Personal Views

Becoming a grandmother—Has childbirth really changed?

BMJ 1996; 312 doi: (Published 01 June 1996) Cite this as: BMJ 1996;312:1426
  1. Ann Oakley

    It was a long labour—23 hours from when the membranes ruptured to the birth. But then the length of labour has always been one of the subjects on which mothers and obstetric case notes tend to differ. There are quite a lot of things that mothers and health professionals disagree about, and it is partly because we now understand these better that childbirth has changed so much over the past 30 years.

    Women in Britain used to give birth in a horizontal position and in the presence of masked and gowned hospital staff without the support of familiar companions. The dehumanising rituals of shaving and enemas prevailed. No one was allowed to eat in labour, and walking around or even getting off the bed were unthinkable. And then all the new gadgetry of electronic fetal heart rate monitoring, syntocinon pumping machines, and epidural analgesia arrived to make the labouring mother even more of a hostage to technology. No wonder women complained.

    This was how it was when my own first child was born in 1967. And here he was with his partner, Sanja, awaiting the birth of his own first child in a wilting, resource starved London hospital. Sanja comes from a culture (Croatia) that puts more trust in women's experiences than our own, and her mother lives in Zagreb, so she had asked me to be with her during labour. It was not the first childbirth I had attended apart from my own three; my work as a sociologist had included observations of many births. But this was not just any birth. This was the birth of a child I expected to love and know intimately. Why does no one tell you how to be a grandmother?

    I thought about this during the long hours of labour, but mostly I thought about social support. For now we understand that technology is not always good. For example, shaving does not reduce infection and your enema is not always necessary. Even the hallowed practice of withholding nourishment is fairly unscientific. Now we know that social support in labour is associated with less medication for pain relief, including fewer epidurals, fewer operative deliveries, and better psychosocial health for women after childbirth.

    The midwives who attended Sanja respected her desire to have Adam and me with her, and they did not seem to mind the stream of other Oakleys and friends who drifted in and out of the fathers' waiting room all night. I did notice that the technology contended somewhat for the midwives' attention, rather as it had in the old days. Several hours, it seemed, were spent adjusting bits of the electronic fetal heart rate monitor. Sometimes it seemed that the machine was more important than the baby.

    Childbirth is brutal and bloody. You always tend to forget just how much it challenges a woman's body—and all that paraphernalia of femininity and modesty that being a woman in our culture means. The baby was born at 3 am. Because Adam and Sanja were occupied with the third stage, I was given her to hold. She peered around her with the marvellously intense navy eyes of the newly born. I could almost sense her wondering what kind of world she had come into. Could she count on the benefits of social support, health care, education, a decent standard of living—all those human rights to which all babies ought to be entitled?

    You could say that the birth was a success. No epidural or pethidine; four hours in the second stage and we kept the doctors away. But as in the old days the doctors were hovering with their forceps outside the door, and various threats were made about having “to give you a little help to get the baby out.” But the midwives' healthily competitive attitude triumphed and the doctors stayed outside the door.

    No one showed Sanja how to breastfeed or how to change a nappy—perhaps they thought she had enough social support. Sanja and the baby went home the next afternoon—she gave up waiting for a doctor to discharge her.

    Adam bought flowers for the midwife, as we had done for his birth. I went back to work. But I kept replaying the birth in my head, like a video. And I have the baby photos, which people are fed up with seeing. In any case, time has moved on and the baby is nearly a kilo heavier now, with that fine pearly look of breastfed babies. Continuing disputes about names and worries about spots on the cheeks have taken over.

    The point is that the baby belongs to Adam and Sanja. I count it as an enormous privilege to have been at her birth, I am so glad that I got to know her so soon after she was born, and I am pleased that childbirth has changed. Would it be ungrateful to say that I would just like it to change some more?—ANN OAKLEY is a professor in social science in London

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