The politics of childbirth: An interview with Paula Michaels

Did you know that Lamaze, a well-known childbirth method originated in the Soviet Union?  The politics of pain relief in childbirth has a fascinating history, revealed by historian Paula Michaels.

What is Lamaze?

Historically, the Lamaze method, also known as psychoprophylaxis, was is a way of giving birth that attempted to manage labor pain without drugs, relying primarily on psychological conditioning and conscious relaxation. It was premised on the belief that pain in labor is wholly psychogenic in origin—that is, in women's minds and not their bodies. Today that sounds pretty absurd but, in fact, the original promoters of psychoprophylaxis asserted that labor pain was not just exacerbated by, but stemmed from fear, anxiety, and a collective cultural conditioning that led women to expect childbirth to be painful and which, in turn, created the pain.

The Lamaze Method combined instruction in relaxation and patterned breathing to combat pain. In the weeks prior to labor, women studied the physiology of labor and birth to dispel any anxiety they might have about what was going to happen when labor began. Prenatal classes trained women to greet labor's onset with profound relaxation and calm. They used conscious relaxation to remove tension from the body. Patterned breathing, the method's hallmark, was intended as a distraction, supposedly preoccupying the cerebral cortex and interfering with the perception of pain signals in the cerebral cortex. Focus on the breath also allegedly facilitated relaxation and, when necessary, helped women to resist the urge to push prematurely.

This is an historical description of the Lamaze Method because, though we still hear the word today, its meaning has changed. In the mid-1980s Lamaze International, which promoted psychoprophylaxis in the United States, abandoned its focus on this particular approach and disavowed the centrality of the patterned breathing. "Lamaze" became a philosophy about birth rather than a method, with an emphasis on evidence-based, woman-centered maternity care.

Can you tell us more about the Soviet history of Lamaze?

World War II devastated the Soviet Union economically and demographically. Continuing an effort begun in the 1930s, the government hoped to boost the population. Public health officials believed that tackling the problem of pain in childbirth was critical to encouraging women to have more children. Nitrous oxide was a safe and effective method favored by physicians. But there were desperate shortages of the drug and, amid the fiscal constraints of the postwar years, the Soviet government had no spare rubles to increase production for obstetric use.

Led by I. Z. Velvovskii, a team of psychologists working in Kharkov (today, Kharkiv) in eastern Ukraine had been working on psychological approaches to obstetric pain management—especially hypnosis and suggestion—since the 1920s and, after an interruption during the war, they returned to this work in 1947. Velvovskii became convinced that hypnosis would never be practical on a national scale because it required too much one-on-one work between the patient and the hypnotherapist. Trained hypnotherapists were also a rarity in the USSR. To circumvent these obstacles, Velvovskii and his colleagues devised psychoprophylaxis, with its group classes offering a realistic alternative to individual patient sessions. The fact that they drew on the work of famed Russian psychologist Ivan Pavlov to explain how the conditioning and breathing techniques worked to ease or even eliminate pain made this approach not only economically feasible but politically palatable in the intensely nationalistic times of the early Cold War.

What can we learn about the politics of childbirth by studying the history of Lamaze?

There is nothing inherently feminist or empowering about the Lamaze method, even though those are the associations we have with it. In the United States today, often without spelling it out, women tend to define an empowered birth experience as one that is "natural" and "natural," in turn, is narrowly construed to mean foregoing pharmacological pain relief entirely.  However, the definition of natural childbirth was not always so all-or-nothing and in other national contexts the feminist response to male obstetric control was to demand, not shun drugs. In France, reliance on the Lamaze method came to be used as an excuse to deny women access to pain relief medication. Feminists there fought hard throughout the 1970s and 1980s to gain the right, when medically safe, to drugs on patient demand.

By looking at the Lamaze Method internationally, we can see how idiosyncratic the American experience was. In the USSR and France, yoking psychoprophylaxis to communist ideals served to promote the method. French obstetrician Fernand Lamaze, drew on financial support and the organizational strength of the French Communist Party and its allies to promote psychoprophylaxis but in the US, though the method came to be renamed after Lamaze, it had to be stripped of this pedigree to be palatable to the American public. The rise of what has been called "medicalized" or "technocratic" birth in the US contributed to American mothers' interest in psychoprophylaxis, but in other national contexts there were different economic and political factors in play to spur its popularity.

This glance backward is an opportunity to ask questions about what constitutes an empowered birth experience and to see how our definition has narrowed, perhaps unnecessarily, over time. A more flexible attitude toward the modest and judicious use of pharmacological pain relief might leave more women with positive feelings about their birth experiences. Surely that would be empowering. 

Paula Michaels is a Senior Lecturer in history and international studies at Monash University (Melbourne, Australia). Her latest book, Lamaze: An International History, [hotlink: http://www.amazon.com/Lamaze-International-History-Oxford-Studies/dp/0199738645] was shortlisted for the New South Wales Premier's Prize and received honorable mention for the Association for Women in Slavic Studies' Heldt Prize.

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