the unintended legacy – since we lost Dick-Read – of kindly, idealistic women, as opposed to a technocratic fraternity. Although, when they realized the amazing savings of low intervention, men could also experience the special pleasure of being simultaneously feminist and authoritarian.

If the revised, post-Ockenden lessons eventually get through to the sort of trusts that were advertising earlier this month for midwives “committed to the philosophy of normal birth”, the wider culture still promoting this approach may be harder to challenge. Outside hospitals, a prosperous industry revolves around the coaching required, as in the days of Dick-Read, for truly instinctive birth. Within the NHS, where hypnobirthing classes are currently in vogue, a sympathy for the “normal” plainly informs classes, such as those in Thurrockwhere women can learn to “relax, breathe and trust their body to know what to do instinctively”.

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At the Cambridge Rosie hospital, at £39 video-tutorial offers “significantly less pharmacological pain relief” and “a tool for increasing normal births and reducing operative delivery rates”.

Should women not be that fussed for themselves, the Rosie goes further: “Babies born using hypnobirthing techniques tend to be more alert, calm, feed better and sleep better as they have been brought into the world at their own pace in a more calm and gentle way.” For anyone not keen on a dull yet agitated and wakeful baby with no appetite, there could hardly be a more powerful incentive to internalize that caesarean-defying acronym, Brain, and to understand Ockenden’s findings as an affront to everything the great Grantly Dick-Read eleven held dear.

Catherine Bennett is an Observer columnist


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