I am really sorry to see that, in my humble opinion, Tim Worstall has got it wrong for once, here and here, as have those he is criticising. The NHS wants to label epidurals as “abnormal” - in a pretty embarrassing, dumb ass attempt to be progressive and reduce the numbers of women opting for them. The oh-so-predictable reduction of this argument to the Glorious Scientific Progress-v-Golden Age Earth Mother polemic is seriously misguided and ill-informed. Whether uncritically championing scientific progress or insisting that all women must assert their right to "natural" childbirth, these narrow-minded arguments have the potential to hamper individual families attempting to understand real issues of autonomy, control and informed choice. That’s not very libertarian at all, which saddens me.

Benefits of scientific progress

When it was normal for women to give birth in the community, the main cause of death in childbirth was poor sanitation. So yes, of course, let’s give a big cheer for scientific progress. We’re all a lot cleaner, healthier and longer-living as a result. No-one can deny the benefits of necessary pain relief, although Golden Age Earth Mothers might try. Ditto for life-saving surgery – you’ve only got Jehovah’s Witnesses to contend with there. I am all for technology and progress - I love it. It's how we choose to make our money, and it significantly benefits our lives in all manner of ways. But...

What individuals have always needed

Our bodies have not changed so significantly. They are still designed to perform the same bodily functions they have always done (crapping, peeing, coming, giving birth) and in order to do those things easily and effectively, they still need the same fundamental conditions - such as physical and mental safety, control and privacy.   

Why childbirth became a medical matter 

The move of childbirth from communities to hospital settings was just another addition to the medical monopoly on diverse human conditions. We see it now with the ever-increasing array of mental disorders, for example, and the corresponding structures of medical professionals diagnosing, prescribing and counselling and treating us in order that we fit their own construction of “normal” or “ordered”. 

Hospital as a setting for childbirth

Of course death rates decreased over time – the medical profession’s claiming of childbirth coincided with improved sanitation and a far more sophisticated understanding of infection transmission. The few unfortunates experiencing life-threatening complications were also likely to be picked up. However, whilst great in an emergency, hospitals aren't best placed to cater to individuals' needs and requirements – they are institutes and run as such. They might be safe in an intellectual sense (although they aren't always) but they’re not best known for offering great levels of individual physical and mental control, privacy or comfort.  

Bowels - an analogy

1. I know childbirth isn’t a popular discussion topic, but let me try and make it as clear as possible. Imagine you are trying to have the biggest, most important turd of your life. It’s normally pretty easy to evacuate your bowels in your own house. In complete privacy, you can choose where and when to go. You can lock the door, maybe read something and generally take as long as you need. You can stop if you want and try again later - only you know what feels right for you. There might be discomfort or even quite severe pain sometimes, but as you (and society at large) have supreme confidence in the body’s general ability to perform the task of defecation, you would know if and when to seek medical help. You are the expert in your own body, so you can decide when medical assistance is necessary, and what level of intervention might be appropriate - on your terms.
    
   
2. Imagine, now, having that choice taken from you. The medical profession decides that the way you’ve been crapping all your life looks and sounds pretty uncivilised, undignified, and too long-winded (no pun intended) for their own liking. To boot, there’s an entire specialist profession to be built up and lots of money to be made if everyone poops in hospital, whether they like it or not. In fact, because there have been and always will be instances of people dying mid-poop out of hospitals, it’s best to teach everyone that it’s really a very dangerous activity to undertake in any environment other than a hospital, so that medical experts can take control for the sake and safety of everyone.
   
   
3. Finally, your time comes. You get to the hospital as instructed. You lie down, semi-naked, in front of a bunch of strangers whilst they give you a strict timeframe in which you must produce your turd. People bustle in and out of your sparse, brightly lit room without knocking. They sometimes leave the door open. They talk about your body - but not to you. They talk about someone else's body, someone else's turds. It's all the same to them. A spotlight is shone upon your backside and a succession of people stick their fingers up your anus, providing a running commentary on whether or not you’re progressing according to their externally-defined criteria, designed for the express purposes of efficient hospital management  and professional protection from litigation. You are discouraged (or forcibly prevented) from sitting up to shit, because it’s easier on the back of the medical professional who is giving you the examination. The bed is narrow, uncomfortable, and the room smells of disinfectant (if you're lucky). You are updated on your progress (or lack thereof) every hour, and reminded that failure to progress will result in stirrups and a mechanically assisted bowel movement, or major surgery to remove the turd.
    
   
4. In these conditions, you may well be described as (and feel) incompetent when it comes to producing your turd yourself. It’s likely that you’ll feel violated, unsafe, and completely without control. You’re just another number – you're certainly not a free person. You’ll probably start begging for relief, or demanding that someone just gets the turd out for you, just to get the whole experience over and done with ASAP. And this cycle, repeated over and over will provide clear evidence to everyone involved that pooping is almost impossible with medical assistance. It's clearly inherently dangerous, absolutely horrific and therefore something that only an utter lunatic or fanatic would try to reclaim as their own.

Why it’s not about sandals and hairy armpits

For many, many families, choosing childbirth outside of hospital (which includes birthing centres, midwife units and homes) has sod all to do with whale music, joss sticks, self-enlightenment and some misguided notion of returning to a better, technology-free age. It is about recognising that unnecessary medical intervention leads to more unnecessary medical intervention in an ever-escalating cycle of self-correction.

An example: Entering a hospital system significantly increases the likelihood of your being defined as pathological according to their narrow and specific medical standards (medics are trained to see the pathological. They can see it when it isn't even there). Deviating from these standards significantly increases the likelihood of your needing an epidural. Having an epidural significantly increases the length of your labour and the likelihood of your needing a caesarean. Having a caesarean significantly increases the likelihood of – guess what? Death in childbirth.

Another example: Just in case you might need a caesarean, most hospitals will not allow you to eat anything during labour, because of the (tiny) risk of aspiration under anaesthetic. You do not have a choice. But hospitals are just thinking of safety, aren't they? Well... failure to eat in labour can leave you with insufficient energy to actually continue labouring - and can you guess what the end result of that might be? That's right, folks. You're far more likely to end up having a caesarean. I appreciate that the overall risks are still very small, but that really isn't my point.

Scientific progress alone does not benefit humanity

Practically every element of standard hospital delivery procedure and intervention foisted upon labouring women has some other risk or cost for mother or child attached to it, information about which is rarely explained or easily accessible. These risks and costs can only ever be outweighed by the procedure or intervention being necessary for the individual or desired by them in the first place - so please don’t tell me that today, in this country, childbirth in hospital quite obviously carries less risk than childbirth outside of hospital, and only a Golden Age Earth Mother would disagree. I disagree. This misinformation is propagated at large and does much to damage real, informed choice for individual families who deserve dignity wherever they choose to go to have their children.

Getting it right – semantics or reality?

Unless the NHS is prepared to make some really radical changes to its service delivery*, rather than its semantics, standard hospital birth is always going to require some level of medical intervention, precisely because it takes place in a standard hospital environment. If this is the case, those hospitals need to keep epidurals at the ready, because such pain relief will always be quite rightly demanded and will never, ever become “abnormal”, regardless of whether it is labelled as such.

*I don't believe a giant, creaking state machine can or will ever be able to successfully achieve this.