Rethinking Childbearing - Part 2

"Natural" childbirth came into fashion in the 1970s with the practice of husbands or other support persons being present during the labor and birth of their children while assuming the role of labor coach and companion for the birthing mother. Many heralded this as a great advance, and hospitals began to provide nicely decorated birthing rooms so that women could labor and deliver their babies in an atmosphere much closer to a bedroom than a hospital room. Previous hospital practice had involved a woman being moved to a delivery room once she had dilated fully, so this was a big change. The hope was that women would regain the capacity to deliver babies without unnecessary interventions, as they were deemed to be detrimental to both mother and baby. The idea was to let nature take its course.

One would expect that this change would have established "natural childbirth" as the norm, rather than the exception; allowing a woman to have someone of her choosing present was supposed to be a sure way to relax and comfort her. However, there has been an increase in the number of women requesting non-emergency medical interventions during the process of laboring, resulting in an increase in the use of electronic fetal monitoring (to note the vital signs of the baby in utero), epidurals (spinal medication used to numb the woman from the waist down), Pitocin (a synthetic form of the hormone oxytocin to speed up the first stage of labor), rupturing of membranes (in cases where the amniotic sac has not done so spontaneously), episiotomies (a surgical cut to expand the opening from which the baby passes), and cesarean sections (major surgery to deliver a baby in place of vaginal delivery).

The first issue that needs to be addressed is why these interventions are best avoided. If in the end it doesn't matter how a baby is born, just that it is born, why make this a concern at all?

Simply put, these interventions have consequences for the long-term relationship between mother and child. Because today there is an unrealistic expectation on the part of parents and medical personnel as to how long labor should take, especially a first labor, the many "helps" that are available from the hospital "pain reduction" menu often are the very factors that lead to eventual C-sections.

Michel Odent, a French obstetrician, gets to the heart of the matter when he says,

Oxytocin is the hormone of love, and to give birth without releasing this complex cocktail of love chemicals disturbs the first contact between the mother and the baby. The hormone is produced during sex and breastfeeding, as well as birth, but in the moments after birth, a woman's oxytocin level is the highest it will ever be in her life, and this peak is vital. It is this hormone flood that enables a woman to fall in love with her newborn and forget the pain of birth.
What we can say for sure is that when a woman gives birth with a pre-labour Caesarean section she does not release this flow of love hormones, so she is a different woman than if she had given birth naturally and the first contact between mother and baby is different.¹

As it turned out, the push for natural childbirth didn't materialize into a significant change. The woman still was placed in a bed on her back with feet in stirrups, a very unnatural position for giving birth. That in itself intensifies the pain and lengthens the labor. Given these "accepted practices," over time women resorted to the pain meds that were readily offered as the only way to endure.²

Add to that the artificial time schedule assigned to "normal" labor that made it so birth had to occur at the convenience of the hospital staff, who would have a tendency to rush things along if a shift change were approaching, or to accommodate a doctor's schedule, or should there be a need for the hospital bed.

So, what happened to the natural part of childbirth? What does the term even mean?

Natural Childbirth

Obstetrician Grantly Dick-Read is credited with coining the term "natural childbirth," which he used in his books Natural Childbirth (1933) and Childbirth Without Fear (1944). His philosophy centers on the idea that women are innately able to give birth to children, without external intervention. He took a stand against the pathological model modern medicine had adopted, and he feared practitioners were rapidly forgetting what a normal birth even looked like.

One of the most important factors in the production of complicated labour and therefore of maternal and infantile morbidity, is the inability of obstetricians and midwives to stand by and allow the natural and uninterrupted course of labour. It may be an excess of zeal, or anxiety born of ignorance, but it is an unquestionable fact that interference is still one of the greatest dangers with which both mother and child have to contend.³

Dick-Read was addressing what Dr. Jo Loomis outlined in a recent FFAOL article⁴-the shift that had occurred in the practice of childbearing in the West in the early part of the twentieth century. The routine practice of homebirth attended by a midwife had given way to obstetricians (surgeons) and nurses overseeing the birthing process in hospital settings.

Had adopting the hospital model caused women to lose their innate instincts of how to give birth? Had the shift in thinking produced a generation of women who wanted "natural childbirth" but found it difficult to proceed because their own perspective (as well as the hospital's perspective) of "natural childbirth" lacked a full understanding of the process? Was it inevitable that the trend toward natural childbirth would give way to the practice of unnecessary medical interventions?

Dick-Read sized up the situation back in the 30s and 40s:

Woman ... is adapted primarily for the perfection of womanhood which is, according to the law of Nature, reproduction. All that is most beautiful in her life is associated with the emotions leading up to this ultimate function. But unfortunately in the final perfection of these joys a large majority remember only the pain and anguish and even terror that they were called upon to endure at the birth of their first child. That is indeed a paradox. For generations, childbirth has been accepted as a dangerous and painful experience.⁵

He noted that medicine had placed too much focus in the direction of pharmaceutical relief, and not enough emphasis on adequately preparing women for the birthing process.

Obstetric teaching has made great advances in the use of drugs, analgesics and anaesthetics, but little has been done to investigate the problem of pain from the point of view of its preclusion ... Anything that disturbs the confidence and peacefulness of the mother disrupts the neuromuscular harmony of her labour ... In childbirth, fear and the anticipation of pain give rise to natural protective tensions in the body.
Unfortunately, the natural muscular tension produced by fear also influences the muscles that close the womb and thus delay the progress of the labour and create pain ... The safest and most effective way to minimise the discomforts of childbirth is to enable a woman, by preparation for, and understanding attention at labour to have her baby naturally ... Education and antenatal instruction are important factors in the relief of pain in childbirth.⁶

A Systematic Theology of Childbirth

In Part 1 of this essay, I explored what the Bible has to say about labor, pointing out that the travail of childbirth is an important component for women becoming committed to the task of motherhood. Jesus's analogy to His apostles concerning their future sadness at His death being turned to joy at His resurrection drew comparisons to the process of labor and delivery, with the apparent implication that this travail was not something to be avoided (John 16:21) but rather one that would actually result in an exuberant outcome.⁷

Dick-Read made the observation based on his experience:

It is my custom to lift up the crying child even before the cord is cut so that the mother may see ... the reality of her dreams ... the first to grasp the small fingers and touch gingerly the soft skin of the infant's cheek ... Its first cry remains an indelible memory on the mind of a mother ... No mother and no child should be denied that great mystical association ... it lays a foundation of unity of both body and spirit upon which the whole edifice of mother love stands. Many times I have called attention to the wonderful picture of pure ecstasy that we see at a natural birth ... Is it just an accident that the brilliant sunlight of motherhood breaks through and dispels for all time the clouds of her labour? No change in human emotions is more dramatic ... Such an aura of beauty has filled the whole atmosphere of the room and such superhuman loveliness has swept over the features of the girl whose baby is crying in her hands ... I have experienced a sense of happiness myself much more akin to reverence and awe than to the simple satisfaction of just another natural birth.⁸

On its face, then, John 16:21 seems quite compatible with this firsthand observation by an experienced practitioner. In that light, it would seem to follow that to achieve the God-intended bond between mother and child, the first prerequisite to a "good labor" is for the mother to be spiritually prepared and bolstered for what lies ahead.

There are numerous Bible passages that speak to the reality that bringing a child into the world is not without intense emotion and physical discomfort (Rev. 12:2; Isa. 13:8, 21:3, 37:3). Given the concomitant realities-intense physical, often painful, exertion followed by equally intense emotional exuberance-women are well advised to look to additional passages of Scripture that, while not expressly written to a woman in labor, have a fitting general application to her estate as she moves through the normal stages of labor that culminate in the delivery of her child.

Come to Me, all you who labor and are heavy laden, and I will give you rest. Take My yoke upon you, and learn from Me, for I am gentle and lowly in heart, and you will find rest for your souls. For My yoke is easy and My burden is light. (Matt. 11:28-30 NKJV)
Yea, though I walk through the valley of the shadow of death, I will fear no evil; for You are with me; Your rod and Your staff, they comfort me (Ps. 23:4 NKJV)
Cast your burden on the LORD, and He shall sustain you; He shall never permit the righteous to be moved. (Ps. 55:22 NKJV)

As with every area of life and thought, approaching childbirth with the most Biblical mindset we can muster will surely maximize the blessings God intends for His people.

The Husband's Dilemma

Dick-Read, in positing a better way to approach the process of childbearing and birth, noted,

I never left any woman alone during labour, a prey to the destructive forces of uncontrolled imagination. If I could not be there myself from the start, I made sure that someone was with her-her husband, mother, or sister, to whom I had already given a little instruction on what to expect.⁹

So, the resurgence of natural childbirth practices proved correct in attempting to create a safe, secure environment for the birthing woman, but some unexpected results came about with the introduction of the husband into the process.

Partly due to the breakdown of the trustee family, many couples in the 70s and 80s were living within the atomistic framework of family life. Women who wanted their mothers or other mother-like figures present were few and far between, and the hospital nurse, often a new acquaintance, was the major support a woman received. That left the husband to fulfill a role that over the centuries usually fell to doulas and midwives, women with the position and experience to bolster a woman through successful labor and delivery. Most men would readily admit that they are at a deficit when it comes to achieving an authentic understanding of all the changes that begin for a woman at the outset of pregnancy all the way to delivery. The calm that is needed is one that is not a natural response to seeing the woman they love in such apparent pain.

Michel Odent, an obstetrician with thousands of births to his credit, points out that the last thing a woman in labor needs is adrenaline-her own or that of her support person. Adrenaline is a combatant to oxytocin, the hormone that is at play to encourage contractions and bring about a narcotic type relief between them. According to Odent, often the husband, inadvertently, produces such an adrenaline response that he lengthens her labor considerably.¹⁰

Peter Dunn, in his paper for the National Institutes of Health, summarizes Dick-Read's observations after Dick-Read had spent a considerable amount of time traveling throughout Africa in 1948. Through his travels, he discovered that childbirth was not a forgotten skill among the women he encountered.

[Dick-Read] found that well over 90 per cent of women in the tribes he visited had normal, natural births and needed no more convalescence than a few hours' rest. He noted how they automatically adopted an upright position which made passage through the birth canal both safer and easier for the child. He observed that in most tribes the mother was well instructed in the course of labour by old women in whom she had complete confidence and that she was never left alone when in labour. It was particularly interesting to him to see at first hand the profound respect that every tribe had for the afterbirth and the manner of its delivery. Again, any interference with the work of nature was banned. A child was never separated from the placenta until that structure had been delivered. Only then might the cord be cut and the offspring delivered into its mother's embrace.¹¹

The Ultimate Athletic Event

Consider the woman who is pregnant with her first child. It is an understatement to say everything is new for her. Contrast her with a woman who is pregnant for a second or third time. This woman's body has already undergone delivery; she has a greater sense of the marathon before her, and has previously experienced the joy of holding, nursing, and loving the child she labored over.

Since every woman's birthing experience will be unique to her, physical, mental, and spiritual preparation is of vital importance, especially if she has to combat the images she's seen in film and television depictions of screaming, out-of-control women.¹² Having a mentor, an experienced doula, or midwife helping her maneuver her way through this strenuous, athletic process enables her to remain focused on the task at hand, not getting too far ahead of herself and taking each contraction as it comes, without a pre-determined agenda for how long her labor should take.

Dick-Read, in the preface to the fourth edition (1959) of Childbirth Without Fear, speaks to the importance of approaching the birth of a baby with reverence and respect.

[C]hildbirth is fundamentally a spiritual as well as physical achievement and throughout this book it must be read and understood that the birth of a child is the ultimate perfection of human love. In the Christian ethic we teach that God is love in which the blessing of sexual necessity and pleasure is but an essential part. Obstetrics must be approached as a science demanding the most profound respect. It must maintain the poise and dignity of those whose estimate of values finds a place for all types and variations of women. It demands cheerfulness without frivolity and sacrifice without reward, for of itself no guerdon could be greater than the gratitude of those whom we are privileged to serve.
I am persuaded from long years of experience amongst women of many nationalities that good midwifery is essential for the true happiness of motherhood-that good midwifery is the birth of a baby in a manner nearest to the natural law and design-and good midwifery, next to wise and healthy pregnancy, sets the pattern of the newborn infant and its relationship to its mother.
For this sequence a sound and stable philosophy is a basic necessity. Materialism and atheism are not included in the make-up of motherhood. Neither can a robot lead a blind man across the road.¹³

Conclusion

Michel Odent, a strong proponent of gentle birth, points out the irony that if non-emergency medical interventions were to stop altogether, many women and children today would be put at risk-not because C-sections and other standard medical practices are good for mother or baby in the long term, but rather because women have lost their innate capacity to travail through the normal birthing process and need to learn how to regain that skill.¹⁴

Why have Western women seemingly lost the ability to proceed through labor and delivery without medical interventions when women from less medically advanced cultures seem to glide through the process? Could it be that with the humanistic thrust that has dominated the West, with science determining there is no longer any need for God and His Word, that women have become convinced that their bodies are incapable of doing precisely that task God has designed them to do? From a Biblical point of view, childbirth cannot as a rule be seen as a pathology that demands massive intervention, but rather as a God-ordained process through which the command to be fruitful and multiply is to be fulfilled.

When people put their trust in materialistic philosophies in opposition to the triune God and fail to acknowledge the supremacy of Scripture over every activity and segment of life, the results are sure to be detrimental. R. J. Rushdoony hits the nail on the head when he notes,

The growth of non-Christian materialism had led to false and rather mechanical views of medicine. If our car needs oil or gas, we add these things to the car; if we need a new fuel pump, we replace the old one. In like manner, some people expect cure-all dosages and changes and are resentful when the doctor cannot work miracles. Their expectation, however mechanical, is still religious, but it is in essence paganism, not Biblical faith.
This, of course, is the heart of the matter. There must be a return to a Biblical view of medicine as a calling, and as a priestly-pastoral calling, but there must also be a return to Christian faith on the part of the people, or false and unreasonable demands will be made of medicine.¹⁵

1. Quoted in Emily Cook, "Women who have Caesarean's ‘less likely to bond,'" Mail Online, July 13, 2006, http://www.dailymail.co.uk/health/article-395218/Women-Caesareans-likely-bond.html#ixzz1Oi15Fyh6. Dr. Odent was speaking at a conference sponsored by an educational charity promoting a holistic approach to pregnancy, birth, and babyhood.

2. To be sure, there are other factors that contributed to this and will be discussed in future installments.

3. Peter Dunn, "Perinatal Lessons from the Past," Archives of Disease in Childhood 1994; 71: F145-F146, accessed via http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1061103/pdf/archdischfn00037-0073.pdf.

4. Dr. Jo Loomis, "Important Considerations for Expectant Parents," Faith for All of Life, May/June 2011. 

5. Dunn, "Perinatal Lessons."

6. Ibid.

7. This is in no way to posit that childbirth must be excruciatingly painful in order for it to be handled in a scriptural fashion, given the limited weight we can attach to any arguments drawn from an analogy. See Andrea Schwartz, "Rethinking Childbearing - Part 1," Faith for All of Life, May/June 2011.

8. Dunn, "Perinatal Lessons."

9. Ibid.

10. The subject of the husband's role will be given further attention in a future essay on this topic.

11. Dunn, "Perinatal Lessons."

12. A recent Lifetime Channel series called "One Born Every Minute" gave such a lopsided view of labor, to the point that in their opening trailer, woman after woman is shown screaming and groaning. Repeatedly, nurses offered epidurals the way waitresses offer water to restaurant customers. It was expected that women would want and need one.

13. Grantly Dick-Read, Childbirth Without Fear, Appendix: Preface to the Fourth Edition (1959), 568-577.

14. "Michel Odent - on gentle birth [parts 1-3]," YouTube videos, from an interview by OWL productions, uploaded by elmerpostleowl, November 3, 2007, Michel Oden on Gentle Birth Part 1, Michel Oden on Gentle Birth Part 2, Michel Oden on Birth Part 3.

15. R. J. Rushdoony, "Chalcedon Medical Report No. 1: The Medical Profession as a Priestly Calling," Roots of Reconstruction (Vallecito, CA: Ross House Books, 1991), 459-460.