Hektoen International

A Journal of Medical Humanities

Cultural warfare: investigating childbirth practices in Doctor Zhivago

Stephanie S. Colello
New York, United States


Caption: “Stalin’s tenderness to our future children shines!”

I was fortunate to spend a year studying the transformation of Russian childbirth practices through the lens of Russian literature—an endeavor that at first glance may seem farfetched. However, I quickly realized that no birth scene is written as a proverbial “island”; often stemming directly from the societal perception of women, fertility, and life itself, childbirth customs are “cultural products of particular historical moments.”1 Each scene reflects the experiences of the author, who writes the birth story by “negotiat[ing] with prevailing ideologies” present in the historic and cultural moment of the author’s life.2 Here, I chose to share one of my favorite scenes from Boris Pasternak’s controversial novel Doctor Zhivago, to highlight the presence of what I will call cultural warfare, imposed by Soviet regulations on Russian birth practices.

In traditional Russian practices, both the pregnancy and childbirth events were kept as secret as possible in order to protect the mother and newborn from “evil forces” that could be set against them, willingly or accidentally, by envious neighbors and strangers. A pregnant woman was thought to be particularly vulnerable to forces caused by the “evil eye”, or sglaz, because of her unique contact with the spiritual realm during birth, where she served as the vessel transporting a soul from it into the human realm. For protection, women would often give birth alone or with the assistance of a single midwife, as it was commonly believed that “the more people who knew about the birth, the more difficult it would be,” because of the increased chances of being given the evil eye.3

Another key feature of traditional Russian birth practices was the ritual exclusion of men and childless women from the birth scene because of their complete lack of prior exposure to this unique portal between the spiritual and physical worlds. They could be “contaminated” from this contact, causing harm to themselves or to the birthing woman.4 Thus, a main characteristic of traditional birth rituals and preparation was the exclusive role and action of women—who have successfully given birth—in the delivery. The traditional midwife or povitukha was the most important figure involved in the birth besides the mother and child. She was often a widowed, postmenopausal woman “whose children had survived infancy.”5 Because of the extreme vulnerability pregnant women and newborn infants were seen to face during the delivery process, the midwife guided the child’s soul during its transition from the “other” world to the physical world.6 The midwives were respected members of society, as “contact with the spirit world was laden with power, resulting in a liminal status for all those involved in the ritual.”7

However, village midwives began to be persecuted during the Stalinist terror of the 1930s, and by the fifties there were scarcely any to be found. Medicalization was strongly promoted by the Soviet government as a way to transform and ideally obliterate the beliefs and practices of traditional Russian village life, including childbirth ritual.8 Leaders of the early Soviet period mounted a campaign attack against these traditions, as David Ransel describes: “The OMM [Office of Maternal and Infant Care] officers and medical staff agreed that the objective had to be not merely changing a few practices, but initiating a systematic attack on village culture” [emphasis mine].9

In this way, the medicalization of childbirth was used as a weapon by the Soviet State as a way to engage in a type of cultural warfare—the elimination of backwards “folk” rituals, and the implementation of highly regulated, scientifically-based “Soviet” rituals. Both sides of this battle may be observed in birth scenes found in Russian literature, as the roles of the village midwives (povitukhi), the female and male medical midwives (akusheri), and male physicians interact with the pregnant woman and guide her through the delivery process. In healthcare settings, women—and female midwives especially—often comprised the force opposing Soviet-mandated reforms in birth settings, as they attempted to “[mediate] the entry . . . of modern scientific ideas of birthing and child care.”10

The medical personnel who were attempting to turn “backwards” Russian practices into scientific Soviet practices, however, were themselves products of centuries of folk customs. They could not avoid their own “system of folk beliefs when shifting from traditional norms to the medical model,” and consequently, some new medical practices were made to justify the continuation of pre-Soviet customs; these surfaced as subconscious resistance to Soviet regulations.11 For example, unlike in Western hospitals, men continued to be excluded from maternity wards in Soviet Russia throughout the twentieth century. The Soviet reasoning for this practice was founded in the fear that men would “contaminate” the wards with bacteria—ignoring the fact that birth is by no means a sterile event. Even today, as I personally witnessed in a hospital in Moscow in 2013, men are noticeably absent from maternity wards and obstetric divisions.

The retention of folk belief and practices in Boris Pasternak’s famous novel Doctor Zhivago (1957) demonstrates the backlash against imposed Soviet practices in the birth setting. In his rebellious novel—which was banned from publication in the USSR—Pasternak uses vivid imagery of the birthing woman as a connection between the spiritual and human realms, and also shows the importance of the midwife—and inaction of men—during the birth scene. The persistence of these views and traditions opposed the prevailing Soviet ideology to eliminate spirituality and traditional superstition.

Pasternak describes the spirituality of the event by comparing the birthing woman to “a boat that plied between an unknown country and the continent of life, across the waters of death, with a cargo of new immigrant souls.”12 This unknown country is the spiritual realm, the continent of life is the human world, and the cargo was the soul of her newborn son. He also claims that she has been “raised higher, closer to the ceiling than ordinary mortals are.”13 She has been lifted to the spiritual realm and returned, attaining the liminal status traditionally attested to birthing women. On her return he realizes that “as no one had explored the country where she was registered, no one knew the language in which to speak to her.”14

The ritual exclusion of men is further maintained in this scene, alongside the importance of the spiritual aspects of birth. Dr. Zhivago drops his wife, Tonia, off at the gynecological ward of the hospital and leaves her in the care of a midwife. He is not expected to attend the birth, and will be only contacted during “a time of need.”15 Furthermore, he is said to be standing “outside of the door of the maternity ward”—it does not appear that he even entered the ward.16 During the birth, he hears Tonia’s screams from down the hallway, but, as the narrator explains, was not permitted to see her (“emu nel’zja bylo k nej”).17 The reader sees his frustration with this exclusion as he is “biting his knuckle until he drew blood.”18 When Dr. Zhivago attempts to get closer to her into the gynecological ward, he is stopped by the huge, male, gynecologist in the lobby: “‘Where do you think you’re going?’ he whispered breathlessly so that the new mother should not hear. ‘Are you out of your mind?’” he asks. Dr. Zhivago, exasperated, replies, “I didn’t mean to . . . Do let me have just a glance. Just from here, through the crack,” to which the gynecologist responds: “Oh, well, that’s different. All right, if you must.”19 The husband is forbidden to be physically near his wife, the new mother, after birth, but the reasoning is not made clear to the modern reader. His presence, one could argue, would be a comfort to her. But, as traditional beliefs dictated, as depicted by Pasternak, his presence was forbidden.

Although the gynecologist at the hospital is male, showing the gradual movement from folk to the Soviet “medicalized” practices, we notice that Tonia has direct contact only with female medical personnel—a nurse (nyanyushka) and a medical midwife (akusherka). Dr. Zhivago looks inside the delivery room and sees that “inside the ward two women in white uniforms stood with their backs to the door; they were the midwife and the nurse.”20 The midwife and nurse form a barrier between the birthing woman and the outside world by standing with their backs to the reader. This protective stance reflects the special vulnerability of the birthing woman as the spiritual portal, as the midwives attempt to insulate her from the uninitiated. The role of women in this setting is again evident, as it is the female nurse who attends to the newborn and not the male gynecologist: “Squirming on the palm of the nurse’s hand lay a tender, squealing, tiny human creature, stretching and contracting like a dark red piece of rubber.”21 It is a female nurse, not the male gynecologist, who announces the sex of the baby.22 These women have the most direct contact with Tonia before, during, and after birth. In fact, we see no interactions between the male gynecologist and Tonia at all during this scene. The existence of this male gynecologist, however, reflects the growing movement towards the medicalization of childbirth, as marked by increased male intervention in the previously exclusive woman’s domain.23 However, the restricted participation of women in the birth and the exclusion of males from the birth scene both hint at the retention of the underlying pre-Soviet traditions.

Pasternak’s description of the exclusion of men and the spiritual imagery of the birthing woman demonstrate the resistance in society against the new anti-spiritual and anti-traditional Soviet regulations. Through these scenes we are afforded a peek into Pasternak’s world and the actions of those around him, who consciously or subconsciously resisted Soviet regulation by maintaining pre-Soviet birth rituals.



  1. Tess Cosslett. Women Writing Childbirth: Modern Discourses of Motherhood. Manchester University Press. 1994. Print 3.
  2. Cosslett, Women Writing Childbirth, 3.
  3. Jeanmarie Rouhier-Willoughby,. “Birth Customs: Ancient Traditions in Modern Guise.” The Slavic and East European Journal 47.2 (2003): 229. Print.
  4. Rouhier-Willoughby, “Birth Customs”, 230.
  5. Rouhier-Willoughby, “Birth Customs”, 230.
  6. Rouhier-Willoughby, “Birth Customs”, 230.
  7. Rouhier-Willoughby, “Birth Customs”, 230.
  8. David L. Ransel .Village mothers: three generations of change in Russia and Tataria. Bloomington: Indiana University Press, 2000. Print. 42.
  9. Ransel, Village Mothers, 46.
  10. Ransel, Village Mothers, 4.
  11. Rouhier-Willoughby, Birth Customs, 246.
  12. Boris Leonidovich Pasternak. Doctor Zhivago. New York: Pantheon, 1958. Print. 104
  13. Pasternak, Doctor Zhivago, 104.
  14. Pasternak, Doctor Zhivago, 104-105.
  15. Pasternak, Doctor Zhivago, 101.
  16. Pasternak, Doctor Zhivago, 101.
  17. Pasternak, Doctor Zhivago, 103.
  18. Pasternak, Doctor Zhivago, 103.
  19. Pasternak, Doctor Zhivago, 104.
  20. Pasternak, Doctor Zhivago, 104.
  21. Pasternak, Doctor Zhivago, 104.
  22. Pasternak, Doctor Zhivago, 103.
  23. Heather Cahill. “Male appropriation and medicalization of childbirth: an historical analysis”. Journal of advanced nursing, 33(3), (2001): 334–42. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11489022.



STEPHANIE S. COLELLO is a fourth year resident in the Combined Internal Medicine and Pediatrics Program (Med-Peds) at the Hospital of UPenn and CHOP, graduating in 2022. She plans to pursue a career in cardiology with a focus on congenital heart disease and cardio-obstetrics.


Highlighted in Frontispiece Spring 2017 – Volume 9, Issue 2
Spring 2015   |  Sections  |  Birth, Pregnancy, & Obstetrics

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