Bad treatment and bad advice is endangering mothers and discouraging would-be parents
In 1951, maternity hospitals across the USSR officially adopted the “psychoprophylactic method of painless childbirth”. Inspired by the work of Pavlov and developed by neurologist lIl’ia Zakharevich Vel’vovskii, the psychoprophylactic method mainly consisted of various breathing and massage techniques. Vel’vovskii described labour pain as a backward social phenomenon and pregnant women were told that if they deployed his techniques correctly, childbirth would quite simply not be painful. Because of his wretched quackery, millions of women across the USSR gave birth in uncontrolled agony.
Perhaps some surviving Vel’vovskii protegées have had a hand in the UK’s maternity policies
Perhaps some surviving Vel’vovskii protegées have had a hand in the UK’s maternity policies. In 2024, water injections became available for labouring women on the NHS. This involves injecting a small amount of sterile water underneath the skin, causing an extremely painful blister to develop. Accompanied by much criticism from doctors, NICE approved the use of sterile water injections for labouring women on the basis that there are no side effects and low to medium quality evidence they reduce labour pain. This pamphlet from Oxford University Hospitals Trust confidently asserts that water injections “provide significant pain relief”. As I prepared to give birth last year, I was taken aback to see aromatherapy included on the official list of pain relief methods provided to me by a midwife.
During my pregnancy, midwives and friends asked if I had considered going to hypnobirthing classes. Hypnobirthing involves encouraging women to focus on their breathing and positive visualisations during birth. In a particularly Soviet flourish, hypnobirthing practitioners also often avoid the use of the word “pain” to describe the sensations of labour. Breathing techniques are a nice thing and no doubt keeping calm if one can is of great use during labour. But why does this official NHS Scotland website list these breathing and relaxation techniques as a “Type of pain relief”? Imagine you went in for an operation generally performed under local or general anesthesia and instead of being offered pain relief, were instead told to focus on your breathing and avoid using the word “pain”. It’s worth noting that roughly 30 per cent of women giving birth vaginally in England have an epidural, the most effective form of pain relief for labour. In France, it’s over 80 per cent.
Meanwhile, fourteen NHS maternity units are currently under investigation for failures in care that have led to babies dying. These investigations come against a backdrop of years of very serious NHS maternity scandals. These include that at Shrewsbury and Telford Trust, which led to the avoidable deaths of 201 babies and nine women. Donna Ockenden’s investigation into Shrewsbury and Telford concluded that an “overzealous” emphasis on natural birth — giving birth with minimal medical intervention — was a contributor to the deaths. But just a year and a half after Ockenden’s investigation ended, the Telegraph found many NHS trusts still using the language of natural birth in guidance documents, with an emphasis on so-called “normal birth”, and even targets for the number of “normal births”.
After a baby is born, the emphasis on the “natural” way doesn’t stop, with many women encountering NHS professionals haranguing them to breastfeed. Attending appointments at various community midwife centres to check on the development of my little girl and my health, I only ever saw two kinds of posters on the walls: those warning parents about cot death and those encouraging mothers to breastfeed. One friend whose daughter was born last year was told by a community midwife — who new parents will see shortly after the birth of a child — that the executives of baby formula companies should be “strung up”.
And yet claims that it is far better for babies to be breast rather than bottle-fed are based on shaky evidence. I enjoyed nursing my daughter and am glad I was able to do it. But there is no well-evidenced health reason to press or cajole mothers who do not find that nursing suits themselves or their babies to do it, let alone if it is painful or the baby is failing to eat enough.
Vel’vovskii, father of psychoprophylaxis, came up with his method after Soviet officials made developing techniques and medicines for painless childbirth a priority. Why? Because they wanted Soviet women to have more children. There was sense in their approach even if the method they patronised was wrong-headed and cruel: women who have painful and traumatic births are less likely to have further children.
The UK’s total fertility rate is 1.41 and falling. A future of ever fewer children has serious social and economic consequences for us all. Making becoming and being a parent easier, tangibly improving the lives of parents, are clear ways in which we can help those who already want to be parents or have a further child to do so.
And that is what history tells us. By the 1920s, more than 50 per cent of Europeans lived in a country with a below replacement fertility rate. In 1935, the UK’s fertility rate had dropped to only 1.79. Then, the Baby Boom happened and people in countries all over the world began having more children and doing so earlier in life. There is strong evidence that better maternal medicine was a major contributor to the Boom. The widespread availability of blood transfusions and antibiotics made having a child significantly safer and so women became more likely to choose to become mothers or have a further child.
The experience that women have bringing children into the world matters, to those individual women and their partners and families, and to all of us as the need to make parents’ lives better increases. An NHS that believes aromatherapy, sterile water injections and relaxation techniques belong in the same category as highly effective analgesics like epidurals has gone down the wrong path.
