Page last updated at 14:30 GMT, Wednesday, 13 December 2006

Pushing 50 - three ages of childbirth

Left: Margaret and Bronwen 1947 Right: Bronwen and Megan, Far right: Megan and Myfanwy

By Hanna White and Alison Trowsdale
BBC News website

It's more than 50 years since the birth of the National Childbirth Trust, Europe's largest parents' charity, and in that time maternity services have been transformed.

As the experiences of three generations show, strict rules and regulations on the labour ward have given way to a more informal and woman-centred approach.


Margaret and Glyn Thomas
Nowadays so many little faults are caught in time, and general support is there if the woman wants it - there was nothing like that
Margaret Thomas

Margaret and Glyn Thomas had their first daughter Bronwen in February 1947 in a Manchester hospital. Now in their 80s, they look back on the experience with mixed feelings.

While the birth went smoothly, Margaret was ill-prepared for childbirth by today's standards.

Antenatal classes were not on offer, so Margaret had to rely on knowledge of anatomy picked up at school and from helping her husband, who was studying dentistry.

She had also read a best-selling book by obstetrician Grantly Dick-Read who coined the phrase "natural childbirth" and advocated breathing techniques and other ways of coping with labour pain.

Margaret and Glyn on the their wedding day

Dr Dick-Read's philosophy of natural birthing inspired Prunella Briance to found the NCT in 1956.

But he was regarded by the medical profession as a maverick and his philosophy as unscientific.

In fact, as Margaret was putting into practice Dr Dick-Read's advice during her labour - crawling around on all fours - she remembers the hospital doctor coming in and telling her off, saying she might even kill the baby or herself.

For most of the two hour labour she was left to cope on her own with no pain relief, apart from gas and air in the final stages. It was "very new at the time" and she was unsure how to use it.

Woman in labour breathes in gas and air (entonox) - late 1940s
1850s - chloroform, ether Said to have been popularised by Queen Victoria
1933 onwards - Gas and air Nitrous oxide first produced in late 18th century but was not widely available to midwives until invention of portable machine by Dr Minnitt of Liverpool. Combined with air to deliver effective pain relief without making patient unconscious
1945 onwards - pethidine Popular in 1950s and 1960s. Occasional respiratory problems in newborns led to reduction in use
1970s - epidural
A local anaesthetic injected into spine, so restricted to hospitals with 24-hour anaesthetist cover
1990s - Tens
Transcutaneous Electrical Nerve Stimulation machine is an electronic pulsing device strapped to body to deflect pain of contractions during early stage of labour
Mid-1990s - mobile epidurals
Contain a lower dose of analgesic than the traditional epidural and leave some feeling, allowing woman to walk around
Natural pain relief
Relaxation and breathing exercises; self-hypnosis, acupuncture, (since the 1990s) birthing pools.

Glyn was not there, because he was not allowed to be - in those days men were banned from the birth and only allowed into the hospital during visiting hours.

"We were looked upon as an awful nuisance if we turned up out of office hours," says Glyn.

They were also usually prevented from holding their newborns for "hygiene" reasons.

Even contact between mother and baby was limited, as newborns were kept in nurseries away from the ward, and only brought to their mothers at feeding time.

Margaret is sure maternity care has changed for the better: "The first eight months after I knew I was pregnant until my waters broke I saw nobody and nobody came to see me. Nowadays so many little faults are caught in time, and general support is there if the woman wants it. There was nothing like that."

But Glyn feels there is a price to pay for all the antenatal testing available now: "If some abnormality is noticed are you going to do anything about it or not? That never arose before the tests so you never worried about it."

Margaret admits she would have been anxious. "So it suited me, in a way, to be left alone, left to get on with it."


Margaret and Glyn's daughter, Bronwen, and her husband Crispin Hodges began their family in March 1973 with the birth of Megan in hospital in Taunton, Somerset.

Crispin and Bronwen
I had faith in the medical profession. I didn't question any of it.
Bronwen Hodges

While the couple had not heard of the NCT at the time, their childbirth experience was influenced by its campaigns. Bronwen attended antenatal classes run by the district nurse, an approach pioneered by the NCT in 1967. And Crispin was with her during labour, a change also brought about by the NCT.

Intervention was the name of the game in the 1970s and it was common practice to induce babies, news that came as a shock to Bronwen when she was a few days past her due date - with her blood pressure rising, doctors wanted to speed up the process.

Crispin drove Bronwen to hospital in the early afternoon. After an enema - "the in-thing" - she was shaved, bathed, her waters were broken and she went into labour.

Crispin Hodges
One felt it was a new wave - fathers were now being involved.
Crispin Hodges

"The worst pain, I found, was having a catheter inserted into my bladder - far more painful than any contractions," she says.

Crispin was allowed in whenever the doctors were not busy and "as long as I kept up at the head end".

"I wasn't encouraged to see anything, but to hold hands and do a lot of there-there-ing. But one felt it was a new wave - fathers were now being involved," he adds.

Bronwen was glad to have him with her. "I can't imagine going through that without your partner there. I think it would have been awful," she says.

Labour progressed well. For pain relief, Bronwen had a small dose of pethidine and gas and air towards the end of the first stage - epidurals were rare in those days.

Left: Crispin with baby Megan - Right: Bronwen with Megan
Crispin with Megan and Bronwen with Megan in 1973

Megan was born at about 2115. Bronwen stayed in hospital for 10 days and Megan spent the night in a nursery, much as babies had in her parents' day.

Bronwen looks back on Megan's birth as "the best day of my life at that stage - and then I had a second child, which was just as good".

She accepted the level of intervention she experienced. "I didn't question any of it. I was happy to trust the medics' judgement."

A year after Megan was born the NCT began a campaign against unnecessary inductions and by the mid-1980s routine shaving, enemas and episiotomies (cutting to prevent tearing during childbirth) had also ceased.

Pie chart showing dramatic decline in home births since 1955


By the time Bronwen and Crispin's daughter Megan and her husband Richard Greene started a family in January 2004, the emphasis had changed. With "patient choice" the buzz word, they had the luxury denied to their parents and grandparents of selecting the place where they wanted their baby to be born.

Blood tests Identify mother's blood group, see whether blood is rhesus positive or negative, check for conditions that could affect mother or baby's health, check mother's immunity to rubella (German measles), check for anaemia.
Ultrasound scan to date pregnancy and check health of foetus - frequency and timing differ according to local policy and parental needs
Amniocentesis tests for Down's Syndrome and other genetic abnormalities. Long needle inserted into womb to draw off some of fluid surrounding baby. Small risk of miscarriage.
Chorionic villus sampling (CVS) tests for Down's Syndorome. Needle inserted in abdomen and small sample of placenta removed. Small risk of miscarriage.

In 1970 the Peel report had recommended all women should give birth in hospital for the safety of mother and baby, resulting in a dramatic fall in home births.

By the 1990s the tide of opinion had turned, based on evidence gathered by the NCT among others, and in 1993 official policy shifted as it was concluded that maternity services should be centred on the mother.

Megan and Richard chose their local hospital, the Royal Free in north London, which has a birth centre attached to it.

"I knew I wanted to go into hospital," says Megan. "I wasn't brave enough to have a home birth. I thought if anything goes wrong, I don't want to have that association in my own home."

They both attended free NHS-run antenatal classes and throughout her pregnancy Megan saw her local midwife - a comforting experience. "It was just so reassuring and [she was] very experienced and kind of informal. You aren't a patient, you are just somebody who is having a baby."

Left: Richard and Myfanwy Right: Richard, Megan and Myfanwy - photo courtesy Crispin Hodges
I went from hoping to have it all naturally to having the whole lot
Megan Greene

But Megan's labour did not progress and she ended up having a Caesarean.

"We did start in the birth centre and it was all very friendly and fairly stress-free, but my contractions weren't coming as regularly as they should have done. I was strongly advised to have an epidural.

"So I went from hoping to have it all naturally to having the whole lot."

Richard was with her throughout. "We went into the operating theatre together and I stayed up at her head and they dropped a curtain just above the bump.

Richard, Bronwen, baby Myfanwy and Megan
Bronwen arrives at the hospital to see her granddaughter Myfanwy
"There was a great comedy moment when after a few minutes she said, 'Would you just tell me when you're going to start?' and they already had."

Megan recalls: "The baby was delivered and taken straight to a table on the side where they did all the tests on newborns. Richard went over to her and told me it was a girl, which was a surprise to both of us because, for some reason, we were expecting a boy."

Richard said he was glad he was present at the birth of his daughter, Myfanwy, but he has his doubts about what he achieved. "I didn't feel like I was doing very much. Megan has told me I was very useful. I was there, I held her, she grabbed my shoulders and forearms through the contractions."

Two years later Megan gave birth to Reuben after a vaginal delivery. "I was really pleased I had managed to do a delivery without any intervention at all."


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