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Welcoming the Baby at Birth:

A Personalist Analysis of Natural vs. Medicalized Childbirth

Sarah Smith Bartel

December 8, 2003

How are we going to welcome our newest members into our society? How will Catholics welcome their children into the “civilization of life and love” of John Paul II’s vision? And how should the women who bring them into the world be treated at the time of birth?

The mainstream obstetrical management of childbirth in the U.S. is marked by an overuse of medical technology and medical intervention in the management of normal childbirth in the U.S.. This trend has only continued and increased in recent decades to the point that the displacement of natural vaginal birth with cesarean surgical birth without medically indicated reasons is officially considered “ethical” by the American College of Obstetricians and Gynecologists. The ACOG ethics committee’s recent endorsement of elective cesareans shows the extent to which the personal dignity of natural childbirth has become devalued in favor of a medicalized model which does not hesitate to “replace a natural process -- vaginal delivery -- with a major surgical procedure.” [1]

 The widespread Catholic acceptance of the medicalized status of pregnancy and childbirth needs to be questioned, as it has been already by many feminist thinkers.[2]The discussion of the ethics of reproduction among Catholic moralists has remained largely concerned with contraception, artificial insemination/fertilization etc., treating pregnancy and birth only when extreme medical situations require discernment about what medical decisions and technical procedures are morally licit. The medicalization of normal, healthy pregnancy and childbirth, with the increased risks such medicalization poses to both mother and child, is a phenomenon that Catholic ethics needs to examine critically.

After describing the overuse of medical technology in birth management and noting its critique from feminism, I propose to provide a preliminary Catholic ethical critique of medicalized birth based on a personalist ethical framework. Personalist ethics have been used to argue for Catholic doctrine on the beginning-of-life issues of contraception, artificial reproduction, and abortion (successfully, in this author’s opinion). Given the fundamental unity of the unitive and procreative aspects of human sexuality and human generation, this framework can be applied to the aspect of procreation that occurs at about nine months after the union: childbirth. I will argue that a midwifery model of pregnancy and birth management, which good obstetricians can also follow, that has as its goal mother- and child-friendly natural childbirth best respects the dignity of the persons involved. [3]

This project is important even though it does not as directly concern the question of the life or death of the smallest of human beings as do other “beginning of life” questions, such as in vitro fertilization, cloning, embryonic stem cell research and embryo adoption.  It is significant because the extent to which normal pregnancy and birth now takes place in a medical and technical arena illustrates the dark side of deterministic manipulation that surrounds all aspects of sexuality and reproduction in contemporary culture.

I. Medical Overuse in Childbirth

Most of the commonly practiced, routine medical interventions during childbirth are of unproven merit, and their overuse on otherwise healthy women and babies often leads to iatrogenic (medically caused) complications and problems. [4] Though modern medical science has saved the lives of many mothers and babies caught in true emergencies, it is the common, routine use of these procedures which causes harm and, I would argue, constitutes an unethical treatment of newborns and mothers.

While it is commonly thought that the move of the majority of the population to birthing in the hospital under physician’s control early in the 20th century significantly decreased death rates, the opposite is true. [5] Contemporary studies comparing hospital births to attended home-births (that is, births attended by either a trained midwife or physician) and births in free-standing birthing centers show similar or better outcome for out-of-hospital births, fewer fetal and newborn complications, and greater rates of maternal satisfaction. [6] This is even after controlling for levels of risk; in fact, a British study showed that “the perinatal mortality rate for high-risk births outside of the hospital (16 per 1,000) was lower that that for low-risk in-hospital births (18 per 1,000).” [7] Routine episiotomy, the cutting of the area surrounding the birth canal, is still common, despite the research that shows it does not prevent but actually causes further tissue tearing into the anus. [8] Hospitalized labor and birth in the U.S. are now accompanied by continuous electric fetal monitoring, [9]  which study after study has proven to have no improved birth outcome for mother and child  but rather is correlated with an increased c-section rate. In addition to restricting the laboring woman’s mobility, these machines have been shown to take the focus of attendants in the delivery room—those who should be supporting the mother--off the woman and on to the screen. [10]

Because of the presence of (again, unnecessarily routine) IVs, the administration of hormones and drugs to artifically induce labor and to act as painkillers, and the convenience of the position for doctors, most women deliver in the “lithotomy” position, on their backs with their legs up in stirrups. This is the least effective and most painful position. [11] As Dr. William Sears and Martha Sears, R.N. write, “back birthing makes no medical sense.” [12] The lithotomy position narrows the pelvic outlet, forces the mother to work against gravity by pushing “uphill,” it allows the heavy uterus to compress the blood vessels supplying the uterus and the baby, diminishing the baby’s oxygen supply, all of which are the reverse in vertical delivering positions such as standing and squatting. Delivering lithotomy-style tenses the pelvic muscles, which need to relax to allow the baby passage. In addition to increasing pain, this position predisposes to tears and unnecessary episiotomies and slows labor, increasing the likelihood of pain medication use, the use of forceps and vacuum extractors, and c-sections.

C-sections represent the ultimate intervention, and are often the final step of the “spiral of interventions” common in mainstream obstetric practice, in which one medical intervention practice causes complications “necessitating” another. [13]  Many practices can initiate this spiral: laboring in the lithotomy position, EFM, or an epidural all work together slow down labor, requiring other interventions to speed it up and ultimately an intervention to deliver the child. For example, an epidural slows down labor since sensation in the uterus cannot be felt and the effectiveness of the contractions is diminished. Pitocin (artificial oxytocin) is then administered to speed up the progress of labor. The IV is required to maintain hydration and administer the pitocin, and the EFM is required to monitor contractions. These also slow down labor, reducing mobility and encouraging the lithotomy position. Artificial rupture of membranes might be administered to “speed things along,” but when time runs out and infection is feared, an “emergency” c-section takes place. [14] 

The c-section rate in the US rose from 5% in 1970 [15] to 25% today, despite WHO recommendations that it be no more than 15%. [16] Many of these c-sections result from a “failure to progress” brought about by the use of counter-productive measures such as epidurals and the lithotomy position, as outlined above. Others arise due to “false positive” readings of fetal distress on the electric fetal monitor. C-sections pose a risk to mothers and babies: babies who are born surgically rather than vaginally are more likely to have asthma, other respiratory problems, and jaundice. [17] Aside from the pain associated with recovering from major abdominal surgery [18] and the complications posed to bonding with her newborn, [19] women undergoing c-sections suffer from greater risk of infection,  fever, hemorrhaging, leg clots, paralyzed bowel or bladder, accidental injuries to surrounding organs, and death, which a 1979 study showed occurred at a rate of one in a thousand operations—ten times higher than the morbidity rate in vaginal births. [20] Risks to the subsequent reproductive life of the mother are posed by the scar tissue, from complete infertility to ectopic pregnancy to improper placental attachment in subsequent pregnancies. [21] Later births are compromised. While women with the low, horizontal cut can attempt a VBAC (vaginal birth after cesarean) if the scar tissue is judged strong enough and they find a willing birth attendant, women going for repeat caesarians, whether elective or not, face a more technically difficult surgery due to the presence of a previous scar.

Epidurals, while often (but not always) effectively blocking the pain of childbirth, are also fraught with complications, risks, and adverse side-effects for mother and child. Some of these include: (as mentioned above) slowing labor, which leads to the use of Pitocin to stimulate labor, which brings about unnaturally strong, fast, and painful contractions that usually lead to higher episiotomy rates; greater use of vacuum-extractors and forceps (which cause a greater likelihood of anal tears); higher cesarean rates; and greater likelihood of needing bladder catheterization (which can cause urinary tract infections). [22] Administering an epidural requires that the laboring mother be hooked up to an IV and an EFM, both of which have risks themselves. There are risks associated with the needle used to inject the epidural piercing the wrong space in the spine. The health of the baby is compromised as well; not only can the instrumental deliveries made more likely by an epidural cause harm to the child and the increased Pitocin use subject the baby to unnaturally strong contractions that it may not be able to bear, the first days and weeks of the child’s life are spent drugged. The drugs administered pass through the cerbrospinal fluid into the maternal bloodstream and from there cross the placenta to ender the baby’s circulation at a rate of 1/3 of maternal levels for bupivicaine, and 1/3 to 4/5 of maternal levels for the anesthetics fentanyl and sufentanil. Other effects of epidurals on the baby include increased instances of abnormal heart rate before birth (which would, of course, prompt c-sections when perceived on the EFM) and impaired motor and neurological functions. [23] Mother-baby interaction in the critical bonding period after birth is compromised: the child is more likely to have complications requiring that he or she be kept in the NICU, and both mother and baby are drugged, less responsive, and may have wounds or complications from which to heal that decrease their available energies.

The feminist critique of mainstream obstetric practice centers around the loss of women’s power; they protest against a male obstetrical model that controls women’s bodies and appropriates the mysterious, natural feminine world of birthing into the orderly, predictable masculine, hierarchical (and of course patriarchical) world of science. [24 Women are isolated and dis-empowered. Adrienne Rich paints a poignant picture: “The loneliness, the sense of abandonment, of being imprisoned, powerless, and depersonalized is the chief collective memory of women who have given birth in American hospitals.” [25] The importance of the support of other women in labor and delivery in non-Western cultures is highlighted by Germaine Greer, who notes that “in non-technocratic societies, except for remarkable accidents, birth is always attended,” [26] by other women who give support and encouragement, touching, helping, in some cases straining with the woman giving birth. This is the essence of midwifery, whose name means “with-woman,” as opposed to technical, medical, obstetrical intervention, which is not so much about presence and support as about technique. Rich’s observation of differences in birth-management styles in the 17th century is just as valid today: 

One major difference distinguished the midwife and the male obstetrician. The midwife not only gave prenatal care and advice, but came to the woman at the beginning of her labor and stayed with her till after delivery. She gave not only physical assistance but psychological support. The male birth-attendant was historically called in only to perform the functions (podalic version, Caesarean, forceps delivery) which were forbidden to the midwife. He was a technician rather than a counselor, guide, and source of morale; he worked ‘on’ rather than ‘with’ the mother.[27]

Midwives work with the natural process in healthy, low-risk situations to empower women to give birth. In contemporary mainstream obstetric practice, women are not encouraged to labor and give birth through their own God-given power, but are literally expected to passively lie down while the drugs, machines, and equipment allow the technico-medical team to separate the child from the woman’s body.

2. Personalistic Ethical Critique

Catholic personalism centers around the human being as made in the image and likeness of God, willed for its own sake, and possessing incommensurable worth and dignity. This ought to shape how we welcome such creatures into the world. Should a new human’s first impressions be of glaring lights glancing off surrounding steel medical equipment, of instruments and monitors, of figures with masked faces? Should the child’s first touch be of cold metal forceps or a mechanical vacuum extractor, or human hands—perhaps those of her mother or father? Almost three decades ago, Frédéric Leboyer advocated a gentler welcome for our babies, a welcome marked by soft lighting, reverential voices, and gentle handling. “We must behave with the most enormous respect toward this instant of birth, this fragile moment,” for “there is a grace which radiates in silence that crowns with a halo every child who arrives among us,” [28] he wrote. As Catholics claiming to see in each new child the image of God, we should offer them a fitting welcome.

And how ought the mother who brings new life into the world be supported? Henci Goer points out that the adverse side effects of a medicalized birth are not only physical, but emotional and psychological. Here she describes the state of a woman with an epidural:

By the time you are hooked up to an IV, an oxytocin delivery pump, a fetal monitor, an automated blood pressure cuff, an epidural pump, and have a bladder catheter, what was a perfectly normal labor has been transformed into a high-tech event. This has profound consequences for how you view yourself and your labor and how your partner, other support people, and medical caregivers perceive you and your labor as well. [29]

Agnes R. Howard opens her excellent reflection on the medicalization of pregnancy and childbirth with a striking image:

Last Christmas our parish hall displayed a Nativity painting by a local artist, showing a dark–haired woman in a wheelchair holding an infant, with a man in hospital scrubs standing solicitously behind them. The scene was instantly recognizable to anyone who has had a baby in this country in the last few decades. It was a typical hospital birth: the just–delivered mother bonding with her newborn, the father outfitted as birth assistant. Here was Madonna as primipara, what doctors call a woman delivering her firstborn. [30]

A medicalized birth event puts women in wheelchairs, viewing them as invalid patients.

The medicalization of birth loses sight of the reality of the persons at the heart of birth: the child, the mother, the father and the community of the family which the child enters. I will now describe the values of personalist ethics, briefly mentioning how they have been used in arguments for Catholic teaching in reproductive issues (contraception, artificial conception, and abortion) and how they are applicable to issues in birthing.

Key aspects of personalism and Catholic personalist ethics (and in particular those of Karol Wotyla/Pope John Paul II) are: an emphasis on the value of persons and on spiritual values rather than on technology, the centrality of free choice, the significance of the body, the “personalist” norm, and the centrality of Christ in revealing man’s deepest vocation of self-giving love. [31]

Childbirth as practiced in the US today is a technological rather than a spiritual and personal, familial event, which it properly should be to respect the meaning of birth. [32] Catholic opposition to artificial reproductive technologies and to abortion refer to the need for man to “retain his freedom and authentic spiritual character in the face of a massive technology that is more dominated by material considerations than by spiritual values.” [33] The consistency of the Catholic position against artificial reproduction, abortion, and contraception with an opposition to artificializing normal birth make sense when we consider the inseparable connection between the procreative and unitive aspects of sexual intercourse. [34]

Pope John Paul II cites the valuation of technology over persons as a key component of the Culture of Death which supports abortion. As the Holy Father articulates in Evangelium Vitae 22:

Thus, in relation to life at birth or at death, man is no longer capable of posing the question of the truest meaning of his own existence… He is concerned only with "doing", and, using all kinds of technology, he busies himself with programming, controlling and dominating birth and death. Birth and death, instead of being primary experiences demanding to be "lived", become things to be merely "possessed" or "rejected". Moreover, once all reference to God has been removed, it is not surprising that the meaning of everything else becomes profoundly distorted. Nature itself, from being "mater" (mother), is now reduced to being "matter", and is subjected to every kind of manipulation.

The predominant model of American obstetric practices is based on “using all kinds of technology” for the purpose of “controlling and dominating birth,” obscuring the “plan of God for life” which could be found in pregnancy and birth if these experiences were respected in their natural integrity. This can introduce fear and subservience to technical intervention rather than awe and wonder at the power God has entrusted to women in their bodies. The forces of a Culture of Death would rob life of its joy and meaning right at the very entrance of new life into the world. William Virtue argues for a “normative natural childbirth” which he describes as “essentially and achievably a natural physiological process rather than a pathological or surgical event, and a landmark personal experience with deep and lasting psychological consequences for both mother and child.” [35]

Mainstream obstetrics is guided by the belief that “technology is superior to nature and machines are more reliable than people,” [36] or as Virtue puts it, “[p]hysicians are under the spell of a philosophy of medicine as dominating or displacing nature.” [37] This explains the readiness of the ACOG to proclaim elective cesareans ethical. A gender bias distrustful of women’s bodies does seem to be at work as well: women’s bodies are thought to be “weak and defective and cannot be trusted to do what they are supposed to do.” [38] The language of obstetrics reflects this—the diagnoses of “failure to progress” and “incompetent cervix” seem pejorative. Ironically, these very conditions often arise out of interventive obstetrics! Contrasting with this attitude are the beliefs foundational to the Coalition to Improve Maternity Services: birth is a normal, natural, and healthy process; women and babies have the inherent wisdom necessary for birth; babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such; birth can safely take place in hospitals, birth centers, and homes; and the midwifery model of care, which supports and protects the normal birth process, is the most appropriate for the majority of women during pregnancy and birth. [39] William Virtue agrees that giving birth is “a natural and normal act for a healthy mother and child,” and should not be viewed as “an illness to be treated, but as an act to be respected and assisted by medical care on those occasions when nature is unable to achieve her end….The majority of women and babies are capable of a normal birth, when mothers are free from dependence on technological intervention….” [40]

            The overemphasis on technology is also characteristic of in vitro fertilization, as William May has articulated. [41] The laboratory generation of human life is governed by the “logic of manufacture”—efficiency, quality control, and, I would add, mass production—and it views the child as a “product.” [42] This logic governs medicalized birth as well. Labor and birth hurried along by the use of Pitocin, forceps, vacuum extractors, and episiotomies are often simply time-savers for busy doctors. Busy nurses can monitor a whole wing of laboring women’s contractions on the EFM screens at the nurses’ station. C-sections at the slightest hint of “fetal distress” on the EFM ensure newborn quality-control in the doctors’ mind. [43]  Is the baby then a product? According to Wertz and Wertz, “production metaphor” [44] operative in the artificial techniques of reproduction with genetic screening, and prenatal testing, also extends to excessive obstetric intervention. All of these “indicate a mentality wherein childbearing and birth is dominated by the aim to ‘produce’ a ‘perfect baby’ who is ‘delivered’ during ‘labor.’” [45] The sad irony is that, as shown above, this intervention on otherwise healthy mothers and babies does not improve birth outcomes, sometimes even making sad outcomes worse.  

The laboratory generation of human life is fundamentally technical, “making” rather than “doing,” an “action” rather than an “act.” [46] However, babies are not “made” at birth either by the mother or her attendants, rather,  “[b]irth is an act of the child and of the mother.” [47] Virtue argues that this act “has both a material and a formal aspect, or one might say, both a physical and a personal aspect. When the physical aspects are subordinated or integrated into the personal, the act becomes a truly interpersonal event between mother and child. When the mother is able to consciously accompany her child during labor, birth is an act of welcoming her newborn in the way of love” (emphasis original). [48] It is also an act of the infant, who is “accompanied and warmly welcomed into the world by the parents and attendants.” [49] Virtue proposes a practice of birthing in which “the mother is able to reveal her love for her child before, during, and immediately following birth. Hence, the first signal the child receives is love welcoming him or her into the family, into the human community of persons” (emphasis original). [50]

Pope John Paul II’s personalism emphasizes the freedom at the core of the person by which “we make ourselves to be our unique selves by the actions that we freely choose.” [51] A mother giving birth should be active, aware, and alert so that as she labors to bring forth her child, she also labors to make herself into the specific mother of this specific child. Her choices in birth shape the character of her motherhood. The mother is thus an active moral agent in birthing her child, not a passive medical patient. The methods of prepared natural childbirth developed in the 20th century emphasize the active participation of the mother and/or appeal to her intelligence, competence, nobility, and character. Fernand Lamaze’s psycho-prophylactic method, based on Pavlovian psychology, assumed women could be educated to break what he thought was a culturally imposed association between childbirth and pain [52]; Grantly Dick-Read’s  1944 classic Childbirth Without Fear also counts on the intelligence and will of the mother in his theory that pain is caused by a cycle of ignorance and fear, though he suggests the mother be in a state of “dulled consciousness” in the second stage of labor. [53]  Dr. Bradley’s Husband-Coached Childbirth [54]counts on the mother to learn to become a “relaxation expert” using natural breathing and focusing on allowing her body to do its work. Sheila Kitzinger’s “psycho-sexual” method teaches the mother to “‘trust her body and her instincts’ and to understand the complex emotional network in which she comes to parturition,” and insists on “the power of self-direction, of self-control, of choice, of voluntary decision and active cooperation with doctor and nurse.” [55] All of these methods honor the freedom, intellect, and will of the self-determining mother, rather than viewing her as an object upon which to operate.

The significance of the body in John Paul II’s personalist argument against contraception is articulated in the “theology of the body” he expounded in the Wednesday audiences given early in his pontificate. [56] The significance of the bodies of the mother and child are such that they should be treated with  respect according to their innate dignity. The bodily, physical aspects of childbirth are morally significant precisely because human persons are bodily persons.

 The third aspect of personalist ethics for John Paul II (as articulated by May) is the “personalist norm” which holds that “the person is a good toward which the only proper and adequate attitude is love.” [57] This should dictate the treatment of the baby and the mother by the birth attendants as well as the position of the mother towards her child. Whereas in marital sexual ethics this norm pertains to the perfective love of the spouses for each other, in birth the call to “discover the goods that are truly perfective of human persons, the goods meant to flourish in them and contribute to their being fully themselves" [58] takes the form of birthing practices which do not diminish the personal dignity of the mother as a competent, active participant in the birthing nor the dignity of the child to be born. In the second half of the twentieth century an awareness of the unborn and newborn baby’s awareness and capabilities helped enhance an awareness of the dignity of their personhood. [59] The significance of prenatal experiences, birth, and the time immediately after for a person’s psychological development was described by Dr. Thomas Verny, [60] who recounts how harsh obstetrical practices can adversely affect the newborn bodily and psychologically years later.

Just as personalist sexual ethics sees the sexual act in its integrity as a communio personarum, so too natural birthing practices highlight the communion of mother and child at birth. As Virtue puts it, “[n]ormative natural childbirth thus is an inter-personal act in which the mother integrates her labor by her focus on her childaccompanying the infant. Thus mother and newborn are able to be present to one another throughout and immediately following birth, when they are both in an optimum state physically, emotionally, and spiritually, to begin forming a bond and to ‘…initiate a lifelong reciprocal bosom friendship’” (emphasis original). [61] Encouraging bonding in the important hour after delivery when mother and child are both in prime condition for it by not separating the baby from the mother at birth, by encouraging skin-to-skin contact, and by promoting breastfeeding all serve the mother-child communion. [62] These, moreover, all help the mother and the infant flourish as persons. The interventions and frequent separation of the newborn from the mother in the current mainstream management of birth often lead to what Dr. Sears calls “poor start syndrome,” in which the mother’s energy the first few days and weeks is spent “healing her birth wounds instead of using that energy to get to know her baby…As a result, breastfeeding problems occur, the infant-distress syndrome (fussiness and colic) is more common, and the pair spends most of the time during the early weeks solving problems, many of which could have been avoided.” [63] Spending the first hours, days, and weeks of life dazed, drugged, and wounded does not contribute to the flourishing of new persons, nor does starting extra-utero motherhood dazed, drugged, and wounded contribute to the flourishing of the mother in her motherhood.

A personalist norm operative in birth management will seek effective comfort measures for the mother that respect her dignity and do not put her at risk: massage, personal presence, support, encouragement (all of which can be offered by doulas, midwives, and most importantly of all, prepared husbands), freedom of position, freedom to eat and drink at will, freedom of movement, immersion in warm water, massage, soft music,. These, along with the various methods of prepared childbirth, can all contribute to eliminating much of the pain of childbirth, or at least bringing it down to manageable levels:

Christ and the Christian seek to heal these wounds in so far as God permits. Yet ultimately we approach the difficulties of birth as we do all things in life: with the Christian attitude toward suffering as a redemptive work. Thus we will place the difficulties of birth in the context of the gift of one’s body as a sacrifice for the life of another. [64]

Two popes have voiced such sentiments as well: Pope Pius XII, in an address approving the use of the psycho-prophylactic method (developed by Lamaze), reflected that “in the event of only partial success or of failure, [the mother] knows that the suffering can be a source of good, if it is borne with God and in obedience to His will,” in union with the sufferings of Christ. [65] Likewise Pope John Paul II praises the “brave mothers who devote themselves to their own family without reserve, who suffer in giving birth to their children and who are ready to make any effort, to face any sacrifice, in order to pass on to them the best of themselves.” [66] Natural childbirth accepts and assuages the natural labor, effort, and often, pain of childbirth and leaves it in its natural place, where it is productive, making of it a gift to the child. Heavy-handed intervention may block pain before birth but, in the recovery from obstetric practices, pain is often experienced after birth, when it is not productive, and when it impedes bonding. This calls to mind the Christian attitude of “first the fast, then the feast,” versus the secular attitude of “first the feast, then the hangover.”

Christ’s revelation of God’s love to man in his gift of himself encourages persons to find their deepest meaning and vocation in self-gift. Just as the spouses show each other their love by giving themselves fully to each other in non-contraceptive bodily union, the mother gives herself to her child in a birth planned to be as free from the damaging effects of drugs and medical intervention as possible. Giving birth to her child using her own strength and will as much as possible allows the body of the child to be strong.  Virtue speaks of the “donative” qualities of birth. [67] This would seem intuitive; in fact, we speak of “giving” birth, implying that birth is a gift the mother gives the child.  This gift is “the gift of independence…as the body of the child’s presence goes out from the maternal body and into the world so that the child himself or herself can be present.” [68] Christian childbirth is truly a loving, dignified event, one whose personal qualities need to be brought to the fore in order to allow families to experience the deepest meaning of the arrival of new children into the world. A midwifery model of birth management, in patiently respecting the natural order of birth and attending to the personal qualities of the mother and child, clears the way for a more spiritual appreciation of birth that allows God’s hand to be more visible.. “The womanly art of giving birth also is a creative act that imitates and shares in God’s creative work,” [69] notes Virtue. Rather than a subservient attitude in awe of the technology that delivers the child, as in mainstream obstetrics, gentler birthing practices allow families to experience awe at the wonder God works in childbirth. This leads to human flourishing and can only contribute to building up the Culture of Life.

Works Cited

Arms, Suzanne. Immaculate Deception: A new Look at Women and Childbirth in America. Boston: Houghton Mifflin, 1975.

Boston Women’s Health Book Collective, The. The New Our Bodies, Ourselves. Boston: Touchstone, 1998.

Bradley, Robert A. Husband-Coached Childbirth. 3rd ed. New York: Harper & Row, 1981.

Dick-Read, Grantly. Childbirth Without Fear: the Principles and Practice of Natural Childbirth. New York: Harper & Row, 1944.

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. Berkley Publishing Group, 1999.

Greer, Germaine. Sex and Destiny: The Politics of Human Fertility. London: Secker & Warburg, 1984.

Howard, Agnes R. “What Else to Expect When You’re Expecting.” First Things. 129 (January 2003): 17-19.

J. A. Mann/Eds., “Personalism,” in The New Catholic Encyclopedia, p. 153.

John Paul II, Pope. Evangelium Vitae. Washington, D.C.: USCC/NCCB, 1995.

---------. Theology of the Body: Human Love in the Divine Plan, with a forward by John S. Grabowski, Ph.D. Boston: Daughters of St. Paul, 1997.

Kitzinger, Sheila. The Experience of Childbirth. Baltimore: Penguin, 1973.

Klaus, Marshall & Klaus, Phyllis. The Amazing Newborn. New York: Addison Wesley, 1985.

Klaus, Marshall and John Kennel, Maternal-Infant Bonding: The Impact of Separation or Loss on Family Development (St. Louis: Mosby, 1976).

Lamaze, Fernand. Painless Childbirth. Rev. ed. NTC/Contemporary Publishing, 1984.

Leboyer, Frédéric. Birth Without Violence. New York: Alfred Knopf, 1975.

May, William E. Catholic Bioethics and the Gift of Human Life. Huntington, Ind.: Our Sunday Visitor, 2000.

---------.“Personalist Ethics.” The New Catholic Encyclopedia. 2nd ed. Chicago: Gale, 2002. pp. 153-155.

McCutcheon, Susan. Natural Childbirth the Bradley Way. New York: Plume, 1996.

Montague, Ashley Montague. Touching: The Human Significance of the Skin. New York: Columbia University Press, 1971.

Paul VI, Pope. Humanae Vitae, 1968. Available online at


Pincus, Jane. Critique of Childbearing Advice Books. Online at www.bwhbc.org (Boston Women’s Health Book Collective Web Site).

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Rich, Adrienne. Of Woman Born. New York: Norton, 1976.

Sears, William and Martha Sears. The Baby Book. Boston-New York-Toronto-London: Little, Brown and Co, 1993.

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Virtue, Rev. William D. Mother and Infant: The Moral Theology of Embodied Self-Giving in Motherhood in Light of the Exemplar Couplet Mary and Jesus Christ. Pontificia Studiorum Universitas A S. Thomae Aquino in Urbe. 1995.

Wessel, Helen. Natural Childbirth and the Christian Family. New York: Harper & Row, 1963.

1.     From the ACOG news release, “New ACOG Opinion Addresses Elective Cesarean Controversy,”

available online at http://www.acog.org/from_home/publications/press_releases/nr10-31-03-1.cfm.

2.     Feminist criticism of mainstream birthing practices will be discussed below.

3.     An outline of mother- and child-friendly birth practices can be found in “The Mother-Friendly Childbirth Initiative,” a project of the Coalition to Improve Maternity Services. This document is available online at http://www.motherfriendly.org/MFCI/.

4.     William D. Virtue, Mother and Infant: The Moral Theology of Embodied Self-Giving in Motherhood in Light of the Exemplar Couplet Mary and Jesus Christ. Disertatio ad Lauream in Facultate Theologicae apud Pontificiam Universitatem S. Thomae in Urbe. (Rome: 1995), p. 180. Henci Goer, in The Thinking Woman’s Guide to A Better Birth (New York: Perigee, 1999), provides information on the rates and risks of common obstetrical procedures, as well as information about natural alternatives.

5.      Goer, p. 202, shows that maternal death rates actually rose from 60 per 10,000 births in 1915, before the hospitalization of birth, to the 1932 figures of 63 per 10,000 births for rural women overall and 74 per 10,000 births in cities, where three-quarters of women gave birth in hospitals. Meanwhile, infant death from birth injuries increased 40 to 50 percent between 1915 and 1929.

6.     Goer, p. 314-320, reviews and treats the available research on these questions, all of which points to these conclusions. A sampling of the 47 studies she references includes: Fullerton, JF and Severino R. In-hospital care for low-risk childbirth: comparison with results from the National Birth Center Study. J Nurse Midwifery 1992;37(5):331-340, which showed women in hospitals were ten times more likely to have the life-threatening emergency of umbilical cord prolapse (associated with artificial rupture of membranes, a procedure performed in half the instances of the emergency in this study); Feldamn E and Hurst M. Outcomes and procedures in low risk birth: a comparison of hospital and birth center settings. Birth 1987;14(1):18-24, showed an abnormal fetal heart rate of 25 percent of babies birthed in hospitals versus 5 percent of those out-of-hospital (epidurals and the electric fetal monitor, with its limitation of maternal mobility and the tendency to read false positives associated with it, might explain this); Scupholme A, McLeod AGW, and Robertson EG. A birth center affiliated with the tertiary care center; comparison of outcome, in Obstet Gynecol 1986;67 (4):598-603, found that a greater percentage of babies born in hospitals had the potentially life-threatening shoulder dystocia, or shoulders stuck in the birth canal (a condition to which the hospital procedures of delivery flat on the back and forceps delivery predisposes the infant); and Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24(1):4-13, that about twice as many babies born in hospitals were born in poor condition; Waldenstrom U and Nilsson CA. Women’s satisfaction with birth center care: a randomized, controlled study. Birth 1993;20(1):3-13 and MacVicar J et al. Simulated home delivery in hospital: a randomised controlled trial. Br J Obstet Gynaecol 1993;100(4)”316-323 both showed much higher rates of satisfaction for women assigned to birth centers than those assigned to birth in hospitals.

7.     Goer, p. 203.

8.     Goer, p. 276-284 reviews 45 studies on episiotomies, including Ecker JL et al. Is there a benefit to episiotomy at operative vaginal delivery? Observations over ten years in a stable population. Am J Obstet Gynecol 1997;176(2):411-414 and Wilcox LS et al. Episiotomy and its role in the incidence of perineal lacerations in a meternity center and a teriary hospital obstetric service. Am J Obstet Gynecol 1989;160(5 Pt 1):1047-1052.

9.     Goer, pp. 244-249 reviews 33 studies on the use of EFM.

10.     Goer, p. 86: “It’s mesmerizing. Nobody pays attention to the mother who’s attached to one—not her partner, not the medical staff. Everything centers around the machine. You would think it was having the baby. Fathers sit intently gazing at…the machine…Nurses and doctors come in to tend and scrutinize the machine. One study analyzing medical staff behavior during the pushing phase of labor records that during one arbitrarily chosen five-minute segment of videotape, the nurse looked at the monitor nineteen times.”  Sears, William and Martha Sears. The Baby Book (Boston-New York-Toronto-London: Little, Brown and Co, 1993), p. 22: “Once or twice a week I enter a labor room to see a mother lying on her back with the EFM belt girding her protruding abdomen and attached to a video display terminal. Instead of watching the mother, the nurses watch the monitor, which ‘watches’ the mother. All too often these mothers ‘fail to progress’ in their labor and ‘need’ a cesarean section.”  

11.     Roberto Caldeyro-Barcia notes that “Except for being hanged by the feet…the supine position is the worst conceivable position for labor and delivery,” qtd. in Adrienne Rich, Of Woman Born (New York: Norton, 1976), p. 178.

12.     Sears, William and Martha Sears. The Baby Book (Boston-New York-Toronto-London: Little, Brown and Co, 1993), p. 26.

13     Richard Wertz & Dorothy Wertz, Lying-In: A History of Childbirth in America (New Haven: Yale, 1989) call this the “cascade of interventions,” p. 295, qtd. in Virtue, p. 178. Rich, p. 178 comments that “as so often, medical technology creates its own artificial problem for which an artificial remedy must be found.

14.     Virtue, p. 180, describes a different possible series of events in the “cascade” or “spiral” of intervention: “For example, physicians who are in a hurry, instead of letting the woman’s cervix expand slowly, administer hormones (a pitocin drip) intravenously. But this causes powerful and fast contractions…so the baby is pushed along faster than the woman can dilate. Then this ‘requires’ forceps to be used to extract the baby. And since she has not been allowed to dilate sufficiently, then one must routinely cut the perineum. Having put the woman on her back, she is less able to expel the child and so a cesarean is done. All these interventions in a normal birth disrupt the rhythm and functioning of her body and cause complications for which the next intervention is done. Thus the interventions become self-justifying. Yet few of these are needed in natural childbirth when the natural process is respected in the first place.”

15.     Goer, p. 11.

16.      “ACOG Statement Calling Elective C-Sections Ethical 'Downplays Risks' of Procedure, Women's Health Organizations Say,” [Nov 20, 2003] http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=20946

17.     Goer, p. 24, p. 286.

18.     Goer, p. 22 refers to the literature documenting women’s reports of pain and impairment of their normal activities for weeks after their c-sections.

19.     Goer, p. 24.

20.     According to Marieskind, H. I., An Evaluation of Caesarean Surgury in the United States (Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1979), p. 1, qtd. in Susan  McCutcheon, Natural Childbirth the Bradley Way (New York: Plume, 1996), p. 199.

21.     Goer, p. 25.

22.     Goer, p. 125-146,

23.     Goer, p. 271.

24.      For example, Rich, op. cit.,  Suzanne Arms, Immaculate Deception: A new Look at Women and Childbirth in America (Boston: Houghton Mifflin, 1975), Shelly Romalis, ed. Childbirth: Alternatives to Medical Control (Austin: University of Texas Press, 1981), Deborah A. Sullivan & Rose Weitz, Labor Pains (New Haven: Yale University Press, 1988); Germaine Greer, Sex and Destiny: The Politics of Human Fertility (London: Secker & Warburg, 1984), The Boston Women’s Health Book Collective, The New Our Bodies, Ourselves (Boston: Touchstone, 1998), Jane Pincus. Critique of Childbearing Advice Books. Online at www.bwhbc.org (Boston Women’s Health Book Collective Web Site).

25.     Rich, p. 176.

26.     Greer, p. 17.

27.     Rich, p. 150-151.

28.     Frédéric Leboyer, Birth Without Violence (New York: Alfred Knopf, 1975), pp. 41, 97.

29.     Goer, p. 134.

30.     Agnes R. Howard, “What Else to Expect When You’re Expecting,” First Things 129 (January 2003), p. 17.

31.     These latter four points are drawn from William E. May, “Personalist Ethics,” in The New Catholic Encyclopedia, 2nd ed. (Chicago: Gale, 2002), pp. 153-155.

32.     Robert Slesiniski, “The Personalist Meaning of Childbearing,” The Linacre Quarterly 56:72-87 F 1989.

33.     J. A. Mann/Eds., “Personalism,” in The New Catholic Encyclopedia, p. 153.

34.     Pope Paul VI, Humanae Vitae, #12. Birth and sex are compared as “analogous” by Christian psychiatrist and birthing expert Helen Wessel, Natural Childbirth and the Christian Family (New York: Harper and Row, 1963), p. 256-257, qtd. in Virtue, p. 186. Wessel compares the descending baby in the vagina to the penis at intercourse: “as the climax is reached in both situations, the woman utters involuntary sounds and performs involuntary pelvic movements. With the expulsion of the child, as in reaching the climax of orgasm, the woman suddenly relaxes and there appears a calm ecstatic look on her face.” 

35.      Virtue, p. 177.

36.      Goer, p. 3.

37.     Virtue, p. 180.

38.     Goer, p. 4.

39.      These are taken from the document “The Mother-Friendly Childbirth Initiative,” n. 3.

40.     Virtue, p. 181-183.

41.     William May, Catholic Bioethics and the Gift of Human Life (Huntington, Ind.: Our Sunday Visitor, 2000), p. 81.

42.     Ibid, pp. 81-82.

43.     Virtue, p. 180, n. 7 observes that “obstetricians may be influenced by pressures such as modern women…who expect a perfect baby, and who may be potential litigants.”

44.     This phrase is used by Richard Wertz & Dorothy Wertz, Lying-In: A History of Childbirth in America, (New Haven: Yale, 1989) pp. 257, 272-274, 325-326, 242-244, qtd. in Virtue, p. 179.

45.     Ibid.

46.     May, p. 81.

47.     Virtue, p. 179.

48.     Ibid.

49.     Ibid.

50.     Virtue, p. 179.

51.     May, “Personalist Ethics,” p. 154.

52.     Fernand Lamaze, Painless Childbirth. Rev. ed. (NTC/Contemporary Publishing, 1984).

However, his method has been criticized for “greatly altering a woman’s natural experience of birth from one of deep involvement inside her body to a controlled distraction,” the view of Suzanne Arms, pp. 145-146, qtd. in Rich, p. 173. The unnatural breathing patterns he prescribes can also lead to hyperventilation of the mother and baby, dangerously depriving the child much-needed oxygen—see Motoyama, E. K., et al., “Adverse Affects of Maternal Hyperventilation on the Foetus,” Lancet 1 (1966), pp. 286-288, qtd. in McCutcheon, p. 11.

53.     Grantly Dick-Read, Childbirth Without Fear: the Principles and Practice of Natural Childbirth (New York: Harper & Row, 1944), qtd in Rich, p. 172.

54.     Robert A. Bradley, Husband-Coached Childbirth, 3rd ed., (New York: Harper & Row, 1981).

55.     Sheila Kitzinger, The Experience of Childbirth (Baltimore: Penguin, 1973), pp. 17-25, qtd. in Rich, 172.

56.     These have been compiled and are available in the following volume: John Paul II, Theology of the Body: Human Love in the Divine Plan, with a Foreword by John S. Grabowski, Ph.D. (Boston: Daughters of St. Paul, 1997).

57.     May, “Personalist Ethics,” p. 154.

58.     May, “Personalist Ethics,” p. 154.

59.     I do not wish to claim that personal dignity is tied to awareness and ability, but the practical outcome of this new information is that the treatment of the baby is different when it is recognized that the baby “realizes” and is aware of what is being done to him or her. Dr. Frédéric Leboyer’s classic book Birth Without Violence described the experience of birth from the baby’s point of view (see note 28). Drs. Klaus brought new insights into the sensory perception and mind of the newborn with their book: Klaus, Marshall & Klaus, Phyllis, The Amazing Newborn (New York: Addison Wesley, 1985).

60.   Thomas Verny, M.D. with John Kelly, The Secret Life of the Unborn Child (New York: Summit Books, 1981).

61.     Virtue, p. 216.

62.      The importance of bonding has been scientifically studied in Klaus, Marshall and John Kennel, Maternal-Infant Bonding: The Impact of Separation or Loss on Family Development (St. Louis: Mosby, 1976). The importance of skin-to-skin contact has been made known in Ashley Montague, Touching: The Human Significance of the Skin. (New York: Columbia University Press, 1971). Skin-to-skin contact greatly enhances an infant’s physical, emotional, and cognitive development.

63.     Sears and Sears, p. 28.

64.     Virtue p. 179.

65.     Pope Pius XII, “Natural Painless Childbirth,” The Pope Speaks, Spring-Summer (1956), p. 34.

66.    John Paul II, “Homily for the Beatification of Isidore Bakanja, Elisabetta Canori, and Gianna Beretta Molla (April 24, 1994): L’Osservatore Romano, April 25-26, 1994, 5, qtd. in John Paul II, Theology of the Body, p. 560.

67.     Virtue, p. 22.

68.     Virtue, p. 177.

69.     Virtue, p. 187.

Copyright ©; Sarah Smith Bartel 2003

Version: 18th December 2003

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