My first child was born two and a half months prematurely, on only gas and air. Despite the excruciating pain I was in, I didn't realise I was in labour when my husband dropped me off at St. Michael's Hospital in Bristol.
I went in wearing my work clothes, as if I might actually deliver the lecture I was scheduled to give, rather than my son. People always say that you forget the pain of birth, but this helpful amnesia depends on being given a baby at the end of your ordeal: the trauma of birth gives way to the love and joy of holding your child. The fact that my son was whisked away from me the moment he was born, has meant that the pain of his birth remains in my mind separate from any joy of seeing him. During the final stages of labour I kept my eyes closed tight. I felt that I was both in the room and somewhere else. And all the while four lines from Marvell's 'To His Coy Mistress', were stuck on repeat in my head (the bizarreness of this struck me even at the time). It was as if a strange madness had come over me.
This experience is a million miles away from the labour and birth most of the women seem to have on One Born Every Minute USA, currently showing on More4 on Thursdays at 21.00. The first thing I was struck by was the absence of screams. At first, I thought this was just because it was early in the episode. However, it soon became clear that almost every woman featured had been given an epidural. The result is to transform the show from gripping television to something both more surreal and mundane. 'You have completed' (the American term for fully dilated), one midwife informed a bored-looking mother to be, 'You are ready to push'.
I have mixed emotions watching the US version of this show, both as an American and as a mother of two, whose children were born in the UK. Certainly, there is something disturbing about the way in which these women appear so detached from the cataclysmic event happening to them. The tendency for most women to have epidurals (and to have them fairly early) not only medicalises birth, but also renders the mothers-to-be oddly passive. A woman with an epidural requires continuous foetal monitoring and a catheter, making her unable to get up and move about the room (activities thought to help with labour pain and ensure that the baby is in the right position for birth). The women also seem passive and detached in more fundamental ways: they are unaware of the changes happening within their bodies, so it is for the nurses and obstetricians to inform them of what is happening.
Interestingly, when a woman is shown giving birth without medication it changes the interpersonal, power dynamics of the event in striking ways. Marcella, a non-medicated pretty young mother-to-be, is told by her nurse that she will check on her again in a couple of hours as she probably has a long way to go in her labour. However, minutes after the nurse leaves the room, Marcella starts to scream, 'I have to push!' Nurses rush in to prepare the room for the baby's imminent arrival. 'I would have never expected this!', her confused nurse comments. The attention is all on Marcelle and it is clearly her body, not the doctors and nurses, that has taken charge.
But is it right to idealise the pain of childbirth? Although this may be pain with a purpose, accounts of women in labour for several days who end up too exhausted to push or with emergency c-sections make it seem less like a joyful, natural process than a form of torture. Unrelieved pain is also thought to be one of the risk factors for difficulties in breastfeeding and in post-natal depression. So isn't pain relief a good thing? Surely Elaine Scarry is right to observe in The Body in Pain: 'the most crucial fact about pain is its presentness'. When you are in pain, what is significant is that it is happening to you right now. And for most of us, our chief desire is simply that it ends.
So why is it that, according to some studies, approximately 65% of American women have epidurals while only 25% of women in the UK do the same? In the NHS, where money is tight and anaesthetists fewer on the ground, it may be the case in some instances not that women are actively choosing natural births, but rather that requests for epidurals are not being met. Epidurals can slow labour down and, once administered, midwives are legally bound to provide the woman with one-to-one care. Too many women having epidurals can thus lead to staffing problems and a shortage of beds. In America, on the other hand, where the patient is the client, epidurals are more readily available and a potential source of revenue (they generally cost somewhere between $1000 and $2500).
However, I do not think that the more natural, mobile births we see in the UK are simply the product of the NHS's overstretched resources. The midwives I've encountered try to tread a fine line between finding alternative ways for women to manage their pain and listening to requests for epidurals. And there are, after all, some good medical reasons to favour natural birth, or at least to delay the use of an epidural for as long as possible: as well as slowing labour down, epidurals make it less likely that the baby rotates into the correct position for delivery. They can also lead to a drop in the woman's blood pressure and slow the baby's heart rate down. As a result, women who have epidurals are more likely to need to help of an instrumental delivery (such as forceps) or to have an emergency caesarean.
I am glad that I have given birth without medication, simply because it is an experience beyond what I could have imagined. That being said, when I was in labour with my daughter I asked for, and was given, an epidural in the final stages of labour. So what right do I have to feel critical of women who choose an excellent form of pain-relief from the outset? None whatsoever. I may like the idea of natural, non-medicated birth, but it is easy have such views from the safety of my front room. Indeed, I think we need to be wary of our ability to judge real life situations. It isn't just that unmedicalised births make for better television (and let's face it, they do). It is the fact that there is an unbridgeable gulf between the person in pain and the person witnessing it. I may find my son's birth a source of fascination, but it is without doubt an experience I would rather recollect than repeat.