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Thursday 14 April 2022

Childbirth, chronology and contributory causes

 An article in today's Guardian on recent shocking scandals over childbirth mentions the important influence of Grantly Dick Read on the rise of the concept of 'natural childbirth.

I would point out that while Glaser suggests that Dick Read drew on exoticised notions of the 'primitive' - although he later invoked very dubious ideas about 'African women' and how easily they gave birth (we think that organisations which have been working for decades on maternal health issues in various African countries such as vesico-vaginal fissure would be sceptical) - his initial legendary awakening that 'childbirth does not need to mean pain' actually occurred when he was a young medical student at the London Hospital, 'on the district' in Whitechapel, before the First World War. One night he was called out to a small, damp, and poorly lit room where he delivered a woman of her first child.She refused chloroform, and said after the child was born, ''It didn't hurt. It wasn't meant to, was it Doctor?'". Dick Read's 'African Safari' took place much later in his career, 1953-4, after his period of practice in South Africa, 1948-53.

It was not until 1933 that he published his first work on the subject, Natural Childbirth. His teaching that women who knew what to expect when they went into labour, and who had been taught to relax, and thus did not not become tense and fearful, would be able to have a delivery without problems, did not, at that point, gain a great deal of traction. 

This was not perhaps surprising at a date when a successful labour was one which ended with mother and child both alive, while rates of maternal and infant mortality were still high enough to be matters of public concern. But when he published the updated and revised Revelation of Childbirth (1942)/ Childbirth without Fear (1944 in the USA) the advent of antibiotics - first sulphanomides in the mid-1930s, and then penicillin - had made a dramatic difference*, as had significant developments in blood transfusion technology. Thus basic survival was no longer the first concern, and the quality of the experience was available for consideration.

Also in the mix in the 1940s were the conditions under which women were giving birth: from the copious correspondence Dick Read began to receive - now preserved in the Wellcome Library, some it of published in Mary Thomas, Post-war mothers: childbirth letters to Grantly Dick-Read (1997) - these were far from optimum. Women wrote of being left alone in pain and fear, not knowing what was happening to them for hours: this must have been presumably at least partly due to pressure on resources under wartime/post-war/setting up of the NHS conditions. The concept of knowing what to expect, of having a strategy - breathing through the various stages - and a partner during birth was therefore very attractive.

One might also suggest that due to the discovery of the aetiology of rickets and the role of Vitamin D and sunlight, by the 1940s fewer women were likely to have pelvic deformities affecting labour from that cause.

It was, for its time, a revelation, but perhaps his theories should not have been taken up quite so much as a Universal Gospel.

(I am also given to raising my eyebrows when people describe 'natural childbirth' as being the offspring of 'second-wave feminism'. Dick Read was very far from being a feminist, what with the invocation of the simple primitive woman as the one who had not been corrupted by civilisation/education/listening to other women's horror stories into fear of childbirth, and the notion that, freed from that fear, women would be popping out babies liked whoah.)

*This had a similar impact on other attitudes: would Bowlby and Robertson's work on the need for parents to be with their childen in hospital been so acceptable at an earlier period, when the containment of infection was the prime concern?