The Theory and Practice of Natural Childbirth

Now that six years have elapsed since the study of natural childbirth was begun at Yale it seems appropriate to review the status of this philosophy in the perspective of time and experience. Not only is this appropriate, but it is necessary in view of the continuing enthusiasm of its proponents and the continuing attacks of its opponents. Is it a universally objectionable, backward step in the forward progress of obstetrics or a universally applicable and beneficial technique? Is it a complex ritual suitable only for the obsessive, dependent woman or are its routines simple enough and sufficiently valuable to merit incorporation in all prenatal programs? So much has been written and said supporting both these points of view and the controversy has spilled over into the lay press so frequently that it becomes important that both obstetricians and patients have a clear understanding of its basic principles and applications. Such an understanding is doubly important if, as even its opponents admit, natural childbirth has certain advantages, lest these advantages be discredited in the heat of controversy. To me, natural childbirth is basically a system of intellectual, emotional, and physical preparation for childbirth to the end that mothers may enjoy a healthier and happier pregnancy and delivery. That these aims are difficult, if not impossible, to evaluate objectively is admitted, but does this mean that attempts to reach these goals are useless or that we must deny clinical judgment because it cannot be proven (or disproven) in the laboratory? The experience of those who have made a genuine attempt to apply the techniques of natural childbirth seems to prove otherwise since their numbers increase every year. More and more hospitals are adding prenatal classes to their maternity care programs, more and more frequently the subject is appearing on medical programs, and recently the New York City Department of Health recommended that all hospitals with prenatal clinics organize parents' classes. A recent article entitled "Is Natural Childbirth Natural," by Mandy et al.' epitomizes the objections of the opponents of this philosophy. Recognizing the fact that "Read's basic concept, that fear of childbirth increases the patient's tension state and thereby produces pain in labor, is sufficiently broad for general acceptance," they go on to attack the means of combatting