February 18, 2022

Family and relationships

Birth rites

By Martin McKenzie-Murray
Illustration by Jeff Fisher
Why do some insist women should forgo pain relief in childbirth?

I recently became an uncle for the first time, and while I’m physically estranged from my sister and niece by Western Australia’s hard border, we always have the telephone. When I called last week and asked my sister about the birth, I heard a familiar story of fear, uncertainty and guilt that she wasn’t sufficiently stoic or pain-bearing.

A few years ago, during my partner’s final trimester, when her nausea was replaced with the wonderfully affirming but sleep-depriving thumps of foetal limbs, the two of us attended a calm birthing course run by a midwife over a weekend.

I think I can fairly summarise its principles, at least as they were described to us that first morning: women are taught to fear birth, which increases the likelihood of their choosing medical interventions, like an epidural or caesarean section. These interventions effectively estrange women from their own bodies – from their own deep, evolutionarily refined abilities – and may even estrange them from their own child, if only at birth.

Modern medicine, and its industrial, impersonal logic of efficiency, works impatiently with the slower, “agricultural” time of birth. The frequency of interventions is the result of women yielding to fear – a fear unjustified by biology, but justified by the contingencies of freeing up hospital beds. In this industrialisation of nature, the woman’s body becomes a mere subject of modernity, rather than a sacred thing possessed of ancient strength that should be encouraged to assert its abilities.

This was the gist of the midwife’s introduction to the dozen couples who sat quietly in a circle before her, and her monologue faintly struck me as being simultaneously romantic and cynical. She spoke in an exceptionally quiet voice that belied her insurrectionist fervour, though at the time I thought much of what she said made sense. What’s more, she was asking the men to step up and to carefully consider our role on The Day.

I supported my partner’s desire to have a “natural” birth – that is, a vaginal birth without the aid of any intervention, including pain relief, unless necessitated by crisis. But my support was more an effect of ignorance than magnanimity, and simple deference to the fact that it wasn’t my body that would soon be delivering another. (As a man, there’s always the temptation of an “aw, shucks” kind of self-effacement, a pose that is culturally popular, but really gives us an alibi for wilful ignorance.) 

So together, we learnt meditation techniques. We closed our eyes and were invited to occupy a lush meadow beside a stream. Predictably, my neuroses polluted the idyll. Maybe I’ll be a terrible father, impatient and hateful. Consider the movement of the clear water, its constancy, its gentle burbling… It carries a leaf downstream. I should probably learn to drive. Get over the fear, you clown. And figure out how to work those straps on the baby seat. Why do they confound and intimidate you so much?

Now open your eyes.

There were lessons in labour and the stages of dilation, and on video we watched a home water birth enjoyed by serene practitioners of the philosophy now being taught to us. It was hard to question the wisdom of this quietly passionate sparrow – a woman who had delivered hundreds of babies, and who seemed to effortlessly embody calmness herself. 

While learning massage techniques, and lightly running my fingers across my partner’s back in haphazard but hopefully calming patterns, I facetiously suggested to her that I was an artist rendering an invisible but brilliantly accurate copy of Guernica on her back. Unknown to me, the midwife heard this, or at least the bit about me being an “artist”, and later asked: “What kind of art do you do?”

I was briefly confused, before I realised the origin of her question. Embarrassed for us both, I politely explained that it was just a joke. And at this point I thought I saw anger flare in her otherwise tranquil eyes; a reposed soul briefly unseated by the threat of my levity.

Anyway, I was accepting of everything until we got home that evening. Then I thought about how no female friend of mine who has given birth has ever described the process to me as beautiful, empowering or liberating. More common adjectives were “harrowing”, “interminable” and “bloody”. What’s typically described is an agonising shitshow that must be endured – and medically assisted – before the revelatory presentation of the child.

In other words, this isn’t a case of the journey being as important as the destination. It’s only about the destination – a healthy child – and within six months, the memory of birth, subject to a biologically useful amnesia, sharply declines. Now, I’m obviously speaking anecdotally here. And no doubt the cleric of calm birthing would respond: Well, fear stole their confidence.

But that evening, after recalling the midwife’s lines about how (indisputably) ancient this process was, I got to thinking about how romantic invocations of the brilliant durability of the female body were misleading if you weren’t also mentioning historic infant mortality rates.

If women shouldn’t be afraid, then they shouldn’t be afraid because of the availability of modern medical interventions – right? These interventions weren’t a kind of fast food invented by craven medical industrialists. They were often life-saving.

I assume some interventions are unnecessary, but it seems disingenuous to appeal to the ancient, quasi-mystical strength of the female body without ever mentioning that as recently as the year of my birth, the Australian infant mortality rate was more than three times greater than it is today. To ignore this fact is ideological atavism.

If being partially sedated during birth – or undergoing a caesarean – might estrange you from your child, then surely the estrangement’s brief. The greater risk, I modestly propose, is a woman’s longer psychological estrangement from their child because of the trauma of the birth, and if medical intervention can lessen or remove that trauma, then all the better for the mystic chords between mother and child. 

Now, I didn’t say any of this to my partner. Not then, anyway. And the next day we returned to the workshop, and learnt to better withstand the pain of holding ice cubes. Today, my partner wishes that she had accepted the laughing gas much earlier, believing it would’ve shortened a very long labour, and perhaps forestalled the escalation of care that was eventually required.

It is only now, after my niece’s recent birth – and three years after the birth of my daughter – that I’ve discovered the Morecambe Bay investigation, a 2015 British inquiry into the avoidable deaths of 11 babies and one mother in the Furness General Hospital over nine years. The inquiry found a “lethal mix” of failures, of which one part was a dysfunctional rivalry between doctors and midwives, the latter of whom were so self-consciously cavalier that they nicknamed themselves “the musketeers” and pursued natural birth “at any cost”.

Then, in late 2020, another British inquiry into “serious failings in maternity care” at an English hospital released its interim findings. The Ockenden report, named for the distinguished midwife who led the investigation, found systemic – and complex – failures, which resulted in the avoidable deaths of babies. Like the Morecambe Bay report, these failures included unworkable relations between doctors and midwives, and a myopically zealous approach to natural birthing.

And then I came across a column by the British writer Barbara Ellen in response to the Ockenden report, which neatly expressed what I had felt during those calm birthing classes. “Women who don’t have natural births are made to feel like failures,” she wrote. “There’s a quasi-macho pride attached to going without pain relief. Why are high risk and lack of pain management deemed normal and laudable in maternity, but not in other branches of medicine?”

It’s a good question and, as Ellen goes on to say, it’s a strange feminism that shames women into assuming greater pain and risk. It also speaks to a small subculture of midwifery that, for me, resonates uncomfortably with the Novak Djokovic school of refusing vaccines on the quasi-mystical grounds of purity. Apparently, our bodies are born to bear everything – not for them is Thomas Hobbes’s injunction that, without civil society, life is nasty, brutish and short. It certainly was for many infants in Hobbes’s 17th century – 12 per cent of newborns died in their first year.

My opinions, naturally, are not definitive. Far from it. And I appreciate that it’s fraught, unpopular, even provocative for men to write about feminism, much less childbirth. But this cultural policing seems a neat way of excusing men from thinking about them.

Martin McKenzie-Murray

Martin McKenzie-Murray is the author of The Speechwriter and A Murder Without Motive: The Killing of Rebecca Ryle.

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