By Whitney Wood
Pregnancy is an anxiety-ridden period for many expectant parents. In recent years, newspapers, the popular press, women’s magazines, and a growing body of “mommy blogs” have increasingly suggested that the fear of childbirth has become “a modern day epidemic” amongst pregnant women. This fear, first described as a psychological disorder and classified as tokophobia (from the Greek tokos, meaning childbirth) in an article published in the British Journal of Psychiatry in 2000, has the potential to result in a number of symptoms including nightmares, panic attacks and psychosomatic complaints. Perhaps not surprisingly, many women’s anxieties center on a fear of the painful experience of vaginal birth, a fact that many social commentators have cited as contributing to recent increases in rates of caesarean section.
Like other current anxieties surrounding health and the body, however, these fears are historically situated. By the beginning of the nineteenth century, the links between pain and the experience of giving birth had long been “common sense” for many women. This was partly legitimized by religious notions, as in Genesis 3:16, which, in the King James Bible reads: “Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children…” Additionally, childbearing had often been portrayed in both art and literature as an experience that had a significant chance of resulting in the mother’s death.
But although these anxieties have much older historical roots, women’s fears of the pain of parturition appear to have escalated significantly over the course of the nineteenth century, in tandem with a number of social, cultural and professional changes.
Although these shifts were by no means swift or uniform, physicians laid greater claim to childbearing women as a new group of patients, and asserted dominance and control over the events that took place in the birthing room.  To legitimize their professional authority, physicians (who were almost all men) sought to distance themselves from midwives, who they portrayed as unskilled, sentimental, and superstitious women, who were perhaps most significantly, unable to offer modern medical interventions, including anesthesia that promised an easier childbirth.
This conscious professional strategy was, to a certain extent, quite successful. By the late-Victorian years, many “well-to-do” middle- and upper-class women were choosing to seek the “modern” assistance of a physician, rather than the more “traditional” services offered by a midwife, as they approached their confinements.
As the traditional and female-dominated culture of social childbirth – which saw women attend the confinements of female kith and kin – continued to decline over the course of the nineteenth century, a growing group of women were effectively caught adrift between these two approaches. While their mothers and grandmothers had learned about sex, reproduction and birth in the female-dominated birthing room, new generations of women coming of age in the late-nineteenth century, were raised in a different way. In their efforts to bring up respectable and modest future wives, middle-class mothers in particular were seen to be setting their daughters up for a lifetime of ignorance about the “laws of health” and their own bodies, and as a result, debilitating and painful experiences in giving birth.
This lack of knowledge went hand-in-hand with women’s growing fears about the pain of giving birth. In the late-nineteenth and early-twentieth centuries, many Canadian women noted that the uncertainty of what awaited them in the birthing room was a major cause of anxiety. Among them was Lucy Maud Montgomery, the internationally renowned children’s author made famous by her Anne of Green Gables stories. Writing during her first pregnancy in 1912, Montgomery commented that she felt very nervous when she thought of the ordeal before her, and speculated that “it cannot be easy at the best.” After giving birth, she recounted her emotions during the final weeks of her pregnancy:
in the dead, dim hours of night, fears and gloomy dreads came to me… they always lurked in the background of my mind. Would I escape with my life? Would I, as some of my friends have done, suffer so dreadfully that the remembrance would always be a horror? Would my child live? These and a score of other fears haunted me.
Although there are limitations when using diaries as historical sources, other middle-class Canadian women echoed these sentiments in their journals and private correspondence. Women consistently wrote about their anxieties and fears throughout the gestation period, alongside their complaints about the many, various, and vexing physical symptoms associated with pregnancy – complaints that included headaches, toothaches, and “neuralgia” that left one woman feeling like “a semi-invalid.”
While women’s descriptions of the physical discomforts and pain they experienced during pregnancy and childbearing speak to the increasing medicalization and pathologization of both pregnancy and birth, what they wrote about their particular anxieties and fears is telling. Such expressions demonstrate that for many middle-class women in late-nineteenth and early-twentieth century Canada, the pain of giving birth also included a distinct emotional component in the form of fears and anxieties that led Montgomery, for one, to declare in the final weeks of her 1912 pregnancy that the “misery” she experienced was “partly physical, partly anxious.” Distanced from traditional social childbirth networks, and anxious about the physical sensations of giving birth, more and more women who could afford to chose a physician, who, unlike a midwife, promised to offer “scientific” and “modern” interventions, the most of important of which was anesthesia.
Although many expectant mothers continue to fear the experience and pain of giving birth, responses to this fear have shifted with changing historical and medical contexts. For women at the turn of the twentieth century, this anxiety prompted the affluent to pursue the promise of “modern” scientific childbirth. While this trend continued throughout the first half of the twentieth century, the rise of the natural childbirth movement with the women’s and consumer health movements of the 1970s, led to a growing (re)acceptance of midwifery and a changing conceptualization of birth. Nowadays, what we might consider as the same group of anxious “well-to-do” women are encouraged instead to turn to a doula to guide them through the experience of giving birth. In other words, though women’s fears of the pain of giving birth have persisted, the professional personnel who are seen to have the greatest potential for “curing” or countering these fears have changed. Looking at women’s emotional responses to the pain of giving birth, then, provides a thought-provoking example of both continuity and change in the history of medicine.
Whitney Wood is a PhD Candidate in the Department of History at Wilfrid Laurier University in Waterloo, Canada, and a former visiting research student at Birkbeck, University of London. Her chapter, “‘When I think of what is before me, I feel afraid’: Narratives of Fear, Pain, and Childbirth in Victorian Canada” appears in Pain and Emotion in Modern History, ed. Rob Boddice, published in July 2014 by Palgrave Macmillan.
Feature image: An obese midwife on her way to a labor in the early hours of the morning. Colored etching by Thomas Rowlandson, 1811. Wellcome Library, London. http://catalogue.wellcomelibrary.org/record=b1174869
 Kristina Hofberg and I.F. Brockington, “Tokophobia: an unreasoning dread of childbirth,” The British Journal of Psychiatry 176 (2000): 83-85.
 See, for example, Judith Walzer Leavitt’s classic work, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986).
 For more on the professionalization of obstetrics in the Canadian context, see Wendy Mitchinson, Giving Birth in Canada: 1900-1950 (Toronto: University of Toronto Press, 2002),
 It is important to point out that despite this increasing medicalization, the majority of births in Canada, Great Britain and the United States were still taking place in the home. In Ontario, for example, which was arguably Canada’s most “modern” and medicalized province, the majority of births took place in the home until 1938. Jo Oppenheimer, “Childbirth in Ontario: The Transition from Home to Hospital in the Early Twentieth Century,” Ontario History 75 (1983): 36-60.
 Elisabeth Robinson Scovil, who aside from her work as a hospital superintendent had served as associate editor of the Ladies Home Journal, noted in 1896 that the ambition to raise respectable young women prompted many mothers to avoid discussing sex and reproduction with their daughters. Scovil cited this aversion as one of the key reasons why many young American women were unhealthy. Elisabeth Robinson Scovil, Preparation for Motherhood (Philadelphia: Henry Altemus, 1896), 265. These themes are further explored in my forthcoming article, “‘The Luxurious Daughters of Artificial Life’: Female ‘Delicacy’ and Pain in Late-Victorian Advice Literature,” Canadian Bulletin of Medical History 31, no. 2 (Fall 2014).
 For more information see Whitney Wood, “‘When I think of what is before me, I feel afraid’: Narratives of Fear, Pain, and Childbirth in Victorian Canada,” in Pain and Emotion in Modern History, ed. Rob Boddice (Houndsmills: Palgrave Macmillan, 2014), 187-203.
 Montgomery’s anxieties about what she would encounter in the birthing room often centered on the pain of giving birth, as evident by her statement: “I have never had to endure any intense physical pain. So I fear I shall not bear it well or be very brave or patient… Now, when the end is coming so near, I cannot avoid feeling dread or anxiety.” The Selected Journals of L.M. Montgomery, Volume II: 1910-1920, eds. Mary Rubio and Elizabeth Waterson (Toronto: Oxford University Press, 1987), 4 April 1912 and 22 September 1912.
 Gwyneth Logan to Harry Logan, 29 November 1919, Harry Tremaine Logan and Family Fonds, MG 30 C215, Library and Archives Canada.
 Selected Journals of L.M. Montgomery, 30 April 1912. This statement presents a challenge to what David B. Morris has referred to as “the myth of two pains” – the idea that experiences of pain can be neatly categorized as either physical or emotional/mental. See David B. Morris, The Culture of Pain (Berkeley: University of California Press, 1991). For more on challenging the artificial division between physical and emotional pain, see Pain and Emotion in Modern History.
 Rosalind Ryan, “How to fight your fear of childbirth,” http://www.dailymail.co.uk/health/article-84204/How-fight-fear-childbirth.html