Labour and Sexuality
Midwifery Matters. Issue No 61, Summer 1994.
This piece was first sent to the Midwives' Journal, and was initially accepted, possibly for publication in the main body of the Nursing Times, but following a change of editor, it was rejected. The rejecting editor found its 'personal and exploratory' tone discomforting and said it was poorly referenced.
I chose a personal tone because it seemed I was asking midwives to consider intimate and personal issues, and it seemed only fair to disclose some of my own feelings and observations. It is exploratory (and poorly referenced) because I don't know any other work in this area.
Midwifery has become very conscious of the need for soundly based research and this is necessary, though in order to judge whether research is sound, midwives need to be very critical of methodology and aware how easy it is to bias results. But research must be based on hypotheses, and those have to emerge from somewhere. Where they are formed is in a messy stew of speculation and questioning. In my article I am trying to speculate, and to bring in a dimension of the experience of giving birth, rather than examine birth from a pseudo-objective perspective. Midwifery research can take place in disciplines other than the biomedical; in sociology and psychology for example. Speculation and questioning are legitimate and necessary preliminaries to research.
I believe that midwifery must also encompass qualities which are not amenable to research because they are not measurable, such as a midwife's intuition and the quality of care she feels and expresses to a woman. I think it would be a terrible pity if midwifery took on the values of science to the extent that it lost the unquantifiable. Where then could these messy speculations be shared? The language of science is the language of public discourse, what Ursula le Guin calls the father tongue. In her attempt to describe the mother tongue, the language that women use in the private and domestic sphere she wrote:
We are told in words and not in words, we are told by their deafness, by their stone ears, that our experience of life, the life experience of women is not acceptable to men, therefore not valuable to society, to humanity. We are valued by men only as an element of their experience...anything we may say, anything we may do, is recognised only if said or done in their service.
One thing we incontestably do is have babies. So we have babies as the male priests, lawmakers and doctors tell us to have them, when and how to have them, how often and how to have them; so that all is under control. But we are not to talk about having them because that is not part of the experience of men.
What I have done here is to talk about having babies in language which may not be the mother tongue, because I don't know whether it will strike a chord with any other women, but its rejection by the Nursing Times shows that it is certainly not in the father tongue either. We need research and well referenced articles, but we also need to understand and speak the mother tongue; that is the language our clients speak. As midwives maybe we can forge a unique dialect of it for ourselves.
Since I was a student midwife I have assumed that labour is a sexual event, but recently I have been discussing this, usually in the context of the debate about male midwives, and it has become evident that others do not see labour in this way. So I have begun to question what I really mean when I make this assertion.
My first experience of birth was of hearing my mother talk about how I was born. Her story was of pain, humiliation and a final need for surgery. Then I saw a number of television programmes about birth. This was in the mid 1970s when the rates of induction were beginning to be publicly questioned. I found these images of birth exciting and moving, but it was the emergence of the baby which touched me. So I had no preconception of labour as a sexual act when I came to witness my first birth as a student midwife.
It was an entirely typical hospital birth of the time - the woman, disinhibited by pethidine, lay in the lithotomy position, pubis completely shaved, being enthusiastically exhorted to push with every contraction. In between contractions she begged for her legs to be taken down from the stirrups, (they weren't. It was unthinkable). As the baby came closer to delivery her cries became more intense and, after the birth, changed with dramatic speed to gasping relieved acceptance as she repeated, 'Oh baby, oh my baby'. The rhythm of her response to the contractions and the sudden release and change seemed orgasmic to me, though I accept that they may not have felt like that to the woman. But some women have reported feeling sexual arousal in labour (Gaskin) and Ina May Gaskin famously encourages women and their partners to 'smooch' to augment labour, advice reiterated by Caroline Flint. I have personal experience as a midwife to a woman who, late in second stage, was begging the student midwife to masturbate her.
Even if labour does not directly evoke sexual feeling in the woman, the process of childbearing must surely indirectly evoke sex. How are babies conceived? And how are they born? The reproductive organs are sexual organs and I do not believe that women can expose themselves and open up to give birth without making this connection. When women have gynaecological examinations there is as much care taken as possible to neutralise the sexual charge of exposing the genitalia. It makes sense to me that the shaving and elaborate draping which used to occur performed the same function for vaginal examination in labour and the act of birth.
The hormones of childbirth are sex hormones. Oxytocin, which we know is produced in response to nipple stimulation, causes the uterus to contract in orgasm as well as in labour and later in afterpains.
The impact that this inevitable evocation of the sexual will have for women in labour will vary according to her personal sexual experience. Some women's experience of sex will have been invasive and traumatic as a result of rape, incest or some other sexual abuse.
In general, women's relationship with their sexuality is more complex than that of men. For a combination of reasons - physical, psychological and social - it is comparatively common for women not to experience orgasm during sexual activity. Women's experience of sexuality is influenced by a male dominated society through social norms which inhibit women, for instance by encouraging girls to be quiet and passive, and allowing images which exploit the female body to sell products.
Women's experiences in labour often further underline this distancing from their bodies. They are expected to give birth away from their own territory and surrounded by people who, however caring, remain strangers. For a sensitised woman the whole of labour, and particularly procedures such as vaginal examination, application of fetal monitoring requiring immobility, and the sensations of birth, will evoke pain and trauma. A woman giving birth in those circumstances may well find it easier to choose analgesia to blur reality, or anaesthesia to block feeling, or simply cut off from the sexual impact of labour as she does during a gynaecological examination.
But giving birth is not the same as having a smear test. It is the beginning of what is probably the strongest relationship in this or any society - that of mother and child. It seems a pity to start it off in a way which mirrors a medical procedure when it could be an act of passion.
Midwives, when helping to create the conditions in which a woman gives birth, cannot expect to cure past trauma or undo years of social conditioning. But they can offer the potential for a more satisfying experience. When I gave birth, my primary concerns were for safety and privacy. I needed the latter if I were to be sufficiently uninhibited to labour without drugs. I chose to give birth at home, but place of birth is not my concern here. What further contributed to my sense of safety was that I could trust my midwives not to intervene, unless it was truly necessary for my sake or that of my baby. In other words we were not constrained by policies or procedures. I also believed that my midwives were comfortable with their own sexuality and were not likely to judge or condemn anything I might do, be or appear in labour.
My experience of labour confirms my belief that it is a sexual event, not because the sensations were similar to those I feel when making love - labour was too fierce and savage for any comparison. But there were similarities in that my priorities were altered to concentrate entirely on the task in hand. I was overwhelmed by rhythmic waves of sensation to which the only response was to open up to them and let go. I was not aware of feeling vulnerable which testifies to the good care I received from my midwives. But I was exquisitely sensitive to atmosphere and had my midwives not also been sensitive to me, had they been gossiping about their own concerns or even earnestly reassuring each other that my progress conformed to set norms, I would have felt distracted and maybe also hurt.
Looking at my birth photographs later, I was further confirmed in what I had observed on the labour ward - that the total concentration which the intensity of labour demands causes women in labour to look like people in orgasm. It may be said that one of the tasks of a midwife is to protect the woman's privacy and enable her to heighten her awareness of and response to contractions, which strikes me as rather dangerously analogous to being a lover. Certainly to be present as a midwife when women are enthralled like this reminds me of my sexual experiences.
Just as women will respond to labour according to their past experience of sex, so will midwives respond to the sexuality of women in labour. They may deal with it in many ways, including denial, disgust, acceptance or arousal. Of all these, acceptance of the woman would seem the best for her. But midwives need acceptance for themselves, and acknowledgement that what they do can bring them up against difficult feelings.
I believe that to accept in ourselves what might be judged as negative is an important and difficult step in enabling women to accept and be themselves in labour.
To sum up; if midwives are to offer the chance of a more satisfying experience for women in labour they need:
- the labour ward to be a safe place, free from interruption;
- to be free from policies and procedures, in other words, to be allowed
- to develop and trust their own individual competence;
- to engender in themselves an awareness of their own feelings, and be supported by peers and management to encourage this.
The editorship of Midwifery Matters was organised differently in 1994 and I received a phone call from the then editor after it was published to tell me that the Nursing Times was considering suing Midwifery Matters for libel. They evidently considered being described as using the father tongue as seriously derogatory. I was very distressed, to the point of tears. My loyalty and regard for the Association of Radical Midwives is great and the last thing I had wanted to do was facilitate its destruction. I think that the response was a bizarre overreaction but it was also a testament to the disproportionate influence wielded by ARM. I think that the Nursing Times had no idea that they were dealing with a comparatively small group of volunteers, most of whom were employed as midwives. I think that they must have believed that litigation would have brought some financial reward. If not, it was an empty threat the purpose of which I now think must have been an over determined attempt at vengeance. I'm not sure how the issue was resolved. Certainly no legal action was taken.
Another possibly more parsimonious explanation is that the entire area of sexuality is still taboo and this threat of litigation was an attempt by the Nursing Times to distance themselves from this dangerous area.