Special Articles  |   April 1996
Who Said Childbirth Is Natural?: The Medical Mission of Grantly Dick Read
Author Notes
  • (Caton) Professor of Anesthesiology and Obstetrics and Gynecology.
  • Received from the Departments of Anesthesiology and Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida. Submitted for publication August 28, 1995. Accepted for publication December 12, 1995. Supported in part by a Research Travel Grant from the Burroughs Wellcome Fund.
  • Address reprint requests to Dr. Caton: Editorial Office, Department of Anesthesiology, University of Florida College of Medicine, Box 100254, Gainesville, Florida 32610-0254.
Article Information
Special Articles
Special Articles   |   April 1996
Who Said Childbirth Is Natural?: The Medical Mission of Grantly Dick Read
Anesthesiology 4 1996, Vol.84, 955-964.. doi:
Anesthesiology 4 1996, Vol.84, 955-964.. doi:
Key words: Anesthesia: obstetric. Childbirth: Lamaze; natural; painless. Dick-Read. National Birthday Trust. Obstetrics.
To me this work is no longer an obstetric practice only, but a mission--no longer a pursuit, but a calling. I am not a holy person, but sincerely believe that time has shown clearly that the only justification for my professional existence . . . is to give everything to spread the Gospel of sane and happy childbirth.a
Grantly Dick Read
GRANTLY Dick Read, the son of a Norfolk farmer, was born in 1889. He died in 1959, after his 35-year quest to change obstetric practice. In one sense, he succeeded. Even before his death, his method of "natural childbirth" had become a household phrase. His major book, Childbirth Without Fear, [1] had been translated into several languages and education programs patterned after his methods had appeared around the world. Recognition for this work, however, a particularly important goal, eluded him. Even after many obstetricians began to adopt his methods, they did not accord Read the respect he believed he had earned.
We know much about Read's work through the copious lecture notes, papers, letters, manuscripts, scrapbooks of news clippings, and detailed autobiographical material that he accumulated throughout his career. The entire collection now rests in the archives of the Wellcome Institute for the History of Medicine in 63 neatly organized boxes.
Read's Vision
Grantly Dick Read believed that "healthy childbirth was never intended by the natural law to be painful."bNormally, he said, birth is "carried out by natural processes from beginning to end, influenced by natural emotions and perfected by the harmony of the mechanism [with the woman] conscious throughout the progress of her baby's birth, so that she can truly fulfill herself emotionally when she sees and welcomes the child emerging from her womb into the world," [2] Natural childbirth also meant that the baby "is not separated from its mother and placed in a communal nursery [and] that she can have her husband with her during her baby's birth."c
Read believed that the art of natural childbirth had been lost, except among "women of the more primitive types."bHe attributed the success of these women to the condition of their bodies, prepared by a life of hard physical work, and their innate understanding of the biologic and social significance of childbirth. Primitive women, he wrote, are:
". . . rarely troubled by anxiety states or toxic manifestations. Malaise or sickness seldom prevents them from continuing such work as they are in the habit of performing. The primitive knows that she will have little trouble when her child is born. She knows that it will be small and healthy, and she has no knowledge of bones misshapen by rickets disease and faulty habits during childhood. Natural birth is all that she looks for; there are no fears in her mind; no midwives spoiling the natural process; she has no knowledge of the tragedies of sepsis, infection and hemorrhage. To have conceived is her joy; the ultimate result of her conception is her ambition. Eventually, and probably whilst even yet at her work, labor commences. . . . There is unquestionably a sense of satisfaction when she feels the first symptoms and receives the impatiently awaited indications that her child is about to arrive. . . [she] isolates herself, and, in a thicket, quietly and undisturbed she patiently waits. [2],p86".
Read claimed that the few women who died in these circumstances, "two, three or four percent of some tribes [do so] without any sadness . . . realizing if they were not competent to produce children for the spirits of their fathers and for the tribe, they had no place in the tribe."b
Read believed that "primitives" have no inherent physical advantages over "moderns," and attributed their success to their state of mind. Modern women, Read said, had lost their competence for natural childbirth through the cumulative effects of acculturation. "From the earliest childhood, the modern cultured girl is brought up protected from the hard facts of life. . . . She is rarely called upon to use her natural instincts . . . alas, reproduction does not move with civilization and parturition is almost invariably the first primitive, fundamental physical act which she is called upon to perform." [2],p86.
Among the factors mitigating women's natural instincts for childbirth, Read included secrecy, false information disseminated by friends and relatives, and religions that teach that labor pain is just punishment for sin. [3] He also believed that fear [1] increases obstetric problems for the mother and infant, and that pain itself, may cause permanent neurologic damage.d
Read believed that modern obstetric practices also distort childbirth and increase its risks:
"It is generally agreed that one of the most important factors in the production of complicated labor, and therefore, of maternal and infantile mortality, is the inability of obstetricians and midwives to stand by and allow the natural and uninterrupted course of labor. . . . It is an unquestionable fact that interference is still one of the greatest dangers with which both the mother and child have to contend. [2],p86".
The Basis of Read's Ideas
Read's books and personal papers, although intensely personal, render only a glimpse of the source of his ideas. Many of his stories seem apocryphal rather than real. He writes, for example, that he observed deleterious effects of secrecy when he was a boy on the family farm in Norfolk. He recognized the potential for an easy and beautiful birth as an awestruck young medical officer during the first World War when he watched a Greek woman and a Flemish woman "drop a quick one" in the fields, smile, and then resume their activities almost without interruption.eThe origin of Read's ideas about "primitive" births is less clear. Presumably, he learned something about tribal practices after he moved to South Africa in 1948, but his ideas were formed long before while living in England, where his entire obstetric experience had consisted of a year's training at University College Hospital in London and a decade of private practice in nearby Woking. Presumably, neither situation offered many opportunities to deliver infants of "primitive women." Opportunities may have been equally scarce in South Africa, because his was an urban practice. Read despaired of how fast tribal women mimic European customs. "I have seen them come into a maternity hospital, well on in labor, and demand 'the needle'. . . don't go to the towns to learn about Africans . . . they have already become the flotsam of the torrent of the white man's infiltration."fRead's definition of "primitives" presents yet another problem. He does not define the word and includes in the category women from "the South Sea Islands, Hindustan, China, India and Japan," [2] cultures that, in fact, were as sophisticated as his own.
Equally personal are Read's stories about the mind's effect on childbirth pain. Exhausted by the trench warfare of World War I, and almost in shell shock, he learned from an Indian subaltern the protective value of mental relaxation techniques. Progressive Relaxation, [4] a book by Edmund Jacobson, helped Read refine these ideas. Read credits Langley and Anderson, two of his professors at Cambridge, for teaching him about the sympathetic nervous system. From Sherrington's book, The Integrative Action of the Nervous System, [5] he learned about nociceptors. The Wisdom of the Body, [6] by Harvard physiologist, W. B. Cannon, introduced him to physiologic concepts of "flight or fight." Finally, papers dated 1944-5 contain his notes about 43 scientific articles about pain.gConsidering the material available at that time, Read's list is sparse. Moreover, he said that he found this material confusing and contradictory, and that he preferred to rely more on his clinical experience and common sense than on the experiments and opinions of experts.hIndeed, his personal papers do contain detailed notes on deliveries and mothers' descriptions of childbirth.
Whatever Read's reluctance regarding the use of science, he cited physiologic concepts whenever possible to substantiate his theory. He said, when frightened, women in labor activate a "flight or fight" response during which they release neurohumors. Neurohumors inhibit labor by causing the longitudinal muscles of the uterus to relax and the circular muscles to constrict. Contractions of circular muscles prevent cervical dilation, and, if strong or prolonged, cause ischemia. Ischemia causes maternal pain and increases the risk of permanent hypoxic damage to the fetus.bSimply eliminating this "fear-tension-pain syndrome," as he called it, would prevent this abnormal sequence: circular muscles will relax, longitudinal muscles will contract, the cervix will dilate quickly, without ischemia or pain, and the woman will deliver. [1] .
Read sought to restore childbirth to its natural state by changing obstetric practice and by stripping away the damaging effects of acculturation. He told obstetricians and midwives to deliver women "as God intended," that is, without anesthesia, forceps, or other "meddlesome" medical practices. Coincidentally, he told women to prepare their bodies with exercise and their minds with information and mental techniques necessary to cope. He publicized his ideas through books, chapters, pamphlets, lectures, and a voluminous correspondence with patients, physicians, and newspaper editors. Read wrote the first version of his book in 1919, but refrained from publishing it when his professors suggested that he should finish his obstetric training first. The first published version of his theory, Natural Childbirth, [2] appeared in England in 1933 and its sequel, Revelation of Childbirth, [3] in 1943. The latter was published in America 2 years later as Childbirth Without Fear, [1] the title used for subsequent versions in both countries.
Read's Motivation
Read's second wife, Jessie, a former patient whom he had married in 1952, described her late husband as a "dedicated man" to whom "childbirth was a holy event--a spiritual and physical manifestation of all that is creatively beautiful within woman."iRead's unshakable belief in the beauty of natural childbirth, and in the "motherlove" that springs from it, was the inspiration for his life's work.
"Motherlove," Read said, is primal force, capable of causing permanent change in the lives of individuals, and of shaping the course of history:
"No woman who remembers her child's birth ever ceases to love that child, and no child who has been born in love and learned of its mother's love, ever ceases to love its mother . . . and so more unselfish love will fill the world . . . and all the actions and ambitions of men and women will be influenced from selfishness to the path which is followed by love.j"
Transformed by "motherlove," men and women will abolish "poverty, distress and misery among the masses," change the character of nations, and eventually the world. All this must grow from the seed of motherlove, the inevitable product, he believed, of a natural birth.jConversely, "the pain of labor, and its initiating cause, fear, extend their evil influence into the very roots of our social structure. They corrupt the minds and bodies of successive generations and bring distress and calamity where happiness and prosperity are the natural reward of a simple physiological performance." [1] Thus, the goal of Read's obstetric mission was nothing less than a new world order. The idealism and sentimentality suggest a young man, but Read was 49 years old when he wrote these lines to his mother. That he originally had planned to be a missionary may explain the intensity and fervor of his work. This style may have influenced patients, but it frequently impeded his work with physicians.
The Response to Read's Ideas
The Public and the Work of the National Birthday Trust
Read's ideas about childbirth pain contradicted ideas long established among the public. After Simpson's introduction of anesthesia for women in labor, women sought medical relief from childbirth pain, often over the protests of conservative physicians. In the United States, a prolonged public campaign early in the century had persuaded reluctant practitioners to use "Twilight Sleep," [7] a mixture of opioids and scopolamine. Others used spinal anesthesiakor Gwathmey's "balanced method," [8] a combination of large amounts of sedatives, opioids, and anesthetics, administered at propitious times during labor. Women in Great Britain also wanted anesthesia for childbirth, a sentiment that led to the formation of a private organization called the National Birthday Trust.
Founders of the National Birthday Trust were disturbed by the inaccessibility of obstetric care to poorer classes of British women, particularly the low proportion of women offered adequate relief from labor pain. Women in Great Britain received anesthesia less often, not from any fundamental difference in medical philosophy, but because of insufficient resources. Except for those who could afford to pay for a hospital delivery, women usually delivered at home with a midwife or, less often, a general practitioner. Concerned about these inequities, a group of socially prominent and politically influential women met in 1928 and formed The National Birthday Trust Fund (NBTF), an organization dedicated to the improvement of medical care for lower class women and children. Members sought to increase the availability of anesthesia for childbirth. Led by Lady Baldwin, wife of Prime Minister Stanley Baldwin, the NBTF sought donations and staged charitable events to raise money for research to develop anesthetic techniques suitable for midwives to use in the home. Successful projects included glass ampules containing a measured amount of chloroform, which could be emptied onto gauze placed on the patient's face, and a "gas-air" apparatus for the administration of a predetermined concentration of nitrous oxide. R. J. Minnitt, the inventor, developed two versions of this machine, a portable model for midwives to use for home delivery, and a larger hospital model. The NBTF bought and distributed Minnitt's apparatus to communities that could not afford them and paid anesthesiologists to work in the obstetric units. It also initiated research to evaluate the maternal and fetal effects of anesthesia, successfully lobbied Parliament to abolish laws that prohibited midwives from administering anesthesia, developed programs to teach midwives safe anesthetic techniques, and, after World War II, encouraged the use of trichloroethylene. [1] In addition, the NBTF initiated a sustained publicity campaign to convince government officials to increase support for maternal and infant care.
Two anecdotes illustrate the effectiveness of the NBTF campaign. Minutes of a Herefordshire government committee meeting note that the "sufferings of women [are a] question of great national importance . . . methods which can be adopted to alleviate such suffering should receive the earnest consideration of all concerned . . . (a) deputation is being organized to the Minister of Health to demand that the means are obtained for giving relief in childbirth to all mothers who need it." Newspaper articles also illustrate public sentiments. One reads:
Women are no longer willing to put up with unnecessary pain just because the grandmothers were told that it was normal to suffer during childbirth. Science has proved that it can make things easier for them . . . and they want the help that science can give them. Red tape and the die hard attitude of local authorities are responsible for the pain and suffering each day in child-birth of hundreds of British mothers.m.
The headline of another article reads: "Mothers want the Princess' Drugs" in reference to the meperidine and trichloroethylene planned for the impending delivery of Prince Charles.nRead's quest began, therefore, when patients, private organizations, and government agencies, began to believe that anesthesia offered the best hope for relief.
Public sentiment changed, however, in part because of Read's work. Interest in natural childbirth increased and Read received more letters from grateful women. A meeting reported in Wife and Citizen: A Journal Advocating the Economic and Social Emancipation of all Women,odegrees illustrates the transition. Invited speakers included Minnitt, John Elam, an anesthesiologist who had encouraged him, and Lady Rhys Williams, then president of the NBTF. The panel was surprised that "some members of the audience were enthusiastic to the point of heckling the platform that a treatment of relaxation, practiced with some success by a few doctors, was superior to the gas and air analgesia." Within 12 years of the publication of his first book, Read had garnered support from a vocal and assertive segment of the public.
Read also gathered support from some physicians. In 1947, he lectured at 14 institutions along the East Coast of the United States. Nicholson Eastman, chairman of obstetrics at Johns Hopkins, invited him to speak. Four years earlier, Eastman had written Read saying, "Your attitude toward childbearing is a most wholesome one and points to an ideal towards which we should strive . . . my former chief, the late Dr. J. Whitridge Williams, used to speak of your work with much interest."pEastman also had written a thoughtful and supportive critique of one of Read's few professional papers. [9] Read received another invitation from Herbert Thoms, chairman of obstetrics at Yale. Subsequently, Thoms and several coworkers taught and applied Read's methods and published several papers describing their work. [10] During this time, Helen Heardman, an English physiotherapist, started a program of teaching relaxation techniques for childbirth and wrote a book describing her methods. Thoms and Heardman remained strong advocates. Eastman did not.
The Reactions of Physicians: The History of Natural Childbirth and "Meddlesome" Obstetrics
Ironically, as patients became more enthusiastic about Read's methods, many physicians became more hostile. That there should have been any resistance is strange, because Read's message really contained little that was new. Experts had long recognized the importance of a woman's mental state for a fast and safe delivery. In 1832, for example, English obstetrician Thomas Denman wrote:
As the infirmities and particular state of the body have a powerful influence upon the mind, and as the affections of the mind have on various occasions a reciprocal effect upon the body, it might be reasonably expected, that the progress of a labor should sometimes be forwarded or hindered by the passions. It is constantly found that the fear of a labor, or the same impression from any other cause at the time of labor, often lessens the energy of all the powers of the constitution and diminishes, or wholly suppresses for a time the action of the parts concerned in parturition. It is also observed that a cheerful flow of the spirits, which arises from the hope of a happy event, inspires women with an activity and a resolution which are extremely useful and favorable in that situation. [11] .
Denman then elucidates the demeanor that attendants should adopt to create a supportive atmosphere. [11] Samuel Bard had written similar comments in his textbook, published two decades earlier. [12] Read knew of this philosophy and cited early authors who supported it.
"Meddlesome" obstetrics was another old issue. It underlay debates about ergot early in the nineteenth century, and it resurfaced when James Young Simpson introduced general anesthesia to obstetrics in 1847. Ironically, the arguments used against anesthesia in 1847 resemble those used by Read a century later to promote natural childbirth. [13] Charges of meddling reemerged in the twentieth century, when some obstetricians began to recommend routine use of podalic version, episiotomy, and manual exploration of the uterus even for normal deliveries. [14] Joseph DeLee, for example, created a furor at the 1920 meeting of The American Gynecological Society, when he called for the "prophylactic" use of forceps. [15] Prominent obstetricians, including Eastman's mentor, J. Witterage Williams, denounced DeLee's presentation in barely civil terms. [16] When Read criticized "meddlesome obstetrics," therefore, he thought that he had simply taken a traditional stance in an ongoing debate. It puzzled, frustrated, and angered him that so many physicians found his suggestions controversial. He never seemed to grasp that his style, far more than his message, may have irritated his colleagues.*.
Read's Style
An obituary in the British Medical Journal described Read as a "man of striking appearance and handsome presence . . . a brilliant speaker, expounding his views with a single minded enthusiasm which carried his audience with him . . . in private life . . . very gay and excellent company."qThose less enthralled with him mentioned Read's flair for self-aggrandizement. One critic observed that Read rivaled James Dean, Liberace, and Elvis Presley in his ability to create mass hysteria and differed from them only in that his work preceded theirs and probably would last much longer.rOn several occasions, this trait almost destroyed Read's career. Allegations of unprofessional advertising had caused Read's partners in Woking to dissolve their group in 1938. Similar concerns 10 years later may have prompted the newly formed National Health Service to deny him a hospital consultantship. Forced by this rebuff to move to South Africa, Read encountered a similar problem there. Citing several irregularities, unprofessional promotion among them, the South African Medical and Dental Registry attempted to withhold licensure. Read contested the decision and won, but only after bringing the matter to court.sHe did have a flair for publicity. Without it, his mission surely would have faltered.
Read also had a flair for obfuscation. The man who once had identified pagan religion as the best religion he had metband had called Christianity a major cause of childbirth fear and pain, [3], pp41-52 also called the New Testament "the greatest book upon health" sup t and said "you cannot find a modern theory of physiology which is not clearly known to have been recognized in the ethical application of Christianity."uAlthough he used physiologic principles to promote his own work, Read also said that he believed that the emotional and psychological state of the mother during pregnancy had more influence on the subsequent development of the child than biochemistry or genetics.bOn occasion, Read even disparaged scientific studies. In one lecture, for example, he ridiculed a colleague who was using electric stimulation to study components of labor pain.v"Laugh with me, ladies and gentlemen," Read said, "we cannot obtain normal reactions by the production of abnormal states. . . . I know him quite well [and] I do not hesitate . . . in exhibiting certain cynicism about his work."
Read made conflicting statements about obstetric anesthesia. In an early paper he wrote, "I do not wish to disagree with the advocates of applied anaesthesia, whether it is caudal, inhalation or parenteral, for pain must be prevented or relieved. Every effort to make childbirth a painless function should be carefully considered." [17] Yet he also wrote, "Walt Disney could hardly do justice to the Silly Symphony of Obstetric Analgesia." [3], pp41-52 In the course of one paragraph of his book, Read praised Hingson's use of caudal anesthesia, then criticized it, describing how "thousands of normal labors have been mutilated by this dangerous and unjustifiable procedure" that robs women of an important spiritual experience. He then concludes the passage with the exhortation, "How long, oh, how long will this nonsense go on? Why do not at least some of these first class brains settle down to try really harmless methods of preventing pain in labor? Can the scientific mind see no further than drugs and anesthetics." [1] Although Read maintained that he never said "labor doesn't hurt," no less often he said that "for the perfect labor anaesthesia is unnecessary because there is no pain." [18] He also said that his methods were successful more than 95% of the time, an estimate thought high even by some of Read's supporters. Read's strident criticism of others, his conflicting statements, and exaggerated claims may explain the loud and frequent arguments that accompanied his work.
Read was contentious. Although the leaders of the NBTF wanted safer and happier deliveries for all women, Read never acknowledged the value of their work; rather, he criticized their methods, impugned their motives, and suggested that they acted only out of ignorance of the true nature of childbirth. "What sort of people rob women of the full joys of motherhood because of prejudice or worse? Is it not disgraceful to read that in a few areas midwives are under some pressure to produce evidence that their mothers have received anaesthetic? Surely the safety of mothers and babies carries greater political capital than ministerial statistics of unwanted stupor."w.
Physicians pressed Read for data to support his theories and they criticized him when he failed to provide it. One physiologist wrote, "I find it so very difficult to get anything which one can by the remotest chance call Scientific Evidence from the other side. I go on hoping but even when it is apparently just within my grasp, it is whisked away."xMore criticism appeared in professional journals. A physician wrote, "There is a tendency today to introduce all these as a national policy as if benefit therefrom were an established fact. . . . Does childbearing require special training to be natural?" [19] Another noted that Read's methods, far from being simple, were highly technical and difficult to teach.yAnother physician, who was both an anesthesiologist and an avowed supporter of childbirth education, worried that the emphasis on "natural childbirth" would mean a return of public, professional, and government apathy toward the use of anesthesia for childbirth pain. Although she recommended childbirth education and taught a course herself, she believed that the benefits were primarily psychological and not physical.z.
The most devastating criticism, however, came in a long article that appeared in the Journal of the American Medical Association. [20] Its authors, two prominent American obstetricians, challenged the statement that women of "less industrialized societies" have less painful labor, disputed the idea that only fear makes contractions hurt, argued that education about childbirth does not eliminate its pain, documented how maternal and infant mortality had decreased with modern obstetric methods, and said that there are no proven psychological benefits of a "natural birth." Although the authors mention Read only tangentially, their article refutes each and every point of his "fear-tension-pain" theory. Even Eastman expressed concern in an editorial appended to a paper by Thoms. [21] .
Read's response did not assuage his critics. Publicly, he accused them of not reading his book, or of not understanding it. [1] Privately, he wrote to Eastman: "I was not discouraged by your editorial comments. To be discouraged, fortunately, is not in my makeup, otherwise I certainly would not have continued in this work for thirty years in spite of being ostracized, repeatedly insulted by General Medical Councils and subjected to the other antagonistic activities with which I have been surrounded. I assure you that I enjoy the asperity and absence of enthusiasm and indeed the absence of comprehension of that section of my senior colleagues who are fossilized, immobilized and very largely devitalized."aaRead's letter excoriates physicians with "vested interests" who oppose him, he says, simply to improve their own social, financial, or professional interests. On occasion, these strong comments appear in Read's books and lectures. It should be noted that personal as well as professional pique may have motivated the letter to Eastman. Read complained that he had detected only apathy among Hopkins obstetricians since his visit in 1947 and that Dr. and Mrs. Eastman had acknowledged neither his house gift nor his "bread and butter letter."
Read's emotional, contradictory, and censorious style did present a problem. For more than a century, obstetricians had striven to make clinical practice more scientific. Coincident with these efforts, maternal and infant death rates had decreased. Despite apparent success, medical educators still felt obstetrics to be the specialty most in need of improvement. [22] Perhaps they perceived Read's flamboyant style as a threat to the scientific development of the specialty. In the midst of this personal and professional adversity, Read received unexpected help from two improbable allies, Fernand Lamaze and the Pope.
Fernand Lamaze and the Pope
Russian claims of a method of Pavlovian training that achieved "painless childbirth" for 90% of all women intrigued Fernand Lamaze. An obstetrician on the staff of the Metal Worker's Union Hospital in Paris, Lamaze traveled twice to Leningrad to learn more. Painless Childbirth, [23] a book describing what he learned, appeared in 1956. It credits Russian psychologists and physicians for both the theory and the practice of "painless childbirth." The book gives no credit to Read, rather it discredits his methods as vague, mystical, and unscientific. In fairness, Lamaze probably had not read Read's book carefully, for he says that the obstetrician from "Birmingham" (Read was from Norfolk), had little impact on obstetrics (by 1956 it had been discussed extensively in many countries), had been abused and shunned by the Anglican church (not true), and had not had any new ideas in more than 20 years (partly true). His own method, Lamaze claimed, had none of Read's shortcomings. Apparently, the public found the "painless" childbirth promised by Lamaze more appealing than one that was merely "natural." Lamaze's book, an almost identical book by his assistant Pierre Vellay, [24] and a third by American writer Marjorie Karmel [25] sparked intense interest.
Read often said of himself that he tended to respond to professional criticism more like a boxer, which he once had been, than as a scholar.** Forgetting all the nineteenth century advocates of "natural" births he had once cited, Read claimed sole authorship of the idea. He criticized the Russians for having "adopted as their own, this obstetric procedure and deformed it by adding a few distractive and dramatic clinical features which in no way alter the basic principles of the 'new discovery' which was published in England twenty-five years previously." sup bb In an unpublished paper, Read was more caustic. "Lamaze deserves better than this book. It has been said the 'gypsies used to disfigure the child and call it their own.' This book is an unworthy memorial to a man whose intentions were good, but undesirable tactics will taint the noblest design."ccSince they had seized control of Russia, he noted, communists had claimed credit for every major innovation in the world, including works of Shakespeare and Marconi. Read, therefore, was not surprised that they had claimed his idea, too.ddPerceiving a slight to his country as well as to himself, Read began to call his technique the "English" or "British" method. About this time, he began to hyphenate his middle and last names. The feud between Read and Lamaze may have done more to increase public interest in natural childbirth than either of their books. Shortly thereafter, the Pope entered the fray.
Sensing in the fracas issues that transcended the pride and honor of individuals and nations, Pope Pius XII delivered a special encyclical about the moral and spiritual values of "natural childbirth." The text, published in its entirety in the New York Times,eenotes that some patients and physicians still believe that the alleviation of childbirth pain, by whatever means, may contravene Divine Intent. Although childbirth pain may have spiritual value, the Pope explains, nothing in the tradition of the Catholic Church prohibits human beings from using appropriate methods to alleviate it. Although he does not judge the relative merits of the "English" or the "Russian" methods, the Pope does caution against allowing a fascination with either one to supplant spiritual values that should accompany every delivery. To the extent that the English method may be less "materialistic," he believes it may be preferable for those who want a "Christian delivery."
Newspapers responded predictably. Around the world, headlines sup ff read "Pope Okays Drugless Childbirth," "Pontiff Approves System of Painless Childbirth," and "Russian Method is Acceptable for Catholic Mothers." In numerous interviews, Read spoke as though the Pope's encyclical had addressed his work alone. The silence of the medical establishment during these events bothered Mrs. Read, however, for she was quoted as saying, "It is a disgrace to England that the Pope should be the first to recognize my husband."ffPresumably, she referred to recognition of her husband's work.
Concerned though he was that physicians should practice "Christian obstetrics," the Pope must have overlooked portions of Read's book that blamed the Church for the pain and complications of modern childbirth. For his part, Read must have overlooked the Pope's comment that "painless childbirth, considered as a general fact, is in clear contrast with common human experience today, as well as in the past, even from the earliest times . . . in so far as historical sources permit the fact to be verified. The pains of women in childbirth were proverbial . . . and literature, both profane and religious, furnishes proof of this fact." The statement, of course, contradicts Read's premise that once there was a time when women delivered babies easily, safely, and without pain. The philosophical differences, important though they seem, did not deter the Pope from awarding, nor Read from accepting, a silver medal for his work. The international press made much of this event, too.
The encyclical and medal were only two of several newsworthy events that happened to Read in 1957. He issued a record album of the sounds of natural childbirth, with instructions on the jacket. The BBC aired a film showing Read delivering a baby, the first televised human birth in the United Kingdom, if not the world. The show was preceded and followed by an appropriate flurry of newspaper articles and interviews. That same year, Read's English publisher, Heinemann, released a biography, Doctors Courageous, written by A. Noyes Thomas. [18] Read contributed directly to the text, and it has the romantic, sentimental, and apocryphal style of many of his other books. In 1958, at the peak of his influence and fame, Read undertook a second, extensive speaking tour in the United States. A year later he died.
Before and after Read
Read was romantic, visionary, dedicated, and an anachronism, a man whose message was good and appropriate. Obstetric practice had become impersonal and meddlesome and it took a person of Read's talents to redirect the attention of the public and physicians to older values. [11] Ironically, this aspect of Read's work puts him in league with Charles Delucina Meigs, the nineteenth century American obstetrician who argued so long and hard with Simpson about the routine use of anesthesia for vaginal deliveries. [13] Meigs, like Read, believed that childbirth was a "natural" process, and that anesthesia was dangerous and unnecessary in most cases. For these views, many called Meigs reactionary, and even cruel. A century later, the same message helped to make Read a folk hero.
Read failed in his relationships with his colleagues, however, because of his anachronistic style. He relied on rhetoric and emotion, a practice effective for garnering support from the public but unlikely to convince physicians. Physicians expected data and statistics, but Read only offered them a vision. Scientific support came only after his death. We now know that women who are anxious about labor have increased plasma concentrations of catecholamines, longer labors, and an increased incidence of operative deliveries; and that simple methods that alleviate anxiety will facilitate deliveries and decrease the frequency of some postpartum problems. [26-30] None of these data would have surprised Read, but then, they probably would not have surprised many of the obstetricians who opposed him either.
The person who best summarized Read's career is Frank Slaughter, the American surgeon and novelist. In a review of Read's biography he wrote:
After it was announced, the Read method was taken up as a sort of cult with considerable mumbo-jumbo and much popular discussion. For some of the official medical opposition to his theories, Read was himself responsible. He advocated principles of relaxation akin to yoga, which he had learned from an Indian noncommissioned officer in World War I. The methods were effective but such an approach spelled quackery to a suspicious medical profession. . . . It illustrates a very important truth: that those who would get rid of existing shibboleths must be careful how they go about it, lest the opposition they create keep the truth from being widely known."ff.
For anesthesiologists, however, the introduction of natural childbirth may illustrate how public sentiment influences medical care. Read appealed directly to the public and he was very effective. His approach was similar to that used by Simpson in 1847 and by Gause in 1907, differing only in that Simpson and Gause urged the use of anesthesia and Read opposed it. The work of the National Birthday Trust illustrates the same point. Whatever the feelings of physicians about obstetric anesthesia, it was an organization of "consumers" that slowly forced the British government to increase the availability of obstetric anesthesia in hospitals and in homes. Considering current cutbacks in medical funding for obstetric anesthesia in the United States, this lesson should not be lost.
The author thanks C. Lawrence, S. Bragg, and L. Hall, of the Wellcome Institute for the History of Medicine, London, for their assistance.
The following material comes from two collections housed at the Wellcome Institute for the History of Medicine: the Grantly Dick Read (GDR) collection and the National Birthday Trust Fund (NBTF) collection. Numbers and letters following these designations identify the location of the material in each collection.
a Read GD: Autobiography: Installment 5, unpublished manuscript, GDR 9 A/92.
b Read GD: Account of visit to USA 1958, unpublished manuscript, GDR 10 F/107.
c Read GD: Autobiography: Installment I, unpublished manuscript, GDR 9 A/92.
d Read GD: Lecture Notes, London Hospital Medical Society, 5 Oct 1954, GDR 23 C/42.
e Read GD: Autobiography: Installment 2, unpublished manuscript, GDR 9 A/92.
f Read GD: News Chronicle, 20 Jan 1956, GDR 22 C/33.
g Read GD: Typewritten notes, 1944-45, GDR 14 B/13.
h Read GD: Lecture Notes, University of Witwatersrand, 11 Oct 1949, GDR 27 C/76.
i Read GD: Lecture Notes: First International Congress for the Release of Tensions and Re-Education of Functional Movement, Copenhagen, Denmark, 30 July 1959, GDR 9 A/89.
j Read GD: Letter to his mother, 16 June 1938, GDR 10 A/95.
k Kreiss O: Uber Medullarnarkose bei Gebarenden. Centralblatt Gynakologie 28(2):990-2, 1900.
l The National Birthday Trust Fund (pamphlet), 4 May 1948, NBTF 51. G4/3/1.
m Newspaper article, The Daily Mirror 1945, NBTF 69 H2/2.
n Newspaper article, Evening Standard, 15 Nov 1948, NBTF 77 H5/2.
o Wife and Citizen: A Journal Advancing the Economic and Social Emancipation of All Women 6(11), 1945, GDR 58 D/272.
p Eastman N: Letter to GDR, 9 June 1943, GDR 53 L/195.
q Obituary. Brit Med J 1959; 1625.
r Newspaper article, London Medical Gazaette, Sept 1957, GDR 33.
s Read GD: Letter to BW Williams, 8 Feb 1949, GDR 53/L190.
t Read GD: Lecture: the divine healing principle in childbirth, Nov 1955, GDR 22 C/33.
u Read GD: Lecture notes: Middlesex Hospital Medical Society, 10 Mar 1943, GDR 25 C/72.
v Read GD: Lecture Notes: University of Witwatersrand, 11 Oct 1949, GDR 25 C/74.
w Read GD: Newspaper article, The People 13 Feb 1956, GDR23 C/50.
x Deighton T: Letter to Miss Riddick, 9 May 1957, NBT 44 F/10/6.
y A Harley Street gynecologist (letter to the editor). The People, 15, Jan 1956, GDR 23 c/50.
z Roberts H: Letter to the editor. Briefs of the Maternity Center Association of New York 17 Nov 1953, NBTF 77 S/4/4.
aa Read GD: Letter to N. Eastman, 13 Feb 1953, GDR 53 L/195.
bb Read GD: Personal notes, 10 Oct 1958, GDR 22 C/33.
cc Read GD: Unpublished notes, GDR 22 C/33.
dd Read GD: Letter to Dr. Jim Henderson, 8 April 1959, Box 53, L190.
ee Newspaper article, New York Times, 6 Oct 1957, GDR 33.
ff Newspaper articles, 9 Jan 1956, GDR 22 C/33.
*GDR D. 150, Letter from Sir Eardley Holland, January 8, 1949: "I would urge you, though, with respect, to take more thought to win the sympathies of the Profession as distinct from the Public, and give more time and take more trouble in doing so. It is true that Browne and Claye and I happen to be comparatively liberally minded men and to be your professional sympathisers and backers. But you seem to have alienated the sympathies of the rest of the Gynaecological world. Have you even considered that you yourself may be to some extent to blame for that sad state of affairs? You have sometimes tried even me very severely!" [Holland was a longstanding friend and supporter of Read's.]
**GDR 53 D200, Letter to "Dr. Guttmacher," dated June 1946: "It is just a year ago since you published in Parents Magazine . . . a review of a book of mine that came out in America called "Childbirth Without Fear." I read your review with great interest. I enjoy criticism, particularly if it is touched with friendly asperity. . . . I do not include only the academic controversies in which, as you may imagine, I have been engaged, sometimes violently, during the last thirty years but also in athletics, sport, football, and boxing. The last form of sport was of particular interest to me for many years and as a heavyweight--may I be un-English enough to put this in a personal letter--I met with no little success. You will understand, therefore, that I do not read review, criticisms, and correspondence about my work from the scholarly point of view." [Read wrote this letter to Allen Guttmacher, a highly respected American obstetrician and president of the Planned Parenthood Foundation.]
Read GD: Childbirth Without Fear. New York, Harper, 1944.
Read GD: Natural Childbirth. London, Heinemann, 1933.
Read GD: Revelation of Childbirth. London, Heinemann, 1943.
Jacobson E. Progressive Relaxation. Chicago, University of Chicago Press, 1929.
Sherrington CS: The Integrative Action of the Nervous System. New Haven, Yale University Press, 1911.
Cannon WB: The Wisdom of the Body. New York, WW Norton and Co., 1939.
Caton D: "In the present state of our knowledge": early use of opioids in obstetrics. Anesthesiology 1995;82:779-84.
Gwathemey JT: Obstetrical analgesia: A further study based on more than twenty thousand cases. Surg Gynecol Obstet 1930;51:190-5.
Eastman N: Editorial comments. Obstet Gynecol Surv 1946;1:459.
Thoms H, Wyatt RH: A natural childbirth program. Am J Public Health 1950;40:787-91.
Denman T: An introduction to the practice of midwifery. London, E. Cox, 1832, p 235.
Bard S: A Compendium of the Theory and Practice of Midwifery Containing Practical Instructions for the Management of Women During Pregnancy, in Labour and in Child-Bed. New York, Collins and Co., 1812, p 122.
Caton D: Obstetric anesthesia: The first ten years. ANESTHESIOLOGY 1970;33:102-9.
Holmes RW: The fads and fancies of obstetrics: a comment on the pseudoscientific trend of modern obstetrics. Am J Obstet Gynecol 1921;2:224-37.
DeLee JB: The prophylactic forceps operation. Am J Obstet Gynecol 1920;1:34-44.
Williams JW: Discussion of DeLee's Paper: The prophylactic forceps operation. Am J Obstet Gynecol 1920;1:77-84.
Read GD: Correlation of physical and emotional phenomena of natural labor. J Obstet Gynecol Br Emp 1946;53:55-61.
Thomas AN: Doctor Courageous: The Story of Grantly Dick Read. London, Heinemann, 1957, pp 76.
Beynon CL: Whither natural childbirth. Br Med J 1955;475.
Reid D, Cohen ME: Trends in obstetrics. JAMA 1950;142:615-23.
Eastman N: Editorial. Obstet Gynecol Survey 1951;6:163-7.
Flint A: Responsibility of the medical profession in further reducing maternal mortality. Am J Obstet Gynecol 1925;9:864-6.
Lamaze F: Painless Childbirth: Psychoprophylactic Method. Translated Celestin LR, London, Burke, 1956.
Vellay P: Childbirth Without Pain. Translated by Lloyd D. London, Hutchinson, 1959.
Karmel M: Thank you, Dr. Lamaze. New York, Harper & Row, 1981.
Lederman RP, Lederman E, Work BA, Jr, McCann DS: The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol 1978;132:495-500.
Zuspan FP, Cibils LA, Pose SV: Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine. Am J Obstet Gynecol 1962;84:841-51.
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C: Continuous emotional support during labor in a US hospital: A randomized controlled trial. JAMA 1991;265:2197-201.
Scott JR, Rose NB: Effect of psychoprophylaxis (Lamaze preparation) on labor and delivery in primiparas. N Engl J Med 1976;294:1205-7.
Wolman WL, Chalmers B, Hofmeyr GJ, Nikodem VC: Postpartum depression and companionship in the clinical birth environment: A randomized, controlled study. Am J Obstet Gynecol 1993;168:1388-93.