A male midwife in the UK has triggered a venomous reaction after publishing a study that suggests pain during childbirth is good for women. Dr Denis Walsh, associate professor in midwifery at Nottingham University, said pain was a “rite of passage” which often helped regulate childbirth.

Walsh said:

Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.

Dr Walsh maintained that epidurals had a place in childbirth, but not at the rates that they are currently employed. He said epidural rates had been rising over the last 20 years, despite the fact that alternative, less invasive ways to manage pain in labour were available.

But the midwife’s measured comments have been boiled down into headlines like this:

Jezebel’s Male Midwife: Women Need Childbirth Pain To “Prepare” for Demands Of Motherhood

and

The Herald Sun’s Just put up with pain of childbirth: UK professor Dr Denis Walsh

and

The UK Telegraph’s Women ‘should go through pain’ in childbirth, says male midwife

The Herald Sun is currently polling this question:

Should women go without painkillers during childbirth?

Right now, 70% of respondents are saying no.

Jezebel responded with this comment:

See, the pain of labor is apparently great training for, say, taking the kids to soccer practice or cooking them regular meals. If you don’t sacrifice your autonomy by handing decisions about epidurals over to a midwife like Dr. Walsh, you’ll never accomplish the total erasure of selfhood that is the mark of a great mom.

The suggestion is firstly, that this guy is well, a guy, and what would he know? The next is that he’s cruelly suggesting that women should put up with excruciating pain and that he has no right to make such a comment.

Crikey spoke to independent birth educator and birth attendant Rhea Dempsey who has attended over 1000 births, both in homes and in hospitals, for over 32 years.

Dempsey told Crikey that although feminist ideals are underpinning some of the angry responses to Dr Walsh, in truth, our current culture has ensured that pain in birth is seen as women “suffering”, whereas if we “supported women differently, we could reframe it as potency, agency and power”.

One reason that this issue is so controversial, is because “more generally in our culture, we’re not attuned to working with our bodies,” says Dempsey. “The normal experience of functional, physiological pain, a body working outside of a narrow comfort zone, is not asked of us any more because of our sedentary lifestyle.”

The second reason is that “…we equate the pain of childbirth in a medical framework. Pain equals damage, danger and illness,” says Dempsey. “It causes us to view it as suffering in that framework – and so within a medical frame, suffering is viewed as unnecessary and drug regimes are designed to relieve that suffering.”

“Midwifery is more about birthing and seeing birthing as a normal, healthy functional process in a woman’s body.”

Dempsey says that the epidural rate in hospitals in Victoria, for example, vary from 10% in some hospitals to 80% in others.

I’m not diminishing the pain at all. But what I would emphasise is to have really good support from people who know how to work with that pain and feel like it’s a valuable process for women to undertake.

And there’s the (hot oil) rub. The statement in Dr Walsh’s statement that has sparked the most outrage is the suggestion that the pain that comes from pushing something the size of a watermelon out an opening the size of a lemon is “valuable.” Say what?

It comes down to hormones, says Dempsey.

The pain is driven in the first place by the hormone oxytocin driving the contractions. Oxytocin is called the ‘love hormone’ or the ‘tend and befriend’ hormone, as distinct from adrenaline with is the ‘fight and flight’ hormone. So if women are not feeling safe or supported they will feel adrenaline… there should be small surges of adrenaline and key points in the labour but not continuously.

Oxytocin is involved in pretty well all experiences to do with the range of love experience — from nurture and care in the context of parenting, to sibling and friend relationships to romantic love and sensual and sexual relationships.

So oxytocin is the driver of the labour. Because it also is a hormone that is involved in all these other feeling states, and in particular in this relational mode, if you interfere with the oxytocin, you are not only interfering with the ongoing physiology of the birth but you are also diminishing the hormonal support for bonding with the baby.

After birth, women experience greater surges of this hormone, but an epidural diminishes these surges.

Then there’s the good stuff — the endorphins.

As well as moderating the pain, endorphins create a shift in consciousness which allows the primal brain stem to orchestrate the hormonal response to the labour which means then that the oxytocin is more generally likely to be flowing or surging as our evolutionary birth process has designed.

The endorphins start to kick in once women start to get into established labour which is often when epidurals get introduced.

So why are epidurals encouraged, or at least not discouraged, in many hospitals?

“There is this idea that women shouldn’t have to suffer the unnecessary pain of childbirth,” says Dempsey. “In any situation there will be a number of women where either because of length of labour or some other complication that any number of interventions are beneficial to the outcome for the mother of the baby. Epidurals being one of those things.”

“But what Dr Walsh is pointing out which I agree with, that at the levels that epidurals is being used this is not because of complex labours, it’s because of a particular philosophical mindset.”

Jezebel signs out with:

Assuming that women who choose epidurals are simply sissies who “don’t fancy the pain” — and that they will be lesser mothers as a result — is simply insulting. The only thing this attitude “prepares” moms for is a lifetime of being judged.

But Dempsey says it’s not about judging anyone. “There’s a whole birth culture and social culture which is not built around the woman to make her feel that this is something that she could do.”

Peter Fray

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Peter Fray
Editor-in-chief of Crikey

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