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• W2011803247 abstract "Childbirth incited “considerable dread” in Amy Barkas. In 1889, her husband Frederick wrote a series of letters to his family, telling them about the “little beggar” that his wife was “expecting” in September. In one letter, Frederick confided that Amy was a “woman of strong will and determined action”; but she was also “a physical coward, neither can nor will bear bodily pain if by any means suffering can be avoided”. It turns out that Amy was desperately unhappy with her doctor. Dr Nedwell was “a rather rough, gentlemanly Irishman, who has a reputation of being impatient & rough at confinements and who is known to be very inexpert with, and afraid of, chloroform”. The problem was that Amy was determined to take advantage of that anaesthetic. When confronted, Nedwell's response was troubling: he “blustered and said he would make no binding promises on the subject, but would do what he judged right when the time arrived”. Amy was “not re-assured” so the couple managed to “get rid of him” by using the fact that Nedwell had “recently been at a puerperal fever case”. Nedwell was furious. According to Frederick, Nedwell “lost his temper”, shouting that since Amy had “set her mind on having Townsend” (“the most successful man Midwife”), he “therefore declined to attend her”. Townsend proved more than acceptable. Because Frederick was feeling “a good deal of anxiety about the business”, a woman simply described as “The Nurse” was instructed to take charge. “The Nurse” advised Amy to go for a brisk walk, which “did the trick”. Amy went into labour. She was dosed with “Battley's Sedative” (that is, morphine) as well as chloroform so that, after “a good deal of trouble” and the use of forceps, Mary Rushton Barkas was born. All pain was forgotten. Their baby was “really a very nice little thing…quite her Mother's Idol”. Amy's ordeal reminds us that labour pains are both dreaded and desired. Unlike most pain, they can be predicted many months in advance and are often deliberately sought. Yet childbirth is a form of physical suffering that has historically been particularly resistant to pain relief. In 1847, James Young Simpson, the prominent Edinburgh obstetrician and physician to Queen Victoria, had shown that chloroform could effectively eliminate the pangs of labour. Yet, 42 years later, Amy's physician was reported to be “very inexpert with, and afraid of, chloroform”. Indeed, 100 years after Simpson's use of chloroform, and after the introduction of a plethora of safer and more efficient analgesics and anaesthetics, one physician lamented in 1947 that: “We have the knowledge of how to relieve pain, we have excellent machines designed for this purpose, we lack only a genuine national desire to help…What a tale to tell of England one hundred years after Simpson's discovery!” Why did so many women before the mid-20th century endure the agonies in childbirth without any analgesic or anaesthetic? There were, of course, medical risks. Before the introduction of antiseptic and aseptic techniques, the use of chloroform and ether did not cut rates of serious infection or death in childbirth. Physicians were also aware of risks to the fetus—increasingly portrayed as the doctor's “second patient”. However, this explanation begs the question about why more effective analgesics were not developed earlier and why, even when there were effective forms of relief, they were not used. Of hospital confinements in England and Wales in 1948, only about 52% of birthing women were given analgesics even though most hospitals possessed air and gas machines. Linked to medical concerns was the longstanding view that pain was physiologically “natural”, making intervening innately risky. This belief was not restricted to childbirth. As one physician warned in 1851, to suspend pain by “artificial agency is to set at nought the ordinances of nature”. Pain was Nature's benevolent warning system. Religious and moral concerns were also important. In Christian contexts, suffering was intended by God to be a reminder of sin, an instrument of instruction, and a promoter of personal rebirth. Chloroform was nothing less than “a decoy of Satan” that would “harden society and rob God of the deep earnest cries which arise in time of trouble for help”, as one clergyman informed Simpson. Time and again, Genesis 3:16 was recited: “I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children”. Labour pains were also regarded as a valuable tool of redemption. Birthing women were advised to use their anguish to meditate on Christ's sufferings. In the words of an 1874 tract published by the Society for Promoting Christian Knowledge, in childbirth “even the most stout-hearted may well cry out” but women should use the brief moments of respite to think “of the infinitely greater sufferings endured by the Lord of glory for your eternal salvation”. Linked to the religious justifications for suffering were moral ones. Sex was sin; childbirth pangs, the punishment. The author of an 1806 textbook for midwives even contended that women who suffered the most in childbirth were those who possessed “strong passions, who have been used to have all their desires gratified”. Unmarried women had it worse. A physician, Isabel Hutton, recalled in her 1960 memoir that, before the First World War, a mother of a “love-child” would not be offered any pain relief because “this would teach her a lesson that would keep her in the path of virtue ever afterwards!” As late as 1948, the Population Investigation Committee of the Royal College of Obstetricians and Gynaecologists observed that “particularly badly off are the primiparous unmarried mothers whose pains were relieved in only 20% of home confinements”. Prejudices about what type of woman suffered exquisitely in birth also hampered the introduction of pain relief. In the 19th century and early 20th century, some physicians argued that women from particular groups gave birth with no or fairly little pain. Racist beliefs spread the view that African-Americans, immigrants, labourers, and women from the peripheries (Scotland, Wales, and Ireland) did not truly feel the pangs of childbirth because they had broader pelves or because their fetuses had smaller heads. It was only from the 1940s that mainstream medical professionals began to question this assumption. Other physicians believed that “overcivilized” women had a “heightened sensitiveness” to pain. These women needed to be taught how to revert to a more “primitive” state, either through diet and exercise or, from the 1910s, through drugs such as scopolamine or “Twilight Sleep”. In the words of Bertha Van Hoosen, a prominent advocate of the scopolamine-morphine anaesthetic, the drug was important for the “highly organized mothers of modern civilization” because it renders the woman “a good animal to bear her offspring as easily as any other animal”. The women privileged enough to be given prompt relief were, of course, those who could afford it. It was a privilege, not a right. In Britain these attitudes began to change after the First World War, and accelerated from the 1930s and late 1940s. Pronatalist concerns about the declining birth rate and the dramatic rise in hospital births were important reasons for the shift. But public opinion, lobbying, and ideas about the rights of citizens were also important. The rapidity with which these changes took place is striking. In the 1930s, Lucy Baldwin, a prominent member of the National Birthday Trust Fund and wife of the leader of the Conservative Party, let slip that she intended to mention the need to alleviate women's pain in childbirth on the radio. The committee of the Trust, which was formed in 1928 with a mission to improve the lives of women, responded with uproar and begged Baldwin to desist, which she did. Yet, within 10 years, it seemed like everyone was talking about agonising contractions, split perineums, and episiotomies. In 1949, Conservative Member of Parliament Peter Thorneycroft even introduced a private member's bill into Parliament, calling for accessible pain relief for women giving birth. Whilst Labour MP Leah Manning announced to Parliament that if male MPs gave birth, they would ensure that there was something more than “a towel…to pull on”. Newspapers even published strident demands from women demanding pain relief. A letter published in the Gloucestershire Echo in 1942 and signed by “Six Expectant Mothers” complained that “any Cheltonian, rich enough to pay for [pain relief] can have it”, but the “poorer class” were “damned”. The war had changed their expectations. They protested the fact that: “If a man wants a tooth out he has to have gas or cocaine. A soldier on the battlefield, when in great pain, has morphia administered to him. But a poor woman in the throes of childbirth; what does she get? Queen Victoria had her whiff of analgesics for all her confinements and what is good enough for Queen Victoria is good enough for SIX EXPECTANT MOTHERS OF CHELTENHAM.” Women's organisations across the country began lobbying their MPs and pain relief in childbirth was much discussed in debates about the National Health Service. As a result of changing attitudes—and not only of women but physicians and midwives as well—the proportion of women receiving pain relief in childbirth rocketed. In 1946, 68% of women giving birth in Britain had no form of analgesic whatsoever; this figure had halved—34%—within a decade, and then stabilised at about 2% in the 1970s and 1980s. Amy Barkas would have been thrilled with these changes. She had insisted on being given both morphine and chloroform in childbirth and managed to replace the doctor who was “known to be very inexpert with, and afraid of, chloroform”. Her husband Frederick was sympathetic but he believed that stoicism was an important trait and that childbirth was inevitably a moral as well as a physical trial. These belief systems clearly affected the attitudes of birthing women. However, to understand why pain relief was eventually made available to most British women who wanted it we need to understand not only societal attitudes that valorised enduring pain but also attitudes to suffering and citizenship more generally." @default.
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• W2011803247 title "Childbirth in the UK: suffering and citizenship before the 1950s" @default.
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