In Birth Matters you write quite a bit about fear and childbirth. Can you talk about how fear in labor works on a physiological level? Where is this fear coming from?
When we mammals become afraid, the brain causes a dump of adrenaline into our bloodstream that quickens our heart rate, makes us stronger and faster, and hyper-alert. This is called the “fight or flight” reaction. It’s not the ideal state for giving birth. In fact, it’s the ideal state for stopping labor once it has started. Since our skeletal muscles are in a state of hardness and rigidity when we are full of adrenaline, it should be obvious that it would be difficult for a baby to push its way through such rigidity into the outer world. We humans suffer from the fact that we are the only species that has figured out how to scare each other about birth.

Fear of childbirth is a cultural phenomenon that has been pushed to an extreme degree in the US and other countries that have been influenced by our weird birth culture. I’m speaking of the very mainstream view that women’s bodies are some kind of accident of nature, that are unable to give birth without technological assistance at each and every birth. Part of what makes our birth culture weird is that it so emphatically tries to convince us that we are different from all other mammals. That’s kind of trap, especially when it comes to birth, since according to this superstition, they are built better for birth than we are.

Of course, we’re the only species in which the male had any influence on the position taken by the female in labor. The male of other species limits his behavior to providing any protection against predators that might be needed and otherwise, letting the female get into whatever position she wishes to take to facilitate the process of labor and birth.

It’s very easy to scare pregnant women. It’s also easy to bother women in labor enough to interfere with the comfort and efficiency of the biological process taking place. Sometimes it stops altogether. Keeping high levels of adrenaline the norm in many hospital maternity wards has become the norm. Birth is often portrayed in the same way that emergency room medicine is shown on television dramas. The emphasis is on adrenaline and “what if” scenarios. Rarely do we see any example of birth in a relaxed female, and if we do, she is not likely to be a human.

While adrenaline is the hormone that says “Stop” to labor, oxytocin is the one that says “Go”. Oxytocin flows when we aren’t afraid. It suppresses adrenaline. We feel oxytocin when we feel nurtured or help someone else feel that way. Oxytocin helps the relevant parts of the woman’s body to open enough to allow passage of the baby outwards. Good flow of oxytocin requires protected environments surrounding laboring women. The behavior of all of the other 5,000 species of mammals reflects this need for calm during labor. When we humans finally realize how important it is to create environments which favor the flow of natural oxytocin during pregnancy and labor, we’ll all be a lot happier.

When you were invited to speak to students at Yale in the 1970s, your slides of mothers with their newborns were greeted with a “vehement chorus of boos and hisses” from the “young women present.” Why were these liberated women so put off by images of birth and motherhood? And are we still dealing with that legacy today?
I think that those women had been reading feminist writers such as Simone de Beauvoir and Shulamith Firestone, whose writings expressed a strong disgust and loathing of the female body. According to this view, pregnancy was a trap for women, and those who fell into this trap were viewed as traitors to the cause of women’s liberation. Firestone’s strategy for women’s liberation depended upon “extrauterine gestation” in test tubes (she was confident that men could soon create artificial placentas). Most feminist writers of the 70s, 80s and even 90s stayed far away from the subjects of childbirth and lactation. Mary O’Brien is an important exception (except she is less well known than she ought to be). She wrote, “It is from an adequate understanding of the process of reproduction, nature’s traditional and bitter trap for the suppression of women, that women can begin to understand their possibilities and their freedom.” (O’Brien, Mary. 1983. The Politics of Reproduction. Boston: Routledge and Kegan Paul). Whatever they were reading, the dominant view about pregnancy was that it represented a loss of control over their bodies.

Out of the nearly 3000 births that have taken place with your midwifery practice at The Farm, only 1.7% were c-sections. Why is the national c-section average– now  over 30%, and over 40% in some hospitals where I live in New York City– so much higher than this? And what does this mean for women?
About a hundred years ago, the midwifery profession (which greatly predates the profession of medicine) was on its way to complete extinction in our country. This radical experiment in human behavior created a climate of fear surrounding pregnancy and birth that has grown stronger as ever more technology has been invented to solve the “problem of birth”. When midwifery is suppressed, the people who best understand birth are not permitted to have much to do with it—especially when it comes to creating norms of behavior. Half a century ago, this resulted in the very strange habit of pulling 2/3 of US babies into the world with forceps gripping their heads. Today, there is just as little faith held by the obstetrics profession that women’s bodies can give birth without medical intervention as there was half a century ago. The difference is that today’s preferred solution is the c-section in place of the forceps “delivery.” Removing any restraints and subjecting more and more women to c-sections for no good reason increases the perception that such treatment is safe and acceptable. However, there is no question about how pushing up the c-section rate makes sense in a for-profit maternity care industry. In such an industry, there is little or no incentive to keep costs down, and there is much reason to schedule birth for the comfort of the caregivers. This is a big reason why more US babies are born between 9 and 5 on Mondays through Friday, avoiding all holidays if possible.