Birth mother

Sheila Kitzinger has spent decades pushing natural birth. But the scalpels are still out, writes Karen Kissane.

A woman at Sydney Airport heard that Sheila Kitzinger, the high priestess of the natural childbirth movement, was expected to arrive at any moment. “I know her books,” the woman said. “Tell her she’s a liar. She says you can push them out so easy; it’s not like that at all.”

What does Kitzinger say to women who are wheeled out of the labour ward wanting to burn her book – or her?
“They’ve got to be angry with somebody and I suppose I’m as good a person as anyone because I can take it,” she says, with unruffled British calm.

“I do a lot of work with women who’ve had distressing experiences in childbirth and they feel they’ve been cheated, and that it was so awful that it must be the women who write books about childbirth who cheated them. But of course it isn’t, because we know that birth can be beautiful and exultant.”

Kitzinger is credited with having done more than any other activist to change the way hospitals treat women in labour. She has written more than 20 books on birth and female sexuality including Pregnancy and Childbirth, which has become the pregnant woman’s bible since its publication in 1980.

She is in Australia for a conference of the National Association of Childbirth Educators in Sydney this weekend and to speak at the Australian Breastfeeding Association in Melbourne next week.

Her message has never changed. It is simple but, for the medical profession, confronting. She says women should resist medical intervention during birth unless it is truly necessary. She accuses technology-focused hospital systems of disrupting women’s emotional and physical flow in childbirth, which she sees as a psychosexual process akin to lovemaking in its natural rhythms and its need to unfold spontaneously.

She warns that one medical intervention leads to another; a mother who is induced, for example, is more likely to need pain relief and therefore more likely to be unable to push out the baby without forceps or a caesarean. She says that mothers angry about the natural childbirth ethos “tend to say, `Thank God I was in hospital, and thank God I had my labour induced and thank God I had my uterus stimulated and had an epidural because look at all the other things that went wrong.’ And, of course, they went wrong because one thing led to another”.

Kitzinger, 74, is often described as grandmotherly. She wears her hair up in a soft bun, has a face that creases into myriad kind wrinkles when she smiles and is warm and charming to interview.

But there is matriarchal steel beneath the soft demeanour. She never raises her voice but she rarely concedes a point. Doesn’t the fistula hospital in Addis Ababa, which repairs the torn insides of African women left incontinent by obstructed labours, suggest that non-intervention in childbirth is catastrophic for some women?

“It’s not just a question of looking at non-intervention,” she says briskly. “It’s a question of looking at the conduct of the whole second stage of labour. Throughout that part of the world there is tremendous emphasis on `Push push push, come on try harder, you can do better than that, mother!’ ”
But she agrees that women in the Third World have too few caesareans and those in the First World have too many.

Kitzinger has undoubtedly been a major influence on mothers and midwives for several decades. Most big Australian hospitals now offer “birth centres” in which midwives try to support natural childbirth.

Partners or friends are allowed to stay with a labouring woman, and it is not uncommon for women to arrive at hospital with “birth plans” detailing their preferences for treatment during labour.

But there is also evidence of ways in which the movement is failing to get its message across. Caesarean rates in much of the Western world have risen steadily and, in Australia, one in four babies born this year will arrive via caesarean section.

In 1991 Australian caesarean rates were 15.7 per cent for public patients and 21.8 per cent for private. The latest figures, for 1999, showed that 19 per cent of public patients, and 30 per cent of private patients, had caesareans. In some private hospitals – the kind nurses nickname “caesars palaces” – the rate is well over 50 per cent.

“I don’t know how they can justify that,” Kitzinger says tartly. “(It’s about) fee for service, more money for obstetricians and anaesthetists.” She says the World Health Organisation suggests a justifiable rate is 12 per cent.

But what of doctors’ claims that educated private patients pressure them for caesareans: for convenience, or supposed safety, to keep their vaginas “honeymoon tight” or, as some critics put it, “because they’re too posh to push”? What if the increasing rates are partly about a distortion of Kitzinger’s long-held goal: women exercising their freedom to choose the birth they want?

The debate has been too value-free, she says. “We have been talking about choice in childbirth as if we are talking about breakfast cereals on a supermarket shelf; as if each choice was equally valid and free.

“I think this is cheating women and misleading women, and I think an analysis of choice needs to be made.

“The medical system . . . is advertising caesarean sections as the safest option for the baby, and any woman that isn’t being selfish is supposed to choose it because it’s healthier for the baby. And there’s absolutely no evidence that this is the case.”
In fact, she says, babies born by caesarean are more likely to have breathing difficulties, possibly because they have not been stimulated enough by the hard contractions of the birth canal.

She is dismissive of claims that doctors operate because they fear litigation: “Of course it’s an element but what are they saying? `These women are getting uppity? These women are suing us? If they didn’t do that, everything would be all right?’ It’s somehow blaming women.”

Kitzinger’s next book, due out in May, is an expanded edition of Pregnancy and Childbirth, with more information about studies of the consequences of interventions. “There are all sorts of research findings to consider that are evidence-based, and I would ask women to look at them,” she says

Is she dismayed by the fact that so many smart, sassy women don’t? Take American feminist Naomi Wolf. She was shocked by her experience of a bad birth in an American hospital. Nothing happened the way Wolf thought it would. She was put on a drip to speed up her labour; staff watched the foetal monitor rather than her; they terrified her with threats of surgery and her labour stopped.

She finished up lying naked and cold on an operating table, watching the reflection of her emergency caesarean in glass doors opposite as people worked up to their elbows in her body, “a cauldron of blood”.

Wolf later told an interviewer, “I feel absolutely staggered by what I discovered after giving birth. Birth today is like agribusiness. It’s like a chicken plant; they go in, they go out.”

If anyone should have read up beforehand on the politics of childbirth, it was Wolf. What does this say about the childbirth movement’s failure to get its message across? And how does Kitzinger feel about younger feminists discovering, as if for the first time, the need for a crusade when Kitzinger has been waging it for decades?
Kitzinger says Wolf asked for support with her book on motherhood. “I found it awkward at first because I didn’t want to attack Naomi,” she says of a meeting they had over the issue. “It was a real experience for her, and a very painful one. And I wanted to take her in my arms and say, `Good for you. You’ve done something with this awful experience. But I don’t agree with what you’re saying.’
“I think her whole interpretation of it was just looking at the facade. She thought women were being misled about how awful birth was.” Kitzinger believes Wolf had post-traumatic stress disorder. Kitzinger is speaking on distress after childbirth at the Sydney conference tomorrow. She now spends much of her working life with such women, through a birth crisis helpline she has set up in Britain. “I don’t tell them anything; I listen to them. They often say they felt raped, or they look at what was done to them and say they were treated like meat on a table.”

She says that medicating such women with anti-depressants only makes them worse. “With depression, you wake in the morning feeling grim, unable to face the day. When you’re suffering post-traumatic stress, you’re in a state of permanent alarm; you have panic attacks, you might not be able to walk past the hospital, you can’t bear to see anything about birth on television. And flashbacks are a central part of it. That’s different from depression.”

Kitzinger is a social anthropologist who began studying birth in different cultures because the male academics at Oxford ignored women’s lives – “and Margaret Mead (the pioneering US anthropologist) encouraged me”.

She has five daughters and wrote part of her first childbirth book on a notepad that rested on the back of her baby, Polly, as she lay on her lap being burped.

Three of her five daughters are lesbians, which Kitzinger says suggests she has done something right as a mother, “that three women in the family could make such a powerful decision in their lives”. Previously she has suggested that the girls grew up comfortable in a women’s world because they were thrown back on each other as she and her husband Uwe, now a research fellow at Harvard, were so busy with their work. She and her husband are about to take a holiday in Bali to celebrate their 50th wedding anniversary.

The marriage has been successful partly because they have usually lived on different continents, she says, smiling. “And when he is at home he’s a very keen sailor, so he’s out in his boat, and I don’t like housekeeping on a boat. And anyway I don’t like having a skipper in charge of my life. So I tend not to go on the boat.”

Looking back on her life’s work, she believes she can point to progress, but it is uneven, she says. “Midwives in Britain are so much more aware; I can’t handle the number of hospitals who want to send midwives to my workshops. And we still have home births in Britain. In the Bath area, it’s 16 per cent home birth and in part of Devon we’ve got 22 per cent home births.”

And it sounds as if British activists have been more successful than Australian ones in harnessing political will for the cause.

“Another thing we have is an inter-party parliamentary committee (that advises the government on childbirth issues). We are giving an award to the unit in Britain which has increased its home birth rate most in the last two years. And we’re asking units to see how well they can do in promoting normal birth (in hospital).”

Her eyes light up with wicked delight that the system will be subverted to the goals of its critics. “The award will be presented by the Minister of Health. It’s official.” And she laughs.

Sheila Kitzinger will speak informally on birth and breastfeeding at Gasworks Park in Port Melbourne on Wednesday at 11am. Bookings 9555 5135.

Karen Kissane is an Age senior writer.

Delivering the facts

“Normal” birth is far from the norm.

Only a minority of first-time mothers have no intervention, according to a study of 171,000 low-risk women by the University of Technology Sydney.

Sally Tracy, researcher at the Centre for Family Health and Midwifery at UTS, said: “Less than one quarter of public, first-time mothers and one-fifth of private patients give birth without intervention.” The study found that labour was induced or sped up for one in three public patients and half of private patients, while between a quarter (public) and a half (private) of women used spinal anaesthesia. One in three public patients and half of all private patients received an episiotomy (a cut to the vagina).

Dr James King, obstetric epidemiologist with the Royal Women’s Hospital, says Australia’s caesarean rate would now be about 25 per cent, and women have more depression and more problems adjusting to motherhood after caesareans. But he says there are fewer damaged babies than 30 years ago, because doctors no longer allow long and arduous labours.

First published in The Age.