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Interview with Sheila Kitzinger
THE CHILDBIRTH EXPERIENCE
Interview with Sheila Kitzinger
WHM: Your background is in anthropology, and you have described yourself as ‘an anthropologist of birth’. Is childbirth painful in all societies? SK: We tend to speak about pain in very simplistic terms, like a sound produced when a bell is struck. But in fact pain is always perceived within its social context. It is interpreted by the brain, in the context of its meaning and the values that are attached to it. I will give you an example from my research among peasant women and the urban poor in the Caribbean. They welcome low backache in labour, saying it means the door is opening. Their concept of the body during childbirth includes an image of a door that has to open. The sensation of the baby’s head against the sacro-lumbar spine indicates they are making real progress. I am sure that is painful, certainly in way we would interpret pain, but they welcome it. So yes, if by ‘pain’ you mean powerful sensations which can be overwhelming and knock you off balance emotionally, I think it is experienced by women in all societies. There are also some women who do not experience it. On the other hand, my fourth baby was a 40-minute labour from start to finish. It hurt, but it was absolutely wonderful! WHM: But the idea of being able to revel in a sensation that is noxious and unpleasant seems contradictory. SK: Yes, I think one has to be very careful talking about pain in these terms, because people may think that you are loopy, going into a mystical other world. And a woman who has experienced a distressing birth, with a lot of pain, may feel that you are imagining something that does not exist and trying to impose it on her.
Sheila Kitzinger is probably the most well-known childbirth ‘voice’ in the UK. For decades she has campaigned for women to have the information they need to make choices about childbirth. She has written many books, lectures to midwives internationally, is honorary professor at Thames Valley University, and has an informative website (www.sheilakitzinger. com). She trained as an anthropologist. Her research has focused on women’s experiences of antenatal care, birth plans, induction of labour, epidurals, episiotomy, hospital care in childbirth, children’s experiences of being present at birth, post-traumatic stress following childbirth and the many different messages that touch can give during childbirth. Her latest book is The Politics of Birth (Butterworth Heinemann Health, ISBN 0750688769).
WOMEN’S HEALTH MEDICINE 2:4
3
© 2005 The Medicine Publishing Company Ltd
THE CHILDBIRTH EXPERIENCE
© The Politics of Birth, Butterworth Heinemann, 2005
WHM: So does Michel Odent believe that she should be in a shadowy room where she cannot see other people? That could be frightening. SK: I think the important thing is to ask the woman what she wants. WHM: Your first book, The Experience of Childbirth, caused a sensation in the 1960s, not least because it had the pictures of you giving birth, which seemed very shocking. Looking at it now, they seem quite run-of-the-mill. SK: I was surprised by the furore. It was serialised in The Observer! Three different Sundays! The hardback was published by Victor Gollancz, where my brother-in-law worked. Victor Gollanz summoned him in to his office, where he sat behind a huge desk, and said, ‘I have photographs of your sister-in-law’s private parts.’ But he did decide to publish it. A new edition was published last year, but without the pictures because they were not good enough. They were just snapshots. There is now a whole genre of birth photography!
Sheila Kitzinger demonstrating how not to push a baby out.
WHM: Is it a matter of the degree of pain? SK: No, I don’t think it is only a matter of degree. I think it is the context of values and meaning, and that depends on the culture. The culture of birth. And we in our technocratic birth culture take the approach that pain has to be eradicated, completely if possible. WHM: Does pain in childbirth serve any purpose? If so, what?
WHM: The book must have sold a great many copies. Everybody had one.
SK: Oh yes, it does serve a purpose. All over the world, women in labour stop doing their normal tasks and go somewhere to give birth in a place away from men. Otherwise, babies would just drop out all over the place! And because the mother is in pain she calls for help from other women. (There is always woman-to-woman care during childbirth in all traditional societies.)
SK: Not everybody, but it did sell all round the world. WHM: Did you find the attention uncomfortable, or did you think ‘good, people will take notice of what I am trying to say’? SK: The good effect was that women started talking about birth in a way they had not done previously. They had not had the language for it. They needed words to talk about the intensity of the experience, the passion of the experience. And the downside as well as the upside. So I think it opened up communication by women, and that was good.
WHM: But does pain have to be an essential part of that? SK: Yes, I think its function is to say ‘stop making food’, ‘stop cooking this meal’, ‘stop working in the fields’. WHM: That’s an interesting idea – the pain stops you from doing other things. It makes you focus on the birth.
WHM: That was 40 years ago. What have been the most encouraging changes since then, particularly in relation to pain? And presumably there have also been some discouraging developments?
SK: Oh it does. I think it is a safety precaution, and it makes you call in help. Michel Odent [the obstetrician who in the 1970s was the first in the world to introduce birth pools into a hospital] strongly believes that women should be, as far as possible, alone and undisturbed in childbirth. I see his point about being undisturbed because we do disturb childbirth a great deal. You can disturb it just by saying to a woman ‘Good, good, you’re getting through this one very well! Good! GOOD!’ My daughter, when I was saying ‘Good, good’ – this was her first baby – turned to me after a contraction and said ‘Could you just shut up? I know I’m doing well!’ So I learnt something. Michel Odent usually stays outside the birth room when he is attending a birth. He also thinks, for example, that the midwife should not look into the eyes of the woman. She should withdraw, so that she is hardly noticed, hardly there. I think he has a point, but on the other hand I think there also comes a stage in labour, when approaching full dilatation, when you need an anchor. And it is very good to know that someone is there to support you and be with you at every contraction, although they do not necessarily need to say anything. WOMEN’S HEALTH MEDICINE 2:4
SK: In relation to pain, developments have not been encouraging. There is a lot of emphasis on eradicating it, and very little emphasis on how to handle it. Most of us have pain in our lives, and we learn ways of handling it. When a woman is enjoying giving birth hormones are liberated in her bloodstream which take the edge off pain. It is rather similar to somebody rowing in a race or climbing a mountain or surfing who is exerting all their energy, and when you look at the expression on their face you think ‘that looks painful!’ But they don’t notice it, because it is all part of the excitement of what they are doing. There is now perhaps more discussion about this aspect of childbirth, but it does not seem generally accepted that women have the hormonal cocktail ready for birth. Whether they are enabled to experience it depends on the environment. This does not mean having pink walls and a rocking chair. It means the people who are there, and the relationships between the caregivers and the woman in labour. So I suppose, yes, we 4
© 2005 The Medicine Publishing Company Ltd
THE CHILDBIRTH EXPERIENCE
are exploring that aspect more but, on the other hand, you only have to open any parenting magazine, or any woman’s magazine or newspaper to find that pain in childbirth is talked about as if it is just something to be got rid of as fast as possible. And you just hope the means to do so will not affect the baby.
they can suck’. There was a picture of a baby sucking on a bottle. This struck me as appalling miseducation for the next generation! And I am critical of many of the films that are shown to children in schools, for example, about sex education. They showed my 11year-old grandaughter a sex-education film in school of a stallion and a tethered mare mating – and that’s sex! Perhaps the idea is to put girls off! Sex education – of which birth education is a part – tends to be evasive, embarrassed and embarrassing! Whereas I think it should be fun. I go into schools with a foam rubber vagina. The pelvis I have is a box (of the right pelvic shape), and a foam rubber vagina inside it, which gives nicely. And a doll which is the size of a new baby and looks like one. It can be curled to show different positions the baby is in, and rotation and descent of the fetal head. I’ve been into primary schools, and also into classes of older children, with this and I don’t just show it to them, I give birth. I get into a good position for birth, in which I am upright, knees bent with the box in position. And I breathe my way through contractions. We get so they can just see the top of the baby’s head … ‘Here comes another contraction’ [panting loudly]. It’s remarkably like breathing when having an orgasm. It gets quite a reception! I lay it on a bit thicker for the boys and girls when they’re in the upper school.
WHM: What do you think about the tendency to approach birth as a performance, which can make women feel inadequate afterwards? SK: Yes, and the opposite also occurs, ‘My dreadful experience was worse than your dreadful experience’. I have learnt a lot about this from the Birth Crisis Network I set up. Women can ring a number, and I’m often the person who answers, to talk about a distressing birth. I listen and reflect back what they’re saying. I don’t intend to give advice, but I help them to describe how the birth was for them. This is very different from the case notes. It is more like the whole journey through birth that they experienced in terms of a lived experience. These experiences can stay with people for a long time. A woman aged 72 rang yesterday; she had never unloaded her birth experience, and she needed to talk. She had become pregnant as a teenager, and given birth in a home for unmarried mothers, where she was treated with inhumanity. And it had taken her all those years to be able to talk about it.
WHM: Some women do feel shattered by the pain of childbirth that they experienced. How can they be helped?
WHM: What needs to be done now to help women handle pain in childbirth? From what you say, we have not got it right yet.
SK: Yes, and I don’t start talking to them about the joy of pain! I listen and encourage them to describe the pain, where it was, how long it lasted, what they tried to do to deal with it and what other people did to try and help them deal with it. It usually turns out that they felt powerless. They felt stripped of any kind of control over their bodies, because that is what really bad pain does. It is a feeling of powerlessness, of being trapped. Women often use the analogy ‘I felt like fish on a slab’ or ‘meat on the table’. But they may also say that when they have had an epidural.
SK: No. I do think if you are pinpointing pain, you are neglecting bigger issues, of which pain is one part. Women need to look at the benefits and risks of different kinds of intervention, and to think about what they want, and to be able to communicate with their caregivers. They are still very much on the receiving end of care, which can be good care, or negligent care, or harsh care. It is still a matter of women having the vocabulary and realising that birth is a multidimensional experience. I participated in a programme on Woman’s Hour yesterday. A woman on the programme had obviously gone into birth knowing very little, but had wanted a waterbirth. Well she didn’t have a waterbirth. She had a caesarean section. One obvious reason was that the midwives did not feel skilled in waterbirth, and did not feel they were trained for waterbirth. They were anxious – so they were dissuading her from the very beginning. She was in a hostile environment with these nervous midwives. It is almost predictable that things were not going to go well and she does not intend to have another baby.
WHM: So what would you say to a woman who says ‘I’m definitely going to have an epidural?’ Would you perhaps say ‘see how it goes’? Or what? SK: I would not argue with her about whether or not she should have an epidural. I would tell her about other women’s experiences, because certainly there are women who have thought ‘I’ll have an epidural’ and then it has not been immediately available, perhaps because the anaesthetist has been called elsewhere. So we would talk along the lines of ‘How do you think you can cope until the epidural is there for you? You may find that then you are coping rather well.’ Women feel cheated, of course, if they depend on having an epidural as soon as they go in through the hospital door and it is unavailable for whatever reason. They are very angry, and all the other things they feel about the birth are somehow packaged in that anger about not having an epidural when they felt it was due – that they had a right to it. And you may need to listen and help them unpackage it a bit, to identify the other things that made the labour traumatic.
WHM: Really? That’s very sad, if the experience puts people off. SK: There are a lot of babies in the world. I’m not pronatalist! Although I had five! WHM: Do you think more work needs to be done in schools? If so, what? SK: Oh yes. My grandson, aged 5, came home from school with a workbook about what babies can do at different ages: ‘at birth,
WOMEN’S HEALTH MEDICINE 2:4
5
© 2005 The Medicine Publishing Company Ltd
Interview with Sheila Kitzinger
WHM: Your background is in anthropology, and you have described yourself as ‘an anthropologist of birth’. Is childbirth painful in all societies? SK: We tend to speak about pain in very simplistic terms, like a sound produced when a bell is struck. But in fact pain is always perceived within its social context. It is interpreted by the brain, in the context of its meaning and the values that are attached to it. I will give you an example from my research among peasant women and the urban poor in the Caribbean. They welcome low backache in labour, saying it means the door is opening. Their concept of the body during childbirth includes an image of a door that has to open. The sensation of the baby’s head against the sacro-lumbar spine indicates they are making real progress. I am sure that is painful, certainly in way we would interpret pain, but they welcome it. So yes, if by ‘pain’ you mean powerful sensations which can be overwhelming and knock you off balance emotionally, I think it is experienced by women in all societies. There are also some women who do not experience it. On the other hand, my fourth baby was a 40-minute labour from start to finish. It hurt, but it was absolutely wonderful! WHM: But the idea of being able to revel in a sensation that is noxious and unpleasant seems contradictory. SK: Yes, I think one has to be very careful talking about pain in these terms, because people may think that you are loopy, going into a mystical other world. And a woman who has experienced a distressing birth, with a lot of pain, may feel that you are imagining something that does not exist and trying to impose it on her.
Sheila Kitzinger is probably the most well-known childbirth ‘voice’ in the UK. For decades she has campaigned for women to have the information they need to make choices about childbirth. She has written many books, lectures to midwives internationally, is honorary professor at Thames Valley University, and has an informative website (www.sheilakitzinger. com). She trained as an anthropologist. Her research has focused on women’s experiences of antenatal care, birth plans, induction of labour, epidurals, episiotomy, hospital care in childbirth, children’s experiences of being present at birth, post-traumatic stress following childbirth and the many different messages that touch can give during childbirth. Her latest book is The Politics of Birth (Butterworth Heinemann Health, ISBN 0750688769).
WOMEN’S HEALTH MEDICINE 2:4
3
© 2005 The Medicine Publishing Company Ltd
THE CHILDBIRTH EXPERIENCE
© The Politics of Birth, Butterworth Heinemann, 2005
WHM: So does Michel Odent believe that she should be in a shadowy room where she cannot see other people? That could be frightening. SK: I think the important thing is to ask the woman what she wants. WHM: Your first book, The Experience of Childbirth, caused a sensation in the 1960s, not least because it had the pictures of you giving birth, which seemed very shocking. Looking at it now, they seem quite run-of-the-mill. SK: I was surprised by the furore. It was serialised in The Observer! Three different Sundays! The hardback was published by Victor Gollancz, where my brother-in-law worked. Victor Gollanz summoned him in to his office, where he sat behind a huge desk, and said, ‘I have photographs of your sister-in-law’s private parts.’ But he did decide to publish it. A new edition was published last year, but without the pictures because they were not good enough. They were just snapshots. There is now a whole genre of birth photography!
Sheila Kitzinger demonstrating how not to push a baby out.
WHM: Is it a matter of the degree of pain? SK: No, I don’t think it is only a matter of degree. I think it is the context of values and meaning, and that depends on the culture. The culture of birth. And we in our technocratic birth culture take the approach that pain has to be eradicated, completely if possible. WHM: Does pain in childbirth serve any purpose? If so, what?
WHM: The book must have sold a great many copies. Everybody had one.
SK: Oh yes, it does serve a purpose. All over the world, women in labour stop doing their normal tasks and go somewhere to give birth in a place away from men. Otherwise, babies would just drop out all over the place! And because the mother is in pain she calls for help from other women. (There is always woman-to-woman care during childbirth in all traditional societies.)
SK: Not everybody, but it did sell all round the world. WHM: Did you find the attention uncomfortable, or did you think ‘good, people will take notice of what I am trying to say’? SK: The good effect was that women started talking about birth in a way they had not done previously. They had not had the language for it. They needed words to talk about the intensity of the experience, the passion of the experience. And the downside as well as the upside. So I think it opened up communication by women, and that was good.
WHM: But does pain have to be an essential part of that? SK: Yes, I think its function is to say ‘stop making food’, ‘stop cooking this meal’, ‘stop working in the fields’. WHM: That’s an interesting idea – the pain stops you from doing other things. It makes you focus on the birth.
WHM: That was 40 years ago. What have been the most encouraging changes since then, particularly in relation to pain? And presumably there have also been some discouraging developments?
SK: Oh it does. I think it is a safety precaution, and it makes you call in help. Michel Odent [the obstetrician who in the 1970s was the first in the world to introduce birth pools into a hospital] strongly believes that women should be, as far as possible, alone and undisturbed in childbirth. I see his point about being undisturbed because we do disturb childbirth a great deal. You can disturb it just by saying to a woman ‘Good, good, you’re getting through this one very well! Good! GOOD!’ My daughter, when I was saying ‘Good, good’ – this was her first baby – turned to me after a contraction and said ‘Could you just shut up? I know I’m doing well!’ So I learnt something. Michel Odent usually stays outside the birth room when he is attending a birth. He also thinks, for example, that the midwife should not look into the eyes of the woman. She should withdraw, so that she is hardly noticed, hardly there. I think he has a point, but on the other hand I think there also comes a stage in labour, when approaching full dilatation, when you need an anchor. And it is very good to know that someone is there to support you and be with you at every contraction, although they do not necessarily need to say anything. WOMEN’S HEALTH MEDICINE 2:4
SK: In relation to pain, developments have not been encouraging. There is a lot of emphasis on eradicating it, and very little emphasis on how to handle it. Most of us have pain in our lives, and we learn ways of handling it. When a woman is enjoying giving birth hormones are liberated in her bloodstream which take the edge off pain. It is rather similar to somebody rowing in a race or climbing a mountain or surfing who is exerting all their energy, and when you look at the expression on their face you think ‘that looks painful!’ But they don’t notice it, because it is all part of the excitement of what they are doing. There is now perhaps more discussion about this aspect of childbirth, but it does not seem generally accepted that women have the hormonal cocktail ready for birth. Whether they are enabled to experience it depends on the environment. This does not mean having pink walls and a rocking chair. It means the people who are there, and the relationships between the caregivers and the woman in labour. So I suppose, yes, we 4
© 2005 The Medicine Publishing Company Ltd
THE CHILDBIRTH EXPERIENCE
are exploring that aspect more but, on the other hand, you only have to open any parenting magazine, or any woman’s magazine or newspaper to find that pain in childbirth is talked about as if it is just something to be got rid of as fast as possible. And you just hope the means to do so will not affect the baby.
they can suck’. There was a picture of a baby sucking on a bottle. This struck me as appalling miseducation for the next generation! And I am critical of many of the films that are shown to children in schools, for example, about sex education. They showed my 11year-old grandaughter a sex-education film in school of a stallion and a tethered mare mating – and that’s sex! Perhaps the idea is to put girls off! Sex education – of which birth education is a part – tends to be evasive, embarrassed and embarrassing! Whereas I think it should be fun. I go into schools with a foam rubber vagina. The pelvis I have is a box (of the right pelvic shape), and a foam rubber vagina inside it, which gives nicely. And a doll which is the size of a new baby and looks like one. It can be curled to show different positions the baby is in, and rotation and descent of the fetal head. I’ve been into primary schools, and also into classes of older children, with this and I don’t just show it to them, I give birth. I get into a good position for birth, in which I am upright, knees bent with the box in position. And I breathe my way through contractions. We get so they can just see the top of the baby’s head … ‘Here comes another contraction’ [panting loudly]. It’s remarkably like breathing when having an orgasm. It gets quite a reception! I lay it on a bit thicker for the boys and girls when they’re in the upper school.
WHM: What do you think about the tendency to approach birth as a performance, which can make women feel inadequate afterwards? SK: Yes, and the opposite also occurs, ‘My dreadful experience was worse than your dreadful experience’. I have learnt a lot about this from the Birth Crisis Network I set up. Women can ring a number, and I’m often the person who answers, to talk about a distressing birth. I listen and reflect back what they’re saying. I don’t intend to give advice, but I help them to describe how the birth was for them. This is very different from the case notes. It is more like the whole journey through birth that they experienced in terms of a lived experience. These experiences can stay with people for a long time. A woman aged 72 rang yesterday; she had never unloaded her birth experience, and she needed to talk. She had become pregnant as a teenager, and given birth in a home for unmarried mothers, where she was treated with inhumanity. And it had taken her all those years to be able to talk about it.
WHM: Some women do feel shattered by the pain of childbirth that they experienced. How can they be helped?
WHM: What needs to be done now to help women handle pain in childbirth? From what you say, we have not got it right yet.
SK: Yes, and I don’t start talking to them about the joy of pain! I listen and encourage them to describe the pain, where it was, how long it lasted, what they tried to do to deal with it and what other people did to try and help them deal with it. It usually turns out that they felt powerless. They felt stripped of any kind of control over their bodies, because that is what really bad pain does. It is a feeling of powerlessness, of being trapped. Women often use the analogy ‘I felt like fish on a slab’ or ‘meat on the table’. But they may also say that when they have had an epidural.
SK: No. I do think if you are pinpointing pain, you are neglecting bigger issues, of which pain is one part. Women need to look at the benefits and risks of different kinds of intervention, and to think about what they want, and to be able to communicate with their caregivers. They are still very much on the receiving end of care, which can be good care, or negligent care, or harsh care. It is still a matter of women having the vocabulary and realising that birth is a multidimensional experience. I participated in a programme on Woman’s Hour yesterday. A woman on the programme had obviously gone into birth knowing very little, but had wanted a waterbirth. Well she didn’t have a waterbirth. She had a caesarean section. One obvious reason was that the midwives did not feel skilled in waterbirth, and did not feel they were trained for waterbirth. They were anxious – so they were dissuading her from the very beginning. She was in a hostile environment with these nervous midwives. It is almost predictable that things were not going to go well and she does not intend to have another baby.
WHM: So what would you say to a woman who says ‘I’m definitely going to have an epidural?’ Would you perhaps say ‘see how it goes’? Or what? SK: I would not argue with her about whether or not she should have an epidural. I would tell her about other women’s experiences, because certainly there are women who have thought ‘I’ll have an epidural’ and then it has not been immediately available, perhaps because the anaesthetist has been called elsewhere. So we would talk along the lines of ‘How do you think you can cope until the epidural is there for you? You may find that then you are coping rather well.’ Women feel cheated, of course, if they depend on having an epidural as soon as they go in through the hospital door and it is unavailable for whatever reason. They are very angry, and all the other things they feel about the birth are somehow packaged in that anger about not having an epidural when they felt it was due – that they had a right to it. And you may need to listen and help them unpackage it a bit, to identify the other things that made the labour traumatic.
WHM: Really? That’s very sad, if the experience puts people off. SK: There are a lot of babies in the world. I’m not pronatalist! Although I had five! WHM: Do you think more work needs to be done in schools? If so, what? SK: Oh yes. My grandson, aged 5, came home from school with a workbook about what babies can do at different ages: ‘at birth,
WOMEN’S HEALTH MEDICINE 2:4
5
© 2005 The Medicine Publishing Company Ltd