The politics of childbirth

In her new book Bumpology, the British science journalist Linda Geddes aims to ‘investigate the truth behind the old wives’ tales, alarming newspaper headlines and government guidelines’ that frame a woman’s pregnancy in the twenty-first century. Though her research led her to question the orthodoxy on drinking alcohol in pregnancy and exclusive breastfeeding, what ‘most alarmed’ this author was the misinformation surrounding pain relief and medical intervention while giving birth. ‘[M]uch of what women are told about the risks of medical interventions during labour – things like induction, epidural anaesthesia and undergoing a c-section – are overblown,’ she wrote in an article. ‘At the same time, statistics about the odds of needing medical assistance or on complications like tearing during a vaginal birth are frequently not talked about.’ (1)

Geddes’ reflections on the scientific and policy literature speak to an interesting turn within the organisation of maternity services in Britain, which took place in the last quarter of the twentieth century. While pregnancy and new motherhood both became increasingly monitored and medicalised, with emphasis placed on the importance of expert intervention and the role of scientific medicine in determining what was ‘best’ for baby, childbirth appeared almost to become ‘de-medicalised’.

Policymakers have emphasised the importance of women’s choice to give birth at home, if they want to, in sharp contrast to the attempt in the 1970s to ensure that all births took place in hospital.  Over the past few decades, British maternity services have also been organised around a model that emphasises that, where possible, women should give birth vaginally, under midwife-led care, and in settings that facilitate this – midwife-led units rather than high-tech hospital obstetric wards. In practice, this means that many women are provided with fairly minimal pain relief in labour, as epidurals have to be provided by anaesthetists; and surgical interventions, such as Caesarean sections, tend to happen in the context of emergencies, rather than as a strategy decided in advance by the woman or her doctors.

Because maternal and neonatal mortality in the twenty-first century is low, the outcomes of this relatively demedicalised approach to childbirth tend to be generally acceptable. In terms of the ‘birth experience’, for every woman who wishes that she had had more pain relief, or a surgical intervention a few hours earlier into her labour, there is another who will state her preference for having less intervention, and giving birth in a less formal setting than a hospital. But Linda Geddes is not alone in voicing her frustration at the way that women’s choice in childbirth tends to be assumed to run in one direction alone – that is, the choice to have less medical intervention, rather than more.

Writing in the Observer newspaper on 10 March, Alice Roberts, pregnant with her second child and ‘in the happy position of being labelled as a “low-risk” mum’, discusses some of the problems with the way that the decision over where (and therefore, how) to have one’s baby are framed. (2) This is partly because ‘evidence about the risks has been hard to come by and difficult to interpret’ – not least due to the happy fact that ‘the overall risks of maternal and neonatal death are now very small (about five per 100,000 women die in childbirth and four per 1,000 babies), so large numbers of mums are needed to assess relative risks’. But, she writes:

‘Another problem is the politics of birth. It can be quite hard for mums-to-be to access impartial evidence and advice when it seems there are plenty of people wanting to influence your decision in one way or the other. Evangelical advocates of home birth often talk about the importance of women’s choice and empowerment, as well as instilling distrust in obstetricians. For me, being empowered to make a decision requires access to good evidence and the freedom to make up my own mind. And whilst “maternal satisfaction” is often put forward as an important factor to be taken into consideration, I want to know what the relative risks are. And if there’s not yet enough evidence to assess that – I want to know that too.’

Roberts’ point speaks to a number of tensions within the debate about childbirth in Britain, which has been running for over a century. These include debates over women’s autonomy and choice versus the safety of the newborn baby; the professional boundary between obstetrics and midwifery, and who should ‘own’ the childbirth process; and the clash between nature and medicine in women’s experiences and expectations of the birth experience. This article gives an overview of the history of the childbirth debate as it has played out in Britain, to indicate the ways in which this issue has always played to a wider set of concerns than simply the safety of the mother and child.

A brief history of childbirth in Britain

In Women’s Bodies: A social history of women’s encounter with health, ill-health, and medicine, the historian Edward Shorter notes that ‘People today have a romanticized and generally false picture of the typical birth in traditional times’, imagining that ‘Nature is left to take her course, and “intervention” is absent’. (3) In fact, the ‘typical mother’ was, at every step, ‘harassed by meddlers and officious interveners’, who ‘felt compelled to take a hand in Nature’s work, except on those occasions when a little “intervention” might have been welcome’.

These folkloric remedies and interventions included ‘[c]onstantly tugging and hauling at the mother’s birth canal, at the infant’s head, and at the placenta’, and sticking hands into the uterus to turn the child, all of which increased the chances of maternal infection and infant death or damage. Before 1800, writes Shorter, about 1.3 per cent of all births ended in the mother’s death; and ‘If we assume that the typical woman who lived to the end of her fertile years gave birth to an average of six children, her lifetime chance of dying in childbirth would be six times 1.3, or 8 per cent’. He estimates the average mother’s ‘lifetime risk’ of contracting a grave puerperal infection at around 25 per cent.

Before Joseph Lister’s discovery of antisepsis in 1867, hospitals were, in anything, more perilous than the home. Indeed, ‘doctors and midwives were equally septic’, and there was no love lost between the two groups: ‘The doctors have damned the midwives as filthy, ill-kempt slovens. The defenders of the midwives have blasted the doctors for bringing to the mother’s bedside germs contracted on the autopsy table’. The fraught professional ‘boundary wars’ between (male) obstetrics and (female) midwifery continued throughout the twentieth century; but as Shorter makes clear, before the causes of infection were understood and dealt with, ‘The problem was the exploring hand, not the gender of the birth attendant’.

Alongside antisepsis, another important change to childbirth in the nineteenth century was the development of obstetric anaesthesia. This is chronicled in Donald Caton’s fascinating history, What A Blessing She Had Chloroform: The medical and social response to the pain of childbirth from 1800 to the present. (4) The book’s title comes from Queen Victoria, herself an early recipient of obstetric anaesthesia – administered by the physician John Snow, who famously discovered the cause of cholera in London’s contaminated drinking water.

According to Caton, ‘the first known administration of anaesthesia for childbirth’ was in 1847, when James Young Simpson ‘administered diethyl ether to facilitate delivery of a child to a woman with a deformed pelvis’. Its use spread widely, in keeping with the spirit of the times:

‘In 1847 all elements of society, including the medical profession, were in the midst of tremendous change. The prevailing mood was buoyant and optimistic, and there was an eagerness to implement new ideas. The incorporation of anaesthesia into obstetric practice represents a fortuitous confluence of the right person, the right place, and the right social climate.’ 

A significant element of this social climate, for Caton, is the transformation in public attitudes towards pain. By this time, he argues, ‘the public was so convinced that obstetric pain was unnecessary, if not dangerous, that the risks of anaesthesia may have appeared trivial’. This shift in opinion was informed, Caton writes, in part by a change in the religious connotations of obstetric pain, away from the idea that ‘God had a punitive nature and man a sinful nature’, and towards the idea that pain could (and should) be studied and controlled by science and medicine.

It was also informed by a wider spirit of optimism, in which ‘the ability of anaesthesia to obliterate pain dramatized the ability of science to overcome the dark forces of nature and improve life on earth’. As Oliver Wendell Holmes, professor of anatomy at Harvard, put it: ‘The agony which seemed inseparable from maternity has been divorced from it, in the face of the ancestral curse resting upon woman-hood. With the first painless birth, induced by an anaesthetic agent, the reign of tradition was over, and humanity was ready to assert all its rights.’

So powerful was this shift in opinion about the rightness of science controlling obstetric pain that there emerged, towards the end of the nineteenth century, something of a divide between physicians and the public, when it became clearer that anaesthesia and analgesia (in the form of morphine) could have an effect upon the fetus. This concern for the fetus was itself a mark of the progress that had been made, as until the nineteenth century ‘the mortality of women in labor had been so high that the survival of the mother had overshadowed almost all other problems, becoming the most important criterion for the success of clinical management.’ However, the growing awareness of the impact on the fetus meant that, as Caton explains, ‘physicians found themselves trying to find common ground between two different perceptions of pain and disease’, and ‘[c]onflicts between medical science and social values became a recurrent theme during most of the twentieth century’.

The early twentieth century

In the early twentieth century, the push for obstetric anaesthesia seems to have been most vocally led by middle-class women, and linked to the feminist movement. These campaigns took the form in the USA of the National Twilight Sleep Association, and in Britain, the National Birthday Trust Fund. Twilight Sleep, a technique modified by two German obstetricians and first used in European hospitals, combined morphine and scopolamine to offer ‘partial pain relief, and amnesia’ to women labour.  The technique was far from perfect – as Caton explains, ‘Choosing the right amount of scopolamine required judgment. Too much was toxic. Too little left “islands of memory” or, worse yet, recall of the entire period of labour.’ There was a gulf between the aggressive promotion of Twilight Sleep by campaigners, and resistance to this method from most physicians.

Caton explains that ‘In articles and editorials alike American physicians were accused of rejecting Twilight Sleep because of its promotion by patients rather than medical colleagues, because of procrastination in learning about the subject, or a callous indifference to women in labor.’ However, material in the lay press promoted a ‘biased view’: ‘No popular articles or books mentioned how patients screamed or thrashed about in pain. None described the blindfolds, earplugs, and restraints that [Carl Guass, who pioneered the technique] used to control his patients.’

In Britain, the campaign for obstetric anaesthesia took the form of the National Birthday Trust Fund (NBTF), founded in 1927 by Lady Cholmondeley and Lady Rhys-Williams to focus on three issues: increasing the availability of health services for poor women; improving nutrition for young children; and relieving the pain of childbirth. According to Caton, the NBTF was a more effective campaign than the Twilight Sleep Association, partly because it aimed to work with physicians around using the safest forms of anaesthesia, rather than lobbying for a particular form of anaesthesia in the face of obstetricians’ objections; and partly because it had a wider remit, attending to preventative, antenatal care as well.

According to Caton, in this regard ‘[t]he medical goals of English feminists fit well with trends in obstetrics’. A prominent figure was Joseph B. DeLee, an American obstetrician who opposed Twilight Sleep but was a strong advocate of the active management of childbirth, and recommended anaesthesia, the use of instruments such as forceps, and surgical procedures such as episiotomy. DeLee acknowledged that his method ‘interferes with much of Nature’s process’, but he:

‘…often wondered whether Nature did not intend women to be used up in the process of reproduction, in a manner analogous to that of the salmon, which dies after spawning… [I]f you believe that a woman after delivery should be as healthy, as well and anatomically perfect as she was before, and that the child should be undamaged, then you will have to agree with me that labor is pathogenic, because experience has proved such ideal results exceedingly rare.’

Caton notes that other obstetricians agreed with this perspective, citing Austin Flint, who asked how a ‘process that kills thousands of women each year, leaves a quarter of cases more or less invalided, is attended by severe pain and tearing of tissues, and kills three to seven percent of all babies, can be called a normal or physiologic function?’

However, despite the influence of arguments in favour of obstetric anaesthesia within obstetrics and among (particularly middle-class) members of the public in the early part of the twentieth century, cultural ideas and medical practices kept on changing. There was some reaction against the kind of aggressive intervention used by DeLee, and also some resistance to the increase in hospitalised births. The decline in maternal mortality led to an increased medical interest in outcomes for the infant, which tended to be used as an argument for the medicalisation of labour, regardless of the wishes of the labouring women.

The rise of the ‘birth experience’

Shorter explains that ‘by 1930 the technical means existed for letting the mother herself control every aspect of the birth process’, from contraception to anaesthesia:
‘Yet “woman-controlled” birth never happened. And the reason is that in the 1930s the doctors shifted their own concern from keeping the mother alive and undamaged to producing a healthy baby… Doctors increased their own interventions because they started to realize that the “natural” process of birth often produces a damaged infant.’

In Shorter’s account, the denial of autonomy to women in labour has come full circle, from traditional times when, apart from the interventions of meddlesome midwives, ‘it is meaningless to talk of autonomy at all when a woman is vulnerable to the randomness of infection and obstructed labour, and to an unending stream of unwanted pregnancies’, to the medicalised childbirth practices of the late twentieth century, where ‘[e]very stage in delivery would be minutely regulated by protocols and medical conventions.

‘Yet what a difference!’ he exclaims. ‘In return for surrendering their autonomy, women today receive pink, brisk babies. Nobody dies. And the “birth experience” is valued as a basic part of womanhood.’

Many women today make precisely this pragmatic trade-off between their autonomy in childbirth, against their safety and that of their baby. Submitting to a hospital birth gives a woman access to pain relief and to interventions should something go wrong, while any attraction a home birth might hold is compromised by the knowledge of the additional risk. However, despite this reality, there is still an influential cultural ideal of ‘natural’ childbirth which affects, if not how women have their babies, how they think about having them.

The attraction of ‘natural childbirth’ to women in the twenty-first century is the result of a number of factors. Partly, it comes from the distance that now exists between our world and that in which mothers and babies routinely died or suffered damage in childbirth; in modern times, where ‘nobody dies’, it is easier to romanticise nature and to see medical interventions as unpleasant and unnecessary.

Partly, the suspicion of medical intervention and hospital births comes from the crisis of obstetric care experienced in the 1970s, when a flurry of claims around the over-intervention of doctors and surgical techniques led to a backlash against hospital births and a desire by some women’s campaigns to regain control over the birth experience. And partly, the attraction of ‘natural birth’ is the result of an influential lobby group, which began in the UK in the 1950s and became successfully integrated into mainstream maternity care.

The birth of the natural childbirth movement

The National Childbirth Trust (NCT) was founded by Prunella Briance in 1956, originally with the name ‘Natural Childbirth Association’. According to one account, Briance attributed the loss of her baby to technological intervention, and founded the organisation ‘to promote the use of gentler methods in childbirth’. (5) She was greatly influenced by the work of the English general practitioner Grantly Dick-Read, who, as Ornella Moscucci explains, has been called the ‘spiritual father of natural childbirth’. (6) Moscucci writes:

‘Dick Read was a social reformer with a strong interest in preventive medicine. He was also a profoundly religious man, fired by an evangelical faith in the spiritual significance of motherhood. Dick-Read believed that childbirth revealed God’s presence in the universe: it was the task of science to render it explicit, by showing the laws of nature that governed the processes of birth. Dick-Read accordingly rejected materialistic and mechanistic interpretations of pregnancy and birth. In their place he developed a theory of childbirth that sought to integrate body and mind, individual and culture.’

Caton explains that Dick Read was a strong believer in the primal force of ‘motherlove’, the ‘inevitable product of a natural birth’. He described his work as a ‘mission’, and lauded the ‘primitive’ woman over her modern counterpart, who ‘is rarely called upon to use her natural instincts… alas, reproduction does not move with civilisation and parturition is almost invariably the first primitive, fundamental physical act which she is called upon to perform’. (7) One of the factors that increased the influence of Grantly Dick Reed was the 1956 encyclical on the moral and spiritual values of natural childbirth, issued by Pope Pius XII.

As with the early proponents of obstetric anaesthesia, the desire that women learn to experience the pleasure and fulfilment of a ‘natural’ childbirth was, according to Moscucci, linked to a eugenic desire to ‘encourage reproduction among “good stock”’ – in other words, to motivate more middle-class women to have babies. However, as Caton explains, ‘One key difference between Read and the [National Birthday Trust Fund] was in their concepts of the ideal role of women. The fund held that women should ultimately be free to participate in all aspects of public life. Read, on the other hand, wanted women to stay ay home caring for their children.’ Moscucci backs up this point by noting that for the reform eugenics movement, with which the natural childbirth movement was associated, ‘Female education and employment were seen as a particular evil, insofar as they led women to regard motherhood as a burden and to neglect hearth and home’.

For the main proponents of the natural birth cause, if (middle-class) women could be encouraged to embrace labour pain and work with it, they would be better placed mentally to see their role as mothers as centrally important to their lives, and better disposed to having children. Conversely, it was thought that if women saw labour as something to be feared and controlled by doctors, they would be more disposed to seeing all of the privatised tasks of motherhood as things to be outsourced so that they could gain satisfaction from their role in public life.

As Caton goes on to note, ‘It is ironic that natural childbirth, a process embraced by feminists later in the century, was initiated by a man who held very conventional ideas about the role of women as homemakers.’ The translation of the natural birth movement into a feminist cause in the 1970s was indeed remarkable, given its essentialist roots, and early feminists’ championing of obstetric anaesthesia as a way of freeing women both from the agony of labour pain and the notion that a woman’s only place should be in the home. How did this shift take place?

The Great Childbirth Debate of the 1970s

Moscucci cautions that ‘it is necessary to resist any attempt to regard natural childbirth as a universal, value-free category and look at the intellectual and political context in which it was embedded’. She explains:

‘[N]atural childbirth has served as a form of cultural and political critique aimed at various crises of modern Western society, from industrialism, capitalism and materialism, to urbanisation and mass culture. The solution to these evils has been seen to lie in a return to “nature”, variously defined as the country, the primitive, the spiritual, and the instinctual. “Nature” has also been associated with putatively female values such as love, cooperation and altruism, in opposition to the destructive qualities traditionally invested in the male.’

To put it another way: when feminists in the 1970s took up the cause of women’s autonomy and control in childbirth, it was not because this generation somehow relished pain, or wanted to put their babies’ health at risk. Rather, the ideal of the natural chimed with other themes of the counter-culture, which sought harmony with the natural environment and distrusted modern industrial society for being soulless and toxic. For example, Caton notes the significance of Rachel Carson’s 1966 book Silent Spring, which exposed the impact of pesticides upon wildlife, as fuelling the concern over environmental toxins and influencing the notion that, in childbirth as in other areas of human life, ‘natural’ was healthier.

Furthermore, the idea of a ‘natural’ childbirth, assisted by (female) midwives or doulas rather than (male) obstetricians, chimed with the emergence of radical feminism, which saw patriarchal domination as the root of society’s problems, and viewed obstetricians’ control over labour as a key symbol of this, with the labouring woman often forced to lie prone with her feet in stirrups, every aspect of her labour controlled by drugs or interventions, and being reduced to a passive vessel who was merely told what to do.

In this regard, the push for autonomy in labour was seen to symbolise the wider campaign for women’s control over their bodies and experiences, against the ‘men in white coats’; and the notion of ‘natural childbirth’ sought to re-pose birth as a normal part of women’s experience, rather than a pathological, medical crisis that needed external management.

These underlying cultural currents came to the fore in the mid-1970, when concerns about the over-medicalisation of labour began to be raised in the wider media and, crucially, within the medical profession itself. The Peel Report of 1970 stated that 100 per cent of births should take place within hospital, justified on the grounds of ‘greater safety’ for the mother and child. This provided a spur to those consumer groups – primarily the NCT and the Association for Improvements in Maternity Services (AIMS) – to argue the case for women being able to choose home birth.

Most attention at this time was paid to women’s choice, and the quality of her experience. What was seen as the degrading, controlling aspects of hospital births, including the shaving of the vulva, the exclusion of the father from the labour process, and the requirement that women stay in hospital for several days after the birth, even if there were no complications, were highlighted.

In the mid-1970s, however, the safety and desirability of obstetric practices themselves came under the spotlight. An article published by the Lancet medical journal in 1974, followed by a high-profile episode of the BBC2 documentary Horizon in 1975, put the spotlight upon the practice of induction of labour, both titled ‘A Time to be Born’. (8) The central thrust of the argument was that induction was being routinely used, not because of clinical indications, but to fit labouring women into a schedule more convenient for hospital staff. This led to uproar about the arrogance of doctors controlling women in this way, and some concern about the safety of rapid, induced labours for the baby. As the British Medical Journal argued in 1976, the upshot was ‘an acute state of public anxiety that is still echoing’. (9)

In 1977, a controversy erupted over home birth, around the case of Miranda Ward. When Ward told her doctor she wanted to have her baby at home, the doctor said that he could not accept responsibility for her care and sought to have her name removed from the list. Following a protracted battle between Ward and various health professions, she prevailed and safely gave birth to a baby girl. Writing at the time, the journalist Clare Rayner summarised the impact of the case:

‘The story, which hit the headlines, had a profound effect of many women. Many mothers over the past years have complained that having a baby in hospital means being treated as a “case” rather than as a person, and being exposed to a great barrage of treatments that they don’t understand and even find frightening. 

‘Mrs Ward’s story fed their fears and stiffened the resolve of many of them who vowed that they, too, would insist on their right to have their baby where and how they chose.’ (10)

Over the following few years, further controversies would be raised surrounding hospital practices, including episiotomies, the use of forceps, and pain relief. In the 1980s, the rise in C-sections came to the fore as a major issue, when the obstetrician Wendy Savage was accused of incompetence for refusing to perform what she considered to be unnecessary C-sections on women who did not want them. She was cleared by a high-profile inquiry, and has since been hailed as a champion of women’s autonomy in birth.

The upshot of the debates in the mid-1970s was that hospital birth was not only seen as undesirable for some women, but as potentially damaging or unsafe. This marked a crucial development in the campaign for ‘natural birth’, which was now framed not only as a question of women’s choice and autonomy, but as an equivalent option to a hospital birth. Health policymakers, put on the defensive by the barrage of complaints about obstetric care and motivated by additional considerations, would build on this notion of equivalence to develop the maternity services that we have today.

‘Natural’ birth in hospital – the uneasy compromise

The current organisation of maternity services in Britain can be seen as a compromise. The vast majority (98%) of births take place in a hospital or midwife-led birthing unit, but women have the option to choose a home birth if clinical indications allow it; medicalised interventions are routinely used, but elective C-sections and epidurals are often discouraged in practice. The pendulum continues to swing; while the New Labour government encouraged a move in the direction of home birth and midwife-led birthing centres, the Royal College of Obstetricians and Gynaecologists has recently proposed a greater centralisation of services, creating ‘super-units’ where women in labour will have access to round-the-clock specialist care. (11)

When set against the backdrop of the pitched battles of the 1970s, the fact that today’s maternity service positively encourages women in the direction of a ‘natural’ birth could be considered a capitulation of professional self-interest, and a victory for women’s autonomy. However, the ideas around ‘natural childbirth’ that were influential in bringing about this situation have also contributed to new restrictions on women’s choices during birth and afterwards, and in many ways arguably compromise care.

For example, under the previous government, home birth was seen as something that should be positively encouraged; alongside a strategy that sought to ‘demedicalise’ childbirth in general. This resulted in the growth of a number of midwife-led units in place of obstetric wards, and official guidance on promoting vaginal births over C-sections. The language used to discuss these changes was self-consciously woman-centred, drawing on the ideas of the natural birth movement to propose a birth experience that would be more pleasant for women. But another dynamic has been the desire to reduce costs. When it was reported in 2003 that ‘MPs have called for a crack-down on the number of women having Caesarean births on the NHS’, the article noted that a C-section ‘costs the NHS in the region of £760 more than a natural birth’. (12) Research in 2012 hasargued that ‘home births are around £300 cheaper to provide than hospital deliveries for women at low risk of complications’. (13)

Similarly, the idea that a woman’s autonomy is best served through the promotion of home birth speaks not to the idea that choice and control in birth is a good thing, but that a particular kind of birth experience is preferable. This is highlighted by the way in which women wishing to ‘choose’ medical intervention – or even pain relief – in labour tend to be denied that choice. A ‘normal’ birth is often discussed as one that takes place without an epidural, as though there is something ‘abnormal’ about the need for pain relief in labour. The widespread suspicion that exists of the ‘unnatural’ epidural already means that women can have a battle on their hands when trying to get one administered in hospital, finding themselves discouraged and delayed until it is considered ‘too late’ to administer the anaesthetic.

This development, which could be seen as the opposite to woman-centred, shows the extent to which the ideas about the superiority of natural childbirth have been brought into the mainstream.

Midwife-led care is now the norm in Britain for women with uncomplicated pregnancies, and for many reasons this is a very good thing. Midwives have an experience and a developed intuition around pregnancy and birth that many women value. However, when it comes to labour, the inability of midwives to provide epidurals and surgery means that there can be an implicit bias in the recommendations offered to expectant mothers about where they should have their baby. Put bluntly, just because a birth is uncomplicated does not make it painless. When women are advised on the safety of ‘natural’ births, the question of how much they hurt is often glossed over.

The National Childbirth Trust now plays a semi-official role in maternity services, through running antenatal and postnatal groups, which skew the advice and support given to expectant and new mothers in the direction of a ‘natural’ approach. Thus expectant mothers can find themselves encountering both an ideological suspicion of anaesthetics to numb childbirth pain, and a pragmatic pressure – borne out of resource constraints – to have their babies, where possible, in birthing units where they may find themselves lacking in access to adequate pain relief and surgical intervention when things go wrong.

Supporting women’s choice in childbirth means untangling the various political dynamics that inform the way information is provided, and maternity services are organised. It also means recognising that the ‘birth experience’, so important to campaigners for natural birth, is not perceived as a central priority by all new mothers: many of whom simply want to have their baby as safely and painlessly as possible. As Alice Roberts writes, in conclusion to her Observer article:

‘Women should be empowered to make choices, but need evidence to be able to do that, not spin. Having made our choices, we need to bear in mind the unpredictability of birth and our response to it. No one should feel that having an epidural, a forceps delivery or a caesarean section is a failure. When you’ve given birth, however and wherever you’ve done it, and you end up holding a healthy baby – that’s the best outcome in the world.’

First published by bpas Reproductive Review, 2 April 2013


1) Pregnancy advice “scaremongering”, by Linda Geddes. BBC News Online, 3 January 2013
2) Childbirth: why I take the scientific approach to having a baby, by Alice Roberts. Observer, Sunday 10 March 2013
3) Shorter, Edward. Women’s Bodies: A social history of women’s encounter with health, ill-health, and medicine. New Brunswick and London: Transaction Publishers, 1991. [Originally published in 1982 by Basic Books, Inc, as A history of women’s bodies].
4) Caton, Donald. What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present. New Haven and London: Yale University Press, 1999
5) Allsop, Judith; Jones, Kathryn; Baggott, Rob. ‘Health consumer groups in the UK: a new social movement?’Sociology of Health and Illness, Vol 26, No 6, 2004: 737-756
6) Moscucci, Ornella. ‘Holistic obstetrics: the origins of “natural childbirth” in Britain.’ Postgraduate Medical Journal 2003: 79: 168-173.
7) Cited in Caton, p95.
8) Lancet. ‘A time to be born’. The Lancet, November 16, 1974 pp1183-4
9) British Medical Journal. ‘Induction of labour’. British Medical Journal, 27 March 1976, pp729-30
10) Rayner, Clare. ‘What are they doing to our bodies?’ Woman’s Own, circa 1978.
11) Maternity units must be closed to make childbirth safer, report says. Daily Telegraph, 20 September 2012
12) Caesarean crack-down urged: MPs have called for a crack-down on the number of women having Caesarean births on the NHS. BBC News Online, 18 June 2003
13) Home births are cheaper than hospital for the NHS: research. Daily Telegraph, 20 April 2012

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