‘Viewing the Pelvis’: Race,Culture and the Making of ‘Natural’ Childbirth Between Colonial India and Europe

Abstract

Kathleen Olga Vaughan (1869–1956) was a British medical doctor and obstetrician who worked in colonial India from 1903 to the mid-1920s. Unlike most of her contemporaries, she rejected racial explanations for childbirth complications, instead attributing them to pelvic anatomy. Based on her observations in India, Vaughan believed that the squatting position, commonly used by ‘native’ populations in daily life and childbirth, contributed to the healthy and functional development of the pelvis and to safer deliveries. Upon returning to Europe, she sought to validate her hypothesis scientifically and advocated for ‘civilised’ women to adopt practices from supposedly ‘less civilised’ societies. Through medical journals and her clinical practice, she promoted prenatal physical training to enhance pelvic flexibility, while engaging with the growing movement against the medicalisation of childbirth. This article examines Vaughan’s work, exploring how colonial encounters shaped ideas, practices and ideologies surrounding natural childbirth in the West. It also shows how the return to nature that Vaughan propounded as a form of prenatal care was deeply embedded in contemporary eugenic thought, reflecting broader concerns with white bodily improvement.

‘The saint and the criminal, the family, the race, the nation, all mankind pass through the pelvis of woman and are what she makes of them. A faulty mould does not produce good bricks however fine the clay’ (Vaughan, 1937, p. 146). With these words, Kathleen Olga Vaughan (1869–1956), an English medical doctor, concluded Safe Childbirth: The Three Essentials—1. Round Brim, 2. Flexible Joints, 3. Natural Posture. The book was just one of the many medico-scientific publications through which, in the first half of the 20th century, Vaughan popularised her views of childbirth as a natural process.

Vaughan foregrounded the shape and flexibility of the pelvis as critical factors in ensuring safe delivery. However, at a time when the central role of the pelvis in childbirth—particularly from the 1920s through the 1950s—was increasingly framed in racial terms, she emphasised the environmental, cultural and social conditions that shaped women’s bodies. Rather than attributing pelvic capacity to fixed racial traits or viewing childbirth outcomes as biologically determined, Vaughan identified specific ‘manners of life’ that either supported or hindered the health and adaptability of the female pelvis as crucial to parturition (Valdameri, 2024, pp. 207–211).

Through an analysis of her published work and of the information about her professional career in India and Europe, this article looks at Vaughan as an important contributor to the rising (medical) movement that criticised the medicalisation of childbirth, while investigating pars pro toto, how the colonial context influenced meanings, practices and ideologies of ‘natural childbirth’ in Europe. ¹ After training as a medical doctor in London, Vaughan worked for around two decades as an obstetrician in India: This experience exposed her to the social reality of maternal and infant mortality in the subcontinent and, at the same time, allowed her to observe different forms of knowledge and practices connected to childbirth. After her return from India, she selectively appropriated and incorporated her observations into the antenatal courses designed for women in French and British hospitals. Further, this article uses Vaughan and her methods as prisms to understand the circulation of ideologies, beliefs and practices of ‘natural childbirth’ across India, Europe and the world and their intersections with women’s health, eugenic reform and gender politics. As scholars have aptly demonstrated, natural childbirth is not a universal, value-free category, but a malleable cultural construct that needs to be understood against the intellectual and political background in which it emerged (Allotey, 2012; Bourke, 2020; Davis-Floyd & Sargent, 1997, pp. 1–51; Moscucci, 2003, p. 168).

Easy Childbirth: ‘Nature’ or ‘Culture’?

A rich body of scholarship on colonial India has convincingly shown that the provision of medical care for Indian women was strongly predicated on the discourse of the female patient being prevented by purdah (the practice of female seclusion) from seeking medical care from male doctors. From the 1870s onwards, the view that Indian women observing the ‘barbaric’ practice of purdah were trapped in the allegedly unhygienic and infectious zenana (the women’s quarters of a house) prompted the institutionalisation of colonial medicine targeting specifically such women through government-supported organisations such as the Dufferin Fund (established in 1885). By the early 20th century, the practice of purdah had allowed British medical women to be employed in considerable numbers in India, unlike the still male-dominated medical profession in their home country. Zenana medical care was thus crucial in the early years of the professionalisation of British medical women (Burton, 1996; Forbes, 1994, [2005] 2008; Lal, 1994; Sehrawat, 2013, pp. 100–186). The medicalisation of childbirth consisted of attempts to ‘sanitise’ the zenana as a birthing site, establish lying-in purdah hospitals under the supervision of female doctors and, most importantly, replace ‘ignorant’ and ‘dirty’ dais (traditional birth attendants) with trained midwives and qualified women medical doctors (Forbes, [2005] 2008; Guha, 2018; Mukherjee, 2017, pp. 69–94; Saha, 2024, pp. 69–107).

The daughter of a cleric, Kathleen Vaughan was born in 1869 and in 1900 graduated from the London School of Medicine for Women (LSMW) with a bachelor’s in medicine (London School of Medicine for Women, n.d.). Her interest in India was kindled by her ‘revered teacher’ Dame Mary Scharlieb (Vaughan, 1928, p. vi). She moved to Calcutta in 1903, where she was appointed superintendent of the Victoria Dufferin Hospital and was later named superintendent at the Diamond Jubilee Zenana State Hospital in Srinagar (Obituary of Kathleen O. Vaughan, 1957, p. 138). She would return to Europe only around the mid-1920s.

The information we have on Vaughan’s career in India is fragmented, and the few historiographical works that have briefly dealt with Vaughan focussed on her institutional role as a member of the Association of Medical Women of India (AMWI) (Sehrawat, 2013, pp. 140–141, 149, 159, 173; 2018, p. 162). Other studies have in passing analysed Vaughan’s activities in purdah hospitals in India or her pioneering role in the ‘natural childbirth’ movement in England (Guha, 1996, pp. 30–32; 2018, pp. 166–167; Moscucci, 2003, pp. 169, 171–172). These works, however, have not been in dialogue with each other so that existing historiography is yet to analyse Vaughan’s medical work in the British colony and her promotion of ‘natural childbirth’ in Britain within an unified framework. This article addresses this gap by bringing these strands into conversation.

It was, in fact, while working in Kashmir that Vaughan became increasingly interested in the relationship between pelvic (under)development and maternal mortality. In 1922, Vaughan applied for financial assistance with the Dufferin Fund to carry out research on osteomalacia, a disease similar to rickets that caused the deformation of the pelvis and could result in maternal and/or infant mortality during delivery. The fund agreed ‘to offer 50 rupees out of pocket expenses and to submit [Vaughan’s] papers—when completed—to Colonel Greig to decide the remuneration advisable’ (Countess of Dufferin’s Fund, 1922). Broadening the medical research reported in the AMWI, which had demonstrated the link between purdah and osteomalacia, Vaughan observed:

In India the non-purdah women who go about freely have very little trouble during childbirth and have large families, but it is the secluded women who so often die in childbirth, and their children too owing to misshaped pelves, and they suffer from anaemia and general debility. (League of Nations Secretariat, n.d.)

In an article published in the British Medical Journal in 1926 (Vaughan, 1926) and expanded in The Purdah System and Its Effect on Motherhood two years later, Vaughan claimed that the aetiology of osteomalacia lay in insufficient exposure to sunlight, lack of mobility and physical exercise, and an unbalanced diet (Vaughan, 1928, 1943). She claimed that ‘the factor that has always been overlooked in the discussion of the causes of maternal mortality, both in the East and in the West, is the female pelvis and its development’, urging further research on the topic (Vaughan, 1928, p. 41). She averred that the high maternal mortality in childbirth observed in British industrial cities as well as in the countryside, where girls were supposed to be more physically active, could be explained by deformed pelvises. Such underdevelopment, Vaughan hypothesised, was caused by a lack of exposure to sunshine due to family reluctance to allow girls free access to the outside, and to windows fixed high in the walls of schools, cutting off direct sunlight (Vaughan, 1928, pp. 44–45). In other words, an easy or difficult parturition was not a matter of race or nature, as argued in most medical and anthropological literature of the time, but mainly of culture. When back in Europe, Vaughan investigated the possible causes of this phenomenon in the research she conducted in the late 1920s and 1930s. She drew on the work of medical colleagues and anthropologists working across the globe who suggested difficult child delivery could be linked to certain lifestyles. Examples included Chinese women binding their feet (Vaughan, 1931, p. 940) or ‘the negress’, who ‘in her natural surroundings’ would give birth to children with ease, ‘but in America, living in big cities such as New York and Baltimore, Whitridge Williams tells us she has more obstetric difficulties than the American white woman herself’ (Vaughan, 1931, p. 940). ² However, this research had not considered the role of pelvic disfunction seriously. Vaughan’s own observations in Kashmir had shown that, unlike better-off female city dwellers and especially purdah women:

The field worker, the woman who lives out of doors tending the cattle, planting out crops often knee-deep in cold water in the rice-fields, rowing the heavy boats used for transporting grain, the tent dwellers—such as the women of the nomadic tribes on the North-West Frontier of India—all these have their children safely and with no more difficulty than the animals around them have in parturition. (Vaughan, 1931, pp. 939–940)

According to Vaughan, this could be equally observed among people, such as ‘gypsies’ or Shetland women, who lived ‘natural’ lives out of doors and exercised their sacro-iliac joints ‘by hard manual labour, digging, weeding, hauling in nets, carrying and lifting heavy weights, and, more important than all, the daily crouching posture used in attending to the calls of nature’. Not using the ‘modern closet’ and very often not even chairs contributed to keeping the pelvic anatomy healthy and functional (Vaughan, 1931, p. 941). Thus, she explained the difference in the structure and function of the pelvis with its daily use.

Overall, contraposing nature and culture in relation to childbirth and privileging the ‘natural’ over the ‘cultural’, Vaughan claimed that difficult childbirths were then the consequence of civilised conditions and habits which had interfered with ‘nature’. In other words, childbirth was by nature easy, and civilisation had weakened women to the point of rendering childbirth physiologically complicated, if not impossible (Moscucci, 2003, p. 169). Similar arguments supporting an unequivocal nature/culture dichotomy were made, for example, from the mid-19th century onwards in the Germanophone countries by the influential and diverse movement for Lebensreform (life reform), which aimed to improve urban–industrial society by exposing the body to more ‘natural’ ways of living. A mainly bourgeois-dominated movement, Lebensreform associated sickness with the disrupted relation of the individual to nature and encouraged people to be exposed to plenty of fresh air and sun to compensate for the effects of industrialisation and urbanisation (Hau, 2003; Krabbe, 1974; Williams, 2003, pp. 10–30). These ideas spread among the middle classes in Britain and North America (Haley, 1978; Whorton, 1982).

Emerging more or less coterminously with the rising of Lebensreform, since the mid-19th century and well into the 20th century, the belief that ‘primitive’ people, being close to nature, had easy parturition had been a commonly held view in medical and quasi-medical literature across the globe (Al-Gailani, 2017, p. 483; Jasen, 1997, pp. 391–393; Roy, 2003; Russell, 1982; Stanton, 1979). The antecedent of such a view was the Enlightenment trope of the ‘noble savage’, whose healthy way of life was contrasted with that of the upper classes living in cities. This view penetrated medical and academic fields, pervaded cultural and political thought, finding its way into existing fears of racial degeneration. Overall, this validated the anxieties of European and North American elites that the ‘lower’ strata of humanity, both social and racial, were reproducing at a faster pace than the ‘superior’ ones—as those elites perceived themselves—who feared being demographically overwhelmed.

The belief that ‘primitivism’ was somehow associated to health precluded the possibility to criticise, or even see, structural social, environmental and economic inequalities that affected racial or social ‘others’. It was this same belief that, only seemingly at variance with increasing fixations with racial hierarchies and degeneration, engendered discourses about the importance of white middle-class women embracing the virtues of a ‘primitive’ life to counterbalance the effects of civilisation. As will be shown, this had clear eugenicist undertones that would become conspicuous in Vaughan’s research from the 1930s onwards when she joined the ranks of physicians and health professionals in sympathy with the aims of reform eugenics. Thus, it is true that theories of easy childbirth were often based on long-standing myths about the ‘primitive woman’, romanticised and looked upon as strong and healthy, with a considerable level of abstraction from reality—theories and ideas which to an extent must have influenced Vaughan too. However, Vaughan’s firsthand experience in India provided her with a comparative framework that allowed her to perceive the relevance of her observations for the Western context. It also enabled her to build on her reputation and become involved in the medical movement that criticised the prevalent biomedical views of pregnancy and birth.

In 1925, Vaughan spoke about the ‘extinction threat’ to the Kashmiri Hindu race at the British Social Hygiene Council in Wembley (on the Council, see Hall, 2001, pp. 120–136). She argued that the Hindus, who were the ruling class despite being only 5% of the population, were on the brink of ‘race suicide’ in a state where Muslims formed the overwhelming majority (‘Birth Control Menaces State of Hari Singh’, 1925) as a consequence of a low natality rate caused largely by venereal diseases, tuberculosis and osteomalacia (‘Extinction Threat’, 1925). The subtext was that the fate of Kashmiri Hindus, commonly considered ‘one of the oldest races in the world and one of the most intellectual’ (‘Extinction Threat’, 1925), could be a cautionary tale for the British middle classes who were having less children. Vaughan’s statement reflected existing communal (and caste) tensions in India, where fears were rampant that the Hindu upper-caste population could decline both in quality and in quantity due to the advantage of ‘overbreeding’ Muslims and ‘stronger’ lower castes (Nair, 2011). In the British context, however, her words must be situated within the framework of a national discourse on depopulation, physical degradation and social and moral decadence, often impelled by Spencerian-organicist views of societies (Claeys, 2000). It was in this ideological setting of pessimism towards the quality of modern life and civilisation—a pessimism exacerbated by the loss of life in the Franco-Prussian War, the Boer War and the First World War—that the worldwide interest in natural childbirth as a remedy against maternal and infant mortality emerged (Bryder, 2019; Carballido-Coria, 2024; Davin, 1978; Koven & Michel 1990).

Pelvic Imperatives: Eugenics, Prenatal Care and the Role of ‘Natural’ Delivery

Vaughan’s view of childbirth and antenatal care too was framed by eugenic concerns about low birth rates, high maternal mortality among the ‘over-civilised’ middle and upper classes as well as the ‘increasing mental degeneracy as a race’ in Great Britain (Vaughan, 1937, p. 7). ³ She expressed these views in Safe Childbirth, her book based on research conducted in France and England with the aim of simplifying ‘our attendance on childbirth while making it a safer and easier process for both mother and child’ (Vaughan, 1937, p. viii). This, in her view, would affect the ‘quality of our births that is the unseen cause of the rise and fall both of families and nations and is the determining factor in man’s slow evolution’ (Vaughan, 1937, p. viii, emphasis in original). Prolonged and difficult labour were in fact considered responsible for the destruction of the ‘finest children and too often in the survival of the feebleminded’ (Vaughan, 1937, p. 5).

Through her research, Vaughan intended to investigate whether civilisation was at fault by ‘creating conditions of life that so deform the skeleton of the race that the woman’s pelvis is no longer capable of allowing her infant’s head to pass without danger and damage to herself, and death or gross head injury to her child’ (Vaughan, 1937, p. 8). In order to investigate difficult deliveries from an anatomical standpoint, Vaughan contacted the famous anatomist, anthropologist and proponent of scientific racism Sir Arthur Keith (1855–1966), who propounded the view that while heads were getting bigger among civilised people, women’s pelvises seemed to be getting smaller (Keith, 1923). In 1929, with Keith’s permission, Vaughan started to measure human specimens at the Hunterian Museum of the Royal College of Surgeons of England, in London. In her research, she considered two factors: the unyielding pelvic brim of the mother and the yielding foetal head which passes through the brim (Vaughan, 1931, p. 940).

Vaughan described her findings at the Royal College:

Surrounded by skeletons from all parts of the world, I soon became aware of the great variability in shape shown by this portion of the human frame [the pelvis], but especially was this variability of form noticeable in the female skeleton, and, contrary to received opinion, it does not possess a shape peculiar to one race distinguishing it from another, but even in the same race and the same family the shape of the pelvic brim varies widely among all women, perhaps more so than any other feature of their anatomy. (Vaughan, 1937, p. 33)

With this conclusion, Vaughan disputed common racial explanations of pelvic variations and questioned, at least to some degree, the ‘science’ of pelvimetry that had originated in the 19th century and had since then undergirded various racial hierarchies (Caldwell & Moloy, 1933; Thoms, 1939). Her research pointed out that there was no clear relation between pelvis size and race or between racial anatomy and easy or difficult childbirth. The pelvic brim and the foetal head, Vaughan argued, were meant to fit, and when this was not the case, it was a matter of undeveloped pelvis, due to the ankylosis of the sacro-iliac joints. In other words, the lack of mobility associated with a ‘modern’ manner of life—and not simply with ‘heathen’ customs—had made the pelvis rigid and deprived it of its natural elasticity (Vaughan, 1931, pp. 940–941). Vaughan drew on the work of Professor Havelock Charles, who had observed that among Punjabis, the practice of regular squatting modified the sacro-iliac joints and produced a larger articular surface (Charles, 1893; Vaughan, 1931).

After her work at the Hunterian Museum, Vaughan wanted to scientifically demonstrate why the squatting position assumed by the ‘native’ races of the East seemed to ensure easy childbirth. She recalled a case that first made her interested in Indian obstetric practice:

When I was called to a difficult and delayed confinement in an Afghan family of high caste … I told them to give her [the woman giving birth] a bowl of hot bread and milk, and sat by her afterwards while she slept, to make sure she was not awakened. When she woke up, she asked if she might be confined ‘as their custom was’. A woman, possibly her mother, knelt behind her and supported her under the armpits, while she knelt on the floor with knees apart, and the child was easily born into my hands as I knelt in front of her. In a few more minutes she pressed her abdomen and the afterbirth came away. (Vaughan, 1937, pp. 117–118)

Unable to raise enough interest in England in the alleged effect of the squatting position on the pelvis, Vaughan spent over a year in France. There, with the support of the Compagnie Générale de Radiologie, she was introduced to X-ray specialists who assisted her in viewing and measuring pelvises. Using a simple X-ray apparatus normally employed to show whether shoes fitted (Vaughan, 1934) and collaborating with medical colleagues Professors Réchou and Wangermez and Dr Anderodias at the hospital St. André in Bordeaux, Vaughan took the pelvic measurements of young white children and pregnant women and observed that, in the squatting position, the pelvis was considerably wider. When two of the pregnant women, one at term, the other at the eighth month, were measured with a pelvimeter, the external conjugate showed a difference of 4 cm from a standing-on-toes position to squatting. This phenomenon, made possible by the physiological loosening and softening of the pelvic joints during pregnancy, was similar to what could be seen in ‘native races’, whose sacro-iliac joints ‘are well developed because in constant use (as chairs are unknown) [and] there is always a well-marked depression on the sacrum, into which a definite projection of the os ilium fits, and it is upon this pivot that the sacrum swings’ (Vaughan, 1937, p. 93). Another study conducted on a 10-year-old girl in Arcachon by Vaughan together with Dr Rubenthaler, a radiologist with special knowledge of obstetrics, showed that the width of the pelvis was at its minimum in the lying position with legs extended but would increase by 2 cm when lying with forcibly flexed knees, that is to say, the equivalent of the squatting position (Vaughan, 1932). This was, for Vaughan, the scientific confirmation of her hypothesis based on observations of ‘native’ tribal women in India, ‘the reason why all native women crouch to have children. Crouching is the natural posture for childbirth, for the brim of the pelvis is then at its largest’ (Vaughan, 1937, p. 95). The squatting position, Vaughan would maintain, was even better than the Walcher one—with the parturient woman lying on her back with her legs hanging over the edge of the bed—as, besides being more pleasant, it allowed greater mobility for the woman giving birth.

Vaughan was well aware of the fact that the trend of lying in bed on the back or on the side during confinement was the result of the increasing medical and techno-obstetric control over childbirth. Being a doctor herself, she narrated her first maternity case where, on a remote Orkney island, ‘the crofter’s wife delivered herself quite normally … and was much less perturbed about the whole process than I was, overflowing with knowledge as I seemed to be!’ (Robinson & Vaughan, 1933). That episode was a lesson for Vaughan:

Though I have seen about as bad obstetric cases in India as anyone, I have never forgotten it—that birth is a natural act, and will accomplish itself simply if you or your stupid civilization have not put obstacles in the way by deforming the pelvis when growing, stiffening the joints of the brim so that it cannot expand, and, most important of all: insisting that the woman is confined in an unnatural position. This last is the only one of the obstacles we have it in our power to control when she is already in labour. … As I cannot get anyone in England to allow me to do anything so dangerous as to return to Nature and allow the patient to deliver herself naturally, I have had to come to France to study the subject, because many French women still insist on being confined thus—when the doctor is not there! (Robinson & Vaughan, 1933)

Based on her years of research, Vaughan concluded that the essential factors for the safety of mother and child during childbirth were a round pelvis, mobile pelvic joints and the natural posture for delivery. These were, in her opinion, ‘characteristic of the healthy woman, to whatever race she belongs’, and difficult childbirth followed ‘the violation of the fundamental laws of health’ (Vaughan, 1937, p. vi). The more ‘primitive’ were the habits of life, the more circular was the pelvis (Vaughan, 1931, p. 941). It becomes crystal clear how the ideology of ‘natural’ childbirth was prescriptive and undisputable, not only conveying the idea of the social responsibility of women as the biological reproducers of the nation—as seen above—but also sanctioning the view that ‘the natural’ was the physiological norm to be followed (Moscucci, 2003, p. 169).

In 1932, Vaughan tested her views near Caen, in France, when she gave prenatal physical training to pregnant women in the Benouville government hospital. With the aim of studying the effect of exercise on the abdominal muscles and pelvic joints, she taught exercises to a class of four or five women due to deliver in 10 days or less. While ‘they were at first unwilling … afterwards they enjoyed the exercises, and I had fifteen women in the class at the end of the time’ (Vaughan, 1937, p. 132). She also wanted to observe the difference between having a woman propped up instead of lying flat during delivery.

Among the exercises were leg swinging, holding on to the bed and kicking up forward and back; leg swinging in circles, squatting with knees apart and together; ascending twice a day, 80 stone stairs two steps at a time (without holding the banisters) and descending in the same way. According to Vaughan, the training ‘certainly improved the patients’ general condition and shortened labour’ (Vaughan, 1937, p. 133). Thus, by claiming that through physical exercise the pelvis could become more flexible—and maternity, as a natural function, easier and safer—Vaughan placated evolutionist fears about pelvises not keeping pace with larger heads with the advancement of civilisation (Vaughan, 1931, pp. 940–941).

Back in London, in 1939, together with Professor William Nixon (1903–1966), an influential obstetrician and gynaecologist at the Soho Hospital and University College, Vaughan offered weekly courses in antenatal exercises to selected expecting women at Paddington hospital and then at St. Mary Abbots hospital (Nixon, 1944, p. 59). Using the training she had tested in Caen, Vaughan prepared a film Childbirth as an Athletic Feat, where she is shown teaching a group of pregnant women how to prepare for ‘the great event’ (Vaughan, 1939). The video, besides being evidence of Vaughan’s media savviness well ahead of the 1950s’ Grantly Dick-Read film to promote his views of childbirth (Al-Gailani, 2017), features British white middle-class women. Assuming they were the ones who suffered most in childbirth, such women were the audience that Vaughan wanted to attract to her prenatal training scheme. Nixon’s approval of the prenatal classes was significant. He saw them as ‘constructive hygiene at its best’ (Nixon, 1951, p. 8) and part of a set of necessary measures to educate birthing women to become more cooperative and active in the labour ward during parturition (Nixon, 1944, pp. 59–60).

The ‘natural’ childbirth—and the antenatal hygiene—advocated by Vaughan through the return to ‘nature’, largely defined as ‘primitive’, entailed creating an active birthing woman: designating childbirth as an athletic feat was meant to confer on her not only more control and awareness during delivery but also greater responsibility to ensure that she would reach that moment well prepared and with a fit pelvis. However, women’s burden of responsibility was not limited to the time immediately preceding or coinciding with delivery. Mothers, in fact, were the ones to be blamed for bringing up daughters who reached the moment of childbirth with dysfunctional pelvises or stiff joints (Vaughan, 1937, p. 141).

Thus, discourses around the pelvis as tied to ‘safe’ childbirth contributed to patriarchal projections that placed on the girl child the burden of reproduction in her primary school years. Acknowledging Vaughan’s work, Nixon would explicate this in unambiguous terms, making it clear that girls could not easily escape the mothers they had to become:

Preparation [for pregnancy] begins in young girlhood, even in babyhood. It might then be possible to modify the shape even of the bony pelvis, in the way that Dr. Kathleen Vaughan (1937) suggests. It is then, also, that the pattern is set of the-future mother’s attitude to child-bearing and all it implies. The gymnastic exercises given in schools for girls might very well be reconsidered in the light of their future functions as mothers. (Nixon, 1954, p. 19)

Vaughan’s view of ‘natural’ childbirth, then, was useful on a number of fronts. It was a cultural and political critique of modern society which spoke to evolutionist anxieties about women being incapable of attending their biological and social telos. It aimed to challenge the medicalisation of childbirth—almost somehow limiting medical authority—by providing women with knowledge about their anatomy and their role in delivery and empowering them to become active participants rather than passive recipients in the birthing process. However, since Vaughan stressed the social role of women as mothers of the nation and reproducers of future citizens, it is debatable whether women perceived such discourse as liberating or whether they felt further burdened by seeing motherhood as a patriotic duty and, more significantly, by being held responsible for generating ‘mentally defective citizens’ due to ‘difficult birth’ (Vaughan, 1937, p. 145). Vaughan believed that giving birth was supposed to be ‘a perfectly natural process’ that had been transformed ‘into a matter more complicated (and more expensive) than any disease’. Consequently, she was antipathetic towards the routine use of pharmacological pain relief in normal birth and thought that the generalised use of chloroform was a ‘sign of failure’ that could be averted following her preparatory exercises (Vaughan, 1937, p. 141; 1949). This aspect too could hardly relieve the pressure on women who might well feel disincentivised to ask for pain relief if needed (Bourke, 2018; 2020, p. 110).

Conclusion

Kathleen Vaughan, a largely understudied figure in the medical debates surrounding the relationship between racial predisposition, cultural/environmental factors and childbirth, challenged some dominant medical, anthropological and obstetric views. In colonial India, she positioned herself as a representative of Western medicine, leveraging its authority while carving out a space within purdah society as both an alternative to male-dominated professional medicine and a corrective to so-called ‘primitive’ midwifery. In Europe, by contrast, her expertise in South Asian childbirth practices enabled her to contribute to emerging critiques of the medicalisation of childbirth—at a moment when Grantly Dick-Read, later celebrated as the father of ‘natural’ childbirth, had yet to gain prominence. Advocating a ‘return to Nature’ as both a form of prenatal care and a route to white middle-class bodily improvement, Vaughan reinterpreted—albeit through a lens often marked by Orientalist undertones—‘native’ practices observed among Indian women from the ‘lower’ strata as techniques to be learned and appropriated for the successful delivery of healthy offspring. In doing so, she unsettled entrenched binaries—coloniser/colonised, Western/non-Western, scientific/unscientific—and blurred the boundaries between dominant and marginalised bodies of knowledge. At least in part, Vaughan subverted a core logic of imperial rule: the civilising mission predicated on coercively ushering colonised subjects into the future, based on a supposedly superior western modernity.

Kathleen Vaughan’s views anticipate several themes that would later become central to feminist critiques of obstetric authority and the medicalisation of childbirth. Her emphasis on the active participation of expectant mothers, their physical preparedness and the cultivation of confidence, well-being and bodily autonomy (Vaughan, 1942) closely mirrors mid- to late-20th-century feminist advocacy for women’s agency in childbirth. Vaughan’s framing of parturition as a collaborative, empowering process—where women are not passive patients but engaged participants—resonates with later movements that re-centred childbirth in women’s own embodied experiences and challenged the dominance of technocratic, male-centred obstetric regimes.

Vaughan’s vision, however, was not fully emancipatory in a feminist sense. Her thought is shaped by, and deeply entangled with, eugenic ideals and colonial hierarchies. The notion that white middle-class women should train for childbirth as a form of self-improvement speaks to a biopolitical project: the cultivation of ideal, efficient and reproductively capable bodies. Vaughan casts childbirth not only as a personal event but also as a mission—a national or racial duty—where the mother’s preparation and comportment are judged by the standards of a collective reputation. This reintroduces an evaluative gaze that aligns women’s bodily performance with broader social goals, echoing the eugenic concern with the quality and fitness of populations, reinforcing and upholding racial views that she had dismissed through her research on pelvic anatomy.

In sum, Vaughan occupies a complex position: she embraces a proto-feminist vision of childbirth as empowering and embodied, but one that is overlaid with eugenic logics and imperial appropriations. Her advocacy for prenatal exercise and emotional well-being speaks to a genuine concern for maternal health and autonomy, yet it is simultaneously a project of bodily regulation and moralisation rooted in racialised and classed understandings of reproduction.