Tuesday, April 6, 2010

"Natural childbirth: just another shuck"

With the help of the Village Voice senior editor, Tony Ortega, I have tracked down an early essay by my mother: "Natural childbirth: just another shuck," The Village Voice, September 30, 1971.

I knew most of the story of my birth, and how angry my mother remained at her jackass of a doctor. This essay captures her anger clearly, makes some excellent points, and is definitely of its time. And I respect that she doesn't end with how fabulous I was. That wasn't the point, after all, and would have actually undermined her point by saying, "Well, the doctor and birth were horrible, but I got my lovely baby."

I am not surprised she never had another child (though this experience was not her only reason); nor am I surprised that she worried about my "natural" birth choices. (I had much more and better support and preparation both times.)

In its entirety:

Natural childbirth: just another shuck
by Glenda Adams

“We young, modern gynecologists believe that pregnancy and childbirth is a happy, healthy time, no different from any other period in a woman’s life,” my doctor told me when he confirmed I was pregnant. I nodded and smiled along with him, glad that I was the patient of a young, modern expert who seemed to regard me as the intelligent young woman I knew I was. And thus he set the rules of the game.

During the months that followed I heard only of the joys and pleasures of childbirth. I heard of women and their husbands laboring in ecstasy in the hospital, breaking open bottles of champagne in the delivery room, and toasting the baby while a chorus of laughing doctors and nurses joined in.

I believed this enchanting fairy-tale version of birth, peddled by the sexist stalwarts of Parents Magazine and Baby Talk and by their enlightened opposites at Ramparts and WBAI. I believed that women trained in the Lamaze method of natural birth popped out their babies the way kids spit out watermelon seeds and were in complete control of the whole event. It took a long and difficult labor for me to perceive that natural childbirth can be just another shuck.

There is nothing wrong in delivering a baby without anesthetics or medication, with your husband by your side. But I discovered that the uncritical championing of natural birth by both the gung-ho American motherhood types and the radical sisters has left unchallenged the total power of doctors over their patients and has deceived women into believing that natural birth somehow liberates them from the traditional female straightjacket.

The 16 hours I spent in labor in the hospital, after 24 hours or labor at home, turned out to be the worst hours of my life. And I realized in the middle of it all that preparation for natural birth gives a woman only the illusion of being in control of the birth and of her baby, while the doctors and nurses carry out their tasks in the traditional way, unchallenged. The woman in labor is manipulated by yet another technique which maintains the status quo.

I wanted to scream and kick and curse the natural childbirth establishment that had taken advantage of me. But I did not give in to any of these spontaneous acts because I was afraid to lose my carefully cultivated self-control. Needless to say, screaming and kicking in labor does not make childbirth painless or easy. But the ability not to scream is symptomatic of our fanatic desire to be always in control.

And so the best candidate for natural birth is the intelligent woman with what is called common sense, who will see that it is in her own interest to obey and not make a fuss about having a baby. In other words, the young, educated, middle-class woman. And because of her ability to keep her head and contain her agony during labor, this is the woman who many also suffer the most in giving birth, especially if the birth is difficult and not of the melon-seed variety.

Like most eager, middle-class educated young women, I had been taught to believe that you have only to acquire knowledge to solve a problem, and you have only to set your mind to it and you can do it, be it getting an A in your finals, making a soufflé, or giving birth to a baby. To show how far we bright, modern women have come from the terror and misery our mothers and grandmothers endured, we even insist that giving birth is fun.

I am sure that the women who have told of their joyous experience in childbirth are telling the truth. They are simply the lucky ones who had an easy time in labor and delivery. They would have had the same uncomplicated experience with or without training in natural birth techniques. But they fail to see that their experience is an accident of nature. In their eagerness to champion the apparent reform, this apparently revolutionary method of childbirth, they fail to understand that they, together with their unfortunate sisters whose labor and delivery are “abnormal” or difficult, have been misled. All are victims of a current fad, propagated by women themselves and by some members of the medical profession, the latter often in bad faith.

                                    *                      *                      *         

“I have a few questions, “I said reasonably to the doctor the day he told me I was pregnant.

He held up his hand to stop me. “Read this book. It will answer all questions.” He handed me a slim hardback titled “Expectant Motherhood,” by Nicholson Eastman.

I read the book. I learned chiefly that my uterus would grow larger and that at the end of approximately 280 days I would have a baby. So I bought another book, a paperback by Alan Guttmacher, “Pregnancy and Birth,” which went into a little more detail and was uncluttered by coyness.

On my next visit the doctor asked if I had done my homework and dismissed with a mild grimace the few questions I had. He asked if I was interested in natural childbirth, expressed his pleasure that I was, and said: “There is nothing worse than seeing a woman in the labor room thrashing around and screaming when there is absolutely no need for it.” He told me his hospital was one of the few in New York that encouraged natural childbirth and insisted that all its nurses be trained in the method. He gave me the name of a midwife who conducted classes and the name of another book, “Six practical Lessons for an Easier Childbirth,” by Elisabeth Bing. In my zeal I bought yet another, “Childbirth Without Pain,” by Pierre Vellay.

Nothing in the books and articles my husband and I read, nothing in the natural childbirth classes we followed, and nothing that my doctor said prepared us for our experience. The disciples of natural birth talk only about “normal” labors and deliveries. The emphasis is on positive thinking. “If you call is pain, then of course it’s bound to hurt—it’s mind over matter,” was the prevailing sweep-the-dust-under-the-rug tone. As if by using Pavlovian techniques one can control one’s cervix, uterus, and the baby’s position.

My husband and I bought this wholesale and were looking forward to the event with excitement. In class we, the appointed, the elect of prospective parenthood, were told to expect some pain (or “discomfort,” as it is called in natural birth Newthink). We smiled in a superior, pitying way at the tales told by our midwife-teacher of the unenlightened women who had not prepared themselves for childbirth and who made everything worse for themselves, for the baby, and for the doctor.

That last phrase is the loaded one: “Let’s make it easier for the doctor. “ A subtle appeal that made us identify upwards, with the medical experts, rather than with those poor women in pain, in the same way that a factory foreman forgets his workmates and identifies with the interests of management. By paying $50 for a course of six classes we felt we had somehow bought our way into the private club of the medical experts. Giving birth would demonstrate the wonderful partnership of doctor, nurse, husband, and wife.

I saw my doctor for 10 minutes a month, then 10 minutes every two weeks during the eighth month, and 10 minutes every week for the last four weeks. He called me by my first name (or someone else’s first name, often Nancy or Margaret). But he never spoke to me about the actual labor and delivery and what I should expect. And I never asked, for I had read the books, taken the classes, and I assumed that both he and I knew it would be a jolly experience which I would control.

I began to perceive the depth of the fraud only when my labor was well under way. I had called the doctor after three hours of 45- to 50-second contractions and three-minute intervals, just as I had been instructed in class. When I checked into the hospital I was told my cervix was only just beginning to open. The week before the doctor had told me my cervix was still closed, but he did not explain what this might mean about the nature of my labor or how I could deal with it. In the hospital the resident clicked his tongue at me. “You’re going to take a long time,” he said. I felt I had spoiled everyone’s day. It was, after all, a Saturday, when people should be having fun. And here I was panting away like a thirsty pup, just as I had been taught, with my husband counting off the seconds in tens, as he had been taught, and reminding me to relax.

I panted from 3 a.m. at home (when I changed from the initial long, slow breathing I had been taught) until 7 p.m. The only comment I got was from a nurse, sometime during the afternoon, who told me I had started the quick breathing too soon. I felt guilty for over-performing. But nobody explained what I ought to have done and nobody explained what was happening to me, although I knew the activity in my abdomen did not tally with the book. All this in a hospital that encourages natural childbirth.

While I was in labor the screams of other women from adjoining labor rooms comforted me. I did not feel quite so alone, for I was beginning to blame myself for the excruciating pain that persisted and increased, despite my controlled breathing, panting, exercising, and positive mental state.

But I did not scream. During those terrible hours I whimpered a little. But not once did I scream. For wasn’t I intelligent, educated, enlightened? Didn’t I understand the birth process and have control over my body?

In that labor room, I waited for my doctor to congratulate me on the good job I was doing, to tell me how brave I was not to give in to the pain. I waited for him to treat me as his equal, include me as he made his decisions, and explain what was happening. I would have asked him, but I was using all my strength to maintain my control, and he jounced into the room, plunged his fist into my vagina, and jounced out again so quickly I did not have time to gasp out anything. My husband, banished from the room during these lightening appearances, had to spend the rest of his time giving his full concentration to seeing me through the pain and encouraging me to stay with it.

I think my doctor addressed me directly three times during those hours: once to say “Not medically justified,” when I whispered a request for a Caesarean (but he gave no explanation or words of encouragement to me to keep up the good work); once to say, as mid-day, when it was only halfway over, “Just pretend you’re starting labor now”; and once at the very end, to say “I’m going to put you to sleep.”

Just before that he had told my husband, not me, that a forceps delivery would be necessary. No one told us, as I pushed and strained for an hour and a half before being “put to sleep,” that they had known for some time I would not be able to push the baby out by myself. My husband overheard my doctor telling this to the resident. But when the doctor appeared he called to me to “push the baby out.” The cry was taken up by the nurse, and my husband found himself in the shattering position of having to go along with the experts in the deception.

After the birth we learned the extent to which we had not been informed. No one had told us that the baby’s head was facing sideways and would not turn to face the back. No one had told us the head was so big that there was a chance a Caesarean might be necessary. No one had told us that my contractions were being sped up by medication, so that when I found myself having long contractions lasting five minutes with practically no interval between them I was unable to adjust my breathing or expectations, since we had been informed in class of contractions lasting a maximum of a minute. These things the doctor and his staff knew, but they consistently failed to inform me of my husband.

It is now clear to me that a doctor’s power can depend on his keeping the mysteries of his profession to himself. And I saw how much quicker and more efficient it was for him not to have to stop and explain things to a woman in labor, particularly a woman who is not causing any trouble because she has herself under control.

“The trouble with natural childbirth,” my young, modern doctor told my husband after our baby was born, “is that it pretends to give women an amateur course in obstetrics and there’s more to obstetrics than that.”

I now understand what this doctor means when he talks about the undesirability of women making a fuss in labor: if you are a technician intent on doing an efficient job, the body and mind of the woman who owns the uterus you are dealing with tend to get in the way. The patient hampers the doctor in his work in the same way that readers hamper librarians by checking out books all the time.

Some doctors oppose natural childbirth. They say, “Leave medicine to us doctors, the experts.” Others espouse the method, use it to serve their own technical goals, and still retain their traditional power. They enlist the support of their patients by giving them the illusion they are taking part in an exciting new development that will make meaningful inroads into the old-guard established power of the medical world.

None of this is clear to the woman who hardly suffers childbirth, whose birth is “normal” with a need for only a minimum of decision-making for the doctor. It is patently clear to those who have a long, hard labor.

Natural childbirth gives you the privilege of paying the same $1300 in doctor and hospital fees to keep your self-control, possibly suffer more pain than if you had given birth the “old” way, and become the victim of just another shuck.


  1. Wow - i didn't know that your mother had had such a bad experience. This essay is very before her time as the 'rah rah' attitude to natural childbirth seems to be alive and well even now. I was always a little skeptical and stopped doing the class with the midwife who seemed to think that having an epidural was akin to personal failure but I did believe a lot of the propaganda about epidurals leading to 'more interventions'. In the end, after an excruciating 9 hours of natural labour (and dilating to only 1cm in 9 hrs) I had an epidural after which I dilated rapidly and pushed Astrid out around 3 hours after having the epi. It was great and saved me from what almost certainly would have been a caesarean birth if I hadn't had it. And with the epi I was able to walk around, change positions and even go to the loo - so I don't know where all those books got the idea that you'd be 'paralysed' after a epidural. Not so - at least here in Italy. I could still feel some pain too but not nearly as much. If I ever have another kid I won't be so scared of having an 'unnatural' birth. I think it pays to question the 'common wisdom' especially when it comes to your own body and your own health.

  2. This is the first of your mother's writings that I've read. No wonder she was a writer. I'm shocked and angry and hurt and frustrated right along with her. Even with an epidural I yelled out once or twice, only to be "shushed" by the nurses and told that I shouldn't scare the other patients. I felt bad like I was doing something wrong. Now I wish I had screamed to my lung's desire.

    Thank you for sharing, especially on mother's day (when I'm reading this).

  3. Thanks, Jess. My mother was a very good writer--and this was a very early piece--well before her short story collections and novels were published. If you want to borrow a novel...

    I will note that I screamed. And I worried, with Isaac, that the door to the delivery room was open (a curtain was pulled across it, but I could see feet walk by) and that people could hear me yelling and all, but I didn't stop, and no one shushed me. I was lucky to have such amazing support; my midwives both times were amazing--I lucked out with the best.