Have you heard the one about the woman who gave birth standing against the wall of an East End slum? She turned down the offer of chloroform and, baby successfully delivered, asked the doctor, "Was it supposed to hurt?"
Chances are that if you attended the National Childbirth Trust's antenatal classes, you were told about this fortunate woman and her admiring doctor, Grantly Dick-Read, who went on to champion the theory that labour pain is exacerbated by fear and can be helped – if not eliminated altogether – by controlled breathing and relaxation techniques. She also appears in Marie Mongan's Hypnobirthing, a book that advances the same thesis and is the basis for a number of private antenatal courses. Recent reports that a few women experience orgasm during labour are the latest and most extreme manifestation of the movement that Dick-Read started.
I congratulate these lucky ladies. If nothing else, their example serves as a reminder of just how unhelpful the Book of Genesis can be, especially to pregnant women. Unfortunately, the influence of Dick-Read, Mongan and the NCT has not always been so benign. On Wednesday, the trust's head was forced to defend its endorsement of "psychoprophylaxis techniques" – breathing and relaxation – after a Swedish study showed no difference in the rate of epidurals between women who attended natural childbirth courses and those whose classes emphasised pain relief.
Belinda Phipps rightly pointed out that psychoprophylaxis is only one element of the NCT's antenatal teaching, and that most British women do not attend any sort of antenatal class. True – and the high fees the NCT charges wealthier parents (about £200 per couple) partly subsidise classes for the less well-off. By encouraging men to become more involved in labour and childcare and prompting women to ask for birthing pools (which, unlike psychoprophylaxis, have been shown to help with labour pain) and to persevere with breastfeeding if they can, the NCT has done a great deal of good. But the view that epidurals are a cop-out to which no self-respecting woman should willingly resort is deeply ingrained in the trust's culture. Earlier this year, I attended a Saturday class, run by the NCT, provided free for women expecting to give birth at University College London hospital. I was curious to see whether the trainer agreed with a UCLH consultant with whom I had discussed the possibility of an epidural a few weeks before. I would rather avoid it, I told him, but I was under no illusions about the possible pain involved and was not particularly attached to the idea of natural childbirth. "Good," he said.
That was not quite the message our NCT trainer gave her audience of eight nervous women and their trembling partners. An epidural would prevent the flow of oxytocin, a natural pain reliever, she told us, and might well prevent us knowing when to push; it crossed the placenta to the baby; and in one in eight cases, it did not even work properly. We were encouraged to think about hiring Tens machines (which the NHS does not provide, probably because they have not been proven to work) and to consider a water birth. Partners were shown how to rub the woman's back during early labour and instructed in timing contractions. Some women, she told us, marched into the hospital with contractions demanding an epidural and telling the midwives it was their right. (In 2006, some members of the Royal College of Midwives proposed charging these women for the injection, a suggestion the Department of Health rejected.) We were left in no doubt of what to think of those women.
I fear the NCT would consider my labour a failure. After around 40 hours of on-off contractions and several paracetamol tablets, I arrived at hospital and was taken to the labour ward so that the baby's heartbeat could be monitored: the presence of meconium in the waters suggested she might be distressed. I asked for gas and air, and then for diamorphine, which left me confused. Eventually, the consultant suggested an epidural. Nineteen hours after I was admitted, my daughter was born by emergency caesarean section. I do not know whether my life or hers would have been threatened without it: I did not ask.
Not every woman will need or want an epidural, and fewer will need a caesarean. But the fact that both are available – and to every woman in Britain, regardless of her income – is an unalloyed good, and something the NCT would do well to celebrate a little more and denigrate a little less. When I saw my daughter in the flesh for the first time, I cried – for joy, of course, but also in gratitude that the medical team had enabled us to emerge from the ordeal safely.
There is no harm in telling women that controlled breathing can sometimes help to make labour pain more bearable. But to play down the efficacy of a local anaesthetic is misguided, and the NHS should think very carefully about endorsing classes that do so. I am glad that Patrick O'Brien, a consultant at UCLH, has acknowledged the lack of evidence that psychoprophylaxis helps.
As for Dick-Read, he died half a century ago, and would doubtless be disappointed that so many women continue to experience severe pain in childbirth. I hope that the decline in the use of general anaesthetic during labour, particularly in the US, would give him some comfort – and perhaps that advances in medicine and pain relief have taken away some of the fear he saw in middle- and upper-class women who, unlike that lucky East End mother, knew that giving birth might kill them.
