The Theft of Childbirth

I

Childbirth has nowhere been regarded merely as one possible event in a woman’s life. The Hebrews saw in women’s travail the working of “Eve’s curse” for tempting Adam to the Fall. The Romans called it poena magna—the great pain. But poena also means punishment, penalty. Whether as a “peak event” or as a torture rack, childbirth has been a charged, discrete happening, mysterious, polluted, often magical; in our current idolatry, a triumph of technology. Thirty years ago, in Male and Female, Margaret Mead noted the violence done by American hospital obstetrics to both infant and mother in the first hours of life.¹ Within the last few years, partly within and partly outside the women’s movement, criticism of technologized childbirth has been growing, notably in California, where an important case is under appeal by a group of midwives in Santa Cruz who are charged with practicing medicine without a license.

Two recent books, with differing tones and perspectives, criticize the depersonalizing of hospital birth (American-style, though increasingly faddish in Europe) and recommend alternatives. Frederick Leboyer, a French obstetrician, is Americanized in the sense that he assumes that the mother’s problems have been solved by hospital delivery; for him the radical issue is the handling of the newborn in the delivery room immediately after birth. Suzanne Arms, an American photographic journalist and a mother, is concerned with the warping of childbirth in modern obstetrical practice, its transformation into a “medical event” with consequent physical and psychic damage to both mother and child.

The technology of childbirth began with the forceps, first used in the seventeenth century by surgeons as a means of hastening slow labors, but forbidden to—and criticized by—midwives. The forceps and its monopoly by male practitioners were decisive in annexing childbirth—previously a woman’s event often taboo to men—to the new medical establishment, from which women were barred. The annulment of pain by ether-inhalation was discovered by a Georgia doctor in 1842; both ether and nitrous oxide were shortly after used in dentistry by Horace Wells and W. T. Morton, and the term “anesthesia,” suggested by Oliver Wendell Holmes, soon became accepted. In 1847, using ether in a case of childbirth, James Simpson in Scotland showed that contractions of the uterus would continue even if the woman was unconscious, and proceeded to experiment with and use chloroform to relieve the pains of labor.

A fierce theological opposition was mounted; the clergy attacked anesthesia as a “decoy of Satan, apparently offering itself to bless women; but in the end it will harden society and rob God of the deep earnest cries which arise in time of trouble for help.”² The lifting of Eve’s curse seemed to threaten the foundations of patriarchal religion; the pain of labor was for the glory of God the Father. Alleviation of female suffering would “harden” society, as if the sole alternative to the mater dolorosa—the suffering and suppliant mother, epitomized by the Virgin—was the fanged blood-goddess, devourer of her children.

This view still finds expression in anti-abortion rhetoric, and has extended beyond any single issue to feminism in general. After the horrible and lingering death of Mary Wollstonecraft from septicemia, the Rev. Richard Polwhele complacently observed that “she had died a death that strongly marked the distinction of the sexes, by pointing out the destiny of women, and the diseases to which they were peculiarly liable.”³

In the nineteenth century the educated woman was seen as a threat to the survival of the species. “Deflecting blood to the brain from the ‘generative organs’…, she had lost touch with the sacred primitive rhythms that bound her to the deepest law of the cosmos.”⁴ (This was a view later shared by D. H. Lawrence and Hitler.) Patriarchal society would seem to require not only that women shall assume the major burden of pain and self-denial for the continuation of the species, but that a majority of that species—women—shall remain essentially uninformed and unquestioning.

The identification of womanhood with suffering—by women as well as men—has been tied to the concept of woman-as-mother. The idea that a woman’s passive suffering is inevitable has worn many guises in history; not only those of Eve or the Virgin Mary but later masks such as Helene Deutsch’s equation of passivity and masochism with femininity. If the medieval woman saw herself as paying by each childbirth for Eve’s transgression, the nineteenth-century middle-class woman could play the Angel in the House, the martyr, her womanhood affirmed by her agonies in travail. Oliver Wendell Holmes supplies one version of the rhetoric:

The woman about to become a mother, or with her newborn infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law…is arrested in its fall at a word which reveals her transient claim for mercy.⁵

The value of a woman’s life would appear to be contingent on her being pregnant or newly delivered. Women who refuse to become mothers are not merely emotionally suspect, they are dangerous. Not only do they refuse to continue the species, they also deprive society of its emotional leaven: the suffering of the mother.

It was therefore a radical act—the truly radical act of her entire reign—when Queen Victoria accepted anesthesia by chloroform for the birth of her seventh child in 1853. In so doing, she opposed clerical and patriarchal tradition and its entire view of women; but her influence and prestige were strong enough to open the way for anesthesia as an accepted obstetrical practice.

It was also under Victoria that the female body became more taboo, more mysterious, more suspected of “complaints and disorders,” and the focus of more ignorant speculation, than ever before. Female sexual responsiveness was deemed pathological, and the “myth of female frailty” dominated the existence of middle and upper-class women. Childbirth and gynecology were now increasingly in male hands, and the developing medical profession had no more interest in female self-determination than any other institution. If education was supposed to atrophy the reproductive organs, women’s suffrage was seen as creating “insane asylums in every county, and…a divorce court in every town.”

Clitorectomies and ovariotomies were performed on thousands of women as a form of behavior modification for “troublesomeness,” “attempted suicide,” and “erotic tendencies.” The professed “reverence” for (upper-class) women in Victorian England and America consisted largely in an exaggerated prudery.⁶ At the onset of labor, the woman was placed in the lithotomy (supine) position, chloroformed, and became the completely passive body on which the obstetrician could perform as on a mannequin. The labor room became an operating theater, childbirth a medical drama, the physician its hero.

In the early twentieth century various forms of anesthesia were developed specifically for labor. “Twilight Sleep,” a compound of morphine and scopolamine, was widely used until it was discovered to have a highly toxic effect on the infant. Sodium amytal and nembutal were found to produce after-amnesia (while only partly blunting pain), and of nembutal Sylvia Plath’s heroine in The Bell Jar bitterly remarks, “I thought it sounded just like the kind of drug a man would invent.”⁷ The development of caudal or saddle-block anesthesia meant that a woman could remain conscious and see her baby born, though she was paralyzed from the waist down. Speert and Guttmacher, in their textbook Obstetric Practice, admit that the use of caudal or saddle-block anesthesia can prolong the second stage of labor, by producing “uterine inertia…(and) the absence of voluntary expulsive efforts by the mother,” thus rendering a forceps delivery “necessary” where the child might have been born more swiftly and without instruments.

There are certain valid reasons for the prevention of exertion by the mother—such as heart disease, tuberculosis, or a previous Caesarean, ⁸ but women are now asking what psychic effect a state of semihelplessness has on a healthy mother, awake during the birth yet unable to participate actively, her legs in stirrups, her wrists strapped down, her physical engagement with the birth process minimized by drugs and by her supine position. This “freedom” from pain, like sexual “liberation,” places a woman physically at the disposal of men though still estranged from her body. While in no way altering her subjection, it can be advertised as a progressive development.

In the 1940s, the English obstetrician Grantly Dick-Read related pain sensation to fear and tension and began to train prospective mothers to relax, to breathe correctly, to understand the stages of labor, and to develop muscular control through exercise. Dick-Read placed great emphasis on the role of calm, supportive birth attendants throughout labor, especially the obstetrician, who was to act as a source of confidence and security rather than as a surgeon needlessly interfering with or accelerating the birth process. He held that anesthesia should always be available but never involuntarily imposed on the woman or administered routinely.

Dick-Read’s work was of considerable importance and many of his observations are still interesting. However, his attitude to women is essentially patriarchal. While in genuine awe of the female capacity to give birth, he writes of “the inborn dependence of woman” finding its natural outlet in her dependence on the doctor. “Biologically, motherhood is her desire,” he remarks, and “Varium et mutabile semper femina, but never more so than in childbirth.”⁹ For him, childbirth is a woman’s peak experience and purpose in life. Remove fear, reinforce ecstasy, and childbirth can be “natural”—that is, virtually without pain. But the male obstetrician remains in control of the situation.

During the Thirties and Forties, Soviet doctors began applying Pavlov’s theories of the conditioned reflex to childbirth. There had been, earlier, successful deliveries in Russia under hypnosis and in post-hypnotic states. This led to increased emphasis on “suggestion,” which was the basis for the first prenatal training: the creation, during pregnancy, of “complex chains of conditioned reflexes which will be applicable at the confinement. The pregnant woman learns to give birth as the child learns to read or swim.” The conditioning toward pain was to be altered and new reflexes set up; the method is described as “verbal analgesia,” using speech as a conditioning stimulus.¹⁰

In 1951, Fernand Lamaze, a French doctor, visited maternity clinics in the USSR which used the “psychoprophylactic method,” and introduced the method at the French maternity hospital he directed, one serving the families of the Metallurgists’ Union. Lamaze, far more than Dick-Read, emphasized the active participation of the mother in every stage of labor, and developed a precise and controlled breathing drill to be used during each stage. Where Dick-Read favors a level of “dulled consciousness” in the second stage, Lamaze would have the mother aware and conscious, responding to a series of verbal cues by panting, pushing, and blowing. However, as Suzanne Arms points out, the Lamaze method “has the unfortunate side-effect of greatly altering a woman’s natural experience of birth from one of deep involvement inside her body to a controlled distraction.” In her “militant control over her body,” she is “separate and detached from the sensations, smells, and sights of her body giving birth. She is too involved in…control.”¹¹

The work of Sheila Kitzinger in England moves beyond that of Dick-Read and Lamaze to a much broader concept of childbearing as part of the context of a woman’s entire existence. Her “psycho-sexual” method stresses the woman’s learning to “trust her body and her instincts” and to understand the complex emotional network in which she comes to parturition. She insists on both physical and psychic education for childbirth if the mother is to retain “the power of self-direction, of self-control, of choice, of voluntary decision and active cooperation with doctor and nurse.” She strongly favors giving birth at home, usually with a midwife.

The mother of five children herself, she is obviously in a better position to evaluate the sensations of labor than is a male physician; and she unequivocally states that “pain in labour is real enough.” But she also describes the sensuous experience of the vagina opening during expulsion—not as painless, but as powerfully exhilarating. Her grasp of female reality is far broader than that of Dick-Read or Lamaze, but like other writers on “prepared” childbirth, she assumes that babies are born only to married women, and that the husband—present and emotionally dependable—will be an active figure in the birth chamber; and she unhesitatingly states that “the experience of bearing a child is central to a woman’s life.”¹²

Recently, in the United States, there has been widespread interest in various combinations of the Dick-Read, Lamaze, and Kitzinger approaches. The move toward midwife-deliveries and away from the depersonalizing hospital and obstetrician has been a crucial aspect of the women’s health-care movement. There is, however, much to question in the idealized photographs of young and lovely pregnant women, naked or in flowered dresses, in rural communes, romanticized as hippie earth-mothers. The conditions affecting the majority of mothers—poverty, malnutrition, desertion by the father, inadequate prenatal care—are ignored in these accounts.

“Prepared” or “natural” childbirth has been a middle-class phenomenon in this country: but even its crusaders acknowledge with Pierre Vellay that “under good physical and psychological conditions” “the woman can expect childbirth without any pain, provided that no family, money or social worries upset her just before the birth,”¹³ and with Lamaze that “it is natural for a mother to feel depressed about her child’s future when her own is overcast.” Shulamith Firestone, as an early feminist theorist, was understandably skeptical of “natural” childbirth as part of a reactionary “counterculture” having little to do with the liberation of women in general

Firestone sees childbearing, however, as purely and simply the victimizing experience it has often been in patriarchal society. “Pregnancy is barbaric,” she declares, and “childbirth hurts.” She discards biological procreation from this shallow and unexamined point of view, without taking account of what biological pregnancy and birth might be in a wholly different political and emotional setting. Finally, Firestone is so eager to move on to artificial reproduction that she fails to examine the important relationship between maternity and sensuality, pain and female alienation.¹⁴

Ideally, of course, women would choose not only whether, when, and where to bear children, and the circumstances of labor, but also between biological and artificial reproduction. But I do not think we can project any such idea onto the future—and hope to realize it—without examining the shadow-images we carry in us, the magical thinking of Eve’s curse, the social victimization of women-as-mothers. To do so is to deny aspects of ourselves that will rise up sooner or later to claim recognition.

II

In 1955, 1957, and 1959, I gave birth to my three children—all but the first normal births—under general anesthesia. In the case of my first labor an allergic reaction to pregnancy, which was presumed to be measles, might have justified medical intervention. But in each subsequent pregnancy I used the same obstetrician, and was “put out” as completely as I had been for the first. Labor seemed to me something to be gotten through; the child—and the state of motherhood—being the mysterious and desired goal.

During those years I often felt apologetic in talking with women who had had a baby by some variant of the Dick-Read method, or had attempted it. I was told: “It hurt like hell, but it was worth it”; or, “It was the most painful, ecstatic experience of my life.” Some women asserted that they had ended crying for anesthesia; others were on the delivery table, anesthetized against their will. At that time, even more than now, the “choice” a woman made of the mode of delivery was likely to be her obstetrician’s choice. But, among those who were awake at delivery, a premium seemed to be placed on the pain endured rather than on an active physical experience. Sometimes I felt that my three unconscious deliveries were yet another sign of my half-suspected inadequacy as a woman: the “real” mothers were those who had “been awake through it all.”

I think now that my refusal of consciousness (approved and implemented by my physician) and my friends’ exhilaration at having experienced and surmounted pain (approved and implemented by their physicians) had a common source: we were trying in our several ways to contain the expected female fate of passive suffering. None of us, I think, had much sense of being in any real command of the experience. Ignorant of our bodies, we were essentially nineteenth-century women where childbirth (and much else) was concerned. (But, unlike our European sisters, none of us dreamed of having a baby at home, with a midwife. In the United States that was a fate reserved for the rural poor.)

We were above all in the hands of male medical technology. The hierarchal structure of the hospital, the definition of childbirth as medical emergency, the fragmentation of body from mind were the environment in which we gave birth, with or without analgesia. The only female presences were nurses, whose training and schedules precluded much female tenderness. (With gratitude and amazement, I woke in the recovery room after my third delivery to find a young student nurse holding my hand.) To lie half-awake in a barred crib, in a room with other women moaning and tossing under drugs, where “no one comes” except to do a pelvic examination or give an injection, is a classic experience of modern childbirth. The loneliness, the sense of being in prison, powerless and forgotten, is the chief collective experience of women who have given birth in American hospitals.¹⁵

Brigitte Jordan, an anthropologist studying childbirth in different cultures, describes routine hospital delivery in the United States as:

a complex of practices…justified, on medical grounds, as being in the best interests of mother and child…induction and stimulation of labor with drugs, the routine administration of sedatives and of medication for pain relief, the separation of the laboring woman from any sources of psychological support, surgical rupturing of the membranes, routine episiotomy, routine forceps delivery, and the lithotomy position for delivery, to name just a few.¹⁶

Her point is not that medical interference should never occur, but that childbirth here is a “culturally produced event,” pursued with the same relentless consistency of method without regard to individual aspects of labor. Episiotomies are justified as preventing tearing in the perineum, but tearing is much more likely when a woman gives birth in the lithotomy position than when squatting, on a birthstool, or (as in the Yucatan) supported in a hammock. Forceps deliveries are also more often required in the lithotomy position, where the full force of gravity cannot aid in the expulsion of the child.

Jordan stresses that in cultures as different as Sweden and Yucatan women have a part in the decisions relating to their deliveries. The Yucatan midwife emphasizes that “every woman has to buscar la forma, find her own way, and…that it is the midwife’s task to assist with whatever decision is made.”¹⁷ This does not mean that births are painless, but that needless pain is avoided, birth is not treated as a medical event, and the woman’s individual temperament and physique are treated with respect.

The artificially induced and stimulated labor, so common in this country, creates longer, stronger contractions with less relaxation-span between them than the contractions of normal labor. This in turn leads to the use of pain-relieving drugs; medical technology here creates its own artificial problem for which an artificial solution must be found. Moreover, these unnaturally strong and lengthy contractions often deprive the fetus of oxygen, while the analgesic drugs interfere with its respiration. If labor in the United States were induced only in cases of medical necessity, only about 3 percent of births would be induced. In fact, at least one in five births are drug-induced or stimulated, for the physician’s convenience and with no medical justification whatsoever.¹⁸

Tucho Perussi, an Argentine doctor, crusades for a return to the obstetrical stool, pointing out that in the lithotomy position a contraction which pushes a fetus downward can be compensated against by the fetus sliding backward, thus lengthening labor, while in the vertical position gravity keeps the fetus from losing ground between contractions. Dr. Robert Caldeyro-Barcia of Argentina puts it succinctly: “Except for being hanged by the feet…the supine position is the worst conceivable position for labor and delivery.” ¹⁹ Vertical delivery prevents loss of oxygen to the fetus which results when the uterus is lying on the largest vein in the body (the vena cava). The chief objection to the use of the obstetrical stool or chair seems to be that obstetricians believe it would be inconvenient for them in attending births.²⁰

The writers cited above have concerned themselves with the labor and birth process, though they criticize the hospital practice of separating child from mother immediately after birth, often for hours. Frederick Leboyer assumes that the mother’s problems have been solved by modern obstetrics, including analgesia, and concentrates on the child’s birth trauma. He evokes the experience of being forced through the birth canal by powerful contractions, in highly charged language:

An intransigent force—wild, out of control—has gripped the infant…. The prison has gone berserk, demanding its prisoner’s death…this monstrous unremitting pressure that is crushing the baby, pushing it out toward the world—and this blind wall, which is holding it back, confining it—These things are all one: the mother!…

It is she who is the enemy. She who stands between the child and life…. The infant is like one possessed. Mad with agony and misery, alone, abandoned, it fights with the strength of despair. The monster drives the baby lower still. And not satisfied with crushing, it twists it in a refinement of cruelty…. And the infant’s head—bearing the brunt of the struggle…why doesn’t the head give way? The monster bears down one more time….²¹

After this cataclysmic struggle, Leboyer insists that the handling of the infant should be rhythmic, tranquil, and as respectful as possible. The child is to be placed on the mother’s belly, on its stomach, and slowly, gently massaged by hands that recall, in their rhythmic stroking, the “peristaltic wave” of the womb; hands that “make love to the child.” (These hands, apparently, belong not to the mother but to the obstetrician; Leboyer seems to assume that mothers have to be taught how to touch their children for the first time.) The umbilical cord is not to be severed until the child breathes naturally through its lungs and is no longer receiving part of its oxygen supply from the mother. The child is then placed in a bath warmed to body temperature where it can re-experience the amniotic waters and sense of weightlessness.

According to Leboyer, the expression on the face of an infant whose transition into life is eased by this procedure is relaxed, alert, even smiling. The eyes open and seem to focus, the hands play as the child unfolds in the warm bath. And certainly the photographs accompanying his text show infants encountering life with a rapt, thoughtful gaze instead of the anguished mask of the newborn.

Respect for weakness and vulnerability is so rare, both within and without the medical establishment, that Leboyer’s book (actually an inflated pamphlet, and, at $7.95, an expensive rip-off), with its concern for the newborn’s acute sensitivity, may appear more original and radical than in fact it is. With the exception of his preference for a semidarkened, hushed delivery room, in which even the mother is urged to utter no loud or sudden sound, his methods, described and defended in oracular tones, have been standard procedure for midwives in various parts of the world. In the heavily technologized, physician-centered ambiance of hospital obstetrics, his proposals indeed seem radical, and have been under heavy attack.

But what is disturbing in Leboyer’s presentation of these methods is not simply his didactic tone but his identification with the infant to the virtual exclusion of the mother. She appears as the “monster” of the uterine contractions, as a belly on which the child is laid, hands that hardly know how to touch her newborn; but the physiological and psychic bond between mother and child is all but dismissed. The heroes of this obstetrical drama are Leboyer and the baby. He goes so far as to observe that each person attending a birth undergoes a kind of transference to the newborn, a return to their own birth struggle, and he believes that the obstetrician’s haste to cut the cord and hear the child cry vigorously has little to do with good midwifery or the child’s needs, being an unconscious identification with the child’s fight for breath.²² (But is this true for women? Does a woman attending a birth identify exclusively with the child?)

Leboyer himself seems possessed both by this transference and by a male need (seen in couvade also) to take over the mana of birth. Assuming as he does a physician-controlled hospital birth, a mother drugged for an “almost painless delivery,” his “birth without violence” is already violent. He fails to recognize, for example, that the infant’s torment in the birth canal can be increased and lengthened by the obstetrical “solution” he accepts for the mother. The limitations of Leboyer’s approach can be appreciated when it is compared to Suzanne Arms’s much more comprehensive view of childbirth. She matter-of-factly describes how in the Amsterdam Kweekschool the midwife bathes the newborn in lukewarm water

very much like its earlier nine-month home. Then she patted the baby dry; wrapped it, and placed it in the mother’s arms, generally just three minutes after birth…. Perhaps most amazing of all was the peaceful yet alert way in which the newborn infants adjusted to their first hours after birth. Even when the darkened nursery (used only at night) was more than half full, often not one baby was crying.²³

Infant and mother are a continuum, and sensitive treatment of the one is incomplete without sensitive treatment of the other. Immaculate Deception both demystifies and pleads for rehumanizing the entire birth and postpartum, for the sake of both mother and child, whose psychic and physical welfare Arms, unlike Leboyer, sees as inseparable.

Placed directly upon its mother’s belly, while still connected to her placenta (by the unsevered umbilical cord), the baby finds the nipple and begins its first suckling activity. The mere licking of the mother’s nipple triggers the nerves in her breast to alert the uterus that the baby is out and safe. In immediate response, the uterus clamps down to begin to expel the placenta. Meanwhile, the suckling action of the baby stimulates its breathing and heat productivity. Most important, the newborn finds peace and calm in direct contact with its mother’s warm body. This moment of security is the first it has known since the onset of labor.²⁴

By contrast, in most American obstetrical units, the infant is immediately separated from the mother, with whom it may have no further contact until the hospital schedule permits it to be brought from the nursery. This separation not only violates a process still unfinished (the expulsion of the placenta, the natural stimulation of the infant’s breathing) but, according to pediatric studies quoted by Arms, weakens the establishment of the “exquisitely important” early mother-child bond, on which the capacity to form intimate relationships strongly depends, and may lead to psychic stress in the child and even to the “battered-child” syndrome.

Of sixteen developed countries, in 1971 and 1972, the United States had the highest infant mortality rate; as of 1973 the rate of decline in these statistics was slower here than in nineteen other countries. Immaculate Deception is a gathering of concrete evidence that hospital delivery, always insisted upon on the grounds of its greater safety, actually contributes to infant mortality in the United States, not to speak of infant brain damage and retardation resulting from the oxygen deprivation caused by the lithotomy position, and toxic damage to the infant caused by drugs administered—most often needlessly—to the mother.

Through accumulated examples, Arms details how the requirements of the OB unit and its panoply of technology became the central issue. The mother’s body is hooked to machines and intravenous units during labor; her belly may not be touched or massaged by human hands lest the fetal heart monitor be disrupted; contractions may be spurred or retarded by drugs in accordance with the doctor’s lunch hour or the delivery room schedule. She is attended by no single person throughout her labor; shifts change, nurses, interns, anesthetists, technicians move in and out; often even her husband is denied access to her.

Arms has also studied home births and midwifery in other Western countries and in the few parts of the US where home-midwifery (as distinct from hospital nurse-midwifery) is practiced. She reports that even as women in the United States are beginning to demand home births, American obstetrical super-hardware is selling itself in countries like England, Holland, and Denmark which have a long tradition of midwifery, maternity clinics, and home births, with a complete backup system of emergency obstetrical care. Despite the much lower infant mortality in Western Europe, the promise of “quick and easy” technological obstetrics is making inroads. Meanwhile, in the United States, “American doctors resist any move to take birth out of the hospital or to make it a woman’s event.”²⁵

But the most moving and impressive parts of her book are those in which the midwives and mothers speak, or in which midwife-assisted births are described. Arms does not, of course, claim that the hospital alone is the creator of pain in childbirth, although she does point out that hospitals are associated with “disease and disorder” and that when a woman in labor enters one her tension is increased by the atmosphere of medical emergency. Fear, she insists, rather than “pain,” is the real barrier separating women from birth. And she rightly observes that “after centuries of ingrained fear, expectation of pain, and obeisance to male domination, she cannot easily come to childbirth a ‘changed woman’ after a few classes in natural childbirth or a heavy dose of Women’s Liberation.”²⁶ What we bring to childbirth is nothing less than our entire socialization as women.

It can be objected that, just as there may be individual obstetricians who are compassionate and flexible, so there may be cold and unsympathetic midwives.²⁷ But the question here is not really one of individuals, any more than in the prison system. Medical tradition schools the doctor to the role of officer of an army, one increasingly technologized. Success, in that tradition, has involved (in the United States especially) embracing the drug industry, the technological solution. Above all, the hospital is a place for disease, and childbirth is not an illness.

Midwives, undoubtedly, vary. But the question is really whether a woman can freely choose to give birth at home, attended by a woman, or at least in a maternity clinic which is not a hospital. It is a question of the mother’s right to decide what she wants: to “buscar la forma.” At this time it is extremely difficult and usually illegal for a woman to give birth to her child at home attended by a self-described professional midwife. The medical establishment continues to claim pregnancy and parturition as a form of disease. The real issue, apart from economic profit, is the mother’s relation to childbirth. To change the experience of childbirth means to change women’s relationship to fear and powerlessness, to our bodies, to our children; it has far-reaching psychic and political implications.

Suzanne Arms provides a patiently reasoned, documented indictment of the American hospital as a place for normal births (and 90 percent of all births are normal ones). But taking birth out of the hospital does not mean simply shifting it into the home or into maternity clinics. Birth is not an isolated event. It has been a central experience in which women have historically felt out of control, at the mercy of biology or chance. If there were local centers to which all women could go for contraceptive and abortion counseling, pregnancy testing, prenatal care, labor classes, films about pregnancy and birth, routine gynecological examinations, discussion groups through and after pregnancy, women would be encouraged to think, talk, and read about the entire process of gestating, bearing, nursing their children, and about the alternatives to motherhood.

III

Childbirth is (or may be) one aspect of a woman’s entire life, beginning with her own expulsion from her mother’s body, her own sensual suckling or holding by a woman, through her earliest sensations of clitoral eroticism and of the vulva as a source of pleasure, her growing sense of her own body and its strengths, her masturbation, her menses, her physical relationship to nature and to other human beings, her first and subsequent orgasmic experiences with another’s body, her conception, pregnancy, to the moment of first holding her child. But that moment is still only a point in the process if we conceive it not according to patriarchal ideas of childbirth as a kind of production but as part of female experience.

Beyond birth comes nursing and the physical relationship with an infant, and these are enmeshed with sexuality. Mary Jane Sherfey has shown that during pregnancy the entire pelvic area increases in vascularity (the production of arteries and veins), increasing the capacity for sexual tension and greatly increasing the frequency and intensity of orgasm. Moreover, during pregnancy the system is flooded with hormones which not only induce the growth of new blood vessels but increase clitoral responsiveness and strengthen the muscles effective in orgasm. Thus a woman who has given birth has a biologically increased capacity for genital pleasure, unless her pelvic organs have been damaged obstetrically, as frequently happens.

Many women experience orgasm for the first time after childbirth, or become erotically aroused while nursing. Frieda Fromm-Reichman, Niles Newton, Masters and Johnson, and others have documented the erotic sensations experienced by some women in actually giving birth. Since there is a strong cultural force which attempts to desexualize women as mothers, the orgasmic sensations felt in childbirth or while suckling infants have probably till recently been denied even by the women feeling them, or have evoked feelings of guilt. Yet, as Niles Newton reminds us, “Women…have a more varied heritage of sexual enjoyment than men”;²⁸ and Alice Rossi observes,

I suspect that the more male dominance characterizes a Western society, the greater is the dissociation between sexuality and maternalism. It is to men’s sexual advantage to restrict women’s sexual gratification to heterosexual coitus, though the price for the woman and a child may be a less psychologically and physically rewarding relationship.²⁹

The divisions of labor and allocations of power in American society demand not merely a suffering Mother, but one divested of sexuality: the Virgin Mary, virgo intacta, perfectly chaste. Women are permitted to be sexual only at a certain time of life. The sensuality of mature—and certainly of aging—women has been perceived as grotesque, threatening, and inappropriate.

If motherhood and sexuality were not wedged resolutely apart by male culture, if we could choose both the forms of our sexuality and the terms of our motherhood or non-motherhood freely, women might achieve sexual autonomy (as opposed to “sexual liberation”). The mother should be able to choose the means of conception (biological, artificial, or even parthenogenetic), the place of birth, her own style of giving birth, and her birth attendants. Birth might then become one event in the unfolding of our diverse and polymorphous sexuality—not a necessary consequence of sex, but one aspect of liberating ourselves from fear and the loathing of our own bodies.

Patriarchal childbirth—childbirth as penance and as medical emergency—and its sequel, institutionalized motherhood, is alienated labor, exploited labor, keyed to an “efficiency” and a profit system having little to do with the needs of mothers and children, carried on in physical and mental circumstances over which the woman in labor has little or no control. It is exploited labor in a form even more devastating than that of the enslaved industrial worker who has, at least, no psychic and physical bond with the sweated product, or with the bosses who control her. Not only have conception, pregnancy, and birth been expropriated from women, but also the deep paraphysical sensations and impulses with which they are saturated.