Birth pains are nothing to celebrate

Ask most people to name a painful event and I would predict a high number would go for childbirth. However, although pushing the equivalent of a bowling ball through a hosepipe is not easy, it might not be the most painful.

Surprisingly, travelling kidney stones are immensely painful. Compared with childbirth the event is mechanically trivial; the stone barely touches the sides of the urethra, but the pain is remarkable. When a piece of stone breaks off in the kidney and starts its journey down the urethra grown men and women turn pale, fall to the floor, curl up in the fetal position and pray for a quick death. The stone eventually reaches the bladder providing instantaneous and glorious relief. It is arguable, of course, whether childbirth is more painful than a travelling kidney stone but at least childbirth results in a baby. A travelling kidney stone just adds a bit of calcified crud to your pee.

Dr Denis Walsh had better hope he never has kidney stones. If he does, the women around him are likely to do everything they can to make the stones travel and then smirk as he collapses in pain. Dr Walsh is a professor of midwifery who has recently argued that labour pain is a ‘rite of passage’ that helps mother and baby bond. He criticised women for their ‘antipathy to birth pain’ and criticised the ‘epidemic’ use of epidurals. Oh dear.

There are many reasons to criticise Walsh for his article, but the fact that Walsh is male is not one of them (1). Yes, it is true that Walsh will never give birth and so will never experience the pain of delivery, but that does not explain his apparent lack of understanding and empathy. Most men and women will never suffer pain because of nerve degeneration, cancer or travelling kidney stones but that does not mean they cannot understand such pains and provide sympathy. Oddly enough, when I argue that women are entitled to demand pain relief during labour, nobody suggests I should shut up because of my Y-chromosome.

There is no reason anyone should be expected to endure pain from an acute trauma such as childbirth. Nobody expects victims of car accidents or those undergoing surgery to just ‘withstand’ the pain. Modern analgesic procedures mean that pain relief can be readily provided and the patient can be rendered both more comfortable and more likely to make a full recovery. No procedure is entirely risk-free, of course, and women should be aware of the risks associated with an epidural so as to make an informed choice. But the risks can easily be exaggerated, as Walsh does in his article, to scare women away from what is an essentially safe, effective and routine procedure.

Walsh is not alone in his crusade against pain relief during labour; there is a widespread belief that childbirth pain should be endured and even celebrated. A good reason not to get overexcited about Walsh being male is that the origins of this idea lie in feminism. Having failed to secure equality, around the mid-1970s feminism took a degenerate turn towards praising the special virtues of women and attacking maleness (2).

Women were presented as having special empathic and nurturing qualities that made them less destructive and put them into closer contact with nature. Their ability to give birth, and their experience of the painful process of giving birth, were held up as evidence of their inner, female wisdom. Business, politics and medicine were seen as problematic because of male domination. Thus, for example, it is argued that the Enron debacle might have been avoided if only there were more female CEOs and accountants, Westminster would be less corrupt and destructive if there were more female MPs, and medicine would be more humane and less arrogant if there were more female doctors.

It’s bunkum. Women can be destructive and arrogant just as men can be empathic and humble. It might be true that medicine in the 1970s was excessively arrogant and paternalistic but that had little to do with the male character of medicine and was more to do with the high esteem in which medicine was then held, both within the profession itself and by society at large. That is certainly no longer the case and modern medicine is, if anything, much too diffident and understanding at the expense of making tough clinical decisions. That’s partly why nonsense discussions of ‘natural’ childbirth and pain control techniques such as yoga, hypnosis and massage now dominate childbirth discussions. Non-pharmacological techniques might have their place for some women but effectiveness is limited and doctors know that. As it happens, so do women. The use of epidurals during childbirth has doubled since 1989 because epidurals work and women demand them.

And rightly so; there is no reason any woman should endure an entirely preventable pain if she doesn’t want to.

Stuart Derbyshire is a senior lecturer in psychology at the University of Birmingham and director of pain imaging at the Birmingham University Imaging Centre.

(1) See A painful lecture on labour, Guardian, 14 July 2009, and Childbirth gives a woman gigantic balls, The Times (London), 20 July 2009

(2) Is the Future Female? Troubled Thoughts on Contemporary Feminism, by Lynne Segal, Peter Bedrick Books, 1988