THE PSYC SAINT MARY’S CQLLEGE LIBRARY 1 v / i Pt>Pn3 AOHf- 9 jul 12 'ea 1 WLIJ5J ^ p r — METHOD ( PAINLESS DF NATURAL CHILDBIRTH Address of His Holiness Pope Pius XII given at an audience for gynecologists on January 8, 1956 NATIONAL CATHOLIC WELFARE CONFERENCE 1312 Massachusetts Avenue, N.W. • Washington 5, D.C. Translation Provided by the Vatican Press Office THE PSYCHOLOGICAL METHOD OF NATURAL PAINLESS CHILDBIRTH ADDRESS OF HIS HOLINESS POPE PIUS XII GIVEN AT AN AUDIENCE FOR GYNECOLOGISTS ON JANUARY 8, 1956 W E HAVE received information concerning a newacquisition in the field of gynecology, and We have been asked to pass judgment thereon from the moral and religious point of view. It is a question here of natural, painless childbirth, in which no artificial means is used, but the mother’s natural forces alone are called into action. 2. In Our allocution to the members of the fourth Interna- tional Congress of Catholic Doctors, on Sept. 29, 1949 (Dis- courses and Radio Messages, Vol. XI, pages 221-234), We said that the doctor proposes to mitigate, at least, the evils and sufferings that afflict men. 3. We then evoked the figure of the surgeon, who strives during his necessary operations to avoid, as much as possi- ble, causing pain ; of the gynecologist, who tries to diminish the sufferings of birth, without endangering either mother or child, and without doing harm to those bonds of motherly affection which—it is affirmed—are ordinarily formed at that moment. 4. This last remark referred to a procedure then used in the maternity hospital of a great modern city : in order to avoid pain for the mother, she was plunged into deep hypnosis, but it was noted that this procedure resulted in emotional indifference toward the child. Others, however, believe that this fact can be otherwise explained. 5. In the light of this experience, care was subsequently taken to waken the mother several times during labor for a few moments each time; in this way, the effect feared was successfully avoided. An analogous verification was made during a prolonged narcosis. 1 2 Outline of the New Method 6. The new method of which We now desire to speak does not entail this danger ; it leaves the mother at childbirth in full consciousness from beginning to end, and with the full use of her psychic forces (intellect, will, emotions) ; it suppresses or, as others would say, diminishes, pain alone. 7. What attitude must be taken in its regard from the moral and religious viewpoint? I OUTLINE OF THE NEW METHOD 1. Its Relations With Past Experience. 8. First of all, painless childbirth considered as a general fact is in clear contrast with common human experience today, as well as in the past, even from the earliest times. 9. Most recent research indicates that some mothers give birth without feeling any pain, even though no analgesic or anesthetic has been used. It also shows that the degree of intensity of pain is lesser among primitive peoples than among civilized peoples ; that is, in many cases, this intensity is medium, yet it is high for the majority of mothers, and it is not rare that it even prove to be insupportable. Such are observations as currently noted. 10. The same must be said of past ages, in so far as histori- cal sources permit the fact to be verified. The pains of women in childbirth were proverbial; they were referred to in order to express the most lively and anguished suf- fering, and literature, both profane and religious, furnishes proof of this fact. Indeed, this way of speaking is general even in the biblical texts of the Old and New Testaments, especially in the writings of the prophets. 11. We shall cite a few examples of this. Isaias compares his people to the woman who is in pain and cries out when she draws near the time of her delivery (cf. Is. 26, 17) ; Jeremias, viewing the approaching judgment of God, says: “I have heard the voice as of a woman in travail, anguishes as of a woman in labor of a child” ( Jer. 4, 31) . The evening before His death, Our Lord compared the situation of His Apostles with that of a mother awaiting the moment of childbirth: “A woman about to give birth has sorrow, be- cause her hour has come. But when she has brought forth the child, she no longer remembers the anguish for her joy that a man is born into the world” (John 16, 21). Outline of the New Method 3 12. All this permits the affirmation, as of a fact accepted among men in the past and now, that mothers give birth in pain. To this, the new method opposes itself. (a) General preliminary considerations made by its sup- porters. 13. Two general considerations, presented by its supporters, guide and orientate whoever desire to outline its principal elements ; the first concerns the difference between painless activity and painful activity of organs and members; the second concerns the origin of pain and its connection with organic function. 14. The functions of the organism, it is said, when normal and accomplished in the proper manner, are not accompanied by any painful sensations. 15. These latter denote the presence of some complication ; otherwise, nature would contradict herself, since she asso- ciates pain with such processes in order to provoke a defense reaction of protection against what would prove harmful to her. Normal childbirth is a natural function, and con- sequently should take place without pain. Whence, then, does such pain derive ? 16. The sensation of pain, it is replied, is set in motion and controlled by the cerebral cortex, where stimuli and signals are received from the whole organism. The central organ reacts to such stimuli in very different ways; some of these reactions (or reflexes) have by nature a precise character, and are associated by nature with determined processes (absolute reflexes), others, on the contrary, have neither their character nor their connections fixed by nature, but are determined by other factors (conditioned reflexes). 17. Sensations of pain are among those reflexes (absolute or conditioned) which arise from the cerebral cortex. Ex- perience has proved that it is possible, by means of arbi- trarily established associations, to provoke sensations of pain, even when the stimulus which arouses them is, by it- self, totally incapable of doing so. 18. On human relations, these conditioned reflexes have their agent, a most efficacious and frequent one—namely, language, the spoken or written word or, if you will, the opinion prevailing in a given group, which everyone shares, and expresses in language. (b) Elements of the new method 19. Consequently, the origin of the lively sensations of pain 4 Outline op the New Method experienced at childbirth is understandable. Such sensa- tions are considered by certain authors to be due to contrary conditioned reflexes set in motion by erroneous ideological and emotional reflexes. 20. The followers of the Russian Pavlov (physiologists, psychologists, gynecologists) , availing themselves of their master’s research into conditioned reflexes, present the question substantially as follows : A. Its basis 21. Childbirth was not always painful; it became so in the course of time because of “conditioned reflexes.” These may have originated in a first painful childbirth; perhaps heredity also plays a part therein, but these are only second- ary factors. The principal motive is language, and that opinion of the group manifested by language. 22. Childbirth, it is said, is “the mother’s difficult hour,” it is a torture imposed by nature, which hands the defense- less mother over to unbearable suffering. This association created by environment provokes fear of childbirth and fear of the terrible pains which accompany it. Thus, when the muscular contractions of the uterus are felt at the be- ginning of labor, the defense reaction against pain sets in. This pain provokes a muscular cramp which in its turn causes increased suffering. Labor pains are, therefore, real pains, but result from a falsely interpreted cause. 23. In childbirth, it is a fact that there are normal contrac- tions of the uterus and organic sensations accompanying them, but these sensations are not interpreted by the central organs for what they really are, namely, simple natural functions. Because of conditioned reflexes, and particularly because of extreme “fear,” they are deviated into the region of painful sensations. B. Its Purpose 24. Consequently, it is clear what the aim and task of pain- less obstetrics will be. By applying scientifically acquired knowledge, it must first disassociate the associations al- ready existing between the normal sensations of contrac- tions of the uterus, and the pain reactions of the cerebral cortex. In this way, negative conditioned reflexes are sup- pressed. At the same time, new, positive reflexes must be created to replace the negative reflexes. C. Its Practical Application Outline of the New Method 5 25. Regarding the practical application, it consists in giving mothers (long before the period of childbirth) intensive instruction—adapted to their intellectual capacities—con- cerning the natural processes which take place in them during pregnancy and, in particular, during childbirth. They already recognized these processes to a certain extent, but most frequently without perceiving clearly their inter- connection. 26. Hence many things still remained enveloped in mys- terious obscurity, and were even susceptible of false inter- pretations. The characteristic conditioned reflexes also acquired a considerable force of action, while anxiety and fear were thereby constantly nourished. All these negative elements would be eliminated by the aforesaid instruction. 27. At the same time, a repeated appeal is made to the mother’s will and emotions not to permit feelings of fear to arise which are, and which have been proved to her to be, without foundation. 28. That impression of pain must also be rejected which might perhaps tend to manifest itself, but which, in any case, is not justified, being based only, as has been taught her, on a false interpretation of the natural organic sensa- tions of the contracting uterus. 29. Mothers are especially induced to consider the natural grandeur and dignity of what they accomplish at the mo- ment of childbirth. 30. Detailed technical explanations are given them concern- ing what they must do to insure normal labor and delivery. They are instructed, for example, concerning precisely how to exert their muscles, how to breathe properly. 31. This teaching takes especially the form of practical exercises, so that the technique may be familiar to them at the moment of delivery. 32. It is then a question of guiding mothers and preparing them not to go through childbirth in a purely passive man- ner, as an inevitable process, but to adopt an active attitude and influence it through the intellect, the will and the emo- tions, so as to bring childbirth to its termination in the manner intended by nature and with her aid. 33. During labor, the mother is not left to her own re- sources. She profits by the assistance and the constant supervision of a personnel trained according to the new 6 Evaluation of the New Method techniques, who remind her of what she had learned and point out at the proper moment what she should do or avoid or change. They quickly right her mistakes as oc- casion arises and aid her to correct the anomalies which may present themselves. . . . 34. This is in essence, according to the Russian researchers, the theory and the practice of painless childbirth. 35. For his part, the Englishman, Grantly Dick Read, has perfected a theory and technique which are analogous in a certain number of points. In his philosophical and meta- physical postulates, however, he differs substantially, be- cause his are not based, like theirs, on a materialistic con- cept. D. Extension and success. 36. Concerning the extension and the success of this new method (called the psycho-prophylactic method), it is as- serted that in Russia and in China it has already been used in hundreds of thousands of cases. 37. It has also taken root in various countries of the West. Many municipal maternity hospitals are said to have placed special sections at its disposal. The maternity hospitals organized exclusively according to these principals seem to be, at present, very few in the West. France, among others, has one such (communist) in Paris. Also in France, two Catholic institutions, at Jallieu and Cambrai, have com- pletely adopted this method among their services, without sacrificing what had previously proved successful. 38. Regarding its success, it is alleged to be very important : 85 per cent to 90 per cent of the births taking place in this manner are said to have been really painless. II EVALUATION OF THE NEW METHOD 1. Scientific Evaluation 39. After having thus given an outline of this method, We pass on to its evaluation. 40. In the documentation that has been referred to Us, there is found this characteristic note : “For the personnel, the primary indispensable requirement is that of having unreserved faith in the method.” Evaluation of the New Method 7 41. Can an absolute faith of this nature be required on the basis of the scientific results attained? 42. The method unquestionably has elements that must be considered as scientifically established ; others that have only a high probability, and still others which remain as yet (at least for the present) of a problematic nature. 43. It is scientifically established that in a general sense conditioned reflexes do exist; that some determined repre- sentations or emotional states can be associated with certain events, and that this can also be verified in regard to the sensation of pain. 44. But at the present moment it is not evident to all that it has been established (or at least that it can be proved from the above) that the pains of childbirth are due ex- clusively to this cause. 45. There are also responsible judges who maintain a re- served attitude in regard to the axiom asserted as quasi a priori : “All normal physiological acts, and thus also normal birth, ought to take place without pain; otherwise nature contradicts herself.” 46. These judges do not admit that the above can be applied universally and without exception, nor that nature would contradict herself if she made childbirth an intensely pain- ful act. 47. They affirm, in effect, that it would be perfectly com- prehensible, physiologically and psychologically, that nature, in her solicitude for the mother who gives birth and for the infant who is born, should have chosen this means to bring about in an inescapable manner a consciousness of the im- portance of this act and wish to compel the taking of the required measures in the interest of the mother and of the infant. 48. The scientific verification of these two axioms, which some claim to be certain and others hold to be debatable, We leave to the competent specialists. But it is necessary, in order to discern the true from the false, to keep to the de- cisive objective criterion: 49. “The scientific character and the value of a discovery should be evaluated exclusively according to its agreement with objective reality.” 50. It is important here not to neglect the distinction be- 8 Evaluation of the New Method tween “truth” and “affirmation” (“interpretation,” “sub- sumption,” “systematization”) of the truth. 51. If nature rendered childbirth painless in factual reality, if it became painful subsequently by reason of conditioned reflexes, if it can become painless again, if all this is not only asserted, interpreted, systematically constructed, but really demonstrated, it follows that the scientific results are true. 52. If this is not so, or at least if it is not yet possible to have entire certitude in this matter, one should abstain from all absolute affirmations and consider the conclusions arrived at as scientific “hypotheses.” 53. But, refraining for the moment from forming a defini- tive judgment on the degree of scientific certitude of the psycho-prophylactic method, we pass on to examine it from the moral viewpoint. 2. Ethical Evaluation 54. Is this method morally irreproachable? 55. The answer, which must take into account the object, end and motive of the method, is enunciated briefly: “Con- sidered in itself, it contains nothing that can be criticized from the moral point of view.” 56. The instruction given in regard to nature’s travail in childbirth: the correction of false interpretations of or- ganic sensations and the invitation to correct them; the influence exercised to avoid groundless anxiety and fear; the assistance afforded the mother in childbirth opportunely to collaborate with nature, to remain tranquil and under self-control ; an increased consciousness of the greatness of motherhood in general, and particularly of the hour when the mother brings forth her child—all these are positive values to which no reproach can be made. 57. They are benefits for the mother in childbirth, and fully conform to the will of the Creator. 58. Viewed and understood in this way, the method is a natural elevating influence, protecting the mother from superficiality and levity. It influences her personality in a positive manner, so that at the very important moment of childbirth she may manifest the firmness and solidity of her character. 59. Under other aspects, too, the method can lead to positive moral achievements. If pain and fear are successfully Evaluation of the New Method 9 eliminated from childbirth, that very fact frequently dimin- ishes any inducement to commit immoral acts in the use of marriage rights. 60. With regard to the motives and the purpose of the aids given to the mother in childbirth, the material action, as such, does not imply any moral justification, either positive or negative ; that is the concern of the one who renders his aid. 61. It can and should be done for motives and for a purpose which are irreproachable, such as the interest presented by a purely scientific fact; the natural and noble sentiment which creates esteem and love for the human person in the mother, which wants to do her good and help her; a deep religious and Christian feeling, which is inspired by the ideals of living Christianity. 62. But it can happen that the assistance seeks an end and yields to motives which are immoral. 63. In this case, it is the personal action of the one who assists which is to be judged wrong. The immoral motive does not change the assistance, which is good, into some- thing that is bad, at least so far as its objective structure is concerned. And, conversely, an assistance which is good in itself cannot justify a bad motive or furnish the proof of its goodness. 3. Theological Evaluation 64. There remains to be said a word of theological and religious evaluation, in so far as this is distinguished from the moral value in the strict sense. 65. The new method is often presented in the context of a materialistic philosophy and culture and in opposition to Holy Scripture and Christianity. 66. The ideology of a researcher and of a scholar is not in itself a proof of the truth and the value of what he has discovered and expounded. 67. The theorem of Pythagoras or (to remain in the field of medicine) the observations of Hippocrates which have been recognized as correct, the discoveries of Pasteur, the hereditary laws of Mendel, do not owe the truth of their content to the moral and religious ideas of their authors. 68. They are not either “pagan,” because Pythagoras and Hippocrates were pagans, or Christian because Pasteur and Mendel were Christians. 10 Final Consideration of Christian Obstetrics 69. These scientific acquisitions are true, because and in so far as they correspond with objective reality. 70. Even a materialistic researcher can make a real and valid scientific discovery, but this contribution does not in any way constitute an argument in favor of his materialistic ideas. 71. The same reasoning holds good for the culture to which a scholar belongs. His discoveries are not true or false according as he is descended from this or that culture, from which he has received inspiration and which has left its mark deeply impressed upon him. 72. The laws, the theory and the technique of natural child- birth, without pain, are undoubtedly valid, but they have been elaborated by scholars who, to a great extent, profess an ideology belonging to a materialistic culture. 73. These latter are not true simply because the scientific results mentioned above are. 74. It is even much less accurate to say that the scientific results are true and demonstrated as such, because their authors and the cultures from which they derive have materialistic orientation. The criterions of truth are else- where. 75. The convinced Christian finds nothing in his philosophi- cal ideas and his culture that prevents him from occupying himself seriously, in theory and in practice, with the psycho- prophylactic method. He knows, as a general rule that reality and truth are not identical with their interpretation, subsumption or systematization, and that, consequently, it is possible at the same time to accept the one entirely and reject the other altogether. 4. The Method and Holy Scripture 76. A criticism of the new method from the theological point of view should in particular give an account of Holy Scripture, because materialistic propaganda claims to find a glaring contradiction between the truth of science and that of scripture. 77. In Genesis ( Genesis , 16), we read: “In dolore pares filios” (“In pain shall you bring forth children”) . 78. In order to understand this saying correctly, it is neces- sary to consider the condemnation passed by God in the whole of its context. Final Consideration of Christian Obstetrics 11 79. In inflicting this punishment on our first parents and their descendants, God did not wish to forbid and did not forbid men to seek after and make use of all the riches of creation; to make progress step by step in culture; to make life in this world more bearable and better ; to lighten the burden of work and fatigue, pain, sickness and death, in a word, to subdue the earth ( Genesis , 1. 28) . 80. Similarly, in punishing Eve, God did not wish to for- bid—nor did he forbid—mothers to make use of means which render childbirth easier and less painful. 81. One must not seek subterfuges for the words of Sacred Scripture. They remain true in the sense intended and ex- pressed by the Creator, namely: motherhood will give the mother much suffering to bear. 82. In what precise manner did God conceive this chatise- ment and how will He carry it out? Sacred Scripture does not say. 83. There are some who allege that originally childbirth was entirely painless, and that it became painful only at a later date (perhaps due to an erroneous interpretation of the judgment of God) as a result of autosuggestion and hetero- suggestion, arbitrary associations, conditioned reflexes, and because of faulty behavior of mothers in labor. So far, however, these assertions on the whole have not been proved. 84. On the other hand, it could be true that an incorrect behavior, psychic or physical, on the part of those in labor is capable of increasing considerably the difficulties of de- livery, and has in reality increased them. 85. Science and technique, can, therefore, use the conclu- sions of experimental psychology, of physiology and of gyne- cology (as in the psycho-prophylactic method) in order to eliminate the sources of error and painful conditioned re- flexes, and to render childbirth as painless as possible. Sa- cred Scripture does not forbid it. FINAL CONSIDERATION OF CHRISTIAN OBSTETRICS 86. By way of conclusion, We would add some remarks on Christian obstetrics. 87. Christian charity has always and ever taken an interest in mothers at the time of their confinement. It has tried and still tries today to render them efficacious assistance, 12 Final Consideration of Christian Obstetrics psychic and physical, in accordance with the state of ad- vancement of science and technique. 88. This could be applicable at the present time to the new discoveries of the psycho-prophylactic method, in the meas- ure in which they meet the approval of serious scholars. Christian obstetrics can here incorporate into its principles and its methods all that is correct and justified. 89. Nevertheless, it must not be content merely with these in the case of patients who are capable of receiving more, nor must it abandon anything of the religious values which it has been turning to account up to the present. 90. In Our address to the Congress of the Italian Associa- tion of Catholic Midwives on October 29, 1951 (Discourses and Radio Messages, Vol. 13, pages 333-353), We spoke in detail of the apostolate which Catholic midwives have in their power to exercise and which they are called upon to practice in their profession. Among other things We men- tioned the personal apostolate, namely that which they exer- cise by means of their science and their art and by the solidity of their Christian faith (l.c. page 334 ss) ; and then the apostolate of motherhood, by endeavoring to remind mothers of its dignity, its seriousness and its nobleness. 91. One can apply here what We have said today, for they assist the mother in the hour of her delivery. 92. From her faith and from her life of grace the Christian mother gets the light and strength to have full confidence in God, to feel that she is under the protection of Provi- dence, and also to accept willingly the suffering God gives her to bear. It would be a pity, therefore, if the Christian obstetrician were to confine himself to rendering her as- sistance of a purely natural order—psycho-prophylactic services. 93. There are two points which deserve to be emphasized here: Christianity does not interpret suffering and the cross in a merely negative fashion. 94. If the new technique spares her the sufferings of child- birth, the mother can accept it without any scruple of conscience ; but she is not obliged to do so. 95. In the case of partial success or failure, she knows that suffering can be a source of good, if she bears it with God and in obedience to His will. 96. The life and sufferings of our Saviour, the pains which Final Consideration of Christian Obstetric s 13 so many great men have borne and even sought and through which they have matured and risen to the summits of Chris- tian heroism, the daily examples we see of acceptance of the cross with resignation : all this reveals the meaning of suf- fering, of the patient acceptance of pain in the present plan of salvation, for the duration of this earthly life. 97. A second remark : Christian thought and life, and there- fore Christian obstetrics, do not attribute an absolute value to the progress of science and the perfection of technique. That attitude, on the contrary, is regarded as natural by materialist thought and by the concept of life which ma- terialism inspires. For them it serves as a religion, or as a substitute for religion. 98. Although the Christian applauds new scientific dis- coveries and makes use of them, he rejects all materialism’s exaggerated glorification of science and culture. 99. He knows that these occupy a place on the scale of ob- jective values, but that, while they are not the lowest, neither are they the highest. In their regard, too, he repeats today as ever and always: “Seek first the kingdom of God and his justice” (Matt. 6, 33). 100. The highest, the ultimate value for man is to be found, not in science or its technical capabilities, but in the love of God and devotion to His service. 101. For these reasons, when faced with scientific discovery of painless childbirth, the Christian is careful not to admire it unreservedly and not to use it with exaggerated haste. He judges it in a positive manner and with reflection, in the light of sane natural reason and in the more vivid light of the faith and love which emanate from God and from the Cross of Christ. 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