Regarding the specific cases of painless labour in healthy women, vouched for by various medical men and women, the following is a representative though by no means exhaustive collection:--

Dr. Honoré Chailly says:  "Entre autres exemples, je puise citer celui d'une jeune fille primipare, agée de 16 ans, arriveée à terme . . . Elle fut réveillé par de légères douleurs à quatre heures du matin, et elle était accouchée seule à six, sans demander aucune assistance."48  {tr:  "Among other examples, I can cite that of a young primipara, age 16 years, at full term . . . She was awakened by light contractions at four a.m., and was in labor only until six, without asking for any assistance." }  Dr. W.S. Playfair writes:  "I am acquainted with a lady, who has had a large family, who assures me that, though the labour is accompanied by a sense of pressure and discomfort, she experiences nothing which can be called actual pain;  such a happy state of affairs is, however, extremely exceptional."49  Dr. Bruno Wolff, after describing a case of his own, in which a perfectly healthy woman had a painless labour, mentions a similar case of a "youthful" primipara reported by Dr. Prothero Smith in 1846;  one reported by Dr. Underhill in 1877 of a primipara 16 years old, another reported by Dr. Rosenberg of a primipara 24 years old, another reported by Dr. Larkin of a fourth child in a woman 29 years old, and another reported by Dr. Säxinger in a primipara 15 years old.50  He also refers to a Dr. Sänger who declared that he had come across them again and again, and to Drs. Rosenberg, Ahlfeld, and Bumm as saying that they are rare.51  He then tries to arrive at the possible morbid causes of his own case, and dismisses them all.52

Dr. John Irving, writing in 1906, says:  "Dr. Horrocks's statement that there is no such thing as painless labour (presumably in normal conditions) is contrary to my experience," and he mentions the case of a woman who had four children (one set of twins) and with whom all three acts of parturition were painless and extremely short - about ten minutes being the time in the first confinements.53

Dr. I. Allen also joins issue with Dr. Horrocks's statement.  "In my opinion," he says, "this is far too sweeping a statement and one which I cannot agree with.  I maintain and fully believe that there are cases of labour which are, practically speaking, painless."  He then mentions a case of a primipara of 18 who had a child in about two hours.  "The infant was a well-developed male . . . 8 lbs.  . . . On questioning the mother it was ascertained that there had been no pains . . . and that the child had been born unconsciously.  There was not the slightest tear in the perinæum.  . . . The mother made a rapid and uninterrupted recovery and the child did well."54

Dr. Harold Renshaw describes the case of a young primipara whose confinement was almost "instantaneous".  She told her mother she "felt queer", then "stepped across the room and leaned on the mantelshelf, when, without warning, the baby fell on the floor".  She made an uninterrupted recovery.55

Dr. G.D. Trevor-Roger reports the case of "a 3-para age 28", who "stated that she woke at about 6:30 a.m. and the child was born immediately.  She told me that she had 'neither ache nor pain'.  Recovery was uneventful.  She had another spontaneous birth four years later.  . . . In neither of her first two labours did she suffer much pain and they both terminated quickly."56

Dr. W.J. Young mentions a similar case of a "girl" who had no pain at her confinement.57

Dr. A. Percy Allan describes two cases of quite painless labour, both in primiparæ, aged 20, in which there was no tear in the perinæum.58

Dr. A. Burn reports the painless birth of a 7 ½ lb. baby after 8 ½ hours labour in a primipara of 29;59  Dr. A.A. Masser that of an 8 lb. full-term baby born immediately after the breaking of the waters in a primipara of 24.60  Dr. A. Patten describes a patient whom he had in 1913, who was not a primipara, but whose confinement, like all her previous ones, was painless.61  Surgeon Commander G.V. Hobbes, R.N., mentions a case of a woman who did not know she was pregnant, who played tennis up to the time of her confinement and who, the day before went a 12 mile walk with her husband.  Her doctor had been treating her for amenorrhoea.  She was painlessly confined of a 7 ½ lb. baby.62

Dr. M.M. Russell reports a similar case, the baby weighing 8 lb., and adds "at the risk of arousing incredulity", there was no perineal laceration.63

Dr. W.M. Murphy reports that he was called at 10 a.m. to a perfectly healthy woman of 36 who had had two previous confinements.  She was up and performing her household duties.  She had no pains "but thought she was in labour as 'water had been coming in little gushes since 8 o'clock'."  He saw her again at 8 p.m. and she had had no pains.  At midnight, when she sent for him again, she gave birth almost immediately to a male child of 7 ½ lb."  The placenta followed in five minutes and there was scarcely any hæmorrhage.  She had no pain whatever during the day and only three pains as the child was being born.  . . . The history of her first confinement at the age of 24 years is similarly painless."64

Dr. Keith Gibson reports a case of a primipara who "had strong uterine contractions, but no suffering;  she remarked that 'if these are labour pains, I can't see what people make all the fuss about'.  Stretching of the perinæum, however, caused some pain later".65

Dr. Eric Kenderdine also reports an interesting case of easy birth in the Midlands.  He says:  "The patient, a primipara, had a hot bath on the Sunday at 23 o'clock, and noticed a slight 'show'.  She went to bed and awoke at one o'clock.  She defæcated normally, but 'had to support herself in front'.  A feeling of weight at the rectum sent her in to see her nurse, sleeping in the next room, at 2:30 when the first real pain occurred.  This made her stand first on one leg and then on the other.  The nurse was surprised to see the head crowned, and hurried her to bed, when the birth took place at three.  The patient started laughing, as she did not think it would be so easy."  The baby was of normal size.66

Dr. Peeters, a Dutch practitioner, records the case of a woman who had seven painless full-term labours in succession.  They were accompanied by slight abdominal discomfort, but no real pain, and the labour on each occasion lasted only a few minutes.  As "the patient did not present any psychical taint . . . the dictum of Halban and Seitz that painless labour only occurred in psychopathic subjects was not applicable".67

I, too, have personal knowledge of two cases of successive painless births in working-class women of Swinbrook Road, North Kensington.  One of them would actually hold conversations with female neighbours through the crack of the door while her child's head was being born.

Finally, here are a few instances of painless birth described by Dr. Mary de Garis herself.

In one of her own cases, a primipara of 20, delivered after three hours' labor of a vigorous female child of 9 lb., said to her that "there was no actual pain in the first stage, and during labour she had had a weakness in the back, perhaps an ache.  In the second stage there was only a feeling as if the bowel was about to act, without real pain".  There was a perineal tear [probably due to the absurdly large baby which was born a fortnight later than expected] which "she did not feel . . . and she did not like the feeling of distention of the vulva by the head when it was fixed, but it was not real pain".  Her puerperium was uneventful, involution was good, and the patient successfully nursed her baby.68

A further case, reported to Dr. de Garis by Dr. Winifred Kennon, relates to a primipara of 24 who "had no pain, and only felt she had something to push out".  Dr. Kennon continues, "The patient could not understand when I told her to push when she got a pain, becaus she did not have any pain, but if I told her when she got the bearing-down feeling to push she understood and delivered herself in that way."69

Dr. de Garis also quotes Dr. Yeatman with reference to a primipara of 20 who "alone in the house after breakfast, felt some discomfort and thought the bowels were going to act but, recollecting her condition, got into bed just in time for a healthy full-term infant to be born . . . the perinæum was not torn.  . . . She persisted in the statement that there was no pain at all, merely the sensation as if passing a large motion".70

Dr. Joyce reported two cases to Dr. de Garis -- one of a patient who "said in a perfectly natural voice that something was coming, and birth followed immediately", with a slight pain or two, and another of a primipara who "while the head was crossing the perinæum, brushed a fly from her arm, and said she felt no pain whatever, only a sense of stretching and pressure".71

Dr. Giommi reported several cases to Dr. de Garis -- one a healthy, robust, and hard-working woman of 36, had given birth to four infants, the first two before either doctor or nurse could be informed.  During the birth of the other two "she never had a pain. . . ."   She would only admit a certain discomfort at the passage of the head at the soft parts at the very last. . . . Involution was more rapid than in the best of the average cases."  The other case was a primipara of 27, living in a tent;  "the womb was seen to be contracting well though there was no sign of pain, and the foetal head appeared at the vulva painlessly.  The placenta followed in two minutes without pain, and the womb became well contracted.  She got up the next day and did her work as usual.  Questioned as regards her feelings, her answer was as in the previous case."72  Dr. Giommi's other cases were like the above, and he "draws attention to the unusually rapid involution in these painless cases, and specifically to the 'normal' character of his cases".73

Dr. Allison also reported a case to Dr. de Garis.  A woman had two confinements in which she complained only of feeling stiffness.  At her third, after seeing Dr. Allison at 10 p.m. she decided at 2 p.m. to walk a distance of 100 yards to the hospital.  Half-way there the child was born.  "She said later that she had had absolutely no pain, not even discomfort, as she merely felt the touch of the baby on her thighs demonstrating its presence."74

Dr. Agnes Bennett's cases were as follows: --

(a) A patient "awoke in the night to find the birth occurring.  While her husband was telephoning for the doctor the child was born in the bed".

(b) Another patient, in hospital for ante-natal treatment, one evening "felt an urgent call to stool, and the child was found in the pan, alive and uninjuried".75

Since the above was written, another case of painless labour has been reported in the literature.  Dr. T.B. Prys-Jones, of Denbigh, writes of a domestic servant of 18 who, having risen at 6:30 a.m. and done her "somewhat laborious general domestic work", ran up the garden at 11:20 a.m. after helping her mistress with the bed-making and "ten minutes later she reappeared with a bundle wrapped in a newspaper . . . the bundle contained a very cold, indignant, and protesting infant".  The girl then went to "clear up the mess", and "returned to the house, picked up the infant, and cheerfully proceeded to walk to her home, about a quarter of a mile distant up the hillside. . . .  At 1 p.m. . . . the placenta was still in the vagina, and was easily expressed by the nurse with membranes intact.  The patient's own statement, her excellent condition, and the firmly contracted uterus showed that there had been but a normal loss of blood.  The infant was a lusty 7 lb. female child. . . . She (the young mother) was insistent that she had no pain whatsoever.  The puerperium was thoroughly uneventful and normal in every respect".76

Commenting on painless labours, Dr. de Garis says that they "are commonly associated with uneventful recoveries and vigorous infants,77 with laceration rare and slight", they "are often primiparous, and successive labours are usually painless also".78

She then asks:  "Is the absence of pain sufficient to brand such labour as abnormal?  It may be unusual, but it is not pathological.  Ought we not to argue from it that pain is not a necessity to a successful childbirth, and to seek rather the cause of the pain than of its absence?"79

After a discussion, in which she deals with the various medical aspects of pathological and non-pathological painless labour, she proceeds:  "Painless labour, with spontaneous delivery, in a healthy woman . . . being the best and easiest labour known, should be taken as the standard or normal labour.  Its adoption would give us an absolute, concrete, and physiological standard of labour -- namely, that a normal labour is one in which the uterine contractions act thoroughly efficiently, leading in a short time to the spontaneous delivery of a healthy infant, and causing little or no pain or suffering to the mother."80

Finally, she makes this weighty statement:  "The chief reason for the lack of progress in midwifery has been the absence of a definite standard of uterine efficiency;  the painless efficient labour supplies this."81

Here we have answered, by an exceptionally enlightened medical woman, the question which I put at the opening of this chapter, and which I maintained lay at the root of the whole matter.

Elsewhere, Dr. de Garis gives us the following bright gems of wisdom amid the prevailing confusion and obscurantism.

"As long as the average labour was taken as the standard there would be no advance."82  (Yes, but who, except medical scientists, would ever confuse "average" with "normal" or "standard"?)

"We have grown so accustomed to the great pains and dangers of childbirth that there is little zeal to diminish them."83  (Particularly as "normal" childbirth as here defined would make the medical profession superfluous at a healthy parturient's bedside.)

"The true object of a definition of normal labour is to provide a norm, or standard by which may be studied the variations therefrom, both in their occurrence and in their causation.  It should plainly be that of the best and easiest labour known."84  (Obviously!  Although we cannot thank Dr. de Garis sufficiently for making this point, we can hardly suppress our astonishment that it should be necessary to make it.)

"Pain in every function but labour is accepted as due to some fault in the process;  why not in labour also?"85  (Exactly!  It is Dr. de Garis's isolation, as of one speaking in the wilderness, that seems inexplicable.)

"In reviewing the literature of painless labour, one finds an anxiety among critics to prove that there was some pain."86  (True!  And how revelatory!)

In short, as a commentator on Dr. de Garis's views declares, she "holds that labour could be defined as the expulsion by a hollow organ composed of plain muscle of the ovum by the action of this muscle.  It was similar to micturition, defæcation, and the heart action.  All these muscular actions were painless when healthy, and she contended that normal labour was painless."87

The reader may imagine my satisfaction when I came across Dr. de Garis's views, confirming, as they did, all that I had long been thinking and writing.

But this is not all.  In 1933 a book appeared, written by another enlightened medical graduate - this time a man - which, although it seems to be independent of Dr. de Garis, and does not mention her, entirely supports her thesis that "normal" birth should be painless.  I have already had occasion to quote it.  Its author's object is "to initiate such change [in our attitude to and treatment of the childbearing functions] as will in future generations re-establish childbirth in the civilized races as a painless procedure".88  Like Dr. Vaughan, he deplores anæsthesia89;  he believes that "there is very little evidence that modern woman is in any way less fitted to produce children painlessly than the woman without culture and without civilization",90 and declares that "probably culture is the greatest enemy of woman, when reduced to the performance of her fundamental activities".91

"Both the fact of the completely painless birth," he says, "and the relative ease with which the pain can be eliminated by mental control, are factors against the acceptance of parturition being necessarily accompanied by pathological change."92  And he proceeds to elaborate his thesis to the effect that, all other conditions being favourable, it is fear in modern woman that makes a painless function painful.

Seeing that "in the majority of cases there is plenty of room in the birth canal for the child that is born",93 and that the main sensations should be no more severe than those which stimulate a demand for evacuation either of the intestine or the urinary bladder, the call to evacuate should satisfy, and in normal circumstances give rise to "a sense more akin to pleasure than to pain".94

If, however, fear intervenes, as it does in defæcating or micturition when there is a fissure in ano or acute urethritis, it destroys the harmony of the function, with intensified pain as a result.  "Applying this to the evacuation of the pregnant uterus, fear disallows the normal neuro-muscular activity, the evacuation pain becomes intensified, the nerve harmony is destroyed, resistance - which is entirely pathological - occasions pain."  And "it is clear that this pain is pathological".95

Finally, "there is no evidence that can be based upon the theory of evolution which suggests that parturition should be accompanied by any discomfort greater than a normal and natural defæcation. . . .  Evolution demonstrates that pain is necessarily the protector of the individual, but there is no evidence that any normal function, whether muscular, metabolic, or reproductive has ever been intended to be painful."96
I cannot here reproduce or even summarize the arguments and scientific data with which Dr. Dick Read {sic} supports his thesis.  Suffice it to say that they are cogent and irresistible.  My only dispute with him is about the true cause of the pain in the majority of civilized childbirths.  While I believe that he is probably right in maintaining that "from the moment that fear is introduced into the mind of the parturient woman normal physiological activity becomes impaired, and pathological changes disturb the integrity of the apparatus",97 and while I agree that "the tyranny of hearsay, the ignorance of instruction, and the perfidy of the mischievous are the seeds from which these terrors grow",98 I should feel inclined to modify his statement somewhat as follows:-

Just as in the emesis or hyperemesis of gestation, a basis of physiological disturbance, more or less severe, is the determining factor in starting the trouble, which ultimately the psyche exaggerates and aggravates, so in the pains of childbirth either various non-congenital morbid conditions, present in most well-constituted modern mothers, are aggravated and accentuated by fear, or else, when these morbid conditions are not present, there is a tendency among modern women to exaggerate or actually invent a history of suffering during their confinements, for purposes of power.

Remove the morbid and non-congenital conditions in all normally constituted women along the lines I shall presently suggest, and then an energetic assault on the fear complex and on the convention that childbirth must be painful will put an end to pain in parturition for all healthy women.

The reader may think that in view of the evidence just advanced, my case for painless parturition, as the norm to which we should aspire, was sufficiently made out to justify all I have claimed and to warrant the sequel.

But fortified by my own investigations among animals, and convinced that all the important vital functions in a conscious creature were intended to be at least painless, and that those connected with the urinary, alimentary, and reproductive organs were actually intended to be also pleasurable, I am reluctant not to press my case still further and claim that the norm to which we should aspire is not painless birth but pleasurable birth.

The scientific reasons for this claim will be found in the next chapter.  Meanwhile, I should like to refer to certain views of responsible medical graduates which, to my great satisfaction, seem to confirm a standpoint I have now maintained, in spite of obloquy and ridicule, in public and private for the last sixteen years.

Go on to the next section, Normal Childbirth Pleasurable.