When I was pregnant last year, I was practically the only woman I knew who admitted to planning an epidural. "Oh, I'm keeping my options open" or "I know drugs are there if I need them" were the typical responses of women who invariably went for an epidural at the earliest opportunity.
At first, I found this timidity surprising. Nobody waits to see if, say, root canal surgery is painful enough to require medication. Surely after thousands of years of human history, the evidence on childbirth is in. Even in ancient Greece, Homer talked about the "agonies brought on by the harsh, birthing spirits."
But after making my way through prenatal yoga, childbirth education class and a heap of pregnancy books, I discovered a childbirth culture that makes women embarrassed to want pain relief -- one that worships the "natural," unmedicated birth as an experience verging on the mystical. This birth culture is extremely influential even though it is out of sync with women's obvious needs: Although 80 percent of pregnant women opt for epidural medication when they feel the pain of labor, many feel guilty about having "failed." Some even require counseling.
It's a culture that has been shaped by an array of professionals, including doulas, who offer labor and post-partum support, and midwives. It offers books like the classic "What to Expect When You're Expecting." It has brought into the mainstream not only birth-education classes but also birth plans (a woman's instruction to her hospital on everything from her delivery position of choice to the kind of lighting she prefers), prenatal yoga, birthing tubs to soak in during labor and birth art -- from nude profiles of the expectant mom's swollen shape to plaster-of-Paris "belly masks." Some devotees of the culture call themselves "birth junkies."
To be sure, the culture has many good points. Most pervasive among feminists, it has encouraged women to wrest back control of their pregnancy and birth from patronizing doctors. The medical establishment has been forced to pay attention, accommodating women's desires to be conscious for the thrilling moment of their babies' arrival and to have their partners in the delivery room to support them. It has also challenged unnecessary medical interventions, such as inducing a baby early so that a doctor can deliver during office hours.
Yet at some point, the movement became almost as proscriptive and patronizing as the establishment it was fighting against. Natural birth ceased to be merely an option and became the "right" kind of birth -- a sign of true womanhood. It is taken for granted in this culture that every woman should go into labor intending to take as much pain as she can stand -- and maybe more. Never mind that there's nothing particularly feminist about women in pain, or that the use of childbirth pain medication began in the first place because an earlier generation of feminists had fought for it. That was when feminism produced the suffragette; today, it gives us the earth mother.
All this reveling in pain seems even more strange in light of a new book on the history of childbirth drugs called "What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present." Written by an obstetric anesthesiologist, Donald Caton, this insightful if earnest book shows that women have eagerly sought an escape from natural birth ever since there was one available. For a long time, women couldn't get childbirth drugs without a fight.
Caton's balanced work helps explain how we have reached such a diametrically opposite point today. One of his most fascinating revelations is that the natural childbirth movement owes its genesis not to modern feminism but to one man -- and an extremely sexist man at that.
The use of childbirth drugs began in 1847 when Scottish obstetrician James Young Simpson introduced ether as an anesthetic during labor. Pioneers in the field soon started using chloroform as well. At first, only the rich and powerful could avail themselves, in part because it was believed that only the most "cultivated and refined" women were "sensitive" enough to feel pain in childbirth. Queen Victoria was an early customer for chloroform, which she used for her eighth and ninth deliveries. She was so pleased that she saw to it that her eldest daughter, Vickey, received what the queen called "this blessed chloroform" during labor as well. But childbirth anesthesia was so controversial that even the queen's use came under attack by the founding editor of the medical journal Lancet.
In many ways, Caton's book reveals, the early arguments against childbirth pain medication are remarkably familiar. Many scientists of the time considered drugs an unnecessary "intervention" that would interfere with the "natural" process of childbirth -- by diminishing contractions, for instance. They also felt that anesthesia posed a risk to the life of the mother and the well-being of the newborn. In addition, many then saw childbirth pain as a dictate from God. So it was only the rare, courageous physician who was willing to use the new childbirth drugs.
Women, however, were clamoring for them. In desperation, some had their husbands administer them, a practice that provided fodder for the skeptics. Often crudely administered, on a questionably clean handkerchief and in no particular dosage, ether and chloroform did slow labor and posed significant risks. Ether made mothers sick, chloroform destroyed their liver and an overdose of both sometimes left a newborn motherless. Studies soon showed that these drugs also crossed the placenta.
As the century turned, Twilight Sleep came on the scene. Introduced in Germany, this brand of anesthetic only offered partial pain relief with a small dose of morphine. But moms forgot much of the experience due to an amnesiac called scopolamine that was added to the mix. "Twilight Sleep" also had serious drawbacks, Caton notes. It diminished contractions and made its way across the placenta, sometimes delaying the baby's first breath. Moreover, because the pain relief was only partial and scopolamine had the added effect of loosening inhibitions, women often thrashed about so wildly that their arms had to be tied down. Attempting to further calm women by means of sensory deprivation, one doctor who pioneered the method, Carl Gauss, also took to bandaging women's eyes with gauze and stuffing their ears with cotton -- procedures that really turned childbirth into a "confinement."
Still, so great was the desire for something, anything, to ease the pain of childbirth that the popularization of Twilight Sleep became a cause cilhbre among suffragettes. Caton quotes one call to arms from 1915: "The insistence of the American women that they shall have the benefits of the new method is bringing results. Keep on ladies! Hammer away with all your might. Emancipation day has come." The New York Times joined in the cause with a series of editorials accusing doctors who resisted the drugs of a callous indifference to women's needs and an exclusive preoccupation with their own convenience.
Sound familiar? That's because natural childbirth proponents today make exactly the same claims about doctors who do offer drugs. The man largely responsible for this turnabout was Grantly Dick Read, an English obstetrician who coined the phrase "natural childbirth" in a popular 1933 book of that name. His even more influential sequel, published in the United States as "Childbirth Without Fear," came out a decade later. Read's theories carried echoes of old ideas about pain and class, but he turned them around to idealize the hardy masses. Unlike "modern cultured girls," he wrote, "primitive" women felt no pain in childbirth -- and he urged modern women to follow their example.
That Read drew such a conclusion from his practice near London is one of the many ironies about the man. And when he later moved to South Africa, he saw tribal women lining up for childbirth drugs. Nevertheless, his thoughts on the high maternal death rate among primitives clue you in to his ideology. Women who realized their fate was at hand took their last breaths, he wrote, "without any sadness, realizing if they were not competent to produce children for the spirits of their fathers and for the tribe, they had no place in the tribe." In short, a woman's "true emancipation lies in freedom to fulfill her biological purpose."
Despite such outrageous sexism, Read's portrayal of natural childbirth as a spiritually satisfying manifestation of women's creativity and power found an audience -- especially given Twilight Sleep's limitations. Oddly, however, the movement he sparked is stronger than ever today. Like Read, modern birth culture loves primitive societies, where everything is so natural that the infant mortality rate is abysmally high and life expectancy abysmally low.
Yet the landscape of childbirth pain medication has completely changed since Read's time. Unlike previous anesthetics, the epidural -- a method of inserting what is usually a combination of drugs in the back -- allows a woman to stay fully conscious for the miracle of birth. And, in contrast to Twilight Sleep, it offers almost complete pain relief. All the more annoying, then, that childbirth classes give short shrift to the use of pain medication. In our own class, the instructor covered how each stage of labor feels, as if drugs had nothing to do with that process. Only several weeks later did she broach the subject of medication, and then she threw a long list of drugs at us without much guidance as to which to concentrate on. You'd hardly know that the epidural is the most effective and widely used.
The instructor further told husbands to argue with their wives if they beg for medication during labor. If the wives can be persuaded, she reasoned, they don't need the drugs after all.
Our textbook, "Pregnancy, Childbirth and the Newborn" (published in Seattle, the birth culture's ground zero), took care to provide a long description of each drug's potential side effects, but lacking was any perspective on how frequently they occur. It's like reading the packaging on aspirin. Yes, it might cause ringing of the ears or hearing loss, but is the risk great enough to stop a reasonable person from taking it? Well, maybe, among this circle of folks who harbor a New Agey disdain for Western medicine. "In contemporary Western culture, the emphasis is greater than ever on development, perfection, and wide utilization of drugs for every health care need," our textbook sniffed.
I tried to find accurate information on side effects elsewhere, looking at specialty publications, searching the Web for medical studies and interviewing the head anesthesiologist at my hospital in the five-minute intervals he would spare me between deliveries. The result was a slew of vague and contradictory information. I saw no solid data on significant risks, however. In fact, I was particularly appalled by the unsupported scare tactics of natural childbirth zealots, like the list of epidural side effects listed in a Canadian periodical called "Birthing." One eye-catching entry, "maternal death," included no explanation or data to support it.
Unfortunately, "What a Blessing She Had Chloroform" is no help in sorting out the information from the misinformation. Absorbed mostly in looking backward, Caton passes on tackling the subject of epidurals -- an astonishing lapse, considering the subject of his book. While he hints that he is perplexed by the "secular religion" Read inspired and gently defends the medical profession against the resulting backlash, Caton obviously doesn't want to cross swords with the movement's rather sanctimonious and accusatory stewards.
I can understand why. When I was still pregnant, I wrote an article for an alternative Seattle newspaper discussing my attitude toward childbirth drugs. A number of stalwarts of the birth movement wrote in to say they were "sad" for me and insinuated that my desire for pain medication must be due to my overall "insecurity." So much for the "choice" that the natural childbirth movement is supposed to be about.
I am not a reckless person. If I had heard a clear case against using drugs on the grounds that they would endanger me or my baby, I would have faced my fear and prepared to do without. What I heard, instead, was that fear should be faced for the sake of it, that labor is some kind of psychological test and that only wimps take the easy way out with drugs. And the message was no less plain for being subtle, as in our textbook's explanation of why women opt for medication: "It is when you think that your labor is worse than it is supposed to be that you begin to worry and seek relief with pain medications or anesthesia." God forbid that women should seek relief from labor's all-too-normal torment.
In the end, I got lucky. The early stages of my labor went so well that I didn't even realize I was in labor. Turns out I have a high tolerance for pain. Eventually, though, I got back-to-back contractions that left me incapable of doing anything but frenetically careening around the room, grabbing objects so that I didn't fall down. Then I got my epidural. In about five minutes, I went from total agony to total comfort. Just as I was getting ready to drift peacefully off to sleep while waiting to push, the nurses discovered to their surprise that I was fully dilated and ready to go. Evidently, the drugs did not slow my contractions one whit. Nor did they keep me flat on my back -- I used a squatting bar to push.
And then my big, strapping, 8-pound, 11-ounce baby got stuck. I pushed for five and a half hours before a doctor went in with forceps. Did that complication have something to do with the epidural? I can't say for sure, but my doctors believe that the baby's size was the deciding factor. I can say that most of the time while I was pushing, I kept thinking how great it was to be feeling no pain.
Best of all, our little girl came out wonderfully healthy, alert and ready to eat. She is easily the most "natural" part of our lives.