S Y N A P S I S

Jennifer Edwell // Recently, there have been a number of articles by health journalists and bioethicists critiqing the concept of “natural birth.” In these projects, writers investigate where the term natural birth comes from and how it affects the way people understand and regard birth experiences (see Martucci, 2018; Tucker, 2018). For example, in May 2019, NYT Parenting published an article explaining why the site wouldn’t employ the term “natural birth,” stating that it is “imprecise and can make families whose births are deemed not ‘natural’ feel shame” (Grose).

Many of these articles locate the origin of this problematic term in Dr. Grantly Dick-Read’s 1933 book, “Natural Childbirth.” Dick-Read was a British physician whose book was very popular in the United States, where it dovetailed with existing ideas about achieving a pain-free, yet unmedicated birth. In the later part of the 20th century, these ideals coalesced into the natural childbirth movement, which promoted putting women in control of their birth process and  chastising the medical establishment.

While I agree wholeheartedly with current criticism of this terminology (as well as the uptake of “good birth,” proposed by Dr. Anne Lyerly, as an alternative), I think this historical narrative could use a critical introduction. Dick-Read molded and popularized the idea of natural birth for his early 20th century audience; however, in the United States, natural birth has a much longer history. In this post, I briefly outline key aspects of natural birth as it was discussed by American physicians in the nineteenth century.

Nature as Divine Will & Agency

At the turn of the nineteenth century, popular opinion held that childbirth was a natural phenomenon—not a medical event—and that pain was essential to the process. This view, commonly called “the doctrine on the necessity of pain,” often cited Genesis 3 (wherein God curses Eve to suffer in childbirth) as explanation for parturient pain. For example, Dr. John Vaughan (1803) writes that women’s sorrow and pain in childbirth are “contingences [sic] to be found in the archives of human misery, enrolled in the list of consequences of the transgression of our first parents” (32). Womankind, Vaughan contends, have inherited Eve’s curse.

The influence of Christian natural theology, however, began to shift how obstetric physicians regarded childbirth. Medical writers characterized “nature” as the manifestation of Divine design, and “naturalness” signified rightly ordered creation. In A Compendium of the Theory and Practice of Midwifery (1807), Samual Bard writes, “beneficent Providence has endued women as well as other animals with powers, which when unimpaired, are equal to all her natural functions” (99-100). In other words, he argues that God specifically designed women for the “natural function” of reproduction. Under the rubric of natural theology, nature was also characterized as an active force capable of conscious, purposeful action. This is evident when Bard defines “all labours natural in which the head of the child presents, and which are completed […]  by the efforts of nature, without the introduction of the hand into the womb, or the use of instruments” (105). Nature—not the birthing woman or her attendant—was the agent of childbirth. In a natural birth, the female body was portrayed as passively opening, allowing the mechanistic process of birth to be carried out by nature, and the main function of a birth attendant was to anticipate nature and observe its efforts.  

Nature and Childbirth Pain

During the mid-19th century, medical writers hotly debated the appropriate response to childbirth pain. Some “old-school” physicians, such as Charles Delucena Meigs, believed that childbirth was naturally a painful operation. In Obstetrics: The Science and Art (1849), Meigs states, “A kindly Providence has so ordered this painful office of parturition, that the accoucheur, in most cases, hath really little to do expect to receive and protect the child, and attend to the delivery of the after-birth” (278). Like earlier writers, Meigs affirms that nature is a capable agent, and he suggests that pain is not inconsistent with Providence—suffering in childbirth is part of God’s design.

However, not all physicians agreed with Meigs about the ‘naturalness’ of childbirth pain. For example, Walter Channing refutes this premise in A Treatise on Etherization in Childbirth (1848). He asserts, “We know of painless labor, of labor wholly without pain; and in too many instances, not now to refer to them, in which the patient was unconscious of delivery […] and who did not pay the penalty of death of the involuntary violation or temporary suspension of natural law” (6). In short, Channing suggests that if childbirth pain were a true natural law, then it would not be possible for any woman to escape the rule. Moreover, Channing locates the source of pain in women’s reproductive organs. He claims that childbirth pain is caused by “disturbance or disorder” in the uterus (28). He says with ether (an anesthetic),

We hold in check, so to speak, a vital function,—separate effect from cause,—restore harmony to the disturbed or disordered functions of an organ, the womb, to which disturbance I have ascribed the pain of labor, and so abolish its suffering; and all this without danger to life, and by the substitution of perfect ease, and often positive pleasure, for a pain, a suffering, an agony, which heretofore the universal experience had taught was as natural and as necessary as it was incidental to the circumstances under which it occurred.

(Channing 28)

According to Channing, pain results from the “suffering” of the womb, which he contends is neither natural nor necessary. Further, he claims that anesthetic treatments can remove pain and, perhaps, even produce pleasure. In short, unlike physicians who regarded pain as inherent to the procedure of childbirth, for Channing pain reveals an underlying (and unnatural) physiological problem.

Nature versus Civilization

To support their claim that childbirth need not be painful and that modern American women’s suffering warranted medical intervention, nineteenth century medical writers often employed the image of “primitive” women. The myth of “primitive” painless childbirth has its own long history. Historian of science Miriam Rich explains that, “From the first, painless birth functioned in these stories as a mark of alterity: specifically, it signified a foreign people’s lack of civilization” (57). Stories of “primitive” women easily giving birth circulated in eighteenth century travel literature, and these anecdotes were taken up by the medical community as proof that childbirth need not be painful.

In Experience in Water Cure (1852), Mary Groves Nichols contrasts European-American women’s suffering in childbirth with the easy, unencumbered childbirth of “the Indian woman.” She writes, “The Indian woman bears her babe, washes herself and her infant in the next running stream, and the travelling party to which she belongs seldom waits more than half a day for her” (74). Nichols’ perception of painlessness is based on a few key factors—namely, that the woman does not seem to be ‘inconvenienced’ by childbirth, does not require an attendant, and quickly returns to vigorous activity. Nichols goes on to say, “The Indian woman is subject to many hardships, but tight lacing and breathing impure air are not among them; and the exhausting influence of the undue indulgence of amativeness, social and solitary, which a luxurious and voluptuous civilization causes and perpetuates, is unknown amongst the Indians, and all people who are exempt from the sufferings of birth” (74). Thus, painlessness is linked to cultural-otherness, and childbirth pain is attributed to the degradation caused by over-civilization.

Conclusion

These basic precepts–nature as Divine agency, the (un)naturalness of pain, and civilization as destructive–supplied the rhetorical gravitas for many antebellum arguments about childbirth. Writers claimed that women who obeyed the laws of nature were capable of a natural birth. However, throughout the century, medical practitioners also argued that American women (particularly white middle/upper-class women in urban areas) were far from this natural ideal. To atone for this fall and ensure the safe delivery of their progeny, they urged women to pursue medically-assisted childbirths.

Delving into the history of “natural birth” illuminates how rhetoric about women, birth, and pain has evolved over time—but not always in straightforward or expected ways. Uncovering the religious antecedents of natural birth, for example, which gave cosmic weight to medical arguments, might help explain the persistence of religio-medical appeals (such as Scherf, 2014). By showing how key tropes or appeals have been refurbished and reiterated over time, this history accounts for the complex, fluctuating claims language makes on us.

Sources

Bard, Samuel. A Compendium of the Theory and Practice of Midwifery. New York: Collins and Perkins, 1807.

Channing, Walter. A Treatise on Etherization in Childbirth, Illustrated by Five Hundred and Eighty-One Cases. Boston: William D. Ticknor and Company, 1848.

Grose, Jessica.”Welcome to NYT Parenting. Here’s Why We Won’t Say ‘Natural Birth.’” NYT Parenting. May 7, 2019.

Lyerly, Anne Drapkin. A Good Birth : Finding the Positive and Profound in Your Childbirth Experience. Avery, a member of Penguin Group (USA) Inc, 2013.

Martucci, Jessica. “Beyond the Nature/Medicine Divide in Maternity Care.” AMA J Ethics. 2018;20(12):E1168-1174. doi: 10.1001/amajethics.2018.1168.

Meigs, Charles Delucena. Obstetrics: The Science and Art. Philadelphia: Lea and Blanchard, 1849.

Nichols, Mary S. Grove. Experience in Water Cure. New York: Fowlers and Wells, 1852.

Rich, Miriam. “The Curse of Civilised Woman: Race, Gender and the Pain of Childbirth in Nineteenth-Century American Medicine.” Gender and History, vol. 28, no. 1, 2016, pp. 57–76, doi:10.1111/1468-0424.12177.

Scherf, Sarah. “Cursed by Natural Childbirth.” Christianity Today. February 3, 2014.

Tucker, Sarah Yahr. “The Movement for Human Rights in Childbirth Is Not a ‘Natural Birth’ Movement.” Rewire.news. Dec 13, 2018.

Vaughan, John. “An Inquiry into the Untility of occasional Blood-letting in the Pregnant State of Disease: communicated in a Letter from Dr. John Vaughan, of Wilmington (Delaware), to Dr. Miller.” The Medical Repository, and Review of American Publications on Medicine, Surgery, and the Auxiliary Branches of Science. 6: 31-37, 150-157. 1803.