ALAN EDMONDS October 1 1967


ALAN EDMONDS October 1 1967


There is, but few Canadians have heard of it. Called psychoprophylaxia, it's positive thinking applied to childbirth, and it's enabling some Canadian women — and their husbands — to take charge during delivery


THERE ARE TWO remarkable things about psychoprophylaxia, the newest childbirth-made-easier method for modern mothers. The first is that its very existence as a new, and therefore controversial, way of having babies proves that childbirth — or women, or both — hasn’t properly emerged from the dark ages. The second is that it should still be largely unknown in the U.S. and Canada — though an increasing number of Canadian doctors and hospitals are using it.

A fair slice of the population explosion has been born via the psychoprophylactic method (or PPM for short) since Russian psychologists — not obstetricians— devised it in 1947 as a beneficial extension of Pavlovian brainwashing techniques. Now it is widely

used throughout Europe and parts of Asia. All French women, for example, must by law be given a chance to practise La Méthode', indeed, it was the French who imported PPM from Russia to the Western world. Major British teaching hospitals have been using it for five years, and their doctor and nurse graduates emigrating to Canada have formed a psychoprophylaxia underground in Canadian medicine. The Pope has pronounced it suitable for Roman Catholics. And in China, the New Childbirth is so widespread that having a baby might almost be a Thought of Chairman Mao.

Oddly, that's just about what psychoprophylaxia amounts to: a thought, an attitude of mind, the Power of Positive Thinking applied to the business of having babies. PPM isn't significantly different in essentials from myriad other so-called natural-childbirth methods — that is, those without, or with a minimum of, sedative and anesthetic. The classic “natural” method is that devised by Dr. Grantley Dick Read, an English physician who stirred a violent controversy in the late 1930s by saying childbirth was a natural function and wouldn't hurt so much if the woman relaxed and stopped being frightened. / Continued on page 64

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If you expect pain, you get it

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The PPM method simply takes the Dick Read philosophy one stage further. Instead of relaxing and being fairly passive in the delivery room, a PPM-trained mother believes, as an article of faith, that she should actively participate, not just be an anesthetized and frequently frightened lump on the delivery table from which the doctor or midwife produces a baby — presto! —much as a conjurer produces a rabbit from a hat.

PPM is, in fact, scarcely more than a subtle change in emphasis. And that’s the remarkable thing about psychoprophylaxia: a minor change in woman’s attitude of mind can apparently make such an enormous difference to the process of human reproduction. Indeed, it’s almost alarming to find the premise on which zealots have based a PPM-propaganda campaign is that while we’re sending rockets to the moon, most women still don’t understand how they give birth, and in their ignorance generally dread childbirth — and, dreading it, suffer needlessly, because if you expect pain, you get it. Equally startling is the fact that to promote simple changes in existing techniques PPM propagandists seem to feel it necessary to gird themselves to battle monumental indifference and opposition from doctors, nurses and hospitals.

Many of these propagandists are mothers whose experiences with psychoprophyiaxia were so rewarding

they’ve since become almost messianic about it. All of them are probably enjoying, as do most people with a cause, a mild and collective martyr complex, but they undoubtedly will meet opposition by indifference to PPM as a whole, and a blunt refusal to permit the ultimate stage of psychoprophylaxia: the presence of the husband during actual delivery. Despite new techniques, most doctors still advocate sedatives and anesthetics during childbirth — and so most women have them. And most doctors refuse to let the father in at the birth.

The controversy over Dr. Dick Read’s “natural - childbirth” method hadn’t entirely ended on his death in the late 1950s, though by then his theories were widely accepted. His method involves preparing the expectant mother with elementary anatomy lessons so she knows what she’ll be going through, and convincing her that giving birth is not necessarily so agonizing that it's best to be anesthetized. Mothers are also taught to breath deeply, with the diaphragm, during labor to make the delivery easier. All this was based on Dick Read’s belief that childbirth was an ordeal only because women had been conditioned by old wives’ tales into believing it was. His aim was to “de-condition” them—and his method worked in about 60 percent of cases.

Dick Read launched his method

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30 years ago. Apparently women still need to be de-conditioned.

Psychoprophylaxia takes this process one stage further: it aims to not only de-condition women, hut also to /e-condition them to the positive belief that having babies is not only a joy, but can be made easier if they stay in control of their bodies and the delivery at all times. One of the few Canadian obstetricians who practises PPM says that “in most cases a woman is anesthetized and is delivered of her baby. Under psychoprophylaxia she delivers the baby herself to the doctor or nurse, who are on hand to assist her and take charge only in the event of complications.”

It sounds like semantics, but it’s not: if the European experts and women who have used the method can be believed, this change in attitude can transform childbirth from an ordeal to an ecstatic experience in 80 to 90 percent of eases.

The PPM six-week course should, ideally, be taken in the two months before the baby is born so the conditioning doesn’t wear off before labor begins. Apart from the elementary anatomy, the expectant mother is also taught — as she would be in the Dick Read method — to relax. Only in this case she is supposed to relax certain muscles at certain times as an instinctive response to the stimulus of the phases of labor and delivery. For instance, the start of each contraction should be the trigger to begin a predetermined shallow, panting, breathing pattern. The breathing itself is different from that advocated by Dick Read: he prescribed using the diaphragm to take deep breaths, while the PPM method says you should use the lungs to take short breaths. In theory the woman is so busy concentrating on her breathing she doesn’t have much time to feel pain.

As a PPM instruction book puts it: “Think of each contraction as a wave at the seaside, rising to a peak, breaking, and then running out again over the sand. It can be a great deal of fun to ride through these large waves if you dive through with absolute control of your body and your breathing.”

PPM-trained women are also told what physical sensations and emotions to expect during labor and delivery and are, hopefully, conditioned to control their reactions.

“For instance, you usually feel terribly tearful and depressed at one stage of labor, and nausea at another, and if you don’t expect it then you're frightened to death,” says Susan Porter, a Toronto lawyer’s wife who became chairman of the Toronto Childbirth Education Association after having her second child by PPM last Christmas. A PPM - trained mother knows she’ll probably feel depressed, or weepy or nauseated, or all three, and so — hopefully — won't panic. According to the instruction book, she is in full control of her body and “reacts in a precise and orderly manner” to these stimuli. She concentrates on something other than the pain. In one of its more extravagant

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moments, the instruction book, as an example of the phenomenon of conditioning, cites the soldier in battle who is so intent on doing well under fire that he is unaware of being wounded — until after the battle has ended, that is.

If a woman does panic or otherwise forgets her training, her husband should be on hand to remind her, especially during labor. Like the Dick Read method, PPM is based partly on the belief that giving birth as well as giving life is a joint effort. Unlike the Dick Read method, PPM requires the husband to attend at least some of the prenatal training classes, and to help rehearse his wife before the actual labor and delivery. The husband’s job during labor is to offer moral support, and to help his wife stay in control of what’s happening by reminding her to follow the prescribed breathing and relaxing patterns when contractions are taking place.

Ideally, the husband should also be present at the birth, still helping with support and reminders. Many otherwise co-operative husbands can’t face the prospect of being in at the birth itself — and they may well be glad of the fact that most doctors don’t permit husbands in the delivery room. However, they are permitted to be present at the birth itself in one Canadian hospital: St. Joseph’s in

Hamilton, Ontario, where PPM was formally adopted last December as a hospital-sponsored program of prenatal education.

Respect — and satisfaction

By mid-June about 50 women had given birth with their husbands on hand whispering breathing instructions into their ear. One such husband attended a midsummer class of 20 couples, all planning to have their babies by PPM, to describe his experiences in the delivery room. Ted Hader, a Hamilton Auto Club representative, told how two days earlier he had been in at the labor and birth of his fourth child, a boy. “I didn’t take the lesson very seriously,” he said, “but then my wife had the hardest labor of all and I was able to help her by staying in control all the time. I tell you, when you see your wife in labor you have a lot more respect for womanhood. I did, at any rate.” Mrs. Barbara Hader says now that her husband had never even stayed with her during labor before, “but this time, as soon as the baby was born and he realized it was a boy, I looked up from the table and I saw the glow on his face — that was satisfaction enough for me.” She says her husband is also more deeply involved with his fourth infant than he ever was with his other children at the same age.

Women who have had successful PPM childbirths—and no one claims it works in all cases — are usually enthusiastic converts afterward. Mrs. Porter, of the Toronto Childbirth Education Association, and Mrs. Renee Brodie, leader of the Vancouver chapter of the U.K.-based National Childbirth Trust, both began to

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CHILDBIRTH continued

First skepticism, then panic, then a sense of wonder

devote time and effort to spreading the PPM gospel after each had her second child hy psychoprophylaxia. Mrs. Porter says that having her second baby last Christmas “was quite the most wonderful, exhilarating thing that ever happened to me, though I had to train myself. My husband didn’t take it seriously, so he had to

read the instructions for husbands while I was in labor.”

Even more compelling testimony comes from Dr. Jack Shekter, a general practitioner in Hamilton. In the past 10 years he has delivered 1,000 babies, give or take a few dozen, so that even the births of his own two sons (he was present, but didn’t de-

liver them) were fairly routine, unemotional occasions. But 16 months ago his wife Sonya gave birth to a daughter by psychoprophylaxia. Dr. Shekter, skeptically, followed his wife’s instructions and sat with her during labor, helping remind her of the breathing exercises. She had no sedative and as contractions became more

frequent to signal the end of labor, it was he, not she, who began to panic. He offered her the spinal anesthetic that most North American women receive for the delivery. Sonya refused. And, filled with what he later described as a sense of wonder, Shekter leaned forward and kissed his wife. Together they went into the delivery room and he performed his duties as prescribed. Afterward he said, “It opened my eyes to what my wife — all women — are capable of. And in that it gave me a greater empathy with expectant mothers, it made me a better doctor.”

The Shekters also apparently had an experience commonly reported by PPM parents: in their togetherness in the delivery room they drew closer together as man and wife. A few hours after the delivery Shekter sent his wife a note of congratulation. She won’t say what he wrote, but you can hear the love in her voice when she says, proudly, that he sent it.

Dr. Shekter is also on record as saying, when he saw his baby daughter, that infants born by psychoprophylaxia “seem brighter than babies born when the mother is under anesthetic. They wriggle more and cry hotter.” One of the less frequently promoted virtues of any “natural” childbirth is that it minimizes the risk of injury or malfunction due to incautious or inexpert anesthesia.

Sonya Shekter was a patient of obstetrician Dr. Murray Enkin, the man responsible for launching the PPM course at St. Joseph’s Hospital, where he is deputy head of the department of obstetrics and gynecology. On a trip to Paris in 1962, Enkin met disciples of Dr. Fernand Lamaze, the French physician who imported PPM to western Europe and ever since has been training expectant mothers in psychoprophylaxia. But the method, to be totally effective, requires that nurses as well as doctor understand what the expectant mother is trying to do, and can help with encouragement — and the extra pillows or adjustable bed that a PPM mother needs to adopt the right posture. The hospital's decision to institute a PPM program provided Dr. Enkin with his first chance to try the entire method, through to having the husband on hand at the birth. Now St. Joseph’s medical director, Dr. James Galloway, says, “We introduced the program largely because of Dr. Enkin’s propaganda. Now we’ve seen it work I’m convinced it's very successful. It wouldn’t work for everyone, but those couples who have had babies this way think it is a wonderful and rewarding experience.”

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Few Canadian doctors are as sympathetic as this: few hospitals would be as co-operative as St. Joseph’s. The medical profession tends, quite properly, to caution when faced with innovation. It is the more skeptical in the absence of scientific evidence. And as Dr. Enkin says, “There's no hope of producing scientific evidence about psychoprophylaxia. Every woman has a singular emotional experience in childbirth, and so it's too subjective to be the basis for any scientific survey. But if you see it at work you'd have no doubts—scientist or not.”

Without some objective proof. North American doctors cling to the belief that women should have all their children with sedative and anesthetic in hospital with a physician in attendance. This system means the woman is spared the traditionally expected pain of childbirth — and is believed to help lessen the risk of childbirth mortality. Cynics suggest it is also good business for the doctors.

In Europe (where the childbirth mortality rates usually compare favorably with those of Canada and the US.) all but a woman's first child are delivered at home by nurse-midwives, who tend to be more sympathetic than male obstetricians to any system of childbirth that might make life easier for the female.

Indeed, immigrant nurse-midwives from Britain already trained in PPM often give expectant mothers at least part of the course — the breathing pattern seems particularly popular as a pain reliever — while their doctors

are preparing for traditional delivery.

But usually psychoprophylaxia stops at the delivery-room door because of doctors' refusal to have husbands in at the birth. As one Montreal obstetrician puts it, “It's true the husband is present at the laying of the keel, but I’m damned if 1 think he has any right to a place at the launching."

Other doctors are less dogmatic. Dr. William Allemang, a professor of obstetrics at the University of Toronto, says, “We’ve all been through these various methods of preparation for childbirth, and I've even had a couple of people go through this psychoprophylaxia, with the husband at the delivery, and find it totally rewarding. But it's a terribly subjective thing. It's a fringe thing in the field ot

obstetrics. I. and 1 suspect most of my colleagues, believe the best preparation for childbirth is to be a mature well-rounded person, able, therefore, to do well under stress.” Dr. Allemang is what you might call a liberalprogressive in his field.

There was initial resistance to the idea of PPM in France, Britain and other European nations when it was first introduced. Mrs. Etna Wright, the nurse famous for popularizing PPM in Britain, spent June on a lecture tour of the U.S. and Canada. Her lectures in both Toronto and Vancouver were packed, mostly with women, and in her prepared speech she explained it would take time for psychoprophylaxia to spread in North America, just as it had in Britain.

She said. “We make no outrageous claims. We don't say childbirth can be painless: we just say it makes childbirth a more rewarding experience with a minimum of pain and discomfort. Slowly, women began insisting on practising the New Childbirth. and when their doctors saw the results they, too, were convinced and began to send other patients to our courses. That's what will happen here. I should think."

There are signs it has begun already. Many hospitals and some doctors are incorporating parts of the PPM program into existing prenatal training for expectant mothers. The 20 couples at the St. Joseph’s Hospital class in June had been sent there by six local doctors who. a few months ago. were skeptics. Largely through the influence of nurses a large part of the PPM program is in use at a handful of hospitals, including the Royal Columbian in New Westminster, British Columbia, and the General Hospital in Sudbury, Ontario.

Even so, the most significant single factor in the spreading of psychoprophylaxia in Canada and the U.S. will probably be — odd though it sounds—the contraceptive pill. Dr. Enkin explains: “Because of The Pill people are now having children by design, not accident. In that case they want the birth of their baby to be as meaningful an experience as possible, and that means psychoprophylaxia will inevitably become widespread. We’ll have to find another name for it first, though — one that isn't such a mouthful." ★