Out of the Womb, Into the Fire

by Jock Doubleday

© 2003 Midwifery Today, Inc. All rights reserved.

[Editor's note: This article first appeared in Midwifery Today Issue 50, Summer 1999. It is a response to Nina Shapiro's article "Birth Control" in The Seattle Weekly, Nov. 26, 1998.]

1. Myth Killer

When you kill a myth, it is like being born.

I know that this is true because I killed one myself, a few years ago, with the help of the professional mythoclast, or myth killer, Joseph Chilton Pearce.

In the early 1970s, Pearce wrote a book entitled Magical Child. Despite its technical language and heavy reliance on medical studies, this book sold an enormous number of copies and is still in print today, twenty years later.

The thesis of Magical Child is that human potential is vastly beyond our current notions and that certain cultural practices are the causes of our diminishment. One such detrimental practice, Pearce argues, is the medicalization of childbirth, which is designed to thwart at virtually every stage nature's three-billion-year-old plan for the miracle of birth.

Pearce describes in heartbreaking detail the drama of modern obstetrics' "cascade effect," in which one medical intervention creates the need for another: how anaesthetic drugs slow the synchronous movements by which the infant is expelled from the womb, extending delivery time to torturous lengths; how the slowing of labor causes increased fear in the mother; how the mother's fear causes her lower uterine muscles to tighten, stopping labor and causing intense pain as her upper uterine muscles continue their contractions; how the mother's increased pain justifies increased medication; how increased medication (each dose of which passes through the placenta to the infant in forty-five seconds) destroys the delicate hormonal conversation between the mother and infant; how the drugged infant's inability to send its final "I'm ready" hormonal signal to the mother precludes the possibility of a vaginal birth; how the mother's recovery time from her now "justified" c-section makes it impossible for her to bond with her newborn in the first critical moments after birth; how the heavily drugged child is unable to respond to its world and engage in primary learning; how the lack of a bond (what Pearce calls "a safe place to stand") affects the child in untold adverse ways for his or her entire life; how the mother's "postpartum blues" is a direct result of technology misused.

2. True Believer

Thus it was with some dismay that I read Nina Shapiro's article "Birth Control" in The Seattle Weekly.

In this article, Shapiro advocates the use of anaesthetic drugs for childbirth—on the grounds that these drugs are safe for both mother and baby. She argues that the "cult" of natural childbirth has suppressed information about the true magnitude of birthing pain, what she calls its "root canal" intensity. She contends that birth cult members "guilt" women into choosing an unnecessarily painful method of birth, that the cult itself is led by misguided gurus, that for "ease" in childbirth, a truly informed choice leads inevitably to state-of-the-art obstetrics technology, that technology is the salvation of women desperate to avoid the travail of Eve.

Her arguments are—and I use these words in their full meanings—completely uninformed. They are composed of parroted "mythological truths," beliefs that are not true but are taken on faith by the culture at large. The belief that the world is flat, or that herbal healers are demonic and should be burned at the stake, are examples of outdated mythological truths.

Her fact-unencumbered, me-centered, high-sounding, "I was in no mood for sappy sentimentalism" style epitomizes the kind of writing that does the most damage to the truth. Its absolute self-confidence, combined with its absolute ignorance, strikes a blow below the level of reason, convincing by brute force alone.

Her statement that the natural childbirth movement "insists on women feeling pain" is so fantastically wrong that it would be laughable if it weren't so dangerous. Her belief that "fulfilling my baby's needs means obliterating my own" is unfathomable. As an eight-year researcher on the subject of childbirth, I believe that the only possible merit of Shapiro's article is as a diary entry.

Shapiro sees herself as wise, awake, and aware, a debunker of myths, an "explorer" discovering truths tragically buried by a small but powerful brainwashed faction. But the territory she purports to explore was bulldozed, graded and paved over by corporate America fifty years ago. She is like Columbus discovering Spain.

Common features of the landscape of her "brave new world" are epidural anaesthesia, the episiotomic knife, cesarean section and a sycophantic surrender to hospitals' corporate line.

3. The "Primitives"

Chanting "informed choice," Shapiro remains uninformed. Although she refers to a desire to "learn" about childbirth, we discover that her reading is limited to two books, both of which she disdains: Pregnancy, Childbirth and the Newborn, which she disdains because it speaks of "savoring" the birth experience, and What To Expect When You're Expecting, which she disdains because it is 1) "sentimental" and 2) respectful of the birth practices of traditional cultures.

Regarding what she terms "primitive" cultures' birth practices, Shapiro writes: "everything is so natural that the infant mortality rate is abysmally high…."

Of all the "facts" composing the mythological bubble of the safety of technological childbirth, this "fact" is the one that I believe has been responsible for the greatest number of infant deaths in the civilized world. While it is true that, in comparison with Western infant mortality rates, traditional cultures' rates are high, these higher rates are not due to birthing practices, but to disease.

As John Robbins writes in his meticulously researched and relentlessly mythoclastic Reclaiming Our Health (1996):

"[Western civilization's] historical decline in maternal and infant mortality (death) and morbidity (injury and illness) has not been due to obstetrical medical interventions. Rather, these gains have been due to the development of antibiotics, the addition of vitamin D to milk (thus preventing rickets), advances in public health, sanitation, and nutrition, improvement in women's working conditions, and other measures that improved maternal health prior to birth. The medical literature is full of studies which reveal that the practices that lie at the heart of modern obstetrics, when used as a matter of course, do not save lives. In fact, study after study shows that they actually lead to higher death rates for both mothers and babies [emphasis mine]."

What the statistics show, in essence, is that antibiotics and other public health advances are saving babies at a rate faster than the routine use of obstetrics technology is killing them.

Indeed, in developed countries around the world, including the United States, the routine use of obstetrics technology is two to nineteen times more likely to lead to infant mortality than midwife-attended birth (Chamberlain et al. in Sheila Kitzinger's Homebirth, 1991). ("Routine use" means "use in births other than those that are high-risk.")

In America alone in the last fifty years (1948–1997), the routine use of obstetrics technology has been directly responsible for, at bare minimum, 1,282,500 infant deaths (Doubleday, "Obstetricians Should Be Heroes," 1998).

The routine use of obstetrics technology has also led to higher rates of infant morbidity (Henci Goer, Obstetric Myths Versus Research Realities, 1995: 332); higher rates of maternal morbidity and mortality (Ibid.); and higher rates of child abuse, specifically for c-section infants (Nancy Cohen, Open Season: Survival Guide for Natural Childbirth and VBAC in the 90s, 1991: 25).

4. Fear

"In truth, I have long been scared of childbirth," writes Shapiro.

Pregnant at the time she wrote her article, she admits she wants to learn anything she can to "make the experience easier." Relating the story of her own mother's natural birth, she writes: "[S]he described it as feeling like she was being split in two." Rolling her eyes at the natural childbirth movement, she adds: "God forbid women should seek [pain] relief from labor's all-too-normal torment."

But is childbirth pain truly normal? Or necessary?

Advocates of technological birth believe that pain in childbirth is a biological necessity, but this is not true.

For instance, I have a friend who describes her first birth as "not at all painful." Of course, her diet is quite unusual: organic raw vegetables and fruits, organic whole grain bread, organic raw nuts and seeds, no dairy products, no meat, no refined sugar. I venture to guess that in western culture one in 10,000 mothers-to-be maintain so strict a healthy diet. (Many maintain strict unhealthy ones.)

My friend also exercises regularly. In particular, she performs squats. I venture to guess that in western culture one in 10,000 mothers-to-be regularly performs squats.

Science has not concluded that bad diets and insufficient exercise are causes of pain in childbirth. The studies have not been performed. And science will dismiss the story about my friend as "anecdotal evidence." Let us then leave diet and exercise, for the moment, and proceed to fear.

Science has concluded that fear is a certain and major determinant of childbirth pain. Nancy Griffin writes in "The Epidural Express: Real Reasons Not to Jump On Board" (Mothering, Spring 1997) that:

"The main cause of pain in a normal childbirth is…the 'Fear-Tension-Pain Syndrome.' …[O]ur biology provides us with powerful instincts during birth. The first is the need to feel safe and protected. All mammals will instinctively seek out a dark, secluded, quiet, and, most of all, safe place in which to give birth. While birthing, mammals give the appearance of sleep and closed eyes to fool would-be predators, and they breathe normally. Some (those who don't perspire) will pant in order to cool down, but humans will most easily achieve a relaxed state through closed eyes and abdominal breathing. This relaxation slows down the birthing mother's brain waves into what is called an alpha state, a state in which it is virtually impossible to release adrenaline, the "fight-flight" hormone. Physical comfort becomes critical, along with the need to have a "nest" ready for the baby. Hospital environments often unintentionally disrupt the birthing atmosphere by introducing bright lights, lots of people, noise, and fear-inducing exams and machines."

How exactly does the mother's fear lead to pain? Griffin explains:

"The uterine muscles are beautifully designed to deal quite effectively with danger, fear, and stress in labor. The uterus is the only muscle in the body that contains within itself two opposing muscle groups—one to induce and continue labor and another to stop labor if the birthing mother is in danger or afraid. Emotional or physical stress will automatically signal danger to a birthing mammal. Her labor will slow down or stop completely so that she can run to safety. In modern times, this goes haywire. We can't run from our fears—which may include the "horror story" our best friend told us about her birth—or even from our hospital or physician. Instead, we may release adrenaline, which causes the short, circular muscle fibers in the lower third of the uterus to contract. These muscles are responsible for stopping labor by closing and tightening the cervix. The result is that we literally "stew" in our own adrenaline. At the same time that the long, straight muscle fibers of the uterus are contracting to efface and dilate the cervix, the short, circular muscle fibers of the lower uterus are also contracting to keep the cervix closed and "fight" the labor. The result? The very real pain of two powerful muscles pulling in opposite directions each time the birthing mother has a contraction."

Having established a direct connection between fear and pain, Griffin concludes:

"By learning to deeply relax mentally, physically, and emotionally; actively dealing with fears about birth; and choosing a birthing environment that feels safe and protective, birthing women will not have to experience the traumatic pain caused by the 'Fear-Tension-Pain Syndrome.' "

Suzanne Arms, a seminal figure in the natural childbirth movement, writes in Immaculate Deception II: Myth, Magic and Birth, 1994:

"Television and the press and birth stories focus on the drama and risks of birth… Perhaps the most important thing anyone can do for a woman going into childbirth is to help her shed her misconceptions and diminish the fears about giving birth that she has picked up in the course of her life."

5. The Epidural Express

"Somewhere along the line," muses Shapiro, "the movement to empower pregnant women to make informed childbirth choices turned into a pressure-laden, guilt-inducing campaign for the right kind of birth—that is, the 'natural,' unmedicated variety… Isn't it interesting…that the movement that's supposedly feminist is the one that insists on women feeling pain?"

Reading a list of descriptions of the potential side effects of various anaesthetic drugs, she writes: "It's like reading the packaging on aspirin: Yes, it might cause ringing in the ears or hearing loss, but is the risk great enough to stop a reasonable person from taking it?"

Let us look at the risks associated with the administration of anaesthetic drugs in childbirth, starting with the risk to the in utero infant. Nancy Griffin (Mothering, Spring 1997) writes:

"All [anaesthetic] drug dosages are determined by the mother's body weight… Because the mother's body weight is approximately 20 times greater than that of her unborn baby at term, there is always a chance that the baby will receive an overdose—perhaps the most compelling food for thought in any discussion on drug usage in childbirth. Following birth, the newborn must metabolize these drugs partly through liver function. Since the newborn arrives into the world with an immature liver, drug metabolism increases the likelihood and severity of newborn jaundice.

"The Physician's Desk Reference (PDR), a well-respected guide to all drugs, their usage, cautions, and side-effects, states the following about the Caine derivatives used in epidurals: 'Local anesthetics rapidly cross the placenta (by passive diffusion) and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal, and neonatal toxicity. Adverse reactions in the mother and baby involve alteration of the central nervous system, peripheral vascular tone, and cardiac function.'

"Research done in the last five years [1992–1997] on the effects of epidural anesthesia on newborns has shown that epidurals result in lowered neurobehavioral scores in the newborn; a decrease in muscle tone and strength, affecting the baby's sucking ability, which can lead to breastfeeding difficulties; respiratory depression in the baby; greater likelihood of fetal heart rate variability, thereby increasing the need for forceps, vacuum, and cesarean deliveries and episiotomies."

Now Griffin gives us the possible side effects for the mother:

"The PDR goes on to list the following possible maternal side effects for Caine derivatives: 'Hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, headache, backache, septic meningitis, slowing of labor, increased need for forceps or vacuum delivery, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting, and seizures.'

"A review of the literature reports that on average, 70 percent of women receiving an epidural during labor experience side effects. The most common include postpartum urinary retention, severe backache, loss of motor power, prolonged first- and second-stage labor, malpositioning of the baby at the end of second-stage labor, hypotension, and in their babies, poorer motor organization.

"Very rare but possible risks of epidurals include trauma to nerve fibers if the epidural needle enters a nerve and the injection goes directly into that nerve; a drug overdose resulting in profound hypertension with respiratory and cardiac arrest and possible death; and central nervous system toxicity resulting from an injection directly into the epidural vein. Epidurals increase maternal and fetal healthcare costs and the professional liability of healthcare providers. Other medical interventions, such as IVs, continuous electronic fetal monitoring, the use of additional drugs, bladder catheterization, frequent blood pressure monitoring, continuous administration of oxygen, and forceps, vacuum extraction, and episiotomies often become necessary as adjunct medical care to an epidural. Epidurals can prolong a labor, leading to the possible need to augment labor with Pitocin (an artificial hormone that mimics the action of oxytocin, the natural hormone that triggers labor and causes uterine contractions)."

Such is the argument against the use of epidural anaesthesia in the year 1999.

On the other side of the argument, we have this brave, technology-cheerleading assurance from Shapiro: "Epidurals now allow women full consciousness and an active role during labor."

6. $50,000 Credential

Shapiro bemoans a dearth of "experts" to tell her what to do. Although I have no medical degree, I am such an expert. For eight years, I have made a study of childbirth-related medical research. As I am neither an obstetrician nor a midwife, I have no professional bias.

What I found in my eight years of research is that there is no evidence, not a single study, in this or in any other country, in support of the routine use of obstetrics technology.

In fact, the conclusions of medical research studies are so overwhelmingly in favor of natural childbirth that, in Midwifery Today's Autumn 1998 issue, I offered $10,000 to the first person who could produce a study published in an industry journal in any country, in any time period, showing hospital birth to be safer, in any category, for most mothers and babies than homebirth with a trained midwife in attendance.

No one has claimed, or even attempted to claim, the money.

At this time, I would like to increase the offer to $50,000.* In addition, I would like to make it clear that the term "midwives" does not include Certified Nurse Midwives, who, because of their conventional medical training, and in spite of their good intentions, bring the fear-based medical model of childbirth with them into the home, thus skewing homebirth data toward the technological. Fear, in any guise, is contagious.

*[Editor's Note: Please read about Jock's new offer. Contact Jock Doubleday by clicking below for his biographical information.]

To answer the cynical: although I am president of a nonprofit corporation advocating natural childbirth, the money I am offering is not the corporation's but my own.

7. Strange New World

It's not easy to kill a myth. You need the help of a professional. But once you kill one myth, it becomes easier to kill others.

Vaclav Havel, president of the Czech Republic, once wrote that, when one steps outside of a myth, "the world takes on a strange new aspect."

In this strange new world, mythological bubbles float serenely. They had been invisible to you, but now you are invisible to them. They are completely vulnerable to you, as for your whole life you had been vulnerable to them. One very large bubble floats by. Around its circumference are the words: We have not discovered a cure for cancer. You reach out tentatively and touch it. Pop! Another bubble drifts into view: The cause of cancer is in nature, not culture. You reach out and touch it. Pop! Healthcare is found in bottles of drugs, doctors' offices, and hospitals. Pop! Tools can improve on nature. Pop! Technology is our salvation. Pop!

Suddenly you realize that you are no longer a subject of corporate America—whose ads create the mythological fabric that controls us—but a free-feeling, free-thinking, free-acting individual with unbound potential.

Shapiro concludes her article with a graceful bow to reason: "If I heard a clear case against using drugs on the grounds that they endangered me or my baby, I'd face my fear and prepare to do without."

I believe that this article presents such a clear case. I believe that Shapiro must face her fear. I believe she owes it to her unborn baby and to herself to step outside the mythological bubble in which she has so long lived.

I believe it is time she was born.

Jock Doubleday is president and founder of Natural Woman, Natural Man, Inc., a California nonprofit corporation. More biographical information here: Jock Doubleday

[Editor's Note: Jock Doubleday reports that the editor of The Seattle Weekly, the publication in which Shapiro's article originally appeared, told him he had no interest in publishing this response, even as a pared-down version for Letters to the Editor.]

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