Lamaze Makes Childbirth Painless as a Kick in the Balls

I was introduced to the Lamaze method [2] at a birth education class during the sixth month of my wife Jennifer’s pregnancy. Jennifer, unlike me, was curious to learn about the Lamaze method, a naturalistic approach to childbirth that first became popular among young liberal couples in America in the ’60s and ’70s.

During the first months of the pregnancy, I had a hard time grasping Jennifer’s anxieties about the pain of childbirth. The reality of what Jennifer was facing only began to sink in when I imagined myself being told that in a few months someone was going to punch me in the balls over and over and that the process might last several days. If I was in that situation, I thought, I too would want both drugs and the chance to prepare with whatever method was the Lamaze equivalent for someone about to be punched in the balls for hours on end.

The first thing I learned about Lamaze when I started my research was that the method was named after Fernand Lamaze, the French doctor who popularized the method. This wasn’t particularly surprising. But almost everything else I read about the origins of the Lamaze method was.

Fernand Lamaze was an excitable man with a round, fleshy face. He had a lifelong passion for literature, and as a young doctor he would write poetry and recite Balzac and Flaubert from memory. Lamaze ran the maternity ward in Paris’ Communist Party-affiliated Metal Workers hospital, and in 1951 he was invited to join a French delegation to an international medical conference in the Soviet Union. Lamaze was excited about the trip. Not long before, a Soviet doctor had attended a gynecological conference in Paris and claimed that his country had discovered a natural method of painless childbirth. Lamaze was intrigued but skeptical. He would have to see it with his own eyes to believe it.

The trip turned out to be a classic Soviet propaganda tour designed to show the world how the USSR had revolutionized modern medicine. With each passing day of the trip, Lamaze was growing increasingly frustrated. He had come to see the natural birth method he had heard about in Paris, but every time he asked to witness such a birth, his hosts made excuses. Just before Lamaze was set to leave the country, his Soviet hosts gave in and brought him to a maternity ward, where he watched a woman in labor and then, according to his own account, began to weep with joy, as she delivered her baby with no sign of distress. “Pain may seem to be the inevitable ransom of childbirth, but it isn’t any longer,” Lamaze told the newspaper Libération upon his return to France. “I saw with my own eyes a woman give birth without pain. I witnessed it. I’ve been in obstetric practice for 30 years. I couldn’t have been fooled. Painless childbirth’s success, without any other treatment or the use of drugs, is almost unbelievable.”

The Soviet childbirth method that Lamaze witnessed was then sometimes referred to as the Pavlov method, and accounts of the method’s origins often note that it was invented by the famous Russian physiologist Ivan Pavlov. But while it’s possible to draw a line from Pavlov and his salivating dogs to Lamaze, the connection is tenuous at best. The true origins of the Lamaze method can be traced to two other Soviet scientists: Konstantin Ivanovich Platonov and Ilia Zakharevich Velvovski.

In the young Soviet republic, pain relief medications were scarce. Platanov and Velvovski became interested in the use of hypnosis as an analgesic in surgery. Realizing that childbirth would be a convenient way to test ideas about hypnosis and pain, Platonov found a 32-year-old medical student who agreed to let him hypnotize her during her labor. In preparation for the delivery, Platonov repeatedly put the woman in a trance and then told her that her pregnancy would be painless. When it came time for the woman to have her baby, Platonov was at her side and managed to put her into a drowsy state. According to his own account, the woman gave birth to a 10-pound baby and felt no pain.

Their work would likely have been lost to history. But more than a decade after World War I, the Soviets were still coming to terms with their losses: More than 3 million citizens dead, 34 times the number of dead Americans. The communist leadership concluded that for the country to realize its grand ambitions, the Soviet Union would have to be repopulated, and in 1935 the government introduced a year-long “motherhood campaign” to encourage more births. The following year, abortion was banned, and the Soviets decided to tackle the problem of labor pain once and for all.

Convinced they had the solution to the Soviet childbirth problem, Platonov and Velvovski began to hypnotize women in groups. “Hypnotariums” began to spring up across Russia. In Leningrad, one researcher attempted to hypnotize as many as 100 pregnant women at once. A Moscow scientist was reported to have tried to hypnotize more than 1,000 women in 1941.

Despite occasional claims of success, Platonov and Velvovski found that hypnosis didn’t lend itself to mass implementation. It was time-consuming and worked best when there was an ongoing, one-on-one relationship between doctor and patient. This time, Velvovski came up with a new answer. Instead of hypnotizing pregnant women, he proposed small classes at which mothers would learn both about the birth process and about what the doctors and nurses would be doing during the labor and delivery. From the classes, the women would also learn that childbirth did not have to be painful. He recommended breathing exercises and massage so that the mother would remain alert and aware of what was happening to her and suggested that a nurse or midwife be present during the delivery to reassure and coach the mother. Velvovski’s new approach was essentially the Lamaze method as it exists today.

Because he left no personal papers, no one knows exactly how Velvovski’s thoughts progressed in the second half of the 1940s. It seems he reasoned that if it was too difficult to use hypnosis on a wide scale, then perhaps doctors could achieve a similar effect without putting women into trances. Maybe the message could be absorbed directly into the conscious mind through education? Maybe all that was necessary for a painless childbirth was to convince a woman that she did not have to experience pain?

However he arrived at this new approach to painless childbirth based on education and breathing, Velvovski was anxious to test it, and in 1949 he received permission from Ukrainian medical authorities to open a maternity clinic in Kharkov to formally experiment with the new technique. Not surprisingly, the local obstetricians weren’t thrilled to learn that a neurologist was operating an experimental maternity clinic in their midst. They lodged a complaint, and Velvovski was called to Moscow to respond to the charge that he was misusing government funds.

Velvovski was savvy enough to know what happened to people who upset the Soviet authorities. And, as the government officials questioned him, Velvovski did what people in trouble have probably been doing since the beginning of time: He faked a heart attack. (After Velvovski’s death, people who knew him said that the heart attack had been a farse. Velvovski himself never acknowledged any deceit.) He was granted a three-month convalescent period, and it was during these months that the founder of the Lamaze method came up with his most brilliant idea of all.

As most high school students learn at some point or another, Pavlov demonstrated that if a sound were made every time dogs were fed, eventually the sound alone would be enough to make the dogs salivate. Pavlov called the salivation in response to the sound alone a “conditional reflex.” As historian David Joravsky had pointed out, people have always known that animal behavior can be shaped by regular patterns of reward and punishment. The real meaning of Pavlov’s dogs was that the philosophers and scientists who believed that humans were mechanical and that the mind and the soul were obsolete notions now had a stronger argument. The mechanistic thinkers had spent the 19th century arguing that all of human behavior could be reduced to reflex reactions to the environment, no different than a leg jerking in response to a tap on the knee.

Historian Robert Tucker has argued that Stalin’s embrace of so-called neo-Pavlovianism was about something much darker. “To the outsider who studies the materials of the neo-Pavlovian movement, nothing is more striking than its insistent endeavor to empty man of all inner spring of action, to visualize human nature as motivationally inert,” Tucker writes. “Man is ‘hollow.’ He has no wishes, instincts, emotions, drives, or impulses, no reservoir of energies of his own. No motive is allowed to intervene between the stimulus emulating from the environment and the person’s reflex response.”

It’s not hard to see why a hollowed-out man might have appealed to Stalin at the height of his paranoia. If mental life was nothing more than a reflexive response to an environment, then mental life could also be molded, the personality of man shaped according to a tyrant’s fantasies. Or, as Tucker puts it, “Man had to be understood as a being whose character and conduct are controlled at every step by the conditioning process, whose every psychic step is a reflex.”

It was in the midst of this upside-down moment in Soviet history that Velvovski emerged, as if on cue, from the recovery of his fake heart attack. He now had a new set of neo-Pavlovian ideas and could explain the pain of childbirth through conditional reflexes. The theory was wrapped in the neo-Pavlovian jargon about cortical dominance. (Despite plenty of evidence to the contrary in his own lifetime, Pavlov believed that all learned behavior relied upon connections made in the cerebral cortex.) The explanation amounted to this: Childbirth was painful because when women heard stories about painful births, their brains were conditioned to associate messages from the uterus during labor as pain stimuli. Velvovski’s birth education program, in turn, would decondition women’s brains so that they did not misinterpret these naturally nonpainful messages from the uterus.

Velvovski was an obscure scientist at the time but another well-known Leningrad obstetrician who had also experimented with hypnosis and labor in the 1920s persuaded the Ministry of Health to quickly set up a pilot program to test Velvovski’s new Pavlovian birthing method. At the end of 1950, Velvovski published the results of the pilot program, claiming that in 82.7 percent of the cases he had “eliminated” or “nearly eliminated” the pain of childbirth, and that drugs had been unnecessary in 95.9 percent of the births. Several months later, at a follow-up conference on the method in Leningrad, the president of the Academy of Medical Sciences described Velvovski’s program as “one of the most brilliant examples of the practical adoption of the principles of the great Pavlovian teaching in medical practice.”

Even in those highly politicized times, several attendees of the conference found the nerve to speak up. One obstetrician who called Velvovski’s success rate into question pointed out that it was hard to believe that the pain could be wiped out, considering that childbirth requires stretching tissue full of sensitive nerve endings by 35 centimeters.

But common sense was no match for fear or ideology, and on February 13, 1951, the Soviet Ministry of Health issued Order No. 142 making Velvovski’s birthing method, newly dubbed psycho-prophylaxis, the official birth method of the Soviet Union.

A plan was quickly set in motion to train physicians across the country in it. The government-endorsed psycho-prophylaxis method called for all pregnant women to attend six group training sessions exactly 56 days before their due dates and noted that a woman should have constant support throughout her delivery from a coach who would massage her, guide her breathing, and offer assurances. According to Bell, the plan also called for the instructor to “emphasize that Pavlovian science and a benevolent Soviet government had freed women from the curse of labor pain.”

It was at this dark moment in Soviet history that Lamaze arrived on the scene and wept for joy at a laboring woman’s bedside. Upon returning to Paris, Lamaze set about preaching the greatness of the Soviet birth method with an evangelical fervor. He immediately retrained the entire staff at his hospital in the Pavlov natural birth method, campaigned for it to become national French policy, and wrote a book filled with scientific claims about the cerebral cortex that had been proven false 50 years earlier.

Lamaze was a great cheerleader, and his enthusiasm briefly spread across France. In 1954, French national radio played the breathy sounds of a Lamaze delivery, which led to a bestselling Lamaze album.

But Lamaze’s critics were suspicious from the start, and he was twice called before a French medical board and accused of false advertising. When, in 1957, Lamaze’s own hospital turned against him, it was more than he could take. A day after a contentious meeting about the hospital’s plans to dismiss his closest colleagues and limit his activities, Lamaze had a heart attack and died.

The excitement about the Lamaze method quickly fizzled out in France, but the method had already been imported to America, where its early champions, conscious of the Cold War mentality, were careful to call it the “Lamaze” rather than the “Pavlov” method.

The Soviets, meanwhile, grew frustrated with the method when it failed to live up to its grandiose promise of painless birth for all women. Stalin died in 1953, and the zeal for neo-Pavlovian thinking quickly came to an end. A Washington Post article in 1976 on the state of the psycho-prophylactic birth in the Soviet Union reported that, while the method was still nominally official policy, it had been more or less abandoned. “To tell us that birth can be pleasant without injection against pain is a joke no one believes,” said one mother.

After learning about the Stalinist roots of Lamaze, I couldn’t help but be skeptical of the method, but just because it had emerged out of ideological nonsense didn’t necessarily mean the method didn’t work. After all, the Lamaze method couldn’t have spread across America if not for the many satisfied customers who were anxious to pass it along.

In the 1980s, Ronald Melzack, a psychologist and highly regarded pain expert at McGill University whose pain-measuring model has been widely adopted in the scientific community, turned his attention to the pain of childbearing and found that Lamaze-style pre-birth training does have a statistically significant impact on pain reduction. But the impact turned out to be small. Most women still experienced considerable pain even when Melzack took the pain reductions into account. Melzack determined that, on average, natural childbirth hurts considerably more than chronic back and cancer pains and that, at its most intense, the pain feels almost as bad as having a finger cut off.

I wasn’t surprised to read Melzack’s findings. But something else Melzack had written about childbirth and pain troubled me more. In a May 1993 issue of the medical journal Pain, Melzack discussed a new body of research that put a twist on his own findings. While some women were benefiting from natural birth classes, others were planning for natural births and then experiencing intense guilt when they ended up needing an epidural. One study [3] found that women who didn’t achieve the natural births they had planned for were more likely to become depressed and have suicidal thoughts.

The problem with many of the natural birth classes, Melzack concluded, is that the students aren’t psychologically prepared for the very real possibility that they might end up needing medical intervention. And at the root of this problem is a failure to recognize a broader truth: People are different. The classes convey the message that one method can work for everyone, but people experience pain differently. Melzack’s research had found that on average natural childbirth caused intense pain, but he also found considerable variation in the degree to which women suffered. Some women found the pain of giving birth overwhelming, but 10 percent of them reported only mild pain. Women who tended to have painful menstrual cramps also tended to have painful contractions. Older women tended to have less pain than younger women, and overweight mothers suffered more than slimmer mothers.

I don’t doubt that Lamaze himself was entirely sincere in his desire to help women, or that many women have benefited from the method. But in spreading the gospel that natural childbirth can be a painless process, Lamaze also no doubt left countless women feeling like failures when, unable to achieve the natural pain-free births he promised, they requested pain relief drugs. And the more I thought about the plight of a woman who is made to feel guilty for choosing pain relief in childbirth, the more annoyed I became.

One night, while reading some of the ridiculously unbelievable claims in Lamaze’s book, Painless Childbirth, I again thought about my male reference point for the pain of childbirth. It occurred to me that what Velvovski and Lamaze really needed was a good punch in the balls. Then, as they were holding their respective groins in agony, they needed to be told that the pain they were feeling was only a product of misplaced fears that had arisen from stories they had heard about other men getting punched in the balls.

This is an excerpt from American Parent: My Strange and Surprising Adventures in Modern Babyland [4], out today.