Photographs transmitted all over the world of prisoner 'Annette', from the notorious Holloway Prison in London, labouring in chains have caused us all to take stock of the penal system's treatment of pregnant women. But the irony of those pictures in a wider, more symbolic context has not been lost on many mothers.
It wasn't that long ago when almost all women were handcuffed in labour as this extract from the rather misleadingly titled book The ABC of Natural Childbirth (Heinemann, 1955) brings vividly to life: '. . . the hospital can't afford to take chances. One patient had gotten so panicky .... that she had actually managed to wrench her arm free of the leather wrist strap, and pressed her hand on her baby's head as it was being born. For many uninstructed patients, the handcuffs are a vital safety measure, and those who've prepared themselves ... can take them in their stride'.
For this author, being prepared meant being prepared for intervention and restraints. Wrist straps, handcuffs and leg restraints were used on labouring women well into the 1960s and beyond and are still a part of some paraphernalia such as birthing chairs and tables to restrain women during painful obstetric interventions. Many of the mothers who have felt deep outrage at media coverage of women in chains could easily have been the products of such a birth themselves.
After all, how many women can say their birth was all that different? Issues such as immobilization, stress, lack of privacy, confidentiality, humiliation, degradation, lack of choice and a sense of failure are felt keenly by many birthing mothers every day in hospitals across the country and around the world. Anything which immobilizes a woman in labour is a chain. Electronic fetal monitors, dextrose or saline drips, and especially epidurals and general anesthetics may not rattle and clank, but they do restrain. And giving birth in chains - whether real or metaphorical - has physiological and emotional consequences for the health of all mothers and babies.
The evidence on the importance of remaining mobile during labour is indisputable. In her book New Life (Sidgewick & Jackson, 1988), childbirth educator Janet Balaskas noted that strong contractions can be managed effectively by walking, standing or leaning forward. These options also promote a shorter labour, better all round circulation (which benefits the baby as well as the mother) and are ultimately less tiring and painful than lying down. Yet a recent survey of obstetricians in the North of England shows more than half refuse women mobility during labour (AIMS Journal 1996; 7:4).
Given a choice, more than a third of women will adopt three or more positions during labour, while 45 per cent will try at least two. This makes a striking comparison to women who are told to lie down - 55 per cent will simply obey, while only 5 per cent will try three or more positions (Br J Ob,1989; 96:1290-6).
There is ample evidence that stress during pregnancy and labour can affect a child's brain development as well as short- and long-term health, chiefly due to lack of oxygen and prematurity (BMJ, 1993; 307: 234; Dev Med Ch Neuro,1994; 36:826-32).
So why all the chains? In the case of prisoners, the officials say it is fear of escape (though few of these women have committed violent crimes - Annette snatched a handbag - and the absurd possibility that a labouring woman might shinny down a hospital drainpipe to do more mischief is unlikely.
As for the rest of us, there is genuinely a case to argue that officialdom fears pregnant and labouring women much more than it does criminals. Birthing women are a product of Nature - the biggest, scariest, most unpredictable monster known to Mankind. More than 30 years ago an obstetrician pointed out, 'The time when the patient actively participates in her delivery is also the time of greatest fetal loss and peril' and that mothers who are not well restrained, in this case by sedation, might actually harm their babies with 'violent bearing-down efforts' ( WL Flem-ming, The Case Against 'Natural' Childbirth, Avon 1962). Just 10 years ago, another stated unequivocably, 'It is not widely appreciated that pregnant women are not only emotionally unstable, they are intensely egocentric' and that encouraging them to participate in their own labours 'can result in a fierce demand to dictate' (Maternal & Child Health, 1985; 10:69-72).
No one should make the mistake of believing that these mindsets have disappeared.
Birthing women are not prisoners, though they often act as if they were. To some extent, this kind of shackling can only continue to be justified as long as mothers continue to act as if they were guilty of something - of not being able to produce 'perfect' babies, of labouring at an inconvenient hour and waking the obstetrician or midwife from a sound sleep, for having dysfunctional wombs and untried pelvises, for labouring too long and too hard, for giving in to the animal/sexual nature of birth instead of keeping a ladylike composure.
As a sop to officialdom, it is now being mooted that labouring prisoners should be electronically tagged instead of chained. It is only a matter of time before they are offered the same full range of 'choices' of 'free' women: being attended by strangers, having an epidural or 'electing' to have a cesarean. Any of those things effectively immobilize even the most threatening of women. All of them carry the same message - pregnant and labouring women need to be restrained for their own, their babies, and for the greater, good.