Do Women Need Labour?; Caesarean sections may be increasing in

MICHEL Odent is not a man to be messed with. The world-renowned childbirth guru is best-known for his proclamation, during the 1970s, that women should have babies in birthing pools. Today, the vast majority of hospitals have taken his ideas on board - at least providing, if not exactly promoting, the watery option.

But now, the 73-year-old French obstetrician is set to ruffle a few more hormones. His latest book, The Caesarean, suggests that soaring levels of surgical births will have calamitous consequences on Western society.

And he has no truck with women journalists who have had sections trying to relate everything to their own experience. This puts me, a double caesarean veteran, in a tricky situation. My own experiences of caesarean were, broadly, positive and I'm sure neither of my kids would be here today - happy, healthy, and not threatening society at all - without surgical intervention. But Odent doesn't want to know.

"It is a huge problem," he states. "Women, especially writers, think it's all about them, their baby, their birth experience. But it is not. This is about civilisation. This is about the big picture. It's not about specifics, it's about the future."

That may be true for a male obstetrician and theorist - but thinking about the world, when you have a ledge where your stomach used to be, isn't a priority for most women. Only last week, Kate Winslet claimed she had lied about the natural delivery of her first child, Mia. The baby was born by caesarean, but Winslet now says she felt too "guilty" to admit this. With attitudes like that and the increasing number of celebrities such as Victoria Beckham and Kate Moss, opting for the knife, how will Odent's latest theory actually affect women and the birth industry?

The crux of his argument is that the way we are born determines our future lives. Odent believes that when a woman gives birth vaginally, she produces an amalgam of hormones, mostly oxytocin, which result in a "cocktail of love". Odent argues that, without labour and without this cocktail, caesarean babies are born at a disadvantage. They have an impaired capacity to love which, in later life, can emerge in various ways, and may tend towards juvenile crime, autism, anorexia nervosa and suicide.

To someone who has delivered two children in this very fashion, this sounds alarming. Then I remember it's not all about me.

"We need to get past the individual. Of course people are disturbed by what I have to say - this isn't about a specific woman having a caesarean today; this is about what will happen to our society in future years."

Odent may have been deified by many in the natural childbirth lobby, but speaking to him brings a few surprises. I had expected a man wrapped up in woolly jasmine-scented birth plans, but his approach is methodical and academic. He talks of the dozens of peer- reviewed research papers which support his previous findings, and which he firmly believes will support this one too. Most importantly, he also talks a lot of sense.

"Caesareans, in themselves, are not 'evil'. They are incredibly safe in our society, and can often help. We must not move too fast; to drastically reduce the rate of sections as a primary objective would actually be dangerous. In the UK, there is a 23% section rate. The first effect of trying to cut that down overnight would be longer and more difficult vaginal deliveries, with later disadvantages.

"What we must do is rediscover the primary need of women in labour, which has been completely forgotten after thousands of years of culturally controlled childbirth and a century of industrialised deliveries." The essential question, he believes, is to determine women's basic needs during labour. Apart from the complication of language, most of our needs are shared with other mammals: the need not to feel observed, to have some privacy during birth, and to feel secure and safe. Non-human animals will not give birth when there is a predator around, delaying or interrupting delivery until they feel everything is fine. If we understand this, and apply it to women, things will change.

Birth is over-complicated in our society, as a consequence of a lack of understanding. If their needs are met, women will never even consider unnecessary caesareans.

Odent is particularly concerned about elective caesareans, since when labour isn't even initiated, the "love cocktail" never hits the baby. Additionally, he believes epidurals and inductions prevent a flood of these natural hormones.

But isn't there another problem here - haven't we just made too big a deal of birth in general? The natural childbirth lobby has focused very hard on the notion of reclaiming birth for women in recent years.

During first pregnancies, many women spend the entire nine months attending antenatal classes, reading books and magazines published on the subject, and becoming so centred on those few hours at the end of labour, that the reality of a baby can come as a shock.

To an extent, Odent agrees: "The birth process is involuntary. An absolutely primitive part of the brain is involved. You cannot teach a woman to give birth, you can just help her cope. Another problem is that we always focus on the negative - how can we achieve pain-free childbirth? How can we have babies without risk? That is the wrong emphasis. We have thousands of years of culturally controlled childbirth to challenge here and one of the first things we must do is rediscover language, as well as realising silence can be important too."

Odent believes all midwives and obstetricians should be mothers who have delivered naturally (ruling himself out in the process).

"That would change things overnight. Midwives need to find their traditional role again, their authentic role as mother-figures. That would reduce intervention."

The trend towards caesareans has brought us to a historic turning point. "Until very recently, in order to have a baby, women had to release a complex cocktail of hormones. It was absolutely necessary. Today, for the first time in history, women do not have to release them. They can have caesareans, inductions with fake hormones, or be forced to give birth in hostile environments with huge levels of interference. What will this mean in the future? In countries such as Brazil and China, women who deliver naturally are in the minority. What will that do to those societies? The method is safe, if we use 21st century criteria: what are infant mortality rates, how much pain relief did the woman need, how quickly did she get back to work? It is all short-term, but the way we are born has lifelong consequences."

Even for a committed surgical mother like me, Odent's views are persuasive, and the idea of returning to more natural birth is attractive. But in a culture more likely to listen to an actress or model extolling the virtues (or evils) of caesareans, how much of a chance does a pioneer like Odent really have?

Is the answer for all pregnant women to read The Caesarean? "Absolutely not!" he laughs. "They shouldn't be reading books on pregnancy, but making the most of this precious time - looking at the moon, singing to their baby, not reading books which will terrify them."

The Caesarean is published by Free Association Books

Copyright 2004 SMG Sunday Newspapers Ltd.
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