The myth of natural childbirth Pt 1

And the development of birth interventions

When I was pregnant with my eldest, I wanted a natural birth.

Only, I didn’t really know what I meant by that. I knew that I wanted to avoid interventions where possible. I knew that I wanted to use water and breathing as pain relief instead of drugs or machines. I didn’t question why I felt that way. In retrospect, maybe it was because I felt that I needed to prove myself capable. As a younger mother, maybe I felt that if I could birth my baby with minimal help, I would earn respect from those who might otherwise judge me.

In the end, I did have an entirely intervention and drug free birth.

Yet there was very little natural about it.

See, when we talk about natural birth, we probably mean “without pain medication or labour-augmenting medication”. This version of a ‘natural’ birth is probably taking place in a hospital (which is not the ‘natural’ place for women to birth their babies). There are probably strangers coming in and out (not the natural support network during birth). It probably involves routine monitoring such as foetal heartrate monitoring (a very recent invention). On the flip side, when some people say natural birth, they mean completely unaided, which is also unnatural! Obligate midwifery (the need for assistance during birth) evolved alongside the evolution of the modern human birth canal, and is present in virtually all traditional societies. Birth interventions have been around almost as long (although unknotting shoes, chanting to ward off evil spirits, and drinking a tonic of roasted human hair are not quite as effective as the interventions we turn to nowadays).

Photo by Tim Bish on Unsplash

The unspoken truth is that birth is something that is shaped by the culture in which we live. We might feel like we can choose the birth we want. We write up birth plans and choose our midwives. We hire a birth pool or elect an epidural. We believe that we are making informed choices. But we don’t often stop to question why those options (and those options alone) are presented to us to choose between. The societal and cultural norms that led to those options are so ingrained into the fabric of our culture that we rarely even notice them, let alone question them.

So, let’s unravel that fabric. Let’s tug on the strands of history and find out how and why birth has changed so dramatically over the last few hundred years.

Forceps and the patriarchy

For most of human history, childbirth was an exclusively female domain. Births would often happen in the mother’s private residence and were attended by the local midwife and a few other women, who together possessed all the knowledge needed to support the labouring woman.

However, not every birth had a happy ending. Obstructed labour was a frequent cause of death for both the mother and child. Male physicians would be summoned to help in cases of prolonged labour, but the crude instruments they had available would guarantee the death of the child (who was probably dead by that point anyway) and frequently cause the death of the mother as well. These tools have been described since at least the 5^th century BCE, and the primary goal was to extract a dead foetus to preserve the life of the mother. This pattern of childbirth – where women were the authoritative knowledge bearers and men were only called in cases of emergency – continued until about the 17^th century.

Then a lifesaving medical device was invented by the Chamberlens – forceps. This tool could be used in cases of obstructed delivery to deliver live babies! Yet this invention was a closely guarded secret, with the instruments carried to deliveries in a gilded chest and only being revealed once the woman was blindfolded, and then only under a sheet with no one else present in the room. This secrecy enabled them to maintain a monopoly for many years, increasing demand for their services.

With time, the description of the forceps was published and shared with others, yet using these tools required considerable skill. Rather than training practicing female midwives in their use, only men-midwives were instructed. Armed with forceps and claims to a greater scientific knowledge of biology, men-midwives charged significantly more for their services than traditional midwives. This was despite their lack of knowledge of the natural physiological process of birth – after all, they were only trained in obstructed birth. Yet their popularity rose, and throughout the 18^th century it became fashionable in England and France to have a male-midwife in attendance. The rise in male dominance wasn’t coincidental. Traditional midwives were actively discredited and devalued. They were excluded from medical institutions, prevented from being licensed or organised. While they still had expertise, this lack of professionalism gave them lower status and income. All this while the death rate in maternity hospitals was ten times higher than that outside of hospitals. Rather than increasing safety or improving outcomes, the involvement of men in childbirth brought new hazards through the increased transmission of puerperal fever and injuries associated with the careless use of forceps.

And thus we see how the patriarchy invaded the female domain of birth.

The knowledge of birth was transferred from women to the male-dominated sphere of science. The experiential knowledge that traditional female midwives possessed came to be seen as less valuable than the often-limited scientific knowledge and training a male-midwife could obtain though medical manuals. Birth was no longer a feminine mystery, but a procedure that could be manipulated with the use of male-wielded tools. Birth was no longer a private female ritual, but an opportunity to train the next generation of male physicians.

Forceps allowed men to enter the realm of birth. Then the patriarchy pushed women out.

Can you imagine for a moment how things would be different now if traditional midwives - women with experiential knowledge of natural birth, most who had given birth themselves, who cared for and intimately knew the women they were supporting – if these were the people who were trained in the life-saving use of forceps?

Episiotomies and medicalization of birth