When I was born, my mother felt no pain. That was thanks to an epidural. She didn't have much say in it, though. It was her doctor who decided what was best for her. Twenty-six years later, when I gave birth to my own first child, I felt quite a lot of pain. That was because I'd decided (way in advance) that I wanted everything natural. An hour into labour, I changed my mind, but because my midwife didn't believe in epidurals, she just told me stop talking nonsense and pay more attention to my focal point: there was nothing wrong (she said) with a little pain.
In those days, an epidural was still a little unusual – in this country, at least. Over the past two decades, the procedure has become more and more popular, with the UK average rising from 17% in 1989 to 1990 to 33% in 2007 to 2008. But now a professor of midwifery has proclaimed that our current rates are much too high, and that birth should not necessarily be pain-free, anyway. Writing in Evidence Based Midwifery, he described pain in labour as a "rite of passage" that helped to strengthen a mother's bond with her baby, establishing a rhythm to childbirth, triggering the release of endorphins that helped women adjust to pain. And in case you did a double-take just then – no, I did not mistype that word. The author of this ground-breaking article is a man.
Now, if there is one thing worse than a painful labour, it is listening to someone who will never know the pain of labour describing it as a "rite of passage". Even if this man had a degree in anthropology, I'd want to question his terms. And what the hell does he know about Bonding with Baby? Bearing in mind the title of the journal for which is writing, where is the evidence?
As is so often the case in discussions about motherhood, it is laden with moral assumptions. It is a lecture from on high, and to me it is also a reminder of the faintly abusive lectures to which certain doctors and midwives subjected to me when I was in labour myself, and too weak to talk back – now, as then, my first inclination is to close my ears. That would be a shame, though. When he sticks to matters strictly medical, Dr Denis Walsh has important things to say. He points out, for example, that some hospitals now offer epidurals almost on demand, even though it is a procedure that comes with real risks, and even though there are alternative, less invasive, and therefore less dangerous ways to manage pain in labour. He also warns that epidurals make it more likely that hormone treatment will be needed to boost contractions, while also bringing up the number of forceps births.
As a veteran of three pretty difficult labours and one that nearly killed me, I would say that Dr Walsh is right to ask if pain avoidance should be the single most important thing in the management of labour. But he cannot presume to know anything about the subjective experience. And he has no business lecturing any mother – past, present or future – on the moral benefits of pain.
