Birth Reflections: On the history of pain in Childbirth

by Olife Team

This article was written by Sawsan Nashaat a childbirth educator, birth and Postpartum Doula, lactation, Hypnobirthing and birth trauma counselor.

“What do you know about childbirth?” I asked a group of college students one morning. "It’s traumatizing, agonizing, scary and dreadful", they quickly replied. One male in attendance nodded sympathetically. Their professor had invited me a few weeks earlier to come and  discuss childbirth with them as part of their psychology course work.  

I remembered asking a pregnant mother about her hopes for birthing her baby. “I hope to go  through it with the least damage possible.” she had said.  

Evidently whether in a classroom with students or in discussions with expecting mothers natural birth has a very bad reputation. 

Around the start of the 20th century few individuals in Europe and North America asked why some women experience very painful births. Their observations of birthing women, especially in  rural less modernized areas, and common sense, had led them to believe that birth was not inherently very painful. After all, why would a normal bodily function like birthing be an exception to other normal bodily functions, like the heart pumping blood or the intestines contracting to  digest food, both aren’t painful in healthy individuals.  

In 1942 British physician Dr Grantly Dick-Read wrote his pioneering book “Birth without Fear'' in  which he explained that women only find birth too painful when they are afraid. Some years later American teacher Marie Mongan, who later founded Hypnobirthing, asked why something beautiful like bringing a baby into the world is so painful and terrifying when it was just a muscle  (the uterus) carrying out its normal function, like any other muscle in the body. She built on Dr.  Read’s observations, and a few others, and designed her popular childbirth preparation program. 

I imagine a conversation between my pregnant self and a healthy Egyptian woman from the  previous century, perhaps my own great grandmother. “Can I give birth easily without excessive  pain? Do you really think my body can do it? I can picture her puzzled reaction to my question. It  sounds to her something like this: “Can I use the toilet without excessive pain? Do you think my body can do it?” 

In medieval Europe, the Christian church propagated for dogmatic, political and economic reasons, that women are supposed to experience severe pain during childbirth. Eve, seductive with an evil streak, had caused Adam to disobey God and eat from the forbidden tree. As a result of her actions her daughters would suffer in childbirth. It was decided that, in this  convenient narrative, anything that made childbirth easy or smooth was against God’s will.  

The situation greatly appealed to male doctors newly specialized in the emerging and lucrative field of obstetrics, and was naturally endorsed by them. It was the all too familiar story of religion being used for political dominance and wealth acquisition for the benefit of the few. Women had  to be deserving of pain and dispensable in this narrative if it were to succeed, and it did.  

Witch hunting, the practice of capturing, torturing and burning at the stake, any woman (usually from the lower classes of the society) suspected of practicing “magic” plagued Europe for long  years. Midwives and women healers were prosecuted and many thousands killed. It was a very  dangerous time to attend to birthing women.  When European women birthed in this hostile environment, largely alone and increasingly at  hospitals with male strangers, birth as dreadful as it should be, from the viewpoint of the medieval church, viewpoint became true. Society accepted that birth is inherently dangerous, and for the fortunate ones, better managed at hospitals with the mothers drugged and under male supervision.  

Before this period in history, and despite maternal and infant deaths which weren’t uncommon, birth was not considered dangerous or dreadful for most women. Sadly high risk women and babies who were born unwell often did not survive, but for the majority of healthy women labor  and birth were straight forward events.  

The foreign idea that childbirth is a medical event that must take place at hospitals for healthy women, found its way into urban Egypt towards the end of the 1930s.  

Along with the exportation of western ideas and practices, childbirth was modernized. In Europe most urban modern women were birthing in hospitals and taking anesthesia in labor so these practices were considered superior in the ex-colonized mindset. In the urban cities of Egypt the western way of birthing became synonymous with modernity and  social statues. Only uneducated rural women birthed at home. I once asked a female relative about where her mother had given birth to her in the early 1940s. She found the implication of  my question offensive. “I was born at the best hospital in town”, she said. When I followed up by asking if all her siblings were also born at the hospital she conceded “my sister was born at  home, but that was before the family moved to Cairo.” She repeated, “But I was born at the best  hospital in town.” 

This short exchange highlights the significance of the birthing place in many families' ascent in social standing, the before and after effect in their story. I asked several other ladies the same  question and they all stated that well to do women in this time period gave birth at hospitals.  Birthing at home became stigmatized and looked down upon.  

I believe that in Egypt many rural women birthed at hospitals mostly for reasons other than pain  management. They didn’t birth at the hospital because it was the place where anesthesia was  offered, they gave birth there because it was a sign of modernity. This is how it started anyway,  because later when birth at the hospital proved very painful, especially with the introduction of  artificial oxytocin (tal2 sina3y), anesthesia gained unprecedented popularity. 

This of course begs the question, “If birth isn’t supposed to be very painful then why do many  women experience and report very painful births?” I address this question in the next section but  first I admit I find the use of the word “pain” in childbirth in our times problematic.

In our times, pain is a very bad word. Its mention is sufficient to induce panic attacks in a  pregnant woman. The pain of childbirth, so unfamiliar and mysterious, triggers high levels of  anxiety. This is unsurprising given that our knowledge of childbirth comes from the terrible  stories we hear growing up or the media dramatization of it. I do not know any woman my age  who grew up witnessing any woman in her family giving birth comfortably or happily (or at all).  

Most Egyptians born in the 70s, 80s and perhaps the 90s only know about birth what they saw  in the movie “The Grandchild” and it's scary portrayal of birth. In the birth scene, the birthing  woman’s screams horrifies her pregnant sister who is waiting outside. Their father decides he  must take the sister and leave the house to escape the trauma unfolding in the next room.  

On the other hand I don’t imagine that if women of past generations were told that birth is  painful that they would have taken the news with much drama. It would not have triggered their  bodies fight or flight responses. By the time women had their own babies, they had already  witnessed several births in the community and the workings of childbirth were not mysterious or  frightening. Their exposure to childbirth was early and routine. If childbirth was painful, it was  also “3ady”, a favorite Egyptian word, meaning normal without any need to fret.  

In other words, the word pain in the context of childbirth did not carry dreadful connotations. If  birth was somewhat painful it didn’t necessarily make it frightening. Bear in mind that older  generations did not grow up watching horrific deceptions of childbirth on TV. Birth was normal  and the women no more questioned their bodies ability to birth than we question today our  bodies ability to digest food.  

This normalization of childbirth resulted in confidence, and a confident mother in labor is a  capable woman who is not thrown off by the normal tightening and stretching sensations of  giving birth. They could call it “painful” all they want and it wouldn’t have been so frightening like  it is today. For those reasons I think using other words like the “exertion” or “intensity” of birth in  our times is wiser; they are not as scary and are also accurate.

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