Can Humanity Survive Socialised Birth?

Michel Odent, now in his 90s, has for decades been at the forefront of new thinking surrounding birth and its immediate aftermath, having written the first article in the medical literature about the initiation of lactation during the hour following birth and on the use of birthing pools. He spoke on this topic at the Mystics and Scientists conference 30 years ago. In this new book, he poses a very serious question that has arisen around the medicalisation (and masculinisation) of birth and the corresponding training of obstetricians and midwives. He identifies ‘the increasing tendency to classify the midwife as a highly specialised technician trained to follow protocols.’ (p. 52) This forms part of the ‘helping-guiding-controlling-supporting-coaching-managing paradigm’ that underpins medical thinking with its emphasis on interventions. Interestingly, this approach is a textbook example of what Iain McGilchrist would term left hemisphere, with an emphasis on (what is regarded as helpful) manipulation and control.

Michel sees this dominant attitude as disempowering and interventionist. What is missing is protection of the space around the woman giving birth, and his most important point in this respect is that birth is facilitated by neocortical inhibition – the neocortex must be inactivated rather than stimulated by noise, bright lights and words. Ideally, the birthing room should be dark and restful, while the midwife knits quietly in the corner, available to support only as and when required. This enables women to give birth naturally, rather than be ‘delivered’ by specialised experts. They are protected against neocortical stimulations, which can repress the foetus ejection reflex. Michel’s more shamanic understanding of the process of childbirth is as ‘an involuntary process under the control of primitive brain structures that we share with other mammals.’ (p. 34) Interestingly, Amazonian cultures use ayahuasca both to access transcendence and facilitate childbirth. In asking such searching questions, Michel’s approach is interdisciplinary and long-term. For instance, is there a correlation between declining fertility rates and increased use of Caesarian sections? Why are births becoming more difficult?

He devotes considerable space to discussing what he calls the epidemic of labour induction for fear of foetal distress related to prolonged pregnancy. The standard approach is length of gestation, while Michel proposes that it would be more rational to evaluate placental function. Some babies are mature before 40 weeks, while others need longer. He is critical of standardised procedures that replace natural oxytocin with its synthetic equivalent within a short-term framework of thinking. Another feature is to consider all microbes as enemies, which has led to a radical alteration of the experience of the perinatal period, especially in relation to the microbiome and the programming of the immune system through the transfer of antibodies, which occurs naturally via the placenta. Birth by Caesarian section is by definition in a sterile environment very different from the home. We now know that the ideal is for the body of the baby to be colonised by a great diversity of familiar microbes.

We now have a situation where ‘the number of women who rely on their oxytocin system to give birth to babies and placentas is becoming insignificant.’ (p. 62) Moreover, a milk ejection reflex is induced by oxytocin release, and when one also considers shortened breastfeeding rates, Michel concludes that the oxytocin system is also underused to feed babies, leading to a weakened system. He considers the results of a study comparing births in the period 1959 to 1966 and 2002 to 2008 where the average duration of the first stage of labour in the second cohort was 2½ hours longer for the first baby, and two hours in other cases. This points to a deterioration of the human capacity to give birth. Another study indicates a possible correlation between loss of the capacity for empathy with a declining oxytocin system. (p. 63)

Michel does not underestimate the challenges of a paradigm shift with respect to birth, arguing that most peer reviewers protect against it and published studies ‘provide information without altering the dominant way of thinking’ while corresponding research protocols represented by the ‘circular epidemiology’ are constantly repeating similar studies. His own solution is provided in a scenario entitled “Childbirth in the Land of Utopia”. He reconstructs a debate between various specialists including the president of ABWL – the Association for Birth with Love (!). The professor of hormonology advances the key argument that women are programmed to release a cocktail of love hormones at the time of natural birth that is critical to mother-baby attachment and may have life-long consequences. A bacteriologist points out that the new born baby is germ-free and that those born via the perineum are guaranteed to be first contaminated by friendly bacteria from the mother – also with respect to gut flora - which is not the case with Caesareans. The overall policy should be to make births as easy as possible in order to reduce the need for obstetrical interventions. He ironically observes that the proposals discussed were ‘unrealistic enough to be adopted without any further discussion and without any delay in the land of Utopia.’ One can only hope that a few well-placed obstetricians will read this book and change their minds, conditioned as they are by training – Michel’s experience and arguments can enable them to rediscover the basic needs of labouring women. This is a true labour of love.