More women than ever are having their babies by Caesarian section. Not the old last-resort emergency type, either; the ones where mothers howl for days, to the point of peril for self or child, until mercy descends in a scalpel — life-saving, but adding to existing trauma. No. This marked increase, by as much as 40 per cent in one year at the Liverpool Women’s Hospital, has been among women who elect a Caesarian; those who plan, often months in advance, to be delivered calmly, swiftly and relatively free of pain in a modern, controlled, 21st-century environment. In short: an increase in women who are aware that there is a choice and are happy to exercise it. So good news all round then.
Unless, that is, you read the coverage of these findings in pretty much any newspaper last week. From the Guardian to the Daily Mail, the consensus was absolute: this is a bad-news story reported in richly pejorative language. They freely quoted those who ‘blame’ the rising trend and ‘experts’ who ‘warn’ against it (unnamed ‘experts’, mind), they introduced us to the word tocophobia, meaning fear of childbirth (is there a word for fear of any other specific agony, I wonder?), while the Guardian topped the admonishment to cowardly electors of Caesarians when it quoted a doctor who berated ‘women’s reluctance to withstand labour pain’, their ‘lesser tolerance’ and observed sternly that ‘They should realise that childbirth is painful.’
It is impossible to imagine any other field of medical endeavour in which a qualified, practising doctor could get away with, to paraphrase: ‘Of course it hurts. What do you expect me to do about it?’ In fact, the reverse is the case; in every other healthcare respect, medical and technological advance leads to therapies seized upon, fought over and politically haggled as strident hot potatoes. A new hip? I want it and I want it now. Avastin? Gimme, gimme. Herceptin? It’s my right, goddammit.
Only in matters of childbirth does there continue to thrive a loquacious lobby that coerces women to keep their distance from any such advance, no matter the pain. There are still versions of the old chin-up along the lines of, ‘Those Injun bints just squat in a field, drop the kid, strap it on their backs and get back to work’ — even though they don’t, they never did and the sadder truth is that the less educated the population, the higher the rate of maternal and infant death.
More usually, such mythology translates into a contemporary vocabulary of approval and, by extension, disapproval. ‘Good girl’ is the encouragement offered to a woman as she struggles in labour, hour after bloody hour, without pain relief; the implicit converse, should she seek drug assistance, is therefore ‘bad girl’. Even those who pride themselves on having an open mind in advance of the event will say, ‘I’ll try it without and see how I get on’ — apparently un-aware that their use of the word ‘try’ carries with it, again implicitly, the possibility that they might ‘fail’.
The evangelical cry is that natural is always, but always best, regardless of suffering and regardless, if necessary, of scrupulous attention to fact. Earlier this year a World Health Organisation study was widely reported to have found Caesarian births three times as likely to lead to the death of mother or child. What was left well down in the small print, however, was that this was a worldwide statistic and thus of scarce relevance to, say, third-millennium Hampstead; in other words, it’s as well to be leery of a Caesarian in conditions where you might feel it unwise to tackle a wisdom tooth — but those are not your conditions or mine.
It is easy to see why successive governments have done all they can to bolster the advocates of leaving well (and ill) alone in childbirth: it’s cheaper. Who can forget the saintly tones of Patricia Hewitt when, as health secretary, she ‘promised’ all women the ‘chance’ of a home birth? It was as if she were offering more when, in fact, she was offering less: less medical expertise, fewer anaesthetists’ skills — no epidurals at home — and no hope for a woman’s right to change her mind; at least, in a hospital, you can start with a birth plan involving no intervention and scream for an about-turn should you want one.
In terms of staffing, to train a home-birth midwife with a handful of GCSEs is a positive steal in comparison with the cost of training an obstetrician for seven years and more. So c’mon: let’s big up the midwives; train a few more while we’re at it.
Even more worrying is the onward march of the ‘doula’, a female birth coach ostensibly employed to offer emotional and practical support but also heard to boast of aiding shorter labours, reducing pain and promoting greater success in breastfeeding. Such practitioners have been around for centuries in primitive cultures, or so goes the hard sell, as if that’s something to cheer. Today’s incarnations are also, in many cases, women on a mission. In spite of having no medical qualifications whatsoever — their ‘training’ amounts to five weekend sessions spread over nine months — one recently hit the headlines with what she regarded as a personal triumph.
Although her mother-to-be client had life-threatening placenta previa, this doula ‘gave her the confidence’ to reject her experienced doctors’ advice to accept a Caesarian, before persuading ‘a reluctant hospital’ to send out midwives — not doctors, obviously — so that the high-risk mother could have her baby at home. It happened that the child lived. So hurrah: doulas douze points, medics nul. But what if…?
And yet, astonishingly, there are plans afoot for government funding for further provision of doulas. Presumably next in line will come the sponsored herbalists: never mind an epidural, duckie; here, suck on this nice sprig of parsley.
It would be nice — well, easy anyway — to attribute this to fiscally mean, misogynist male authorities bludgeoning helpless women. It would not, however, be truthful. For what is really disturbing is that much of the demand that women put up with pain in childbirth is coming from women themselves; indeed, the doctor quoted above as criticising a lack of pain tolerance is as female as the wretched army of doulas.
The resulting sado-masochistic conspiracy is largely a fag end of unreconstructed Seventies feminism. Where women of the Fifties and early Sixties had grabbed gratefully for whatever pain relief had been denied their mothers before them, the newer wave read a couple of books, joined a vociferous collective and called a halt. The reasoning was, roughly, this: doctors, technicians, scientists, researchers and shiny steel instruments were male, the enemy and therefore to be avoided.
Mother Nature — they don’t call ‘her’ Mother for nothing, hah! — along with rites of passage involving breasts, reproduction and attendant pain where the sun don’t shine, were the stuff of women, of the sisterhood and therefore to be embraced.
The tenacity of such philosophy has been as amazing as it has been stupid; it makes no more sense to accept unrelieved pain of the cervix as worthy of praise than similarly extreme pain of hand or foot — any more than it makes sense to accept rebuke for declining to put up with it. Indeed, the improvements since the Seventies in spinal block, epidural anaesthesia and Caesarian section mean that for most Western women and babies the techniques are consolingly safe and for some
actually safer than ‘natural’ alternatives.
If progress for women is to mean anything, it must include a determination to engage with the available technology, take control of it and use it when they please, on their own terms — as free from indecent criticism of cowardice as a wounded soldier would be should he request a veinful of morphine bliss.
Of course it hurts. What do we expect you to do about it? Everything that you can.