Push Back

Eliane Glaser

• Publisher: Fourth Estate
• Year: 2021
• Print ISBN: 9780008311889
• eBook ISBN: 9780008311896
• Topic: Social Sciences
• Subtopic: Feminism & Feminist Theory
• Index: Social Sciences

‘I love my children. They fill me with joy. But I felt guilty when I rebelliously ate runny cheese while pregnant, I felt guilty when I had an epidural for my first baby, and I frequently feel guilty when I sneak off to check my emails while my children are at home.’

We might like to think that in these liberated, self-expressive times, no topic is out of bounds. But where the more difficult aspects of parenting are concerned, a combination of shame and competitiveness kicks in – even among close friends, it’s taboo to discuss how parenthood stretches you to the limits.

It can feel as though parenting guidelines impose blanket bans on doing anything human and ordinary.  And the media mostly fans the flames: there is a mountain of advice literature, but rather than providing context, each book takes a different line – seemingly to distinguish it from all the others.

What provides a genuine antidote is historical, geographic and scientific context. As Push Back shows, parenting styles and practices have varied hugely in different places and over the decades and centuries, and so has the advice. This can be hugely liberating for parents who worry that there is a single correct way – and the fact that attitudes have emerged out of specific historical circumstances (and hand in hand with underlying agendas), enables us to take them with a large pinch of salt.

Our relationship with our children, as well as with our own mothers, is profound and psychologically resonant. Push Back calls for a new feminist motherhood – one that employs comradeship, tolerance, and acceptance. Eliane Glaser argues that how we approach motherhood fundamentally needs to change: from adjustments so that mothers can work school hours to addressing the isolation that so many working mothers feel when they go on maternity leave. We will only change the structure of work and increase fathers’ participation once we debunk prevailing myths about the women being the rightful primary carers, and deconstruct the culture of childcare perfection. After all, if motherhood is natural, why not trust us to do it?

1

MOTHER NATURE

I got out of bed one Sunday morning, and my waters splashed onto the floor. I was about to have my first baby. At the hospital the midwife told me to come back when labour was ‘established’. Throughout the day, my contractions gently ramped up; exciting but inexorable. It was November. It got dark early. My husband and I tried to distract ourselves with television, but the pain of the contractions started to cut through. It got to ten o’clock. We went to the hospital again. We saw a different midwife. I said I wanted to stay. I held a green paper towel between my legs and showed her I was bleeding. She told me that this was normal, that I wasn’t yet in proper labour, and that I should go back home. She laughed lightly as she walked off down the corridor.

Weeks later, that blood would come up in an investigation as a key warning sign of placental abruption, a rare but dangerous condition in which the placenta becomes detached from the wall of the uterus, starving the baby of food and – more urgently – oxygen.

When we got home, it was nearly midnight. My husband lay next to me on the bed while I kneeled over the headboard. The pain was more than I could bear. I felt each contraction approach as if from afar, and each time I didn’t know how I would cope when it broke over me. Time passed, impossibly. The midwife had advised me to have a bath. It seemed an insanely banal suggestion, but I dutifully crouched in the water as dark wisps floated around me. At two in the morning, I was in wild agony. We drove back to the hospital. I writhed in the passenger seat. I had to stop in the brightly lit hallway as another wave of contractions took hold. People say you forget the pain of labour, but even now, over a decade later, I still remember very clearly what it felt like to have to endure the seemingly unendurable.

A different midwife saw me doubled over the reception desk and offered me an epidural. As soon as I was hooked up to the monitor, we heard the baby’s heartbeat slow right down, like a tape machine running out of batteries. The doctor arrived and told me I was going to have a caesarean, right now. My baby was not getting the oxygen he needed to stay alive. I was rushed down a corridor, strip-lights flashing over my head. My husband was told to wait outside the operating theatre. There was no time to top up my epidural; I was given a general anaesthetic. I was scared to lose consciousness. The anaesthetist was probably inserting a cannula, but I imagined he was holding my hand.

When I woke up, it was morning. There was a baby on my chest.

My son was fine: they had got him out just in time. But it was five years before I was able to tell that story without my voice cracking. Even now I have to concentrate on getting to the end.

TELLING THE TRUTH

My experience was shocking, but it did not come as a surprise. The Birth Trauma Association estimates that each year, around 30,000 women in the UK develop Post Traumatic Stress Disorder (PTSD) after having a baby, and as many as 200,000 may feel traumatised by childbirth in some way – nearly a third of all women who give birth. Instead of a joyful experience, these women find childbirth frightening, are left with injuries, or feel they weren’t properly looked after. A 2020 survey by the association of 798 of its members who had been left with PTSD found that nine out of ten said poor communication from staff was a contributing factor, and one in three cited unkindness. The Care Quality Commission’s 2017 survey of 18,426 women’s experiences of maternity care found that of those who raised a concern during labour or birth, 19 per cent felt that it was not taken seriously. Nearly a quarter said that during labour they were left worried and alone.

Years after my son’s birth, I came across a Twitter thread by a woman in the US who had given birth in a hospital designated as ‘baby friendly’. American women are generally more likely to give birth on a labour ward and be offered an epidural, but the trend towards natural birth is on the rise there too. In ‘baby friendly’ hospitals, the woman protested, there is no nursery for the baby: the idea is that the mother should stay with her baby all the time. Nursery, I thought? Nursery? I had an emergency C-section under general anaesthetic at four in the morning; I lost a litre and a half of blood and had to have a transfusion; every time I shifted in bed my hasty stitches pulled alarmingly; I could barely walk. Yet I was expected to look after my baby alone through the first night, when I didn’t really know how to breastfeed or change a nappy. I remember being told off by one of the postnatal nurses because I’d fallen asleep with my baby lying over my stomach. I knew this was not good for him, so the fact that I let it happen was a sign of how exhausted I was. When he cried and I couldn’t manoeuvre myself to lift him out of his crib I had to summon a nurse with a button, and although some were caring, others acted like I was on a plane calling the air steward in the middle of the night for a G&T.

It is customary for stories of gothic gore and touch-and-go risk, of forceps and tearings and cuttings without anaesthesia to end with a statement to the effect that well, it was worth it though; or, he or she is fine, and that’s the important thing. Some acquaintances said similar things to me after I told them my own birth story: at least you and the baby are fine. I have always felt a spike of irritation at this, and also guilt at what I fear is my own narcissism for presuming to believe there are other important things. These people mean well; but why should women go through something so violent, terrifying and life-threatening, and yet feel they should not dwell on how it was for them?

When I was pregnant with child number one, I looked forward to having him out in the world, but there was an unimaginable hurdle to get over first. I found myself reaching for metaphors – camels and eyes of needles, trains speeding inexorably towards wreckage, the film Alien … Given the available methods of exit, fear of childbirth seems an entirely rational response, yet in research terms it is only recognised in the form of an extreme syndrome called tocophobia. Researchers have estimated that around 14 per cent suffer from it worldwide, although this is an average: higher estimates of prevalence reach 43 per cent.

The expectation that mothers should maintain a dignified silence about what they went through has produced a curious vacuum. A media storm blew up in 2018 when Catriona Jones, a senior midwifery lecturer at the University of Hull, claimed social media is partly to blame for the widespread unease. ‘You just have to Google childbirth and you’re met with a tsunami of horror stories,’ she said. ‘If you go on to any of the Mumsnet forums, there are women telling their stories of childbirth – oh, it was terrible, it was a bloodbath, this and that happened.’ Is the idea that we are exaggerating, or that we should just keep the truth to ourselves? Justine Roberts, Mumsnet’s chief executive, countered Jones’s comments: ‘One of the most common complaints we see on this topic is “Why on Earth didn’t anyone tell me the truth about how bad it could be?”’ Women are looking for that truth: a 2016 study by researchers from Bournemouth University found that 79 per cent of pregnant women in the UK read blogs, watch YouTube, or join social media forums to ‘fill voids in their knowledge about the realities of childbirth’.

Not knowing the reality also makes it harder to deal with when it comes. The National Childbirth Trust is supposed to prepare women for childbirth, but I’ve lost count of the women who have told me that their birth experience came as a shock after what they’d been taught in their NCT classes. My group was no exception: nearly all wanted a natural birth, but most ended up having an emergency caesarean, or were induced without anaesthesia – a barbaric combination. Whereas we’d all been giggling and optimistic in the classes, after the event my fellow mothers were wan and disillusioned, with thousand-yard stares. We felt not only traumatised, but tricked.

Before the birth, I was particularly curious about the pain. I searched dozens of message-board threads. On Yahoo, women were asking questions such as: ‘Be honest, how painful is giving birth on a scale of 1-10?’ Google listed popular searches for: ‘How painful is childbirth without an epidural’, ‘How painful is childbirth naturally’, ‘How painful is childbirth scientifically’ and ‘How painful is childbirth compared to a kick in the balls’ – evidence of male curiosity perhaps.

The definitive answers I was looking for online turned out to be – unhelpfully – starkly divided. Some, like Marlon Brando in Apocalypse Now, gestured at an ordeal only imaginable by those who’d been through it: ‘the horror!’ But others insisted it was the most incredible experience of their life. I couldn’t tell if those women found it so because the pain didn’t seem so bad, or because it did, and they survived it. Those who ‘succeed’ are not consciously lording it over the rest of us, but giving birth without pain relief has become – even against women’s better judgement – a competitive test.

I will never know how painful childbirth really can be. During labour, your cervix dilates ten centimetres: I had an epidural at six centimetres, and minutes later was rushed into theatre. I was later told that my son was ‘back to back’, the wrong way around, which is apparently especially painful, so perhaps that bumps me up a couple of notches on the scale of endurance and achievement. What I do know is that at six centimetres I was already in more pain than I felt I could take. I often think about those other four centimetres: about the notorious ‘transition stage’; about pushing, and crowning, and tearing. I feel like I got six out of ten.

BE NATURAL!

Because I was sent home, I didn’t receive the care I wanted, including pain relief. And I started to see the same pattern everywhere. Friends had told me that their requests for an epidural had been discreetly ignored; that they’d been advised to ‘see how you get along’, only to be told later, as they screamed for one, that, sorry, it was now too late. They had told me that the pain was so bad, they wanted to die. One friend was induced and then left alone at night on a labour ward where her screams were ignored, and when a midwife found her on all fours about to push, she said: ‘We all thought you were making a fuss.’

In 2011, a Mumsnet post, ‘Anyone else tricked out of an epidural?’, attracted over a thousand replies in less than two weeks. ‘Why is there such a stigma around having an epidural?’ asked one poster in 2019. ‘I’ve been watching a lot of videos on YouTube & people seem to be celebrating the fact they didn’t have an epidural. A close relative has even told me to “never have an epidural no matter what”.’ She continues: ‘Not looking for a row before anyone starts just genuinely interested in why.’ A respondent is careful to stress: ‘I didn’t have one,’ although she adds: ‘but zero judgement towards anyone who has. Everyone has different pain thresholds …’

Ah, the apparent generosity of the ‘pain thresholds’ licence. Mine were clearly lamentably low. Another Mumsnet poster added: ‘I know someone who had epidurals with their births and developed fibromyalgia after the first and it gradually got worse with the next two. Not saying they’re linked but who knows …,’ illustrating the way that rumours of unproven risks can be fomented online. Too often the underlying message – although muted and disavowed in the cheery agora of social media – is that those who rely on drugs are either feeble or selfish. That judgement is also implied in the praise for those who do it without: the approving comment ‘she did ever so well’. Even among my friends, though we all reject the social judgement, it was the big question: did you have one? We always had to know.

Friends had also told me about their NCT classes: how they’d been gently encouraged to prepare to give birth naturally without ‘interventions’ such as anaesthesia or a caesarean, and how they felt like a failure if they’d ended up needing them. I also found that the NCT – while purporting to be neutral and non-prescriptive – did indeed subtly promote natural birth. We were told stories about African tribeswomen and an Irish farmer’s wife who spent her days milking cows and scrubbing floors, and who wouldn’t dream of using pain relief to aid her birth: she slipped her baby out like the proverbial bar of soap.

The promotion of natural childbirth is often accompanied by such humbling references. One American natural childbirth website notes that ‘the ease with which childbirth was accomplished in indigenous tribes stands in stark contrast to the phenomenal rate of birth interventions and caesarean births in the Western world’. There is a large subgenre of ‘natural’ or ‘normal’ birth videos on YouTube, often filmed in non-Western settings; perhaps that Mumsnet poster was watching one of them. ‘Tribal Woman Gives Birth In Forest’ is a real, and representative, title. Another such offering, of a Utah doula giving birth to her fourth child in a stream in an Australian rainforest, has been watched nearly a hundred million times. ‘My parents had been missionaries in Papua New Guinea,’ she explained to the New York Post in 2016. ‘I remember mom often telling us when a local lady had her baby [she simply] found a nice spot, pushed out the baby, breastfed it, and wrapped it in a carrier cloth, tied the child to her back and went about her business.’

The idealisation of natural childbirth is ubiquitous in antenatal education, in the advice literature, on social media and in the press: ‘11 hours’ labour and all natural! How serene Kate sailed through a textbook delivery as she goes through the perfect birth she was hoping for’, ran a Daily Mail headline after the birth of ‘gorgeous George’. And underneath: ‘Duchess of Cambridge gave birth without recourse to powerful painkillers’.

Websites such as ‘GivingBirthNaturally.com’ and ‘NaturalBirthWorks.com’ abound; the kidshealth.org site (hosted by the American paediatric health care provider Nemours) tells women: ‘You should be applauded for your willingness and enthusiasm to try to deliver naturally.’ ‘I felt inadequate and disappointed after my caesarean,’ one mother wrote on the parenting website BabyCentre. ‘I was made to feel even worse by people constantly harping on about the wonders of “natural” birth.’ The British Pregnancy Advisory Service’s chief executive Clare Murphy told me that while abortion once attracted highly charged debates, she believes there is now even less public support for elective caesareans.

When Katie Goodland, fiancée of England men’s football team captain Harry Kane, used the hypnobirthing technique during her labour in 2018, Kane tweeted that he was: ‘So proud’ of her ‘for having the most amazing water birth with no pain relief at all’. On this occasion, there was some public outrage, to which Kane responded ‘any women can give birth however they would like’, but his initial comment reflected a widespread view. It’s perhaps not surprising, therefore, that epidural use has fallen in the UK – by 70,000, or 6 per cent, between 2008–09 and 2018–19, according to an NHS Digital report.

I believe women should be able to decide how and where they give birth: in a rainforest, in their living room, or via planned caesarean on a labour ward. It is not particular preferences that I question. It is the way that, amidst a rhetoric of feminist empowerment, self-determination, and an array of equally valued options, women are not cared for, supported or listened to in childbirth – one of the most momentous and potentially harrowing experiences of their life: their requests are either disregarded or covertly steered, and only one course of action – natural birth – is invested with moral worth.

Despite the overwhelming dominance of natural childbirth as an ideology, it is presented as the plucky outsider, fighting for recognition in the teeth of the powerful white-coated establishment. It is also viewed as the woman-centred option, with midwives helping women avoid the medicalised ‘default’ and achieve the authentic experience they supposedly really want. Natural childbirth is portrayed as virtuous and brave, medical birth as necessary only if you’re weak or your birth is a failure.

Not only are these characterisations inaccurate; they also restrict women’s real autonomy. Labouring women are being denied medical help, including anaesthesia, in the name of feminism. The violation of women’s rights is dressed up as progress.

As early as 1989, the influential sociologist Ann Oakley described in a lecture how childbirth is governed by a series of binary oppositions: ‘Midwives/obstetricians; Women/men; Subjective/objective; Practice/theory; Emotion/reason; Intuition/intellect; Nature/culture; Family/work; Private/public; Soft/hard’. These oppositions still govern the way we talk about, think about, prepare for and manage birth. Although historically the male, medical, rational camp has prevailed, I believe that the pendulum has now swung too far the other way.

These categories are deeply unhelpful – for all women. As I’ll argue, they make one group of women feel bad about themselves, and perpetuate racist and classist attitudes towards other groups. And as well as being punitively judgemental, they are simply inappropriate terms with which to deal with the highly unpredictable way in which childbirth unfolds.

NORMAL OR PATHOLOGICAL?

What does it mean to say a birth is natural? Does it mean no medical interventions? No pain relief? Lots of pain, or none?

In 2018, the World Health Organisation issued new recommendations attempting to reduce the number of ‘interventions’, stating that ‘childbirth is a normal physiological process that can be accomplished without complications for the majority of women and babies’. So-called ‘normal birth’ has been widely promoted, not only by organisations like the WHO, but by national governments, antenatal classes and parenting advice books and sites. The International Confederation of Midwives issued a position statement in 2014 entitled ‘Keeping Birth Normal’, and the UK’s Maternity Care Working Party produced a consensus statement, ‘Making normal birth a reality’ in 2007, which was supported by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG). There has been a recognition in recent years that this language is problematic: the RCM has now stopped using the term ‘normal birth’ and removed all references to it from its website. But the positive connotations of the concept have lingered in our culture.

I am sympathetic to the view that childbirth should be thought of as a life event rather than a medical emergency. But high rates of maternal and infant mortality and injuries in communities with scarce medical care are also ‘natural’. According to the United Nations, more than 300,000 women a year die during pregnancy or childbirth, most from preventable complications; 94 per cent of those deaths occur in lower-income countries, about two-thirds in Sub-Saharan Africa. Our World in Data has estimated that if we still had the living standards of 1800, maternal mortality would claim 1.26 million lives a year. Save the Children has estimated that nearly a million babies die on their first day, with the vast majority of these in lower-income countries, and mostly in rural areas, where there are fewer skilled birth attendants and more limited access to medical facilities.

The cause of most of these infant deaths is complications during birth. A 2017 report by the RCOG found that three-quarters of the babies who died or were brain damaged during or soon after birth in the UK in 2015 might have been saved by better medical care – that amounted to 863 babies. ‘Natural’ birth carries a 90 per cent risk of a tear or cut to the genitals, and over a 5 per cent risk of tearing through the anus in a woman’s first birth.

I spoke to David Bogod, a consultant obstetric anaesthetist who has a specialism in ethics and law, and has been a vocal supporter of women’s rights to pain relief in labour. ‘We’re actually trying to achieve an abnormal outcome here,’ he told me; ‘we’re trying to achieve a much lower maternal and neonatal morbidity and mortality than would occur naturally – and we’re achieving it. But to do that we have to act unnaturally.’

The question of whether childbirth is a ‘natural’ or a medical event has preoccupied obstetricians for centuries. ‘It is an...

Table of contents

• Cover
• Title Page
• Copyright
• Praise for Motherhood
• Dedication
• Contents
• Introduction
• 1: Mother nature
• 2: Tick, tock
• 3: Down to earth with a bump
• 4: Is it normal to feel like this?
• 5: Nurture on tap
• 6: Red mist
• 7: The juggle
• Conclusion
• Notes on References
• Index
• Acknowledgements
• About the Author
• Also by Eliane Glaser
• About the Publisher