Words: Mollie Watkins
The discovery of the epidural – a block to alleviate pain during childbirth – occurred six decades before the surge in its demand.
The effectiveness of epidurals as a pain relief method was clear from the outset. The first epidural as we know them today was given in Germany, in 1909, by a single shot injection in the base of the spine to 141 women, with variable but promising success. But instead of being catapulted to the forefront of childbirth treatment, the method faded into the background, consolidating the myth perpetuated by Christian ideology and medical professionals alike that childbirth should be an agonising process.
This ambivalence changed dramatically after the 1968 World Congress of Anaesthesiologists. The decision to host the annual conference in London was monumental in changing the direction of British obstetrics in the remaining decades of the twentieth century. Increased publicity on the epidural method and its effects on radio, television and in the general press ignited a renewed interest in epidurals.
Thus, the 1970s, a decade marked by growing feminist activism and the emergent Women’s Liberation Movement, also saw growing knowledge of and debate around epidurals to alleviate childbirth pain. Epidurals gained a position of cultural significance: they offered an escape from the pain of childbirth, and an opportunity to transform the role of those experiencing it as patients.
Writing in a 1972 issue of the newly-founded feminist magazine Spare Rib, Kathleen Tynan discussed her ‘happily conscious’ and ‘entirely pain free’ labour, thanks to the epidural analgesia method. Tynan’s article was one of the earliest contributions to the public debate on epidurals. For the first time, people who gave birth were seeing the pain of the event as a unifying experience of suffering, and one which they could be liberated from.
Women became increasingly vocal and began to share details of their labour experiences in ways that had never been publicly expressed before: treatment under authoritarian and dismissive doctors, having little or no say in the delivery, and, most significantly, the pain that they were forced to endure. The culture of silence surrounding pain during childbirth had been broken.
Towards the end of the decade, women used the letters section of Spare Rib to acknowledge the sense of freedom epidurals gave them. The right to medical agency, choice and ultimate control of pain management had become an obvious feminist issue. Josette Morgan’s letter, featured in the March 1978 issue of Spare Rib, said: ‘[Epidurals] should be available in all maternity units. It should be the woman’s decision as to how much pain she can, or wants to, take.’ Childbirth had previously rendered those who underwent it passive in their own experience; epidurals gave them power.
There had, until this point, been a pervasive belief that it was natural, and therefore necessary, to suffer during childbirth. The belief had a pseudo-religious edge to it. As Tynan put it, many felt that ‘since sex is sinful somebody had better pay, and it might as well be the woman.’ In this sense, epidurals were a form of sexual liberation.
The argument against epidurals, perpetuated throughout the mid-twentieth century, was underpinned by clerical influence. Clergymen argued against epidurals ‘on the grounds that a pain-free delivery was contrary to the Scriptures,’ meaning the increasing use of epidurals in British obstetrics was viewed as un-Christian, immoral and sinful. ‘In sorrow Thou shalt bring forth children,’ clerics had contended in 1947: ‘[epidural anaesthesia] is a decoy of Satan.’
The opinion that pain was a necessary and valuable component of childbirth was not isolated to the Church. ‘Natural’ childbirth advocates claimed that pain played a valuable role in the childbirth process. Shelia Kitzinger, a leading campaigner for ‘natural’ childbirth throughout the seventies, argued that labour pain was different from ordinary pain and could be described as ‘positive’ or ‘functional’ pain, or ‘pain with a purpose’.
The National Childbirth Trust (NCT), created in 1954, championed ‘natural’ childbirth and sought to educate women on breathing and relaxation techniques to alleviate labour pain. ‘We are training mothers precisely for birth,’ wrote Prunella Briance and Jean Cormack in the first NCT newsletter. ‘Women properly trained with good attendants usually have no need for drugs.’
Despite the rising popularity of epidurals in the 1970s, the NCT’s position did not change. An article circulated in the Spring of 1972 shows that they, too, felt their methods were liberationist, in a different way. ‘We believe women should be liberated from the fear of pain during childbirth,’ the newsletter read. ‘We hope we are helping to educate them for childbirth with joy, as one of life’s peak experiences.’
This was the crux of the NCT’s argument: that women’s agency was not infringed by doctors with outdated attitudes or a patriarchal and discriminatory healthcare system, but by the process of pain itself. Since pain could be relieved by breathing and relaxation, epidurals were unnecessary and removed the opportunity for ‘childbirth with joy’ which could only be achieved through natural experience.
The division persisted throughout the seventies. In May 1978, two months after Josette Morgan’s impassioned call for an increased provision of epidurals in maternity units nationally, Spare Rib published a response letter from a woman who took issue with Morgan’s criticism of the NCT and natural childbirth advocates. ‘I felt very sad to read her letter,’ Jennifer Spinks wrote. ‘It [natural childbirth] is an issue of women’s rights. Epidurals are a technique that is in the control of the medical profession. Many women [do not want] to hand their bodies over to the doctors.’
In taking such a strong anti-epidural stance from the outset, natural childbirth advocates succeeded in limiting the choice available to those giving birth. In a decade when the movement for women’s liberation was at its most radical, the push to achieve ‘easier’ childbirth was not realised.
As recently as March 2020, The Department of Health and Social Care found that people in labour were being refused epidurals despite explicitly requesting one. These findings were ‘sadly not surprising’, according to the British Pregnancy Advisory Service (BPAS); those going into labour do not receive information and education on what relief and treatment they are entitled to in childbirth, so the cycle of pain persists. The BPAS stated: ‘We have spoken with many women who have been so traumatised by their experience of childbirth that they are considering ending what would otherwise be wanted pregnancies.’ Kathleen Tynan’s words, written in 1972, remain important today: ‘This [an epidural] is a safe and painless process – officially available on the NHS. So you can demand it.’
- DOCUMENTARY: A Time to be Born – BBC (1974-5)
- BOOK: Hard Labour: A Realist’s Guide to Having a Baby – Victor Gollancz
- ARCHIVE: Spare Rib
Mollie Watkins is a history finalist at Durham University, due to begin an MA course at the University of Birmingham in September. She is interested in perceptions of gender and sexuality in 20th century Britain. Follow her on Twitter.