Misguided, old-fashioned ideas about childbirth are holding back Meghan

Is it some kind of ancient tribal loyalty to the spirit of Sir John Peel, the last bastion of paternalist obstetrics, that causes our dear Royal Family to be so mistrustful of evidence, research or even common sense when it comes to having babies?

Let me explain what I mean by “paternalist obstetrics”. I mean the kind of obstetrics that my mother had to endure in the 1950s: the midwife who could not detect my unborn brother’s heartbeat, declared “Oh, this is a waste of time,” and left the room, without giving my distraught mother a backward glance; the doctor who barged in as she was in the last stage of labour, cried “Well done, Mrs Er,” and whizzed out again; the GP who stopped her breastfeeding me because she had mastitis.

I mean all those doctors, going right back to Dr Smellie and his forceps in the 18th century, who insisted that women should lie on their backs in a hospital bed to give birth even if their bodies were crying out to be upright and moving. I mean the doctors who tried to have pioneering obstetrician Wendy Savage struck off in the 1980s because she encouraged women to ask questions, and to get out of bed.

This is, broadly speaking, the tradition against which the Duchess of Sussex is seen as moving when it’s reported that she is hiring a birth doula.

In fact, Meghan is simply doing what thousands of sensible well-off women do who want to maximise their chances of a normal birth. The research shows that the continual presence of another woman known to the mother reduces the likelihood of interventions such as induction of labour, forceps or caesarean birth.  As not everybody wants their mother there, and it’s impossible to guarantee that a particular NHS midwife will be on duty on the day, the doula is a good, if pricey, option. She’s not a midwife, she’s a source of experienced support, calm reassurance, an extra pair of hands — and maybe a little firm advocacy on the woman’s behalf as well.

Fifteen years ago, emerging from a hospital bathroom with one of my first doula clients, whose back I was massaging, a midwife stopped me in my tracks with a furious glare: “And WHO are YOU?” she boomed, Queen of Hearts-like, her ample bosom fairly swelling with territorial pride.

Fast forwards a few years to the same hospital: “Ah, you’ve brought a doula,” trilled a (different) midwife to my client. “That’s wonderful.” Things had moved on, in Chelsea at least. Having a doula isn’t a big deal any more. But wanting to give birth as naturally as possible? Learning hypnobirthing techniques? If you’re a Royal, that’s another thing altogether. Despite the easy birthing experiences of the Duchess’s sister-in-law Kate, it is considered somehow inappropriate for any royal mum-to-be to do anything other than follow the orders of the royal obstetricians to the letter.

Which brings us to back to Sir John Peel. After being present at the births of all four of the Queen’s children, Peel undertook a major Government report which concluded that all women, regardless of their health and risk level, should give birth in a hospital ward. Peel’s 1970 report meant that funds were channelled into expanding maternity wards, shrinking the “domiciliary” (home birth)  midwife service to nearly zero. Peel simply assumed that home birth was, by its very nature, more risky and insanitary than hospital birth. (Maybe he was shocked to discover that most women didn’t have as many staff as his Top Patient.)

To be sure, perinatal mortality did go down — but induction rates went up from 8 per cent in 1962 to 39 per cent in 1974. By 1979 more women were having episiotomies, where the perineum is cut (ouch) to let the baby be dragged out by forceps, than were not.

In 1986 a statistician, Marjorie Tew, discovered something astonishing. She asked her students to study the risks of home versus hospital birth, fully expecting them to find that home birth was more risky: but they found the reverse: “Perinatal mortality is much higher when obstetric intranatal interventions are used.” It seemed that the better outcomes were more accurately attributed to rising standards in diet and welfare, than to the godlike powers of doctors. And later, in 2011, the large-scale Birthplace Study showed overwhelmingly that low-risk first time mums were more likely to have a “normal” birth in a midwife-led unit than in the standard doctor-directed labour ward.

St Mary’s Hospital, Paddington, now has just such a midwife-led unit. But it’s not the place where the royal babies are born. They first see the light in the Lindo Wing, the hospital’s private section.

For the past twenty years it’s been a truth universally acknowledged that to maximise straightforward births in hospital, the essential bit of kit is a birth pool. It’s a giant bathtub, with convenient steps and underwater lighting. On entering the delicious warmth of a birth pool, many a labouring woman has suddenly felt more like a dancing dolphin than a beached whale, able to relax enough to get the final burst of oxytocin — the “love and labour” hormone — she needs to get her baby out.

Nothing against the Lindo Wing — but it was disappointing that its £9 million refit in 2010 did not include birth pools, “due to space restrictions and the consultants’ preference” (my italics) according to a senior midwife at the time. Enough said.

The Duchess of Cambridge dutifully went with the royal tradition and gave birth there. George came fairly swiftly, it seems, for a first babe, and the obstetricians whose names were on the Palace birth announcement had virtually nothing to do at all, according to rumours, except to wisely let Kate and the (uncredited) midwives do their stuff. Charlotte, as second babies often are, was even more no-nonsense and efficient in her arrival.

The Duchess of Cambridge didn’t (we believe) have “the epidural” (the Lindo Wing is reputed to have an almost 100 per cent epidural rate). She’s obviously a fast birther. Many women with her birth history would have seriously considered a home birth for baby Louis, if only to avoid giving birth in the back of an ambulance on the Bayswater Road. The Birthplace Study said home birth for a low risk, 2nd or 3rd time mum was as safe as hospital. So why couldn’t they have moved a birth team into Kensington Palace instead of making poor Kate schlep over to Paddington in labour?

That’s one reason why I conclude that the long shadow of Sir John Peel still looms over the bed of any Royal mum-to-be. I hope Meghan can banish that shadow forever.