Read - Childbirth without fear: the principles and practice of natural childbirth

Ina May Gaskin

I had no idea when I first read Childbirth Without Fear at the tender age of sixteen that the book would set the course of my life to an extent that is only obvious to me now. I found the book in the public library in my hometown and began what became a lifelong study of birth. Birth was a fascinating and mysterious subject at that time in my sheltered life, and this was the only book I could find about it. The edition I read had no photos, but it prepared me for birth and, amazingly, it prepared me to be a midwife in so many ways that its hard to list them all.

Grantly Dick-Reads description of birth as a biological process, the functioning of which goes best when the labouring woman is calm and unafraid, made sense to me, because it matched all of the stories that I had overheard during the summer I spent at my aunt and uncles farm when I was nine. In case you dont already know this, family farmers talk about birth a lot. My aunt took care to school me on the principles of mammalian birth, principles that my cousins had learned at a much earlier age. Even though I never had a chance to be around a labouring animal or see any kind of birth or pictorial representation of birth in any species, I quickly learned that it is inexcusable behaviour to frighten or bother a labouring female. I also learned how easy it is to unintentionally cause complications in birth in this way.

Never having been exposed to frightening birth stories when I read Childbirth Without Fear (my mother had assured me that giving birth was something that women could do), it wasnt hard for me to accept Dick-Reads message that approaching birth with a positive attitude of trust in ones body and in nature would enhance the spiritual experience that birth was meant to be. He made birth seem an exciting adventure that lay ahead, one that a man might even wish he could experience himself. What could be more encouraging to a young woman than to read a book by a doctor who described birth in this way?

What I didnt know when I was expecting my first baby in the mid-1960s was that hospital birth practices in most parts of the United States (including the place where I lived) were radically different Had I read that chapter before my first pregnancy, it would have warned me about the treatment I would encounter in a typical US hospital. That chapter recorded Dick-Reads astonishment at the degree of ignorance of the physiology of birth in healthy women and the practice of deliberate injury to women (on the excuse that this avoided worse injury) that characterized mainstream obstetrics when he toured many US hospitals over three months in the late 1950s: It seemed there was no possibility of an emergency arising that could not be dealt with immediately, he wrote, but there was no provision for the absence of emergency or abnormality. I was told it did not happen!

As a gynaecologist, Dick-Read knew that many women who had had episiotomies suffered from gynaecological problems caused by the episiotomy itself, and that an episiotomy in a healthy woman often destroyed her enjoyment of further sexual contact with her husband. Knowing from his own experience that 90 per cent of healthy women attended by a competent obstetrician or midwife could give birth without episiotomy or other trauma, he asked several US obstetricians why every womans perineum was deeply cut before the birth of the baby. Their answers amazed him. Episiotomies not only prevented tears, he was told, but they kept the babys head from acting as a battering ram against the rigid perineum of the mother. In each hospital he visited, two-thirds to three-fourths of US babies were being pulled from their mothers bodies with forceps, and episiotomies were mandatory because student doctors were taught it was dangerous for a baby to be born without first cutting through the mothers perineal muscles.