Book Reviews

AIMS Journal, 2005, Vol 17 No 2

Childbirth Without Fear: The principles and practice of natural childbirth. by Grantly Dick-Read

Pinter & Martin, published 6 September 2004, 8.99

Reviewed by Elizabeth Cockerell

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Grantly Dick-Read (1899-1959) was the first childbirth teacher in Britain, whose work developed into modern childbirth education, inspired the National Childbirth Trust and the childbirth movement. Childbirth Without Fear - the progenitor of all those books for pregnant women - was Dick-Read's principle work, first published in 1942 and now republished.

Childbirth Without Fear is charged with Dick-Read's intensive direct communication with patients and with his medical colleagues, although it was unevenly received. The Fear-Tension-Pain Syndrome as the explanation for pain in childbirth (a big subject up to the 1940s), Dick-Read's central message, was passed on to NCT teachers. Tense woman: tense cervix seem (to this reader) a big claim, though refocused by a recent Woman's Hour item on current research (in 2004) into Lactic Acid and progress of 2nd stage.

The obstetrician Michel Odent (famous since his work at Pithiviers) provides the preface for the book and writes that: "modern physiologists can confirm and interpret his [G D-R's] findings. They are now in a position to explain how adrenaline (an emergency hormone released in particular when there is a possible danger) and oxytocin (the hormone necessary to produce uterine contractions) are antagonistic." Precisely the burden of the research at The Liverpool Women's Hospital research reported on Woman's Hour. Compare this with Active Management of Labour devised by in 1965 by Kieren O'Driscoll which has since dominated the whole of obstetrics and maternity care, and for which we still await the evidential basis.

Grantly Dick-Read's clinical practice during the interwar era was years ahead, with elements that took decades to develop elsewhere, at the cost of great struggle by women. Antenatal care, antenatal teaching, partners at labour, emotional care of women, importance of diet, physiogical 3rd stage, rooming in, breastfeeding and breastfeeding on demand had yet to be even discussed. Dick- Read also disliked the indiscriminate use of analgesia and anaesthetic during the interwar years, at the end of which, spinal anaesthesia arrived.

"It is my custom to lift up the crying child, even before the cord is cut, so that the mother may 'see with her own eyes', the reality of her dreams. I have been told that no woman should see her baby until it has been bathed and dressed. My patients, however, are the first to grasp the small fingers and touch gingerly the soft skin of the infant's cheek. They are the first to marvel at the miracle of their own performance." Compare this with everywhere else until very recently.

Dick-Read watched with much misgiving the arrival of episiotomy [first common in America in the 1920s as a way of transforming childbirth into a surgical event]. 'Being good at stitching' was regarded as an achievement in obstetrics. By the time of his death, episiotomy had become a standard feature of childbirth, and suturing was carried out by medical students!

In this book, Grantly Dick-Read was scathing about obstetricians and midwives - the maternity services. The medical profession ignored his work. It is not surprising that Dick-Read attracted a crowd of admirers (i.e. women) who were determined to carry forward his work. Odent notes Dick-Read's scientific eye. Anthropology, psychology, medical statistics, and, always, motherhood interested Grant-Read. He was an observer who learned from his first years working at Whitechapel till the 1950s.

Grantly Dick-Read spoke, of course, for his generation. After a golden period at Cambridge, he served with the R.A.M.C. at Gallipoli, was wounded, and served across the western front. Throughout his professional life, Dick-Read insisted that women in labour be not left alone: " 'I have never known before how frightful loneliness can be'", Dick-Read said at the time. "Perhaps this is the reason why I shudder when I pass the door of those wards where women lie alone enduring the first stage of labour. They are not educated to their job, they are told to 'get on with it'. From time to time, a nurse looks in... No greater curse can fall upon a young woman whose first labour has commenced, than the crime of enforced loneliness." Compare this with modern obstetrics where the main advantage of Electronic Fetal Monitoring has been that the woman can be left unattended.

Like Odent later, Grantly Dick-Read understood that for women, childbirth is a private and domestic matter. The lack of privacy in maternity care has been a constant dread of women across the 20th century; to which obstetricians, GPs and, unfortunately, many midwives have been largely oblivious. The politics of childbirth seems a modern notion, but Dick-Read saw childbirth as of political interest "especially since women have the vote now". From early days at Whitechapel, Dick-Read looked for the woman to have the active, leading role, not a passive role.

This book is a look back to the era of Dr Finlay's Casebook and private practice in nursing homes, when Dick-Read had been Resident Accouccheur at Whitechapel. Childbirth Without Fear is a historical item now, though possibly not altogether superceded. It reads, to this eye, surprisingly fresh and vigorous. Dr Grantly Dick-Read handed on the torch, but the relay is not over.

For further reading, Look up Grantly Dick-Read on an Internet search engine. There's a good paper by Sheila Kitzinger (who reaches back to that generation) called The Politics of Birth.

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