CHILDBIRTH WITHOUT FEAR
by Grantly Dick-Read M.D.
From the 5th edition (revised and edited)
CHAPTER 9
The Influence of Memory
Is it unreasonable that we should pause to consider the mental
picture of labor within the mind of a woman? Is it not essential
that we should create by education and instruction the true and
natural happiness of motherhood within the vision of her mind?
The mental picture of her anticipated experience should be the
image of all that is beautiful in the fulfillment of her love.
For the body is only a vehicle in which and from which a child is
miraculously made and produced. It is the mind of woman that
knows passion and desires the fulfillment of her biological
purpose. It is the mind-its receptivity and its ability to
integrate the fund of new thoughts and feeling that are the
physiological visitations of love and pregnancy-that molds and
fashions the child. It is the mind that bears the spiritual
imprint of the newborn child and around it writes indelibly the
mysterious circumscription of love.
Francis Galton wrote much on the importance of the mind that has
been overlooked in the modern teaching of medicine.' His
investigations emphasize the vividness with which images, based
upon thought and association, can be reproduced in the mind.
Sights, sounds, and associations, real and imaginary, imprint
themselves upon the human mind to mold and influence its
reactions.
As Pavlov points out in his important work on conditioned
reflexes, the things that give the greatest pleasure will become
conditioned causes of acute fear and hatred if continually
offered with a terrifying accompaniment.' Both objective and
subjective associations can condition stimuli that provoke fear
reactions to labor. I know single women who, their natural
longing for a child obliterated from their minds, shudder when
childbirth is mentioned. Associations of pain and mental pictures
of agony and death have become conditioned stimuli for such fear
and abhorrence that these women seek permanent refuge in
virginity and spinsterhood. There are some women who have had one
baby who have been known to refuse all marital relations forever
after for fear they should have to experience labor again. Even
love for the child cannot override the fear and pain that its
arrival occasioned. What devastation to homes, husbands, and
children one ill-conducted labor can bring!
Owing to the nature of Pavlov's experiments, the concept of the
conditioned reflex is often associated only with salivating dogs,
meat, and bells. But earlier writings, such as Galton's in 1883,
made it apparent that the recurrent stimulus frequently arises
within the mind. The memory, or even the visualization, of an
incident may surround a natural and physiological function with
an aura of pain or pleasure so vivid that normal reflexes are
disturbed. Just as a colored light will produce defense reactions
of pain in a dog who was hurt when the light appeared, so will
the words "baby," "childbirth," "labor," or even "motherhood"
produce emotional states and their physical manifestations in
women who suffered in parturition, and every act that leads, in a
normal sequence of events, to the association of painful
childbirth will give impetus to the primitive instinct to escape.
Fear of childbirth, then, becomes the great disturber of the
neuromuscular harmony of labor. I do not wish it to be inferred
that childbirth should be looked upon as a mental process. But
obviously the mechanical efficiency of this function not only
depends upon the structures and forces of the body but upon
emotional stimuli, and upon the integrity of the influences to
which the emotions are subjected.
NEGATIVE INFLUENCES
Many young women from the age of puberty and even before have
inquiring minds, particularly in relation to childbirth. Few hear
much that is encouraging from those of their own age, but since
the temptation to seek information is not curbed, again and
again, drawn as if by sirens, they satiate their greed for
knowledge by listening to voices that capture the imagination but
utterly distort or destroy the truth.
The facts of childbirth may be withheld by the mother, the
logical source, for the mother may have had such unpleasant
experiences herself that she has no wish to communicate them to
the daughter, who she believes will also suffer in childbirth.
If, in a moment of confidence, she gives any information to her
daughter, it is more likely to be fear producing than a stimulus
to pleasant anticipation. Thus the influence of too many mothers
upon their daughters, either through the subtlety of their
information or through the mystery of their silence, is a serious
factor in producing a feeling of fear in regard to childbirth.
We must remember, also, the influence of the friends of a woman
about to have a baby. Wherever women are gathered together and
the subject of childbirth arises, someone may remark that
childbirth is a kind of martyrdom, the suffering during which,
though probably best forgotten, is satisfactorily recalled with
obvious pride. Here it must not be overlooked that those who have
suffered are justified in believing in suffering. There is no
blame to be laid upon those who are honest in their opinions;
neither was it their fault if they suffered. This does not,
however, mitigate in any way the crime of their propaganda, for
to produce alarm can never assist in the accomplishment of a
task, however unimportant.
The influence of husbands is another potential source of anxiety
concerning childbirth, if the husband has formed his opinions
upon hearsay. His ignorance leads to an understandable anxiety
over the welfare of his wife. Unfortunately, he communicates his
anxiety to her.
Apart from the more intimate sources of information about
childbirth, women cannot escape the influence of the general
trend of public and popular opinion. Constantly in contact with
the mod ern foundations of both education and amusement, they
read books, study papers, listen to radio and television
broadcasts, and see motion pictures. In far too many of these the
same atmosphere is found: childbirth is an ordeal, essentially
painful and dangerous to the life of the mother.
If the dramatist finds it necessary to increase the interest of
the story by describing the events that occurred when one of the
chief characters gave birth to a child, the incident is often
fraught with poignancy and tension, drama, suffering, and
possibly death. As a student of human nature, the dramatist well
knows that nothing is more likely to gain the attention of the
reader. Do we often read of a normal character experiencing any
happiness in childbirth, or see such a presentation on the
screen? Similarly, the tense anxiety of the husband gives the
author or producer a wonderful opportunity for drama.
Fortunately, this is sometimes so exaggerated as to become
laughable.
The daily papers are also printed in order to attract readers.
The story of a straightforward birth is not news, unless it
occurs in a taxicab or a telephone booth, but the story of a
mother's death when a child is born is almost worthy of
headlines.
CULTURE VS. NATURAL LAW
I have chosen the term "indigenous" below in reference to woman
in her original condition, as opposed to "cultured" or
"civilized." It is obvious that such a term requires explanation.
I am using it to convey the idea of first or original, primary;
that is, women whose tribal lives and traditional limitations of
experience have not been affected by medieval and/or
twentieth-century culture, compared to the "cultured" woman of
today. There is very little evidence that modern woman is in any
way less fitted to produce children painlessly than the woman
without the influence of Western culture and civilization.
Woman, indigenous or cultured, has before her no evidence
suggesting that nature ever intended pregnancy to be an illness.
The indigenous woman continues her work-in the harvest field, on
trek, in the rubber plantation, or wherever she may be employed.
The child develops while she herself lives a full and natural
existence. Muscularly strong, physiologically efficient, her
mechanism carries out its normal functions without discomfort,
difficulty, or shame. The child then is born easily, small and
firm fleshed. Among cultured women we see this too-the athletic
young woman who continues her active life, who plays golf to the
seventh month, who walks three or four miles a day to the full
term of her pregnancy, who eats sensible food in a sensible way,
who is not diverted from her normal routine by those who try to
advertise special care, rest, diets, and enormous quantities of
milk.
Such exaggerated concern is an offense against nature; it is a
presumption that natural methods require unnatural fortification,
and to those of us who believe in nature it is little short of
inducing a pathological state into a very perfect physiological
function.
Whichever of the many definitions of culture is adopted, one
thing is certain, that culture is dependent primarily upon the
activity of the mind. The greater the education, the more
"cultured" the type. But, unquestionably, we have very largely
lost many of the higher sensibilities that in the original state
were essential to our personal survival. One has only to spend a
few weeks with those who depend upon their wits for the supply of
their food from natural surroundings to appreciate how soon we
should die out if once again we were bereft of cultural
attributes and were called upon to return to the original state!
From this the question naturally follows: To what extent can the
influences of culture have affected those functions that remain
with us as natural physical functions, childbirth in particular?
The mind has developed, and the enormous fund of stimulus that
passes from the consciousness to the autonomic nervous system has
to meet new conditions. The lives of the cultured have gradually
changed as Western civilization has developed. With repression,
emotions of varying intensity have found new means of expression.
The physician of today looks to the emotions and sentiments of
his patients when endeavoring to find the original cause for many
of their physical complaints, practicing "psychosomatic
medicine."
Herein lies the fact of pain in childbirth. Modern woman is
physically competent; modern childbirth is physically unaltered
from earlier times, but our culture has brought to bear upon this
function neuromuscular activities caused by intensifying certain
emotions that inhibit the progress of the birth and thus create
pain. Yet there is no reason why culture should be allowed to
destroy all that is beautiful in the primitive. True culture
should enhance original beauty and purify where contamination has
crept in. If childbirth among indigenous people unaffected by
Western culture still persists today as a relatively painless
procedure, it is indeed a slur upon our utilization of culture
that the most dramatic, the most beautiful, and the most
essential of natural functions should be made unpleasant for so
many.
A woman may be conscious of uterine contractions for hours, but
have no discomfort until she is told she is in labor. This verbal
stimulus to her mental expectation alerts her attention and
anxiety. Although she may appear to be quite calm, a woman in
labor has an inborn alertness to danger, and evidence of anxiety,
however courageously suppressed, will forewarn her attendants of
the special care she may need. In anxiety, the heart beats
strongly and often rapidly, breathing is quicker and sometimes
irregular, and is interspersed with a series of deep, sighing
respirations. The nostrils may be widely dilated to facilitate
the intake of air, and not infrequently the mouth is slightly
open for the same reason.
If women are to be taught to anticipate childbirth with relaxed
confidence, it is necessary to eliminate the tension that gives
rise to pain by removing the causes for fear. Those who seek to
follow as closely as possible the natural law of childbirth
should do everything possible to allay a young woman's anxieties
and give her confidence by simple and truthful reiteration of the
facts of natural childbirth.
HISTORICAL AND RELIGIOUS INFLUENCES
If we survey the history of childbirth in European civilization,
we discover that suffering is often presumed, the minds of both
men and women being conditioned to the idea of suffering as
essential to childbirth. Since it is expected, it is thus caused
and aggravated. For generations the necessity of pain has been
accepted as a fact, even though the motivation for earlier
stories and dramas may have been to concentrate on the negative
in order to attract an audience, just as in our day.
ANCIENT PRACTICES AND PAGAN RELIGIONS
At the time of Hippocrates, four or five hundred years before
Christ, we read of a different outlook. Even prior to his day,
three thousand years before Christ, the priests among the
Egyptians were called to assist women in labor. In many societies
witchcraft was resorted to, often very successfully due to the
power of suggestion, and old writings suggest that herbs and
potions were used to help a woman give birth easily. In fact, it
may be said with some accuracy that among the most primitive
people of whom any record exists, help was given to women in
labor according to the customs of the time.
Hippocrates lived from 460 to 355 B.C. His aphorisms should be
read by every medical man. It was he who realized that "our
natures are the physicians of our diseases"; it was he who
recognized in the routine care of human ailments that prevention
was more important than cure. He emphasized that the daily
discipline of a healthy person was to include diet, exercise, and
fresh air. All the simple things of life to correct an illness
were to be used before medicines, and last of all came surgery.
It may seem strange to some of us that these things were written
so long ago!
Today in the United States, England, and many other countries,
everyone who qualifies to be a doctor has to take the Hippocratic
Oath, an oath of allegiance to our science. This oath is a
magnificent concept, to which one who is accorded the privilege
of attending patients should adhere, for it stands as fresh and
noble as ever. It says in part:
I will prescribe regimen for the good of my patients
according to my ability and my judgment and never do harm to
anyone. To please no one will I prescribe a deadly drug, nor
give advice which may cause his death.... If I keep this
oath faithfully, may I enjoy my life and practice my art,
respected by all men and in all times; but if I swerve from
it or violate it, may the reverse be my lot.
Unfortunately, even today in my professional career, I have often
seen only lip service paid to this oath and its tenets ignored.
Yet it is upon the Hippocratic teaching that all modern medicine
is based. If the principles of Hippocrates were reenacted today
in all their simplicity and wisdom, they would undoubtedly alter
the whole tone and tenor of our lives. Hippocrates made stern
demands upon his pupils, but he always practiced what he
preached.
There is no authority but fact, Hippocrates taught, and
deductions are to be made only from facts. Since observation,
common sense, and clear reasoning are not compatible with the
speculative practice of medicine, a physician should be persuaded
by no influence that cannot be justified by accurate observation.
True science begets knowledge, but opinion, ignorance.
Hippocrates' teaching was largely based upon the laws of nature
as they were understood in his time, that is, exploring the
secrets of life, its origin, its maintenance, and its
reproduction. He endeavored to organize and instruct midwives. He
found no place for fear in childbirth except in the presence of
abnormality, which may or may not have been caused by a faulty
regimen in the life of the individual. Such confidence was placed
in the ability of the natural law to carry out the work of
reproduction that one statement was frequently impressed upon the
students and doctors of that time: "We must refrain from
meddlesome interference!" A statement particularly applicable to
the care of women in childbirth. Indeed, it is important for us
to realize that there is nothing new in the concept of natural
childbirth. It is but a revitalizing and uncovering of that which
conforms to the laws of nature.
Aristotle (384-322 B.C.) went further, and in some of his
writings we find accurate and very desirable observations upon
childbirth. He was probably the first man who ever urged care of
the mind for a woman having a baby. A great naturalist, he was
the first investigator of the development of the chick within the
egg. Followed by Aristotle and other great scientists, the
Hippocratic and Grecian school of medicine held sway until after
Soranus of Ephesus, who, living at the end of the first and the
beginning of the second century after Christ, continued the
emphasis upon the high level and humane principles of Grecian
obstetrics. Writing a famous treatise on obstetrics in about A.D.
79, Soranus was quite possibly the greatest of all the ancient
obstetric clinicians, and must be regarded as their leading
authority upon childbirth and pediatrics. He denied the truth of
certain superstitions about childbirth, and he stressed
consideration of the feelings of the woman herself. He makes no
mention of fear, and did not expect it to occur unless some
abnormality disrupted the healthy function. His writings, as true
today as nineteen hundred years ago, were collected by monks and,
buried in the cellars of great monasteries, were soon forgotten,
not to be rediscovered for many centuries.
Pain in childbirth has been recognized as far back as we can go
in the history of man, but only in the presence of something
contrary to the natural or physiological law, which then gives
rise to fear. Fear is an emotion that, emerging from the
primitive instinct of survival, is the natural protective agent
prompting the individual to escape from danger.
There seems to be little doubt but that the unnatural,
pathological, and destructive condition of fear in childbirth is
found more intensely and frequently in the European civilization
than in any other. Those of us who have traveled among groups who
have not yet come into contact with European civilization have
found that the presence of fear of childbirth affects only a
small percentage of the population, confirming what we have read
in the ancient writings, and those who do suffer from fear almost
invariably have a reasonable cause.
The general tendency is to pass quickly from the discussion of
fear to that of pain. But the origins of fear are important,
because the association between fear and pain is very close. Thus
it is necessary to draw attention to the influences of
superstitions and religious customs, and all those things which
pertain to ethical conduct and beliefs among various peoples.
Fear produced by religious beliefs becomes an offense to the
mental or physical integrity of childbirth. Unnecessary fear is a
pathological condition.
Pagan religions demand an absolute belief in an outside
controlling influence over the events of one's life. That control
is exercised, directly or indirectly, by one's ancestors. All
goes well with the individual, so long as he obeys the rules and
does not offend his or her ancestors. It is the woman who
carries, hidden in her mind, the knowledge of her disobedience of
this law who becomes depressed and filled with fear during labor.
She is anxious not only for her own life but also for the life
and fitness of the child. Pain and suffering in childbirth then
becomes the corollary to "the wages of sin is death," an idea
common to all ethical teachings and religions. Thus if a dead or
abnormal child is born, it is considered the reward of sin and
disobedience of the law.
We found that some tribes in Africa go to extraordinary lengths
to appease the wrath of their forefathers or their gods. When
trouble arises in labor, as it surely does in the presence of
this sin-born fear, free confession overcomes the trouble of a
delayed or prolonged labor. This form of pain relief in difficult
labor is well recognized among many tribes. In the Congo we
obtained first-hand evidence of the curative influence of
confession as a means of palliating the angry ancestors or gods
during labor; in the absence of abnormality, the baby was usually
born soon after confession. Thus the ethical beliefs of an
individual, and the consciousness of sin or disobedience in
respect to these beliefs, do influence the course of labor,
through the emotions.
THE MIDDLE AGES
It was about three hundred years after Christ that a big change
in attitudes came about in Western civilization, due to a
distortion of earlier Judeo-Christian teachings. It is generally
accepted that the institutionalized Christian Church during this
period, more than any other influence in the last two thousand
years, retarded the progress of medicine and medical science. One
of the principles of Christ's teachings is that we should visit
the fatherless and the widows in their affliction, and heal the
sick. But the priests of this middle period -interpreting any
efforts on the part of man to heal the sick as being
presumptuous, placing oneself on an equal with, or even
preeminent over, the God of Christians - went back to pagan
practices, where prayer and fastings were the total remedies. If
medicines or potions were used at all, they came from the
monasteries through the Church, and it was the special
prerogative of the priests to prescribe and distribute them. To
study and believe in the laws of nature became an offense against
the authority of the Church, and all books on medicine that had
been written, including those of Soranus, were seized and buried
beneath the monasteries. When the Roman Empire fell, all medicine
reverted to the lore of superstitions, legends, salves,
poultices, and talismen. The sick were no longer healed; they
either lived or died.
With this as background, it is no wonder that the rites of
paganism were relatively simple, pleasing, and acceptable when
compared to some of the horrors to which women in medieval times
were subjected, owing to the ignorance of those who were entitled
to look after them in childbirth. During the thousand years up to
1520, the responsibility for childbirth was entirely usurped by
the Church. No man was allowed to attend a woman in labor unless
he was a shepherd or a man who looked after animals in sickness.
Childbirth was considered the result of carnal sin, to be
expiated by suffering in giving birth. Should the woman have
trouble during labor, the Church, according to its ethics,
demanded a live baby, whatever might happen to the woman in
question. In fact, if a woman was dying it was not unusual for
the baby to be taken from her through the wall of the abdomen,
for which purpose men accustomed to castrating animals, usually
hog-gelders, were employed.
THE SIXTEENTH AND SEVENTEENTH CENTURIES
It was not until 1513 that a German, Eucharius Roesslin,
discovered the hidden writings of Soranus and others. He wrote
the first obstetric book in nearly fifteen hundred years,
gleaning his manu script from the works of those ancient, astute
physicians, profound philosophers, and most accurate clinical
observers the world has ever known.
The book of Eucharius Roesslin stood as a monument upon the high
road of the development of care in childbirth. Nine years after
its publication a doctor in Hamburg, thinking that too little was
known about childbirth except through books, decided to observe
the birth of a baby. Since no man was allowed to attend a woman
in childbirth and the law was extremely rigid, he dressed as a
midwife and joined the midwives at a birth. His observations were
invaluable.
Success in midwifery had begun to be established once more, but
then he was deceived by a personal acquaintance and reported to
the authorities. For that crime, that heresy, Dr. Weiss of
Hamburg was burned at the stake. Only four hundred years ago!
It was not until 1580 that shepherds and herdsmen were prevented
by law from attending women in labor, though physicians were
still not permitted to assist midwives. Two hundred and fifty
years ago physicians took over the work in certain cases, and
later surgeons applied their skill, but even then little
consideration was shown for the woman's feelings.
In the so-called ages of religious faith, the sixteenth and
seventeenth centuries in England, if there was any difficulty in
labor it was the custom to baptize the child before it was born
so that its soul might be saved, the holy water being introduced
onto the unborn child by use of a special instrument. The fact
that the mother died still called for no remark.
The most important of all historical writings, and the most
likely to be read, is the Bible. It is still the world's
best-selling book. Many women read and study their Bibles-and
many have been influenced to believe that childbirth is a
grievous and painful experience because of passages in the King
James Version like Genesis 3:16, which quotes the Lord as having
said to Eve: "I will greatly multiply thy sorrow and thy
conception; in sorrow thou shalt bring forth children." This
passage has been known as the "curse of Eve," with its assumption
that misery, pain, and sorrow automatically accompany every
birth. Thus many still are of the opinion today that the teaching
of natural childbirth is contrary to the Bible.
Nothing could be further from the truth! For those who believe
the translators and others who compiled the various editions of
the Bible were under divine guidance no argument will be of any
avail, but if the Bible had divine inspiration, it is likely that
the writers of the original manuscripts were inspired, and not
the translators of the various editions in different languages.
Biblical scholars have carefully reexamined the Hebrew and Greek
manuscripts from which much of the Bible was translated, and have
concluded that the words referring to childbirth do not signify
pain, but refer to "labor," or to "a woman in childbirth." Being
interested in this subject myself for many years, I have acquired
in my library a considerable collection of ancient Bibles, and
find that some of the translations differ from those of the great
King James Version, which was started in 1604 and completed in
1611, in the reign of James 1.
Take, for example, Isaiah 21:3. I turned this up in my copy of
the Geneva Bible, first published in 1560, and find that the
words "pain" and "pangs" were not used, but "sorrow" was repeated
three times. In my copy of the Bishop's Bible, however, first
published in 1568, the words "pain" and "pangs" appear, and since
the King James Version was largely a revision of the Bishop's
Bible and not the Geneva Bible, the same terms have been repeated
by the translators.
This matter was referred to Hebrew scholars, one of whom, the
Reverend B. D. Glass, spent much time investigating this subject
and wrote to me as follows:
Quote
One thing, however, that puzzled me was why the Bible referred to
childbirth as such a painful and dangerous ordeal. That is how I
was taught, and later on taught my pupils. After studying your
book, Revelation of Childbirth,' I felt I had to search the Bible
more thoroughly to find the deeper meaning concerning expressions
about childbirth.
I was very pleased when I read the first sentence of Genesis
3:16, where the Hebrew word "etzev" which is usually translated
as sorrow and pain, has obviously been misconstrued. The words of
pain in Hebrew are "keiv" (pain) "tzaar" (sorrow) "yesurim"
(anguish).
At no time would any Hebrew scholar use the word "etzev" as an
expression of pain. The meanings of "etzev" are manyfold, i.e.,
labour (Gen. 5:29, referring to Noah: "The same shall comfort us
concerning our labour and toil of our hands").
In Proverbs 14:13, "etzev" is used as expressing labour, e.g.,
"that in all labour there is profit."
"Etzev" can also mean "concerned" or "anxious" as is mentioned in
Genesis 6:6, where the word "grieved" is not used in its proper
sense - "displeased," or "concerned" would have been more in
keeping.
In chapter 45 para. 5 although "etzev" is again translated as
"grieved," it is used in a wrong sense, "displeased" would have
suited the expression better.
Again in King 11:6, the correct translation of "etzev" is given,
namely, "displeased"--"and his father had not displeased him,"
etc.
"Etzev" has yet another meaning - that "of being perturbed," as
it is expressed in Samuel I 20:3, "Lest he be perturbed."
I find that throughout the Bible the word "etzev" is used
approximately sixteen times, and not once does it convey the
meaning of pain as we are made to believe. "Etzev" can assume
different shades of meaning, regarding the sense in which it is
used.
I think that is why the translators of the Bible in the olden
times, believing in the ordeal of pain and anguish in connection
with childbirth, translated the word "etzev" to imply such. None
of the prophets ever used this word in their expressions
regarding childbirth. They used the words "tzirim" (hinges) and
"vchavalim" (threads) which mean hinges and threads, or nerves.
Not being a medical man it is hard for me to explain these terms.
I can, however, explain "vchavalim," which means the contractions
or stretching of the muscles and fibres.
In all your quotations from the Bible, the above two words were
expressed and they do not really signify pain. It is only because
"yeloda," which means "a woman in childbirth" is always used in
conjunction with these same two words in question that the
translators added on their own behalf these words as meaning
"pain and travail."
End Quote
If we put ourselves in the place of those brilliant classical
scholars of the time of James I, from A.D. 1604 to 1611, the
years occupied by them in completing this translation, we can see
why their negative thoughts on childbirth were expressed in their
translations. They used the word "pain" because they had no
reason to believe any other term was applicable. During this era,
obstetrics was at a low ebb. Anesthetics and antiseptics were not
discovered until two hundred fifty years later. The first English
book on midwifery had been published only fifty years earlier,
and although several manuscripts appeared, mainly for private
circulation, they demonstrated little advance upon the works of
Soranus, who flourished in second century A.D. Women died in
large numbers in maternity hospitals, and the appalling
conditions of the Hotel de Dieu in Paris due to epidemics of
childbed fever were found to some extent in English institutions
as well. Surely it was reasonable that the translators used the
word "pain" in keeping with the accepted belief and experience of
their time. It was not until the nineteenth century that the
foundations of our present knowledge of antiseptics were laid,
and there were no antibiotics for infections until the
mid-twentieth century. We tend to overlook the fact that until
1847 anesthetics or pain-relievers were not even known, so that
when a labor was abnormal the suffering was appalling.
An investigation by Herr Ernst Burkhardt, who translated
Childbirth Without Fear into German, states that the German word
"Wehen" (pain) was not found in German writings before the Middle
Ages:
I enclose an article of mine, published recently by Die Neue
Zeitung. Professor Joseph De Lee (in the preface of his
Principles and Practice of Obstetrics, 1947 edition) says
that since unthinkable times all races understood
contractions in labour as a painful experience and
accordingly spoke either of pains, dolores, dolori, douleurs
or (in German) Wehen. There is no evidence for this
assertion. On the contrary, it seems to be sure that these
termini developed only with civilization. Our German word
"Wehen" cannot be traced beyond the Middle Ages. Our
frequently used painsuggesting word, "Wehmutter" ["midwife,"
literally, "mother of woe"], I found, had a definite
artificial origin. Dr. Martin Luther invented it when
translating the Bible. It does not exist before the year
1540.
Dr. Rudolf Hellman of Hamburg, in his paper "Schmerz oder
Erlebnis der Entbindung" (January 1959), gives additional
consideration from the German Bible translations:
Quote
Dick-Read maintains that the underlying Hebrew word "Etzev"
should not be translated as "pain" but as "toil, trouble,
distress and labour." It is all a question of a predominant
psychic understanding. H. Adler and other investigators I have
questioned have moreover come to the conclusion that there is
here no command of the Lord. Several years ago Dick-Read showed
that a confinement, as a natural event, need not be, and should
not be, associated with violent pains. He is convinced that it
could not have been the will and intention of the Creator.
In the Bible we also find references to easy deliveries, just as
today they are happening in "natural births." In the Second Book
of Moses (Exodus) 1:15, the King of Egypt commanded the He brew
midwives Siphra and Pua to kill the sons immediately on the
stools (here no doubt the reference is to the birth-stools which
were in use in Luther's time). The midwives referred, however, to
the easy deliveries of the Hebrew women with the words: "They
have been born before the arrival of the midwife." This
expression is recognized as sound. Luther, who liked to associate
the birth with pain, probably invented the painful-sounding
"Mother of Woe," a translation which was only discarded after
1540.
Graf Wittgenstein, in his book Man Before Delivery, translated
after Gunkel: "Much will I prepare your toils and groans; in
labor wilt thou bear children..." Archaic, inaccurate
explanations and translations were learned, in good faith, by
clerics and teachers, and by children and grown-ups true to the
words of books and letters.
End Quote
Wittgenstein also mentions in this excellent contribution that
the Greeks called pain the "barking watchdog of health," and that
pain occupies an important place in the extensive system of
warning and protection of the organs: "...it seems to us rather
senseless that it should be the alarm signal of delivery as at
the same time it hinders the mother in her activities."
It is forgivable that the translators of nearly four hundred
years ago should interpret as they did, but I find it difficult
to understand how these obviously controversial translations can
continue to be accepted by many modern scholars of the classics,
who copy and even intensify the mistakes, although they have many
more manuscripts and advantages from which to deduce the
significance of the words.
But that is not all, for a woman's fears are supported by the
Prayer Book, in which there had been no substantial alteration,
until recently, since A.D. 1662. There was a special service
known as "The Churching of Women" which was supposed to be a
thanksgiving after childbirth, which ends: "Oh, Almighty God, we
give Thee humble thanks for that Thou hast vouchsafed to deliver
this woman, Thy servant, from the great pain and peril of
childbirth."
Could we still expect women to believe childbirth was to be
painless, that it could be a moment of transcendental joy? When I
was discussing this service with a girl of twenty-three, she
said: "But you would not expect the most wonderful gift of God to
come unpleasantly." Is the pride of possession and accomplishment
that fills the heart of every young mother when she first sees
her baby unworthy to be recalled? Is a lame apology for gratitude
adequate thanks to the Almighty for the gift of a child? Yet the
Church has asked her to say: "Thank you very much for having
allowed ME to come through all that frightfulness unscathed; it
is so nice to be alive in spite of having performed the greatest
of all natural functions for which You especially built me,
although You did make it dangerous and painful for me."
What a travesty of the truth!!!
It is not for the escape from pain and danger that women thank
God. In my experience mothers are not made like that. They give
thanks for their child.
The Church must once again teach the beauty of childbirth and
encourage confidence in normal, natural function, which is in
harmony with the basic teachings of the Bible. We must not forget
the significance of Christmas or the manger in the stable of a
wayside inn. Millions of Catholics honor the Madonna and Child,
and Protestants also recognize the spiritual implications of
childbirth.
In the meantime, let us assume as historical necessity the
teachings of the past that emphasized the negative aspects of
childbearing, keeping in mind that there can be no more horrible
stigma upon civilization than the history of childbirth.
THE LAST HUNDRED YEARS
In 1847 a brighter picture began to emerge for women in
childbirth, with James Young Simpson's discovery of chloroform,
creating the beginning of the era of pain relief. Simpson was
harshly criticized by the Church for giving women anesthesia in
abnormal labor. A dignitary of the Church wrote in condemnation
of his work: "Chloroform is the decoy of Satan, apparently
offering itself to bless women but in the end it will harden
society and rob God of the deep cries which arise in time of
trouble."
That in my father's time! But anesthesia had come to stay-and to
such an extent that it was used in all labors, abnormal or not.
Why always anesthesia, when in the natural state it is
unnecessary? It has always been easier to utilize the
pain-relieving discoveries of science than to investigate the
complicated causes of pain. Since 1850 a hundred ways and means
have been discovered to rid our women of the pain that has
invariably attacked them, even when they most deserved the
natural joy of their supreme accomplishment. Nevertheless,
anesthesia has been of the greatest service to women, and an
important step forward in the development of humane care during
childbirth.
In 1854 Florence Nightingale became the first person to make it
widely known that cleanliness and fresh air were fundamental
necessities of nursing. It was largely because of her work during
the Crimean War that the standards of both the training and
practice of nursing were raised. The gin-drinking, reprobate
doctors who were found in great numbers at births both in
hospitals and at home began to disappear. With their exodus,
childbed fever occurred less frequently in maternity cases, but
even so, women were still dying in hospitals at the rate of 12 to
15 percent of all normal labors. This means that one in every
eight perfectly healthy women admitted died through childbed
fever!
About this same time, Ignaz Philip Semmelweis, a nervous young
man who was a physician at the Maternity Hospital in Vienna, came
to the conclusion that the cause might be due to something
arising within the hospital. He therefore made his students wash
their hands in a solution of chloride of lime before attending
women in childbirth. In one year, 1858, the death rate in his
wards tumbled to 3 percent and soon afterward to 1 percent. This
was the first great step toward preventing the attendant from
taking death to the patient; for Semmelweis had discovered what
the ancients had always preached, that to interfere with the law
of nature was to invite the hand of death. For his success in
saving lives Semmelweis was asked, for some made-up reason, to
leave the staff of the hospital. He was told he had no right to
require this washing, and was sent away. He returned to his home
and died, a broken man.
Until 1866 there was no knowledge of asepsis. Hospitals were
originally organized by priests whose humane intention was to
move people from the hovels in which they lived to be cared for
by doctors in hospitals. In the homes a certain number died;
those who went to the hospital for safety and good treatment died
in much greater numbers. It is difficult to visualize the state
of affairs that prevailed when limbs were amputated, abdomens
opened, and cesarean sections performed without any anesthesia
and with an almost sure supervention of sepsis, giving rise to a
high percentage of mortality in the simplest operations.
Probably all of us, if we are wise, pause to think sometimes how
much harm we do in our efforts to do good, and how much trouble
we cause when conscientiously endeavoring to prevent it!
In 1866, long after my parents were born, Joseph Lister first
practiced aseptic surgery, and he continued to use antiseptics in
spite of the opposition and ridicule of his colleagues. Then
Pasteur discov ered fermentation and inoculation and Koch
discovered bacteria, the two men becoming co-founders of the
science of bacteriology. This is all recent change and
innovation!
The care of women in childbirth benefited by the advance of these
other branches of medical science, but in obstetrics itself
little happened. At the beginning of the twentieth century the
death rate from childbirth was lower, and severe pain was
relieved, but still childbirth was an ordeal for a woman to face.
Much pain still remained, pain that was unexplained and could
only be obliterated by unconsciousness, which carried its own
dangers. Was unconsciousness safe for mother and baby? It is
incredible how pain was and still is accepted by many doctors and
scholars as an inevitable accompaniment of childbirth.
I cannot understand anyone who says women in childbirth should
not be afraid, for who among us would not have some qualms about
entering into an experience that we desired above all else, but
that we believed must occasion severe pain, danger, possible
mutilation, and even death to either ourself or our child? We
know of only a few who have no fears: there are a number of women
who faithfully believe in the rightness of their God and the
sanctity of their bodies, and in my opinion there are also women
who have an inborn belief in the laws of nature, not by
formulating them to themselves, but because they are natural in
their outlook and experience.
The extent and magnificence of the medical discoveries made
during the last hundred and fifty years is beyond both praise and
gratitude. Gradually truth has been discovered, and the safety of
women in childbirth has been made an object of investigation,
with results that would have been unbelievable when the mothers
and grandmothers of many of us were born. But now that many of
the troubles and dangers have been overcome, we must move on-not
only to save more lives, but actually to bring happiness to
replace the agony of fear. For although the consciousness or
sensations of a woman's discomfort can now be dispelled, it is
only at a price, for with it goes the awareness of birth and the
joyful sensations and emotions that should accompany it. Now we
must bring a fuller life, truer to natural law, to the women who
are called upon to reproduce our species.
It is not only that we want to bring about an easy labor, without
risk of injury to the mother or the child; we must go further. We
must understand that childbirth is fundamentally a spiritual as
well as a physical achievement and throughout this book it must
be understood that the birth of a child is the ultimate
perfection of human love, the culmination of the love between a
man and a woman. In the Christian ethic we teach that God is
love. The blessing of sexual necessity and pleasure is but an
essential part of the love God has given to man and woman. It may
be that in time scientists will be able to give such complete
proof of the rightness of materialism that religion will become a
weapon in the hands of the psychiatrists and the Church will be
replaced by the clinic. But my close association with the birth
of a child has led me to believe there is a limitation to science
and that the extending boundaries of human knowledge have only
reached the foothills of the towering mountains of Omniscience.
This philosophy of childbirth is written, therefore, in terms of
a belief in God.
For my own part, I stand in awe and utter humility before a woman
with her newborn babe. There is so much to see and learn in their
presence, so much that I am unable to understand or to explain,
so much that makes me aware of the limitations of my own ability.
It may be that among my colleagues there are those who feel the
same. Obstetrics must be approached as a science demanding the
most profound respect.
One woman who had feared, because of all the accepted causes, the
arrival of her child, gained confidence and understanding before
her baby was due; she had a natural and happy birth. Toward the
end of the labor that produced her second, and much larger,
child, she worked with tireless energy. "How many more?" she
asked me excitedly, as she rested between the contractions.
"It will soon be here," I replied. "Why do you ask so anxiously?
I hope you are not too weary."
"No, no, not that - but this brings back to me so clearly John's
arrival. I can hear his cry and see his fat pink body in my
hands. I'm longing for that heavenly feeling again - I simply
can't describe it to you. It won't be long now, will it?"
Could we wish to blot out the memory of her first experience? In
the natural state the emotional experience of childbirth raises a
woman to such delight and thankfulness that her mind turns to
spiritual and metaphysical associations to express her gratitude
and joy. Materialism and atheism are not included in the makeup
of motherhood; neither can a robot lead a blind man across the
road.
...............
AMEN to Grantly Dick-Read and to the CORRECT understanding from
the Bible on the wonderful subject of natural childbirth.
Keith Hunt
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