Andrea Robertson
on Childbirth without Fear
Andrea Robertson is one of the world's leading experts on childbirth education. She has written many books and articles and travels the world presenting workshops for childbirth educators, midwives and other health professionals. She is based in Sydney, Australia. She runs Birth International .
Grantly Dick-Read was a pioneer in his field, an obstetrician who was empathetic to the needs of labouring women, an acute observer of the mechanisms of labour and a champion of natural childbirth. His observations, drawn from attending thousands of births, demonstrate an insight and curiosity that are rare in a doctor. The thoughtful explanations documented in his writings reveal a caring man who has always had the best interests of women and babies at heart, and he used his position to pioneer childbirth activism as a worldwide movement.
When this book appeared, there was little else available for either pregnant women or their caregivers. The plethora of professional journals, books for parents and magazines that we take for granted today had not yet begun to appear. Dick-Read’s work filled a void, and was welcomed especially by pregnant women, who sensed his concern for their well being and could relate to his observations of their needs.
This book was aimed at the obstetricians and the genesis of the underlying politics of obstetrics is clearly evident. His many anecdotes of conversations (and debates) with colleagues, and discussions with women about their treatment, demonstrate that the arguments in favour of intervening in birth to give "better outcomes" have been firmly entrenched in the thinking of generations of medical men. In fact, little has changed in the years since this book was first published, except that we now have hard science and careful research to further challenge the kind of rigid obstetric thinking that Dick-Read encountered in his day.
Dick-Read’s most enduring insight has been the "fear-pain-tension" syndrome, caused by the action of adrenaline on the uterus that slows or even halts labour. His observations of this phenomenon and possible solutions that would enable a more productive and comfortable labour make very interesting reading. His chapters on the mechanisms of labour and the inhibiting nature of fear on the process are simply explained and easily understood. Reading his descriptions of normal labour and the outcomes he attributed to a woman’s relaxed "state of mind" we now know to be largely the result of endorphins - hormones that are produced in labour in the absence of adrenalin.
At the time he was writing, the role of endorphins in the birth process had not been discovered, and it was assumed that it was the prenatal training and positive outlook that he engendered in women that had produced the satisfaction and painless births reported by women in his care. Today, in light of our increased understanding of women’s bodies and their capacity for safe birth, the postnatal ecstasy and euphoria he reported would be attributed to endorphins and their ability to ease pain, promote concentration, and increase positive feelings and self-confidence.
The final chapters of the book set out a program for "training" women in pregnancy so they would have easy and painless births. This approach, of prescribing what amounts to a "treatment" (in this case, involving breathing exercises and relaxation drills) reflects the medical model and paternalistic approach that have beset obstetrics from the start. Dick-Read always had the best of intentions driving his thinking and actions, yet his solution for ensuring better birth required women to put their faith in him and the training women received. Those women who gave birth with Dick-Read in attendance did well because his attitudes and philosophy supported and enabled natural birth - it is not clear how many women were successful when cared for by less sympathetic and insightful doctors.
This book is an important historical document, whose ideas still have resonance today. Whilst the writing style and language will frustrate many of today’s feminists and the patronising tone can be off-putting at times, it is worthwhile overlooking the florid descriptions and heavy generalisations to discover the gems within the text. As Michel Odent says in his introduction, if obstetricians of the time had paid attention to the work of Dick-Read, and understood the physiology of natural birth, many of the excesses of modern obstetric practice may have been avoided.
We owe Dick-Read a great debt, for his willingness to take a stand: for women, for nature and for natural birth. There are lessons in this book for everyone - women will find comfort in the author’s unshakable faith in their capacity for birth; historians will find useful insights into the background of current medical thinking; obstetricians could discover the mechanisms of natural birth. Midwives, although not featured to a great extent in his text, will find that many of Dick-Read’s suggestions for care of the pregnant women have already been incorporated into modern midwifery practice.
It takes time to digest this text, however it offers a fascinating insight not only into the mechanisms of birth, but to the thinking of the time. Grantly Dick-Read was a pioneer of the natural childbirth movement, an activist and caring doctor who rightly deserves recognition for his role in promoting normal birth, especially amongst his often hostile colleagues. Women of that generation around the world saluted his efforts and thanked him for his insight and support. At the end of the day, it is always the labouring women who are central to the birth process and they valued his work more than anyone.
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