Editor's Blog

Five centuries of debate about natural birth

I attended an interesting conference last week, entitled ‘500 Years of Pregnancy and Birth’. While the history of parturition is clearly somewhat longer than this(!) the starting point for the conference was the 1513 textbook on midwifery, written by the German physician, Eucharius Rosslin, translated into English under the charming, if slightly puzzling, title of ‘A Rose Garden for Pregnant Women and Midwives’.

The conference was accompanied by a wonderful poster display (which can be seen at the Royal College of Obstetricians and Gynaeologists until November). A central exhibit was a caricature published in 1793 of ‘a newly discovered animal’, the ‘man midwife’, reflecting the increased prominence in the 18th century of male surgeons specialising in childbirth, a development strongly opposed by midwives of the time.

The caricature shows a single person divided in half; one half of the person is a man holding an obstetric instrument and depicted against a background of shelves holding more instruments and medicines. The other half of the person is a woman wearing simple clothes as opposed to the highly fashionable outfit worn by the surgeon, and depicted against a background of water being heated on a stove, and a welcoming fire to keep the mother and baby warm.

Thus the debate around natural versus assisted birth, and the relative merits of the skills of the midwife and the surgeon, started four centuries ago.

I encountered the debate in a contemporary form a couple of weeks ago when I was discussing a new parent education programme with a group of health and social care practitioners. We were designing an exciting new universal programme for families to support them from pregnancy through to the early postnatal period, and our deliberations had reached the point at which we were deciding what to include in our session on giving birth. Some of the practitioners felt strongly that normal birth needed all the support it could get and that we should make it central to the session, so that women and their birth partners saw normality as indeed, the norm. Other practitioners felt that normal birth in the 21st century included women’s prerogative to have strong painkilling medication and invasive procedures such as epidurals, and that the facts about these should definitely be included in the birth session.

In the end, we decided to focus on helping women understand how to work with their bodies to assist the progress of labour and the baby’s birth, and include topics around medical forms of pain relief and assisted birth only if the group requested them. I’m sure that most groups will request these topics so our decision probably won’t mean that our new programme is exclusively about normal birth.

The five centuries long debate about the medicalisation of pregnancy and birth doesn’t seem about to go away. It is vital that debate should be ongoing and vigorous because the lure of techno-birth jeopardises the ancient skills of the sensitive observant practitioner, the skills of conducting deliveries ‘without using any hooks or other instrument, except only the hand’ (Cosme Viardel, surgeon to the French Queen, 1671).



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