All of this is a preamble to asking: how did Britain end up as the C-section capital of the world? One in four births in Britain is now an emergency cesarean. Add to that the 20% of births that are by elective cesarean, and almost half of all babies in the UK come, as they say, out of the sunroof.

This is one of those topics that’s difficult to discuss without someone feeling attacked. Birth gets routinely moralized into the defensive arms race of “mummy wars”. On the one hand, snarky insinuations about being “too posh to push”; on the other, being smugly “natural” or even putting your baby at risk by declining medical help. This isn’t that article. The truth is, most moms just want themselves and their babies to come out alive and well.

In this context, though, what does a C-section rate of almost 50% mean? I don’t think there is a simple answer. It is probably partly attributable to changing life patterns; and partly to fear, and control, and the poverty of spiritual ministry in corners of “Our NHS” where, in truth, nothing else will do.

My own C-section makes me a statistic: I gave birth for the first time in my late thirties, tracking an overall long-term rise in the average age of first-time mothers, a group more at risk in pregnancy and childbirth, and more likely to give birth as I did, by C-section. This has a cascading effect, too: natural birth after a C-section comes with additional risks, and women who have had one will often opt for another for subsequent pregnancies. It’s also likely that declining overall health plays a part. But none of these factors account for how much of an outlier Britain has become. As The Times reports, other European countries have C-section rates ranging from below 15% of births in Norway to 32% in the USA. But in the UK, C-sections now surpass the proportion of spontaneous vaginal (“natural” in old money) births.

Average life patterns in Europe don’t differ that much from ours. So what’s going on? Clinicians suggest that the common factor is fear, among both healthcare staff and expecting mothers. In the wake of multiple scandals over neonatal care, bombarded by critical government reports, and entrusted with the inherently high-stakes business of safely delivering babies, clinicians default to the relatively controllable option of C-section.

It should surprise no one if public discussion of poor perinatal care contributes to a proportion of mothers fearful of risk, and requesting an elective cesarean. At least that way, you can have your baby to a schedule and with some idea of what to expect.

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Perhaps this points in turn toward the heart of the matter: an untenable mismatch between the capabilities of a human-run, bureaucratic healthcare service such as the NHS, and the intensity of the experiences these institutions are tasked with handling — birth and death most of all. It’s sometimes flippantly claimed that “Our NHS” has become a kind of church or religious dogma for Britain. But this is truer than we realize, and in more ways than one.

In Christian history, healthcare and spiritual ministry have been deeply linked. This is natural: hospitals routinely comfort and tend to people in every imaginable form of acute suffering and need, and this has always been at least as much the domain of priests as of healthcare staff. Premodern English hospitals were inextricable from the Church, and after Henry VIII dissolved the monasteries, reformed Christians remained active in caring for the poor and sick including in medical practice. Later, with the upheavals of industrialization, public health again became a focus of Christian social reformers.

The architecture of the often-Christian charitable healthcare they created would later be nationalized after the Second World War, becoming the NHS: an institution whose creation was opposed by some Roman Catholics at the time. Cardinal Bernard Griffin negotiated an opt-out for the small number of Catholic hospitals then in operation, arguing “It will be a sad day for England when charity becomes the affair of the state”.

This is an unfamiliar attitude in the Britain we’ve grown accustomed to since then. But it reflects a view that charity, properly understood, is orthogonal to the intrinsically instrumental, bureaucratic outlook adopted by governments. From this perspective, the proper role of Christians is not campaigning for uniform, nationalized care delivered by secular institutions, but playing an active role in providing such care. This reflects a longstanding Christian view that “care” may refer to practical, physical help, but not always. Sometimes it can also mean noticing and tending to less concrete needs, or simply being present with someone.

But while this kind of accompaniment flows organically from a religious perspective, the NHS is organized so as to sublimate this aspect of healthcare, as much as possible, into secular procedure. Most hospitals have chaplains, but the hospital environment itself is arranged as though they are never needed. Pain and need call forth process, and metrics, not (unless you insist) accompaniment or prayer.

Accordingly, this kind of ministry is typically found in the NHS more in spite of its approach than as a naturally-occurring feature. I will, for example, never forget the healthcare assistant on that intensive ward, who, after my daughter’s birth, stopped to chat every day as I recovered and, once I was well enough, showed me how to breastfeed in the most practical possible way: grabbing a handful of me and then positioning my baby properly. It was a wordless lesson, surely impossible without the gentle relationship-building that preceded it. And it transformed my relationship with my baby.

The ancient world used to treat women undergoing childbirth as on a par with men going to war, not least as the dangers it entailed could be as grave. Even with today’s far lower perinatal mortality, having a baby is probably the most dangerous thing an ordinary woman will ever do. This is reflected in the way new mothers often revel in swapping birth stories, the gorier the better. It’s like retelling your time at the front. And, in the same way, birth stories also speak at least obliquely to that uncanny feeling that surrounds birth, of being catapulted out of secular time.

You get a sense of this even visiting a mother and newborn. In the presence of a new mother-baby dyad, time goes wonky. A moment can last for hours, or days flash by in a heartbeat. If you’re the one giving birth, that feeling is even more pronounced, not least because you’re probably sleep-deprived as well. It’s like the luminous inverse of the equally eerie atmosphere that accompanies being in the presence of death. And just as cultures around the world have rituals that acknowledge this aspect of death, there are numerous examples, cross-culturally, of rituals that acknowledge this around childbirth too, from lying-in and name-giving practices to rituals designed to welcome the child into its spiritual community or protect it against evil.

Like war stories, mothers swap birth stories because having a baby is as much a brush with eternity as encountering death. Pregnancy and motherhood is a kind of hero’s journey. And yet the secular world expects all of us to pick and choose how — or even whether — we acknowledge this dimension at all. If you speak to doctors (at least after a couple of drinks) they’ll tell you all about what folklore would call the thin places: moments or spaces where the line between this world and the next becomes porous. But the NHS as an institution has, by design, nothing to offer those on those high, strange roads.

No wonder, then, that many find this isn’t enough, especially when confronted with the straitened capabilities of the NHS in practice. So perhaps we shouldn’t blame those who respond by reaching for maximal control — a C-section — as though the solution to the absence of spiritual ministry from the NHS is to demand even more NHS.

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But what’s the alternative? It definitely isn’t claiming that maternity is risk-free, so long as we give birth “naturally”. The “natural birth ideology” that is, confusingly, imputed to the NHS alongside the over-caution that incentives C-sections supposedly pressures mothers to eschew “medicalization”, leading to avoidable harms. I knitted all my own birth mantras from organic kale, and we both still nearly died. I’m grateful for every “unnatural” intervention that saved our lives.

But perhaps the error is imagining we can solve a spiritual problem through procedural or technological means. Safety is an abiding cultural obsession in modern Britain; but of all its institutions, the NHS most fully embodies the national yearning to find a basket of procedures that might eliminate risk altogether, forever. That is, implicitly, managing away every encounter with the thin places. And yet, as I learned, even with skilled practitioners and the best will in the world there’s no way of purging risk and danger from childbirth.

Nonetheless, every day, ordinary women face those risks to bring babies into the world. Every mother who has given birth, whether “naturally”, or with assistance, or indeed “through the sunroof”, has walked the thin places between everyday life and eternity. Facing this, fear is natural; we could surely do more to acknowledge the courage it takes to embark on that journey. For that, you need other mothers; rituals; all the other forms of ministry that support medical care, including the spiritual kind.

Celebrating women’s bravery is obviously not a substitute for healthcare. But in conjunction with excellent perinatal wards, we could and should do more to honor and accompany those women who risk their own lives to reach across the veil and bring us the next generation.

My first impression of Simone and Malcolm is that they have walked straight out of Pattern Recognition. Two slender, voluble, dark-haired, medium-height thirty-somethings, they have slicked-back hair, thick-rimmed spectacles and quirky dark clothing. Their children, Torsten, Octavian, and Titan Invictus, are all IVF-conceived, some gene-selected for traits such as IQ or happiness. Simone is pregnant again, she tells me merrily, with Industry Americus Collins, due in April.

The original “‘elite’ couple breeding to save mankind” of countless memes, I sought them out on a recent London visit in the hope of inducing them to say controversial things about biotech. They’re famous (or notorious if you prefer) for their enthusiastic endorsement of a high-tech Bay Area “pro-natalism” that embraces every available reproductive technology. From IVF, through surrogacy, polygenic embryo screening, to potentially gene-editing future offspring, they are what they call “the most talkative iteration” of a “technophilic” movement dedicated to saving the human species from population crash.

There are plenty of conservatives to whom all such technologies are prima facie off-limits. And I have grave concerns about anything that promises to free us from organismic limits — only to demand, in exchange, new kinds of servitude. I’m far from certain whether technophiles are friends or enemies. But what I heard was a message most relevant to the people currently keenest to dismiss them as “terminally online Redditors” or “hipster eugenicists”, or to link them with the far-Right: that the fertility crash is coming, soonest and hardest and most brutally, for liberals. And the Collinses are, in fact, liberals too: just unusually unfiltered and clear-sighted ones.

The Collinses earn a living in financial services, but their passion is education (they run an Institute for the Gifted) and promoting natalist culture. They use email and WhatsApp accounts seemingly interchangeably, and offer opinions as if they’re two interfaces of the same voluble, intelligent and eccentric hive mind. Malcolm proposed marriage to Simone on Reddit. They plan to have seven children.

In the end, we didn’t discuss gene-editing and fertility tech much at all: we converged, instead, on a deeper and arguably more insoluble fear. That is, that the contours of the fertility crisis mean people like the Collinses — subcultures that value intelligence, openness, and technological sophistication — are a critically endangered species.

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In the Collins worldview, what they call the “global monoculture” is the chief antagonist. They mean the largely homogeneous high-tech norms that have emerged in every major developed city in the modern world: Starbucks, tiny families or solo apartments, long working hours. And everywhere this “monoculture” appears, fertility is falling. Human birth rates are now below replacement almost everywhere in the world.

This global monoculture “believes it has a right to other people’s children, because its fertility rates are so low that the only way it can replenish itself is by just taking the children of nearby healthy cultural groups”. In Simone and Malcolm’s view, this dynamic represents “an existential threat to our species”. And as they see it, the motley coalition of interest groups making up the current “conservative movement” is united by hostility to this urban monoculture, and sometimes little else.

And while the Collinses are meticulously Californian in their aversion to offer explicit moral judgement, it would seem that however existential a threat this monoculture is overall, it’s a clear and present danger to people like them. For it poses a long-term threat to intellectual and cultural openness. Malcolm has, Simone tells me, analysed data on the demographic profiles of people having lots of kids — and it turns out that the deciding factor isn’t religiosity at all. It’s the mirror inverse of the high openness exhibited by “terminally online Redditors” and Silicon Valley rationalists.

According to their own studies, Simone tells me, the high-fertility profile comes with “xenophobia and fascism”. That is: people who have lots of kids are authoritarian, hostile to out-groups, and reluctant to consider other viewpoints as valid. And while they assure me, with the typically extravagant tolerance of difference typical of the Bay Area, that they’re “not even antagonistic” to bigotry “so long as they don’t interfere with their neighbours” tacitly the judgement is clear. After all, a defining characteristic of authoritarian outlooks is precisely interfering with your neighbours. Having evidently considered the prognosis for their own way of life, in a future dominated by such cultures, the Collinses show pragmatism and clear-sightedness in doing whatever they can to avert the prospect.

But it’s not just pluralism and openness on the chopping-block if demographic forces continue to select in favour of bigots. It’s also cognitive ability, cultures that value education, and cultures knowledgeable of and engaged with technologies. All these traits are, the Collinses remind me, correlated with low fertility; not that I need reminding, as a bookish, overeducated, and extremely online mother of only one.

Meanwhile, Malcolm continues, the people still having kids are the ones making less money, and wielding less cultural and economic power in the world. In turn, this makes such groups “less good at defending themselves from aggressive forces and less viable as power players on the world stage”. Rather than embracing marginalisation as a condition for survival, the Collinses want to “find and nourish groups that are able to be global economic and technological players while still being high fertility, because that is so rare”.

What’s left unspoken here is that they think failing to support “global economic and technological players” would have very bad effects overall — for it would mean shrugging while the culture selects against clever, bookish, and technologically adept people. They are, in other words, quietly worried that current civilisation is shrinking the future pool of what a Bay Area rationalist is bound to see as the keystone of our genetic heritage: IQ.

They tread carefully around the topic, no doubt mindful of its radioactive connotations. But Malcolm comes close to spelling out the implications when he tells me that, based on research he’s read, “we may see about a one standard deviation drop in IQ in the developed world in the next 75 years, due to genetic reasons”. That is: the smartest people are deleting themselves from the gene pool.

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The Collinses clearly accept that whatever form of human culture makes it to the other side of the current demographic pinch-point will be a brutal survival of the fittest — where “fit” doesn’t necessarily accord with their preferred values. But though they studiously route round any explicit moral statement that might impose coercive obligations on someone else, it’s clear that the Collinses would prefer at least some of the winning demographic subcultures to be high-IQ people with technological capabilities, and a willingness to tolerate different viewpoints. They emphasise that they are firmly against eugenics, where this represents any top-down value-statement about or intervention in the gene pool. But it’s also clear that, albeit in an opt-in, you-do-you Bay Area way, they think there are better and worse ways that gene pool could develop in the future.

To this end, they’re more than happy to collaborate with any group — even those far more authoritarian or anti-tech than they are — if the common goal is reversing what they perceive as the current negative trend. In their view, it’s not for some time — Malcolm suggests, “in 300 or 400 years” — that this coalition might fall to infighting, as pluralistic and technophilic factions such as theirs battle “religious, fundamentalist, xenophobic groups that believe that there can only be one religious group and one ethnic group in the world”. In such a scenario, they accept, “a lot of the conservative pronatalist groups will come into conflict because some are more pluralistic than others”.

In the meantime, though, they see what they’re doing as salvage work, preserving as much of a dying culture as they can. “We have seen this before in the Roman Empire,” they say, “this collapse scenario. Anyone who doesn’t think that we are entering a dark age right now is delusional. We need to begin to round the wagons, to defend as much of our civilisation as we can, so that we can use it going forwards.”

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It’s possible, I put to them, that the rationalistic, high-tech culture they are trying to preserve is too deeply implicated in the “global monoculture” they deplore to be disaggregated — indeed, that it may be driving the problem. Malcolm shrugs. It’s possible, he tells me. But the Collinses are content nonetheless to pursue their bet, and to see who turns out to be right.

Despite our differences on reproductive technologies, I suspect the Collinses and I are more aligned than not — on, if nothing else, devotion to reading the cultural tea-leaves, and extrapolating from the patterns we recognise. Some who do this, such as William Gibson, set out what they see via the written word to sometimes near-prophetic effect. Others, such as the Collinses, work as hard as they can in the real world, to turn the direction of events toward or away from patterns they see on the horizon.

But whatever the longer-term impact of the Collinses’ interventions will be, they’re right to see their beloved culture of logical, rationalistic, high-openness risk-takers as endangered. And there’s a lesson there for liberals of both Right and Left, even a long way from Silicon Valley. For if the traits most immediately at risk are openness, high cognitive ability, and an appreciation for education: those, in a word, commonest in liberals. If the Collinses’ read is right on the larger patterns, and I think it is, those who value intelligence and openness need to be a great deal more deliberate about “rounding the wagons” to protect the values and cultural practices they cherish – including via efforts to inculcate these traits and cultures in the next generation, or indeed to produce a next generation at all.

If this doesn’t happen, all those clever, tolerant, bookish types, many of whom currently leap to denounce voices like the Collinses as at least “far-right” adjacent, may wake up in a generation or so, to find they missed the chance to hand on their own genetic and cultural legacy. And that instead, in a fit of short-sighted self-righteousness, they gifted the world to the only people still having children: their enemies.

And so the father rocks his son back and forth, holding him safely with one hand. Now fully awake himself, he pulls out his phone, and falls into the abyss. His complete attention is on the screen, its blue light seeming like a balm but acting like a bomb, destroying any natural tiredness. The baby, unable to find his father’s gaze, reaches for the phone. The father, jarred into consciousness, pulls up an animated show created for infants. He puts it in his child’s view. The baby looks. He laughs. The characters on the screen do not respond. The baby frowns. He has no friends here. It is a long time before he falls back asleep.

For all its conveniences, the modern age has not removed the challenges of parenting: the exhaustion, the constant demands, the necessary subordination of one’s needs. In fact, in many ways it has intensified them. Parents’ lives are busier — both with necessary things, like work, and tempting distractions, like Instagram. And so to get through the night, we turn to technological solutions like breast pumps, or the expensive advice of sleep trainers. Meanwhile, we spend our days in front of screens, eating food so processed it barely resembles food anymore, and so brings less nutrition and more risk into our lives.

In our new book, A Hunter-Gatherer’s Guide to the 21^st Century: Evolution and the Challenges of Modern Life, Bret Weinstein and I argue that humans are the ultimate generalists, with such incredible capacity to create new niches for ourselves that we have created a rate of change even we cannot keep up with. And so our brains and bodies are out of step with the 21st century. This mismatch has given rise to all sorts of conditions and diseases that would have been unknown in antiquity — from the widespread need for orthodontia to obesity. A lot of these disorders have their roots in our earliest years.

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As a species, we are social and long-lived, with generational overlap and long childhoods. Some other animals are similar to us in these regards — elephants and orcas, parrots and crows — but humans seem to do everything more. We live in larger groups, with the longest post-reproductive lives, and have the longest childhoods.

If a foal can gallop within a day of its birth, why does it take a human baby months just to learn how to roll over? Childhood is not an error, or a waste of time. It is when we learn to be human. Our giant brains, and our ability and need to connect with other human beings, take years to mature. Very early, we need to be assured of our safety. Soon after, we need to be tested, stretched to our limits.

But the baby introduced earlier may rarely be taken outside, never feeling the sun on his face, or experiencing the minor discomfort of being momentarily cold. That experience can offer not just valuable evidence that discomfort can be recovered from, but also enables the reassuring embrace of his mother as she holds him close, warming him, protecting him. As the baby grows, he learns to self-soothe, to a point. But on a path that is cleared of all challenges, he will not learn what real risk is. Nor can he know the true depth of his parents’ love. They have so successfully cocooned him, including from their own selves.

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Imagine a baby from 15,000 years ago, or 150,000. Before the advent of farming, but after we were fully modern at the anatomical and physiological level. We had language and fire and tools, were cooking our food, living in community, exploring ideas around campfires. Sometime late in that time span we began to make art, to hold funerals, to have rites of passage.

Such a baby would have been snuggled close in the embrace of family and friends, never alone, never isolated. A baby alone in that environment was at high risk; he would have been in actual contact with his mother, or another caregiver, for most of his early life. But as he grew, he would have been allowed more and more freedoms. He would have watched the older children, and played around the fire, and handled sharp tools. He would not have been completely protected from harm, but he also would not have been completely protected from exploration. When his body achieved adulthood, his mind would too: he would be anti-fragile, unlike today’s 18-year-olds.

In A Hunter-Gatherer’s Guide, we argue that though modernity has made us healthier in many ways — and expanded our minds — there are exceptions. We do not argue for a return to a simpler time — such a prescription has many problems, but it’s also impossible to fulfil. But we do argue for some caution in adopting all the modern advances, as many of them bring hidden costs, which become visible with an evolutionary lens.

Do not expect tiny babies to sleep alone. It sends a confusing and terrifying message: nobody has your back. If you provide utter reassurance, while they are tiny, that you are there for them, then — far earlier than their coddled counterparts — they will be confident enough to explore on their own, to take and manage risks. They also sleep better — which means you will, too.

Do share parenting as much as possible; early on, this may mean pumping breast milk to save for later. This tool of modernity is so freeing for many women. A mother’s milk is best for nutritional, immunological, and bonding reasons, but the pressure to provide it at all hours can be a burden; sometimes allowing a baby’s father, or another caretaker, to provide it is a gift.

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But here is an example of where moving away from our ancient ways may have hidden costs. What else besides nutrition is stored in that milk? There’s some evidence that breast milk contains circadian cues. If true, then milk delivered at 2 am, straight from the breast, would not only satiate the baby, but also send the signal that it is now time to sleep. Milk expressed at noon, in contrast, would send the opposite signal. When feeding the baby at night, then, it’s best to provide nighttime milk. It won’t hurt, and may very well help.

Do not put screens in front of children, especially screens that have animate objects on them. As Bret and I posit in our book, babies and young children who are entertained by screens will learn to flatten their emotional range; they do not expect humanoid forms to respond to them.

Do eradicate all blue light from the space where you and your baby sleep. Early morning sunlight is so very blue, and those who are regularly exposed to bright outdoor light early in the day are more productive, and more fit, than those who are not. But expose yourself to blue light late at night, when our ancestors would have been gathered around a campfire — or navigating by the pale light of the moon — and find yourself struggling with sleep, and therefore with productivity, creativity, and health.

Do feed your children real food, tempting though it is to lean on processed meals. A healthy person has an incredible diversity of gut flora, obtained from the consumption of whole foods, with as short a supply chain as possible. An unhealthy person ingests shelf-stable products containing multi-syllabic ingredients synthesised in a lab. In house sparrows, eating a diet that is out of whack makes the birds slower to learn, quicker to anger, and generally more stressed. What are the chances that humans are completely unlike house sparrows in this regard?

Do move your body, and encourage your children to move theirs. We are embodied beings. Our screens may compel us to believe that we are mere brains in jars that can manage to type sarcasm and anger and emojis — but we are in fact more, and far better, than that. And it is during our long, lovely childhoods that we find out how connected and creative we can be.

“One of the most disappointing and deeply worrying themes that has emerged is the reported lack of kindness and compassion from some members of the maternity team.”

This is perhaps the most disquieting sentence to be found in the first report into failures at the maternity services at the Shrewsbury and Telford NHS Trust between 2000 and 2019, published last week. The report is critical of many of the practitioners involved in delivering maternity care, but it is the Trust’s midwives that are criticised most of all.

This profession, usually associated so strongly with “kindness and compassion”, is here associated instead with cruelty and tragedy: 13 women dead in childbirth, hundreds of babies dead, and many more left disabled after traumatic births. Speaking to MPs on the Commons Health Select Committee, Donna Ockenden, who is leading the independent investigation, described a legacy of “broken families and women who carry guilt on their shoulders for many many years”.

It seems now that many of these tragedies were a consequence of a dogmatic opposition to performing c-sections. While the national c-section rate averages 24% to 29%, at the Shrewsbury and Telford Trust it was between 8% and 12%, apparently due to a widespread belief among midwives that a low rate was a sign of good maternity care.

In fact the opposite proved true, since the report concludes that in many cases earlier recourse to c-section would have avoided death and injury. And some midwives’ single-minded quest for natural (i.e. vaginal) births at “almost any cost” was often achieved through unnatural means, including the injudicious use of forceps and hormonal induction, causing additional harm. Worst of all, when babies died during these protracted and agonising deliveries, patients’ pleas for c-section having been ignored, some of these grief-stricken women were then told that they themselves were to blame for the disaster.

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When news of this scandal broke, my Twitter feed was immediately filled with women recounting their own experiences of bad care at other NHS Trusts. Most mothers have some sort of horror story to tell — either their own, or that of a friend or family member — and most of these stories include some kind of error on the part of a medical professional. Usually these involve a lack of intervention, or an intervention of the wrong kind, and women almost always report a feeling of not being listened to or cared for — of being treated like rag dolls, passive and mute.

I’m now 18 weeks pregnant with my first child, and I’m in the unusual position of knowing that I will be having a planned c-section for medical reasons. There’s no debate to be had about how the birth will go — I know exactly what’s in store for me come May. And am unlikely to experience the subtle or not-so-subtle pressure often put on pregnant women to stick as closely as possible to the natural childbirth ideal.

Of course, some women are enthusiasts for natural childbirth, and personally fare well by it. But it’s important to recognise that there is a heavy dose of ideology at play here. A woman I used to work with was evangelical about homebirthing, despite the fact that both of her babies had been rushed to hospital in ambulances when their births went wrong. But when telling her birth stories she would include that detail only in passing, focusing instead on the “energy” and “joy” of the experience. The natural approach all too often requires its adherents to gloss over pain, injury, and danger, repeating again and again “pregnancy is not an illness” (then why do I feel so ill?).

There is a reason why the God of the Old Testament punished Eve by condemning her to bring forth children “in sorrow.” The writers of Genesis were no fools — they knew what childbirth was like, and no amount of New Age woo can ever quite conceal an ancient truth: that while this form of human experience may be wonderful, it is also terrible, and even in the modern world still carries with it the stench of death.

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The immense importance of childbirth means that power over it has always been contested, just as it is today. When the ‘man-midwife’ first emerged in the 18th century, this progenitor to the obstetrician was viewed with hostility by the female midwives who traditionally had sole control over the birthing chamber. For a period, the fashionable choice for wealthy British women was to employ a man to attend the birth, and he would arrive in a smart coat and carrying a bag containing the latest in medical technology: a pair of forceps. Poor or unfashionable women continued to rely on their local midwife, until gradually childbirth became more and more medicalised and power over this female domain was passed to male hands.

This centuries-old rivalry between midwives and obstetricians still persists, despite the fact that UK medical graduates are now majority female. Conflict may have been particularly acute at the Shrewsbury and Telford Trust, but it was far from unique. Doctors stereotype midwives as vain ideologues who put women through hell for the sake of their egos (“sadists” is the word used by one of my doctor friends). In turn, midwives condemn doctors as arrogant brutes who see a scalpel as the solution to the slightest complication.

There is some truth to both of these perspectives. A remarkable episode in the third season of Mad Men provides a graphically accurate illustration of the over-medicalisation of hospital births in the 20th century. Betty Draper is shaved, sedated, given an enema, and has her legs placed in stirrups, a birth position that provides better visibility to practitioners, but forces the labouring woman to work against gravity. Frightened and isolated, Betty sobs for mercy and goes uncomforted. We’ve since made progress, but this sort of once typical hospital experience couldn’t be further from the ‘woman-centred care’ that the midwifery profession tries to promote.

Nor do hospital births have an unblemished safety record. Igaz Semmelweis, surely one of the most tragic figures in the history of medicine, realised in 1847 that the high maternal mortality rate in his Viennese hospital was an accidental consequence of doctors’ physical contact with women in labour. Ignorant of germs, doctors would go straight from the dissection lab to the maternity ward without washing their hands, bringing deadly infections with them.

The desperate Semmelweiss tried to alert his peers to the harm they were inadvertently committing and found himself ostracised. He suffered a nervous breakdown, was admitted to an asylum by his colleagues, and died shortly afterwards, with the truth of his theory still unacknowledged. More than 20 years later, Louis Pasteur finally convinced the medical community to accept germ theory and wash their hands before examining patients. We have no way of knowing how many mothers died needlessly in the interim.

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Yes this is history, but my point is that sometimes doctors make things worse, and sometimes midwives do the same. Errors made by both ‘sides’ have been used down the ages to bolster the case for either natural or medicalised childbirth, with feminists generally taking the midwives’ side. Classic second wave texts like Witches, Midwives, and Nurses present a highly politicised historical narrative of feminine knowledge wrested from women by men envious of the power of the female body.

Some proponents of the natural approach are so resentful of this male incursion that they go further even than homebirthing and choose to ‘freebirth’, with no medical assistance at all. With lockdown restrictions limiting access to NHS midwives at home, more women are opting to freebirth illegally, with some reported to social services as a result.

Maybe it’s because I wrote my Master’s dissertation on the grisly history of childbirth, or maybe it’s because I did part of a medical degree and so have some bias towards the doctors’ ‘side’ of the debate, but I’m afraid I can’t see freebirthing as anything other than stupidly reckless. But then again, I do understand the fear women have of giving birth in hospital without their loved ones, as nearly 2,500 women have been forced to since the start of October. The feminist writer and campaigner Caroline Criado Perez has written about her own awful experience of miscarrying in hospital without her partner present. Lockdown adds a new form of suffering to an experience already replete with it.

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The dangerous cult of natural childbirth

By Louise Perry

It does remain thoroughly baffling that the suffering remains, and that the pace of development for obstetric technology is so oddly slow. The maternity team at the Shrewsbury and Telford Trust have been criticised for misusing an implement that has hardly improved in several hundred years: forceps. There is still no good form of pain relief available in labour, it is still common for women to suffer tearing, prolapse, and incontinence and, even in the West, women and babies still die far too often, particularly black women. Our species has been to the moon and built nuclear weapons, but we haven’t yet managed to remove agony and risk from one of life’s shortest journeys.

The mistakes made at the Shrewsbury and Telford Trust show us what happens when the ‘natural’ is fetishised. But, at the same time, we can’t avoid confronting the fact that medicalised childbirth is hardly much better. The Trust’s midwives were not wrong to consider c-section an undesirable option, given that surgery and recovery carry their own harms and risks. What they were wrong about was to assume that denying patients a c-section was a better option.

There are no desirable options when it comes to childbirth, only relatively worse ones, and there is no way through it without pain. I do realise that this isn’t an easy problem to solve. Childbirth is worse for us than it is for other animals because of the trade-off that Genesis describes in metaphor: we stood up to free our hands, and we developed large brains, and in doing so we narrowed the pelvis and enlarged the infant head.

But I look at what happened when the entire world was focused on just one medical problem — producing a vaccine for Covid-19 — and the astonishing speed with which a solution was found. And then I look at what happened at the Shrewsbury and Telford Trust, where patients were denied access to a routine form of lifesaving treatment. Not only do advances in obstetrics lag behind other areas of medicine, it’s also the case that, even when the technology does exist to reduce injury and suffering, it often goes unused, and without even the cheap and simple application of “kindness and compassion” to soften the blow.

A GP that once mentored me used to tell her anxious patients at the antenatal clinic “it’s only one day of your life,” and I thought at the time that a prisoner in fear of the torture chamber would hardly be comforted by such a statement. In our safe and affluent society, we don’t usually tolerate pain and danger, but we do in this case, and the nature of the burden means that it is only women who are asked to bear it. Can that be a coincidence?