Anyone who has had a baby knows that childbirth as a competitive sport puts the Olympics in the shade. I'll never forget the “post-match analysis” at my antenatal class, where intelligent, educated women offered grovelling apologies to our childbirth instructor for their “second rate” (i.e, anaesthetised) births. I couldn't help feeling that two thirds of the class had forked out £150 to be made to feel like bad mothers before their babies had taken their first breath.

So it was a relief to come across the book, Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. He says that the biblical edict to women to “bring forth children in sorrow” is simply no longer applicable.

So which theory is right? I decided to ask experts on both sides to share their views on the “best” way to give birth.

Dr Grant believes that women should get an epidural, even before pain starts. According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry” creates fear and guilt about epidurals. He believes that opposition to anaesthesia during childbirth is the result of a deep-seated misogyny: “There is no other situation in medicine in which pain relief is routinely withheld. No man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.

“Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so.

“Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception. The founders of natural childbirth movements NCT and Lamaze, both men, incidentally, claimed that women in primitive cultures experienced no pain in labour. Pain in childbirth, they claimed, is a product of Western civilised society - a learned phenomenon. The implication was that if women breathed ‘properly' or assumed the ‘correct' positions, the labour would be pain-free. Women were made to feel they had failed if they asked for pain relief. There is evidence that in all cultures giving birth has been a painful experience,” says Grant.

“Opponents of the epidural also claim that it may impact negatively on breast-feeding, but there is little data to prove this. On the other hand, there is evidence that unrelieved pain is one of the risk factors for post-natal depression.

“Modern low-dose ‘walking epidurals' allow women to remain active while retaining the muscle strength to push out the baby. Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth.

“Women should be allowed to choose if they want pain relief, but should have access to accurate information. It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”

We should let women have home births

Sheila Kitzinger, author of Birth Crisis, believes in home birth for women who are not at especially high risk.

“Birth can be ecstatic and empowering,” says Kitzinger. “However, too often women report finding it torture. They feel that they had no control and gratitude that they and their babies are alive is mixed with a sense that they have been violated.

“This can happen even with a so-called normal birth. But it occurs most often with high-tech births: when there are obsetric interventions that may make a woman feel as if she is being treated like an object. A birth experience in which a woman feels, ‘I didn't give birth. I had an operation', that she was 'like meat on a table', or 'it was like a rape' can result in post-traumatic stress, involving nightmaresand panic attacks that adversely affect relationships with her baby and partner. This unhappiness is a result of the aggressive management of birth, typical of a mechanistic approach to the human body and childbirth that is governed by the clock.

“Our medicalised culture is one reason why it is important that there is a home birth alternative. Home birth offers a model on which hospitals should base practice, and that enables midwives to learn how to keep birth normal. Yet for many women, getting a home birth is an obstacle race.

“We need to change the system so that it is simple and straightforward for women to have home births. Birth should be something a woman feels she has achieved, rather than something that has been done to her.”

Pizza boys deliver, women birth

Michel Odent has been instrumental in influencing childbirth practice for decades. He is best known as the obstetrician who introduced birthing pools and home-like birthing rooms, asserting that women feel inhibited in an unfamiliar environment. Controversially, he also believes that the father's presence in the delivery room is the main reason for long and difficult labours.

“Silence and privacy are keywords where childbirth is concerned and birthing pools are useless if these needs are not understood. Yet NICE guidelines encourage midwives to talk to women (discussing birth plans, providing information, asking permission to perform procedures) and the word ‘privacy' never appears,” says Odent.

“A labouring woman needs first to be protected against any stimulation of the thinking part of her brain - the neocortex. This part of the brain needs to take a back seat and allow the primal ‘unthinking' part of the brain connected to basic vital functions to take over. A woman needs to be in a world where she doesn't need to think or talk.

“We need to smash the limits of political correctness where fathers' presence at birth is concerned. In his desire to ‘share the experience' the man asks questions, offers reassuring words and denies his partner the privacy that is one of her most basic needs.

“Studies show that the male presence slows down the process of labour and makes intervention more likely and yet this has become the cultural norm. Theories that emerged in the 1950s with the natural childbirth movement have simply made birth more complicated: women are told how to push or how to breathe, they are conditioned to believe that they are unable to give birth by themselves. The key words in the NICE guidelines are associated with management: women need ‘support', babies need to be ‘delivered'.

“The Free Birth movement advocates a woman's right to a totally unassisted birth. I like both their message and their motto: 'Pizza boys deliver, women birth!'

“It is true that immersion in warm water can help to reduce adrenalin and facilitate the birth process, making contractions more effective. However, after two hours of immersion there is a feedback effect, reducing levels of oxytocin and causing contractions to tail off. Hence birthing pools should not be used until a woman is well advanced in her labour.

“We are at a turning point in the history of childbirth. For centuries different cultures have interfered with the process of birth, imposing cultural rituals which ignore the basic physiological needs of mother and newborn. Now we must get back to basics.”

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