&ldquoIn northern industrialised countries – and increasingly all over the world – our culture of birth is heavily medicalised. On TV, birth is presented as a medical event that is safe only in the hands of doctors, and if women obey the doctors, everything turns out all right. Those who ask questions or opt for home birth are setting themselves up for a medical emergency”

[Birth Crisis – Sheila Kitzinger ]

For over …. Sheila Kitzinger has been asking questions about how we, as a society, treat women in childbirth. She has been described as 'the high priestess' of the birth movement, and is a vigorous campaigner for the rights of women in matters of birth, motherhood, and sex. Her latest book, Birth Crisis looks at the experiences of women who give birth within the hospital system, raising questions about power-relationships, unnecessary techniques that damage women physically and mentally, and the way &ldquoin which childbirth is managed in the 21st Century”.

Three Monkeys Online was intrigued, and Sheila Kitzinger was kind enough to respond (via email) to our questions.

While plenty of evidence exists to suggest that less rather than more medical intervention is needed in childbirth, the system in many European countries remains largely in favour of the medical ‘management’ of childbirth. What’s stopping the system from changing?

Anyone who possesses power over territory and other people has a vested

interest in maintaining that power. Even with the best of intentions to

humanise childbirth, it is easier for care-givers and managers in hospitals

to keep control of the territory and systems of work, lay down protocols

that must be obeyed, and maintain the institutional hierarchy so that there is

clear line of command.

It is also in the interest of international pharmaceutical companies and

medical equipment manufacturers to promote their products and develop new

ones, thus stressing technological and medical elements in the management of

birth.

Many women in Western Europe are choosing to have fewer children, and to start their pregnancies later in life. What effect does that have on how we, as a society, manage our health system? For example, here in Italy many tests, scans etc become both free and recommended for pregnancies in women over 35, as their pregnancies are considered to be high risk (high risk both for medical and emotional reasons – if a woman miscarries in her late thirties, there’s the obvious risk that she may not become pregnant again).

As women start to have families at a later age more and more pregnant women are

classified as high risk. Treated as high risk, with induction of labour, continuous electronic fetal monitoring,

and instrumental delivery or Caesarean section, they become high risk.

How much of an influence, in your opinion, has television/film had in developing our current attitudes to childbirth?

The media generally has a terrific impact on attitudes to birth. On TV,

for instance, medical sit-coms depict situations of drama and danger, and any women

hoping for a home birth almost universally end up with a rush to hospital

and a Caesarean section.

What role has sexual politics played in the medicalisation of birth? Can the emphasis on hospital births be understood as the male colonisation of a hitherto almost exclusively female space?

Certainly obstetric control over birth means that men are usually at the

top of the hierarchy, since most obstetricians are male. This is not true,

however, in Russia, where most obstetricians are female, as they have low status

relative to other specialists.

You describe episiostomy as a “ritual mutilation”. While certainly controversial and perhaps over-used, to describe the technique in terms of ‘ritual mutilation’ seems to ascribe a sinister motivation on the part of obstetricians. Surely obstetricians are working to ensure the safe delivery of the baby and the well-being of the mother?

Episiotomy is, without doubt, mutilation, and there is strong research

evidence that it is employed unnecessarily. To say that is it ritualised

does not imply that it is sinister. A priest who baptises a baby is

conducting a rite. He need not have sinister motives. I agree that

obstetricians are committed to doing the best they can for the mother and

baby. The problem is that they frequently ignore research evidence.

Birth Crisis outlines many of the real and horrific problems that may await a woman in our current childbirth ‘system’. Does it, though, characterise the majority experience of women who give birth in countries like the U.K? What kind of percentage of women have traumatic birth experiences in UK hospitals? Isn't it fair to say that birth is, by nature, traumatic, and that a certain percentage of women are likely to suffer from some form of post-traumatic-stress syndrome after either a natural or medicalised birth?

Research into PTSD is inadequate because many women who seek help for

distress after birth are diagnosed as suffering from depression, when in

fact they are anxious and panic-stricken. Many women never go to their

doctors because they are ashamed at how they feel, or think that nothing can

be done about their distress.

Published research in the UK reveals that one in twenty women is diagnosed as having

PTSD after childbirth.

Birth can be ecstatic. It can be thrilling, dramatic, and overwhelming. It

need not be traumatic. I don’t think we know what ‘natural birth’ is any

longer. Even women who have spontaneous vaginal births may be put to bed,

prohibited from eating, have each phase of labour controlled by the clock,

encounter complete strangers during labour, and be told when and how to push.

There is, it seems to me, a certain paradox in the book in relation to the subject of the epidural. Throughout the book you argue, justifiably, that women need to take control of their own birth experience, and refuse to bow down to supposedly 'superior' medical knowledge. And yet you seem to suggest that women should not be necessarily trusted to take the 'right' choice in relation to pain relief. One of the first moves by the new Minister for Health in Italy has been to make epidurals free for all women – a move to be welcomed or a step that will serve only to exasperate the 'birth crisis'?

I agree that epidurals should be free of charge for every woman. There

should be no discrimination against a woman because she cannot pay. It is

up to each one to decide whether she needs drugs for pain relief, and if

so, which drug to select.

We may make a choice which, in retrospect, is the

wrong one. I may choose rose pink to paint my bedroom wall, and then realise

that it was the wrong choice. Right through life we need to weigh up the

pros and cons of different courses of action, come to decisions, accept the consequences,

and learn for the future.

In much of Western Europe the term 'birth crisis' is taken to mean dramatically falling birth rates or the absence of births, rather than how it is understood in the context of your book – a problem in the way we treat actual births. Are the two different understandings of the term connected – i.e does the way we treat childbirth have any impact on the decision by many women to have fewer or no babies?

I don’t know if women are having fewer babies because they dread

childbirth, and are able to avoid pregnancy with effective contraception.

Doubtless many do achieve this. But in the lives of many women with many

children today who are also working outside the home there are so many variables

that it would be rash to come to a definite conclusion.

Connected to the above question, politicians throughout Europe run on tickets of 'family values', offering solutions to falling birth rates such as baby bonuses etc. Much of the campaigning sounds like rhetoric, and birth rates continue to fall. If you were given a government mandate to change the health system in relation to childbirth, what concrete steps would you take?

Create a Health Service budget that enables women to have continuity of

care and 1-2-1 midwifery. Establish midwife-led centres in every

community. Train midwives to be confident and capable in attending

home births, and make them freely available for women.

Promote one-to-one care for all women, wherever they give birth. Engage

independent midwives, paid for by the health system, and ensure that this

is practicable.

Provide maternity payments and paternal paid leave so that every woman can

take 6 months off work after childbirth, and similar payments for fathers

who choose to do so.

I would suggest that birth, like death, has become a taboo subject in the 'developed' world. We know it happens, but the details are generally left undiscussed. In that vacuum, pregnant women by necessity have to rely on medical opinion and prevailing trends. Do you agree that birth has become taboo, and how can that taboo be broken?

I don’t think birth is taboo. I do think we no longer realise what

birth without any intervention is like, and that we have lost confidence in

our own bodies.

Birth Crisis is published by Routledge. Art work by Jo Nesbitt