July 25, 2004

Grantly Dick-Read and the foundations of hypnobirthing

A CD came my way recently - a documentary record of the birth of a baby delivered by Grantly Dick-Read. Having just read the proofs of a new edition of his last book (written in 1957, just before his death) I was keen to hear him in action, to get a better feeling for the man and his work. The hypnobirthing movement has relied heavily on his writings and philosophy as the basis for their claims, and this was another reason to explore his approach further, especially given my feelings about hypnobirthing as a management strategy for labour.

The sound quality of the recording was very clear, picking up every detail of the final contractions in first stage and the birth itself. It is not clear if the recording has been edited - it lasted 50 minutes, which for a first birth is rather fast. What was clear was the orchestration of the whole event, which is definitely “conducted” by Dick-Read, the chorus being provided by a midwife.

The mother remains anonymous, her name is never mentioned, although we do learn that she will call her baby David. She has been well prepared, having learnt “the breathing” techniques taught by Dick-Read’s wife and she also talks about seeing a film. There is no mention of the father, apart from the comment made by Dick-Read in his introduction that the father had been present in the early stages, and a wistful remark from the new mother at the end, that the baby has the father’s nose.

We are told that the woman is lying on her right side and is “well controlled” from the start. She mentions back pain and is given some back rubs. In response to two requests for warm water and honey she is given water to sip and at one point she asks for a blanket because she is shivering. The entire labour is carefully stage managed by Dick-Read and the midwife, who issue copious instructions throughout.

Instinctive behaviour is not encouraged. At one point the woman says “I want to push, at the end of the contraction” and she is firmly told “you are not yet fully dilated, so don’t put any weight into it”. A little later she is asked “do you want to push?” and when she says, rather forcefully “Oh, yes!”, she is told again she is not yet ready and must keep breathing instead of giving in to the urge. No internal examinations are performed, and the midwife explains that until she pushing urge is overwhelming she must wait. In reply, the mother asks “why are you stopping me from pressing down?”and she is told again “you are not yet ready”.

Other instinctive behaviours are also ignored. As the pushing urge begins to be felt, the woman is told she will be turned over into the delivery position “that you already know - 45 degrees with cushions”. The woman is much relieved and states that now the back pain has gone and she feels much more comfortable. She is instructed to keep her eyes open, and when she is surprised by this (“I want to shut them”) she it told that having her eyes open is important “ to keep you with us in case we want to make any suggestions”. This is reinforced later by the comment “keep your eyes open - I like to have a look at you at this stage”, to which the woman responds weakly “don’t you remember me?”

Dick-Read constantly feeds words into her mouth, anticipating and even dictating what she is either feeling now, or will feel very soon. Several times he asks (I thought, rather anxiously) “Are you feeling any discomfort? “ One time, just as second stage is starting, when the mother says “I can feel the baby moving down a bit, he replies “...very unusual, but quite reasonable”.

The language throughout would make a woman of today cringe. Of course, this was recorded about 50 years ago, and women then were clearly in awe of the doctor and very willing to be told what to do. Dick-Read carries on a semi-scientific explanation of what is happening with the uterine muscles and what will happen next, but carefully refers to “down there” and “back passage” when necessary. The woman, just before the baby crows says “I thought I was being polite” and she is reassured that indeed she is behaving well.

There are lots of “breathe in, breathe out” instructions and “in and out, dear“, “a little more relaxed” “take longer to breathe out” become a regular chorus from the midwife. Dick-Read chimes in constantly “good girl”, “very nice indeed”, “keep level and controlled” and when she seems unsure, issues clear instructions “try and time this one a little better”. As the baby starts to appear, the message becomes: “now fill up, hold it, come along, come along, one more, down here, like this.....” , “determination, right on top of it, come on.. doing well...downwards here... hard work!” and when she succeeds, she is rewarded with the comment “now that’s more like it, good girl, working like a Trojan!”.

There comes a moment when the woman protests “I can’t push any more at the moment” and then asks “how much longer”, to which Dick-Read replies, “still work to do but you don’t mind hard work”. A further protestation “I must stop, I can’t do any more now” is greeted by the remark “I like that spirit!”. The mother then comments “it seems odd that frail women have to do this - look at me, I am very strong and I find it hard.” A few more pushes and she says, when told she mustn’t waste the contraction, she “is just lacking the benefits of a good square meal”.

Insights into the routines of the time are apparent as well. Although no internal examinations are performed, the mother is dressed in “Swiss stockings” (what on earth are those?) and she is told not to put her hands on the sterilised towel covering her tummy. The midwife offers her the gas, and Dick-Read ignores this, quickly saying to the woman, “now watch me, fill up... very nice... lift up now.... come on.... that’ll do, almost there”. Then comes the inevitable “don’t push, let the uterus do the work, we’ll have the head this time”, and then David is born, his sex loudly announced by the doctor. And what is the woman’s comment at the end? “Oh doctor, that’s beautiful. That moment at the end, it is worth all the effort”.

I found this recording fascinating. It was a wonderfully stage managed piece, with the woman’s needs and wishes completely overshadowed or ignored in favour of the doctor’s desire to produce a natural birth. My feeling was that not much has changed, the only reason that Grantly Dick-Read has retained his fame is that he was striving for a “natural birth”. His passion for nature is not that different from many current doctor’s passion for epidurals. The women were a means to an end, and whilst they may have achieved a drug free birth, they were subjected to patronising behaviour that took no account of instinct or individual needs.

At that time, endorphins had not been discovered, so the entire credit for the success of his approach was claimed to be because of the training. In such a forceful presence as Dick-Read, I doubt that many women would have dared to let their feelings show or to show any individuality, especially during labour a nd birth. They were a self-selected group, clearly used to taking orders and to being treated with a degree of condescension we would find completely unacceptable today.

Listening to this CD has given me new insights into this man and done nothing to shift my view that modern interpretations of his methods, such as hypnobirthing, also rely for their claimed successes on domination, brain washing and suggestible personalities in pregnant women.

Posted by andrea at July 25, 2004 05:01 PM

Comments

Forgive this commercial interruption, but the CD Andrea is referring to is called 'Natural Childbirth' and will be available from http://www.pinterandmartin.com from September - Grantly Dick-Read's Childbirth without Fear will be available from Birth International and Pinter & Martin Sep 6 - All the best, Martin

Posted by: Martin Wagner on August 3, 2004 11:23 AM