Lamaze: An International History is newly published book by Paula A. Michaels that takes a look at the historical concept of pain-free childbirth through breath control and other relaxation techniques. Regular contributor, Deena Blumenfeld reviews this book and shares her thoughts on how accurate the book is, what the book does well and where the book falls short. Read Deena's review and if you also have read this perspective on the history of Lamaze, please share your thoughts in our comment section. - Sharon Muza, Science & Sensibility Community Manager.

When we look back at the past, we often see it through the filter of our modern sensibilities, values and sociopolitical beliefs. However, the past is best understood within the context of the social, political and ethical values of the time period. "Lamaze, An International History" by Paula A. Michaels should be read and understood within its appropriate historical context.

Most of us know the Cliff's Notes version of the origins and history of Lamaze. What we may not know are the details of the development of psychoprophylaxis and its journey from Russia to France and then to the United States. We may also not know of its decline in use and the reasons behind the decline.

Psychoprophylaxis is the technique developed by Dr. Vel'vovskii, a psychologist, and his colleagues, in the 1920s. The technique included multiple weeks of childbirth education classes taught by the woman's physician, patterned breathing ("hee, hee, hoo, hoo") and relaxation techniques. This was a training method designed to help women have painless childbirth. The belief was that fear caused pain and through education and training, fear could be eliminated. This follows directly from the belief that women's gynecological health issues were all in their heads. Victorian physicians espoused this idea and the emerging field of psychology latched on to it and perpetuated it.

Michaels seeks to elucidate the social, economic and political influences behind psychoprophylaxis and its relative importance with regards to women's expectations for childbirth; the prevailing opinions on pain during labor; roles of the father and the doctor during birth and the overall social implications regarding feminism and paternalism. She explores not only psychoprophylaxis, but its creators, its rise in popularity and its decline in use. Michaels looks at the medical environment of the day, as well as the social, economic and political influences on women and childbirth at the time (1930s - 1980.)

Only in the final chapter does Michaels address the Lamaze of today. She alludes to the Six Healthy Birth Practices and modern teachings. She appropriately refers to modern Lamaze as more of a "philosophy" rather than a "method."

Being that her intention is to address the origins of Lamaze, more specifically psychoprophylaxis, there is little need for her to discuss how classes are taught currently or about present day birthing culture. The reader should not impress the image of historical childbirth class, or the childbirth class of another culture, onto current day classes. Michaels does say that:

"The international history of psychoprophylaxis speaks to how we arrived at today's status quo, but perhaps more significantly it also reminds us that the values and meanings that we attribute to certain obstetric interventions, like the use of anesthesia, are not constant, but provisional. Practices are historical products of specific technological, economic, social and political conditions. What constituted a desirable birth experience changed with the times, as issues of safety, dignity, control and power each came to be reconfigured under both national and international influence."

There was a review of this book published on The New Republic recently. The review fell into this trap of imposing historical Lamaze and the practice of psychoprophylaxis onto modern Lamaze, thus presenting a false impression of the purpose and intention of current Lamaze childbirth classes and broader Lamaze International organizational work to improve maternity care for all women. It also misrepresented the intention of the book which is, as best I can tell, an historical perspective, set in the context of the prevailing beliefs at the time with regards to women's place in society, proper behavior and issues of power and control.

Power and Control

The proponents of early childbirth education, including Dick-Read, Vel'vovskii (creator of psychoprophylaxis), Lamaze, Bradley and others sought to help women control their pain through education, managing expectations, breath control, and relaxation including very specific techniques for pain management. Their initial intentions fell within the scope of prevalent societal beliefs surrounding women's role in society, religious beliefs, proper behavior, and origins of pain, patriarchy and the political climate of their respective countries.

The author posits that the Russian doctors used psychoprophylaxis as a method to control women during labor, such that they were calm, quiet and obedient. The technique relied on the doctor, nurse, or later, the woman's husband, to assist the laboring mother in maintaining the breathing and relaxation such that she remained in a passive state. So we can see, how taken out of proper historical context, this is offensive to modern sensibilities.

When the Lamaze method, psychoprophylaxis, made its transatlantic trip to the United States the intention behind the technique changed. However, this shift was a transition, not an immediate change. It took a decade or so to adapt to the prevailing beliefs regarding women's autonomy and desire for more control over their bodies. Once the method began to take root, it became more about the feminist movement and women's empowerment as we moved into the latter 1960s and 1970s.

Final Thoughts on the Book and a Look Forward

Being that I don't have a TARDIS to go back in time and observe for myself the successes or failures of psychoprophylaxis; I will have to take into account history's record and Michael's analysis thereof.

"Lamaze, an International History" should have been more appropriately titled "Psychoprophylaxis, an International History," although "Lamaze" is a more well understood title and has the potential to garner more readers. In the book, Michaels paints a paternalistic, often misogynistic, view of how birthing women were treated in mid-century Russia and the rest of the Western world. She describes how psychoprophylaxis, and the proponents of the Lamaze method, strived to reinforce the paternalism and pronatalism of the day, while offering women a non-pharmacological form of pain management during labor, childbirth education and support by bringing husbands into the delivery room.

Psychoprophylaxis and the early days of Lamaze should be viewed in their proper historical context and not through the lens of modern feminism, ethics or social mores. I find Michaels' book to be an eye-opening perspective regarding a piece of the history of my profession. Her book, however, ends rather abruptly at about 1980, with a small concluding chapter of her own perspective on a more modern Lamaze and what her thoughts are as to what women need or want during birth. I would have liked to have seen her take the history of Lamaze through the 1980s, 1990s and into the 2000s.

There's been a large paradigm shift in how we as Lamaze educators approach childbirth education since the decline of the use of psychoprophylaxis. The move from being a one method technique to a comprehensive, evidence-based, hands-on, multi-modal form of childbirth education has brought Lamaze effectively into the 21st century to reach mothers and families in the classroom, online and via social media. Our advocacy for women's health is far reaching, and is not addressed in Michaels' book. I do not find this to be a flaw in her book as her book is a look into our origins and early history. I do find that I want more from her. I want the rest of the story of Lamaze's history. I'd love to see her write another 140 pages of well researched analysis of the social, economic and political influences on Lamaze in the past three plus decades.

A peek back into history can often help us determine why we do what we do today and how to make more appropriate changes for the future. My question to you, blog readers: "Where do you see Lamaze in 10 years? 15 years? 20 years? What social, economic and political factors will influence how we are educating and supporting women in the future?

Additional suggested readings

• From Psychoprophalactic to Orgasmic Birth by Barbara Hotelling
• Psychoprophylaxis during labor: associations with labor-related outcomes and experience of childbirth. By Bergström M, Kieler H, Waldenström U
• Psychoprophylaxis and Labour, by Helen Cary Bell
• Theories of Psychoprophylaxis in Obstetrics (Prophylaxis or Therapy) by L. Chertok

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