Saturday, 9 March 2013

Childbirth Without Fear and the backlash against the breastfeeding backlash...

It feels like deja vu - earlier in the year I tackled birth and breastfeeding newspaper articles in this post; and this week Helen Rumbelow in The Times and Anna White in the Telegraph have been at it again.

I read Helen Rumbelow's article about the new edition of Childbirth Without Fear by Grantly Dick-Read, and its powerful cover image, with some interest, as I've been proofreading it for Pinter and Martin. (I know, I can't believe my luck either.) It's ironic that Rumbelow's piece, which draws heavily on her own experience of birth, and misinterprets many of the main points of the book, perhaps illustrates all too clearly why many of Dick-Read's insights are still relevant today.

Of the cover she writes that the mother looks more like a model 'than the kind of birthing woman I was, or have ever known... and then there is the matter of the neonate she is sort of sitting on top of...' This is surely part of the point (and one that's well made in the book itself) - our mental images of childbirth are cultural and this unmedicated, upright, spontaneous birth looks, to women more used to seeing birth take place in hospital, unusual - even shocking. According to Rumbelow some American booksellers won't stock the book 'because so many readers will assume the image is a spoof; fakery of the kind most women suspect when they hear stories from the likes of Gisele B√ľndchen, claiming that the birth of her son “didn’t hurt in the slightest”, which is Brazilian supermodel shorthand for “why do all you fat birds make such a fuss?”' Really? It wasn't just that they found it a bit graphic for a US public that combusts when it sees a nipple due to a wardrobe malfunction? The rest sounds to me like Rumbelow's personal view. One of the things I object to about Rumbelow's tone, in this and other articles, is the way it casually dismisses the possibility of valid alternative perspectives - I'm no Brazilian supermodel but I've had three pretty painless births - and I can't see how that kind of narrow focus can add anything to the important discussion of the issues surrounding birth.

One section of the article I found particularly troubling.  Rumbelow writes: 'Dick-Read... had been a pariah but slowly his influence crept into NHS hospitals. “Natural” may or may not be desirable, but from the NHS point of view, a bouncy ball and a warm bath were a lot cheaper than the anaesthetist, epidural and staff surveillance required for a medicalised birth. Accountants realised that pain relief could be marketed as a luxury not a right. An unholy alliance grew up between the bean-bag hippies and the bean-counter NHS cost controllers.' To read this you'd think that there was some sort of conspiracy to encourage natural childbirth within the NHS; in fact, it reflects the increased influence of midwifery - woman-centred care - and the best research we currently have about outcomes (in terms of birth injury, postnatal pain, Apgar scores, initiation of breastfeeding) for mothers and babies, which informs the NICE guidelines, as well as the type of birth women want for themselves. (I can't help thinking that if Rumbelow's suggestion were true, the NHS would be encouraging us all to have home births - even cheaper!) And the situation today, although better than in times past, still has room for significant improvements - for more, see this excellent post on The Mule.

What's clear from actually reading Childbirth Without Fear is that Dick-Read was capable of real insight into women's experiences of birth. He observed carefully, thought deeply, and had an appreciation of the magic, or spirituality, or importance - whatever you want to call it - of birth. He recognised the importance of the right kind of support and for the need for women to be educated about the amazing abilities of their own bodies, and that with these came a reduction in the fear that leads to tension, and thus to an interpretation of the physiological process of birth as 'painful'.He understood how culture affects women's expectations of birth and breastfeeding. (The section about the translation of words describing labour in the Bible is just brilliant.) His style of writing may be of his time, but his work couldn't be more relevant today.

As with birth, so with breastfeeding. Fortunately, when it comes to Anna White's bitter article 'The Breastapo need to stop nipple-gazing' there's no need for me to go into too much detail - the Analytical Armadillo has already done a great job here.

What I find myself wondering is why these particular journalists keep writing exactly this kind of article. Are their editors specifically commissioning pieces that take an anti-breastfeeding, or anti-choice stance, and if so, why? Despite Anna White's claim that 'a growing number of academics are questioning the presumed-to-be empirical evidence promoting the health benefits of giving babies the boob' the evidence that artificial feeding presents risks to the health of mothers and babies, in the UK and elsewhere, is overwhelming; we also know from the Infant Feeding Survey that most women start breastfeeding and want to carry on but are derailed by numerous factors, lack of information and support chief among them. We also know that home birth and 'natural' birth is safe and that women in the UK are entitled to choose it if they wish. Whose interests are served by articles that deliberately pit medics against mothers (Rumbelow says of Childbirth Without Fear that it is 'one of the most controversial texts, pitting those in the medical establishment and mothers against each other'), and mothers who feed their children differently against each other? Normally I would suspect vested interests, or the desire to attract certain readers and/or advertisers, but in the case of the broadsheets (as opposed, say, to the parenting glossies or the Tesco baby magazine) this doesn't seem so likely. It's possible that the explanation is simpler - these journalists have emerged from their own experiences of pregnancy, childbirth and breastfeeding in our society with strong feelings, and unlike most people they have a platform where they can work them out in public. It's also possible that those commissioning the articles have experienced, either first or second hand, a type of birth and breastfeeding experience that those of us who support women are working hard to try to improve, through initiatives like the Positive Birth Movement and the establishment of Birthrights.

I'm passionately interested in women's stories of birth and breastfeeding and find them endlessly revealing and informative, in terms of what they tell us about individual women and the influences that affect their experiences. However, it's always a mistake to extrapolate too far based on one's personal experience: hard as it may be, a more objective view, that puts your own experience in the context of many others, and considers the available evidence with an open mind, is what leads to greater understanding, if not agreement. It's something that peer supporters and breastfeeding counsellors cover in training - to debrief their own experiences, deal with their own feelings and then put them aside in order to focus on how they can best support other women with a different set of influences, values and aims, within a society and culture that exert their own pressures on women and their choices. I don't think either Helen Rumbelow or Anna White has yet been through a process of genuine reflection about their own experiences of birth and breastfeeding; had they, their articles would be contributing to a much more rounded discussion of issues that ultimately affect all women.