Transcript: The Soviet Origins of Lamaze

This week’s podcast is an interview with Paula Michaels on Soviet origins of the Lamaze birthing method.

Here’s a partial transcript to whet your appetite. There’s a lot I didn’t include like our discussion on the medicalization of childbirth and the rise and fall of Lamaze in the United States. For that, you’ll have to listen to the interview.

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This abridged version of the interview has been edited for clarity. Look out for the full audio version soon.

Paula Michaels is an Associate Professor of History at Monash University, Australia. Her work bridges the histories of Eastern and Western Europe, integrating the USSR into a pan-European and global narrative through the study of social and cultural history. She is the author of Curative Powers: Medicine and Empire in Stalin’s Soviet Central Asia published by the University of Pittsburgh Press and Lamaze: An International History published by Oxford University Press.

Your book, Lamaze: An International History, looks at the surprising origins of the Lamaze birthing method in the Soviet Union. How have historians treated the history of childbirth?

We tend to think about childbirth as something that doesn’t change because the physiology of it is more or less constant and it’s not like were evolving in any way that’s perceptible. There are people who do talk about the ways that birth is changing physiologically in the sense that women who live in urban areas and live modern lives today aren’t necessarily as physically fit as they were in the past.

There’s a lot of talk about the way obesity is on the rise in the Western world and elsewhere and is impacting childbirth and maybe that’s a factor in the rise in Cesarean Section. But, what I’m interested in is the social-cultural context in which the physiological experience of birth takes place and that, of course, is historically conditioned.

There are basically two big camps of historians of childbirth in the West. One camp derives from the work of Richard and Dorothy Wertz who wrote a book about the history of childbirth in the United States. In their book, they really emphasize a theme that others before them including Barbara Ehrenreich and Dierdre English did, which is about how the medicalization of birth has led to the disempowerment of women.

Another school of thought comes out of the work of Judith Walzer Leavitt and her book really makes the argument that, yes, there is a disempowerment of women that accompanies the move from home to hospital and the shift in care from midwives to physicians, but that women were really part of that transition and that women in a sense collaborated with their physicians and exchanged some power for a sense of security and care. A different kind care they were getting from midwives.

So, Walzer Leavitt tries to emphasize the ways women had agency even in their own disempowerment. So, I think those are the two big approaches to the history of childbirth and I would say more and more scholars are leaning in the Walzer Leavitt direction which really shows a more complicated picture. And there isn’t that much difference between those two schools in they both recognize the ways in which the medicalization of childbirth has cost women something.

Where do you situate your work on the Lamaze Method in those two schools?

I would say I’m probably closer to the Leavitt school and in that, I definitely see the ways in which women are making choices that some may or may not agree with, but that there’s a difference between having power taken from you and giving power away. And especially when we’re talking about the early 20th century, when middle- and upper-class women were very enthusiastic about, for example, the use of pain medication in childbirth. This was not seen as something that was disempowering to them, but it was an active choice they were making.

And I think if we have a fuller picture of how we got to where we are today, we can maybe embrace a wider range of choices, and then, get away from the kind of polarized conversations we have that are sort of all or nothing regarding pain management in childbirth.

What are the Soviet origins of the Lamaze Method?

It is important to remember that what we think of Lamaze today and what it was in the past are different things. So, today, a lot of people, especially younger people, don’t even necessarily recognize it as a particular birthing method. Lamaze International, which is the world’s largest prenatal educational organization is very quick to say that it’s a philosophy about birth, not a technique. That was not true in its origins and in its origins, it was absolutely a technique and its one that your audience would immediately recognize if they’ve ever seen any American movie or television show in which somebody gave birth, and I’m going to go out on a limb here and guess that they probably have.

So, whether it’s All In The Family in which Gloria gave birth or it’s an episode of Friends decades later, you often will see some partner telling somebody “To just breath,” and then, they do this kind of pattern breathing that’s often called the “hee-hee-who” method of breathing, which it’s like short rapid breaths, and then a long exhalation. That pattern breathing is the Lamaze method. But it’s so ubiquitous in our cultural notion of how we give birth that we don’t even associate it with Lamaze.

Those breathing patterns are something that a Soviet psychologist developed and brought into birth practice. The idea was for it to be something that would effectively distract women from pain and that it would be a way to preoccupy the mind with something, or more specifically on a neurological level, the cerebral cortex, and occupy those pathways with something in order to interfere with the transmission of pain signals from the uterus to the brain.

In the Soviet Union this method was called “psychoprophylaxis” and it was developed by Ilya Vel’vovskii. What was his story?

Vel’vovskii was a psychologist, not a physician, and he was a follower of Ivan Pavlov, the Nobel Prize winning Russian neuropsychologist. In the 1940s, there was a boom in psychology that was influenced by Pavlov in part because it was ideologically safe. The upside of Pavlov was he was Russian. In the early years of the Cold War, it was always a good idea to be promoting the ideas of somebody who was Russian rather than someone who was from the West.

But at the same time, it was also something that Vel’vovskii genuinely believed. He wasn’t just being politically savvy. He came out of a school of thinking and had been working in this arena since the late 1920s and 1930s. So, there’s that aspect, and that’s one piece of the puzzle.

The other piece of the puzzle is that in the period after the WWII, the Soviet government was very interested in getting women to have more babies. World War II had, as you well know, a devastating demographic impact on the Soviet Union and they desperately wanted to replenish the population. And to do that, they wanted women to have more children and they believed if childbirth could be made painless, then, women, well, why wouldn’t you have more babies, right? That’s got to be an obstacle.

But, of course, at the same time in the post-war conditions, there wasn’t a whole lot of money lying around to invest in the pharmaceutical infrastructure that would allow the mass production of nitrous oxide which was widely accepted as an effective pharmacological means of pain relief, that was actually used for the first time worldwide in childbirth in Russia in the 1880s. So, it had a long history of use in Russia and was generally regarded as safe and effective. But a lot of equipment was involved to administer it, and, of course, the drugs themselves, and there wasn’t enough to go around.

And was expertise also a consideration?

Yes and no, because by then there were machines that had been developed that would allow for the self-administration of a mix of nitrous oxide and oxygen, and they were constructed in a way that a woman could not overdose inadvertently. But you needed this machine and you needed the drugs to put in the machine. The machine was actually portable as well. In Great Britain, those machines were widely used and there was a lot of investment in making those accessible. I don’t know if you ever watched a show called Call the Midwife, but there is an episode in which one of those gas and air machines, as they were called, is used in a home-birth setting. Those machines were known in the Soviet Union. They had their own model that they had invented, they had the capability of producing those machines and the drugs to go in them. But they chose not invest in the infrastructure that have would allowed a production of those machines on a scale that would have been meaningful nationally.

I would say that my particular concern with the material conditions of the Soviet Union is what distinguishes my work from other historians of childbirth. I think historians who work in the United States or Great Britain are less attentive to the ways in which material conditions impinge on the course of development of medicalization. Maybe because it’s less in your face than it is in the Soviet Union and especially by the way of contrast with the West.

In the Soviet Union, there’s no looking away from how these dire financial straits in the post-war years close off certain pathways of development. And one of those is a more pharmacological pathway.

Vel’vovskii, who was working in the Ukrainian city of Kharkiv, was looking to continue work that he had done before the war on hypnosis in childbirth as a way of managing pain. But he wanted to come up on with a way to do it on a scale that could be a mass method, applied on a mass scale. His team struck upon the idea of having group lessons, that we know of today as Lamaze classes. These group lessons were to train cohorts of women in these breathing patterns that would preoccupy the cerebral cortex and interfere with pain signals and allow for effective pain management.

Another interesting piece of this puzzle is how firmly all of these men, and they were all men, believed that the pain was in women’s minds. They’re very skeptical that something that’s occurring naturally is actually physically painful. I think it’s pretty difficult to believe that childbirth is not genuinely painful for anybody who’s either been through it or seen it happening. That takes a lot of chutzpah.

There seems to be two broad trends in how obstetrics dealt with of managing labor pain. One, of course, is with pharmaceuticals. The other one is with psychology, like Vel’vovskii. How did these various doctors understand labor pain?

Broadly, there’s these two camps. One camp says, “We have these great drugs and there’s no reason why women should have pain.” And there are plenty of women in that camp. It’s important to remember that there’s lots and lots of women who do not see any value in experiencing pain in childbirth. They’re very quick to say look, “You would not have a root canal with pain medication, so why would you give birth without pain medication?”

So, there are those doctors that believe to varying degrees that pain should be mitigated to the best of our ability. In the mid-20th century, that included effectively putting women to sleep through a mixture of morphine and scopolamine, which was an amnesic. Morphine was notoriously ineffective in managing the pain of labor, but women were put in this drugged up, hazy state in which they would then only have the foggiest memory of what they had been through. And this was thought to be humane.

Is this twilight sleep?

Yes, exactly, twilight sleep, which the Germans came up with in the 19th century. It was thought to be good for women that they didn’t remember what they had been through. But by the mid-20th century, and especially in the post-war years, notions about motherhood were changing, about family life, about togetherness between husbands and wives. There began this idea that women were being robbed of something precious by not being able to either fully participate in or even remember. There’s a lot of things going on at that moment about consumer culture, about relations between men and women, and between patients and doctors. A variety of factors are coming together.

The idea that women would be better off if they were, what in the 1960s became known as “awake and aware” had been circling around since the 1930s, but in the late 1940s it got some traction that it hadn’t had before.

What about the psychological notion of labor pain?

In the camp of people who control birth pain pharmacologically, it is accepted that there is a physiological reality to the pain of childbirth that warrants management. In the psychological camp, there’s widespread belief that pain is generated in women’s minds.

There are two different explanations.

In Great Britain, around the physician Grantly Dick-Read, you have one group that envisions women having been essentially culturally conditioned over generations to anticipate that childbirth will be painful. Therefore, they tense up and that tension generates the physical pain. That was Dick-Read’s theory.

Somewhat similarly but not derived from Dick-Read, Vel’vovskii and his team came up with a different explanation. Their explanation relied on Pavlovian ideas about neuropsychology and pain signals being transmitted but the reaction to those pain signals were being exacerbated by cultural expectations. So, they talk about various works of Russian literature that have harrowing childbirth scenes and the way in which this and stories from mothers, aunts, grandmothers, and older sisters builds our expectation not just of pain but behavior in the face of pain.

So, however it is that they explained it, both of those ideas are grounded in an understanding that the pain is generated in women’s minds and not their bodies. Therefore, the field of combat against birthing pain should be psychological rather than pharmacological.

How did Vel’vovskii’s method fit within the practice of childbirth in the Soviet Union?

Not well. In a couple of different ways. So, in one way, there was a widespread cultural belief that pain in childbirth was normal, expected, natural and something women had to endure in a very kind of Russian way, of this, “Well, just suck it up princess, we’ve all been through it, move on.”

And so, there is a kind of indifference, a callousness to women’s pain that’s really quite striking in the Russian context compared to every other context I looked at. What you find more in France, but especially in the United States and Great Britain, a common belief—baseless—but common belief among middle and upper class people that somehow poor and working-class women are better equipped to endure the pain of labor.

And maybe it’s the class issues happening in the Soviet Union that might be a factor that you really don’t have a robust middle-class in the Soviet Union to govern norms, but there are practitioners in Russian birth facilities and maternity wards across the Soviet Union that really don’t care a whole lot about mitigating women’s pain. They don’t care a whole lot about treating women with care and dignity. And I think there’s another factor here, and I’m not necessarily a huge fan of capitalism, but you don’t have any kind of consumer driven reform or demand in the Soviet Union. It’s just you take what the State gives you. And the State chose not to put a lot of resources into women’s pain management.

When Vel’vovskii tries to introduce this idea, the central authorities are actually pretty quick to pick it up and say this is now the official Soviet method of giving birth nationally. And they try to roll it out across the entire country. But what they find is that to do it effectively does actually require a fair amount of training of personnel, and many of those people that they’re trying to train are deeply skeptical both of the method itself and whether there’s any real reason to bother trying to alleviate women’s pain in labor.

Moreover, the women that they’re trying to teach this method aren’t choosing this, which makes it very different from what happens in the consumer-driven movement that occurs in the West. So Vel’vovskii’s method sort of goes over like a lead balloon.

It seems that there wasn’t a lot of buy-in from all sides.

That’s exactly it. Most physicians are very skeptical and reluctant. It all really comes to a head between the psychologists and the physicians at a conference in 1956 on the fifth anniversary nationwide rollout of psychoprophylaxis. What happens is the psychologist come out on the losing side of that argument and it really just dies a pretty precipitous death in the Soviet Union after that.

Yet psychoprophylaxis has a life outside of the Soviet Union. Fernand Lamaze adopts certain aspects of it in France, and then the Lamaze Method finds its way to the United States. How does this cultural transfer occur?

That’s the thing that got me so interested in this topic. I just thought, “Wait, how did that happen?” It’s just this crazy little factoid that this thing came from the Soviet Union and I just thought, “That’s nuts.” And, in fact, it’s much more well-known in the United States than it ever was in the Soviet Union.

Fernand Lamaze worked at a hospital in Paris that was funded by the metallurgical workers union which had deep ties to the Communist Party. The whole leadership of the metallurgist workers’ union were members of the French Communist Party which was quite influential in the late 1940s and 1950s. And Lamaze went on a junket to the Soviet Union.

And the previous year before he did that, this Leningrad obstetrician named Nikolaev had given a paper on psychoprophylaxis in Paris and Fernand Lamaze was curious about it. And so, when he went to the Soviet Union, he insisted, and he had to really press to do it, or at least that’s the story, on witnessing a birth using psychoprophylaxis. One wonders about the experience of the women with this French obstetrician just hanging out, and one wonders what she was told in 1951 about how she’d better behave while giving birth to her child. But we don’t know anything about her side of the story.

What we do know is that Lamaze thought this was the greatest thing since sliced bread. He went back to Paris and with a convert’s zeal sought to spread news of this miraculous psychological approach to pain management. And part of why it got so much uptake in the West was because in the 1950s the kinds of drugs that were available were a really heavy-handed approach to women’s pain management.

Epidurals had been invented, but they were not in widespread use. That doesn’t happen until decades later. And so, women did not yet have an option for being fully awake and conscious and being able to actively participate and at the same time not experience pain. And Lamaze was a way to give them that experience while being awake and aware while also not being overwhelmed by pain.