July 25, 2006

Get The Damn Epidural, Woman! Bos. Ped. Not Feeling Your Pain

Some women don't want to get epidurals, and the good Dr. Darshak Sanghavi just can not wrap his pediatric head around that fact:

But is the shunning of obstetrical anesthesia about something more than natural versus modern? The vocal minority who purposely skip epidurals have created entirely new secular justifications for pain - especially during labor and childbirth - which are no less dogmatic than the earlier holy justifications. Why, even now, are people so unwilling to let go of pain?
Never having given birth myself, I can only say it's totally NOT my call, and all I can imagine doing is supporting the informed, personal decisionmaking process of someone who IS pushing a melon-sized object out of her body.

That said, for all the historical context and seemingly careful analysis in his article, there's a condescension in Dr. Sanghavi that really pisses me off--and I don't even have a uterus. In equally "developed" countries like Japan, almost no woman gets an epidural. And to tar the anti-epidural folks simply as "dogmatic" seems phony to me.

But for people who struggle with making the epidural call, I think there's a wariness of the woman losing control of the delivery process. In our childbirth class, the epidural definitely seemed like the gateway drug to a fully medicalized delivery. There's no more yoga ball or stretching once you've got a needle in your spine. And I think that freaks some people out, partly because we know that billions of people have been born without such medicalization.

But also because doctors themselves have a credibility problem, at least historically. It was within most of our lifetimes that women underwent Caesareans, not for any medical reason, but because their OB's didn't want to work nights or weekends.

You can ask the doctor about that Tuesday at noon; he's doing an online chat at Boston.com.

The Mother Lode of Pain [boston.com via dt reader sara]

10 Comments

Epidural can't be the only thing that matters for the delivery one's baby, can it? I know it's important for many woman to have the feeling that they'd have something to help them coping with the pain, but from what we've read and learned during the 9 months of my wifes pregnancy, there are so many more things to decide regarding the whole pregnancy and delivery then just pain meds.

Besides, with a bit of research it's easy to find that epidural is not as risk-free as some might take it for. It comes with its set of risks, just like any other drugs and artificial intervention.

It really is important to make an educated decision over it rather than just flying through the hospital door, demanding for pankillers and then lying the whole time on ones back telling the paramedics to just go at it and have the baby out.

One really good article discussing the pro and cons of epidurals can be found here.

I loved the part where Sanghavi claims that fetal monitors are looking for fetal suffocation. No mention of the fact that 5 nurses can look after 25 labouring women from the comfort of their desks instead of walking in the rooms one by one (and this isn't because they're jerks, tho some are, it's because L&D nurses are so overburdened).

So, how does a fetus suffocate if it doesn't breathe air? Dumbass!

And, no examination of the fact that the US has higher rates of maternal and fetal death than some third world countries and has the most medicalized , micromanaged births in the world. Perhaps all these epidurals aren't the smartest thing after all?

I had my beautiful baby boy with out pain meds 18 months ago. My water broke 3 weeks early, I did every yoga, walking and bradley exercise my husband and I learned prior to his birth, none got my cervix dialated. Since he was turned (his skull on my spine), my labor could not get started properly to dialate me. So I was given pitocin. I had back labor which an epidural will not help for, I knew what was coming and had a great nurse who helped me and respected our wishes. I had a great husband who also did tons of research and who at first thought I was crazy, his wife who would pop a pill at the mere thought of a headache, would opt for pain free labor. It just did not feel right to me to take such good care of myself and refuse medications while pregnant to say, yea give me meds while in labor.

Add to the fact that I am still breastfeeding our son, I believe that there is an easy way and the way that is more clearly better for your child. My water broke at 6pm, I was giving the pitocin at 130am and had our beautiful baby boy at 920am.

My husband still thanks me for making a decision of natural childbirth because there is always a risk from the pain meds.

Now if our son was in danger, I would have had them cut me open with no hesitation. I just did the best thing for him. :)

Lyn

It's condescending as hell, because Ina May tells him, his colleague the palliative care doctor, and others tell him how they experience it, but he completely fails to credit their experience, because they don't fit into his theory that unmedicated childbirthers are akin to suicide bombers. What the bloody hell?

Do I agree that everyone should have the choice, and have good choices available? Absolutely. Do I feel like I was a martyr for opting not to do meds? No, not at all. It's very condescending that he thinks he knows what my motives were. Was I trying to achieve spiritual enlightenment or an orgasm? Uh, no. Would I have felt like a failure if I had decided during labor that I did want an epidural? Also no.

My way worked for me, simple as that.

I had planned my entire pregnancy to labor and deliver without any meds. I will not bore you with the frustrating events and nurses that led to me having an epidural, but I got one at about 6 cm. I can't say that the pain relief wasn't nice, but after 9 months of absolutely no caffeine, alcohol, nicotine or meds other than Tylenol I felt a bit high and out of it during and after delivery. But maybe adrenaline, emotion and exhaustion in a non-medicated delivery does this too? I just wonder if I would remember things more clearly and perhaps have been more "with it" if I was not medicated. This is exactly why I didn't want it in the first place.

Ah well, as the old quote from Friends says "No uterus... no opinion!" Sounds like the good doctor should really just keep his opinions to himself.

The truth is, yes there are risks to having an epidural however, women all over the country give birth to healthy babies everyday having had one. Some women want them and others don't. Many have done research and are making educated decisions.

My friend whose son was born nearly 2 years ago is terrified of needles so for her she would rather feel the pain of labor than have the epidural and she did just fine (used relaxing techniques like every other woman does when giving birth) and is believed to have had a speedier delivery because of her choice not to... yes it hurt, but oh well.

And then, at the end of her delivery, he got stuck and the doctor had to stick her entire arm up into her body to get him out it hurt like the dickens, her husband said she winced, but didn't scream, so not even then did she wish she'd had the epidural. This go around she has to have a c-section so of course she has no choice, but for every woman who can have the choice I'm all for letting them.

I myself say put it in at 7 months... I don't want to feel A THING!

[ugh. after being so careful to avoid the show all these years, to find out I'm unconsciously quoting Friends... -ed.]

This is a current campaign in the UK to highlight Obstetric Care (with a focus on fistula) in various countries. Although, I am a medical professional (and a person who did everything to have a normal,non medicalised birth)it reminded me about just how lucky we are to have access to good medical care (and choices) during childbirth.
http://www.endfistula.org/obstetric_care.htm

Well, being from a third world country, I just give thanks that I'll have the *option* of getting pain medication when the blessed time comes. Third world countries have babies without pain medication? Sure - cause, more or less, there ain't no other way to have babies. And when you have basically no other choice than to push the kid out in agony, hey, that's what you're gonna do.

Women who choose to have their kids without pain relief, more power to them. Me? If I can have my child without too much suffering: praise the Lord and pass the medication. We're way beyond the ousting from the Garden, here.

As I knew that my son - because of my age - was likely to be my only child I wanted to experience his birth as fully as possible. Besides, the whole process of the epidural - you have to have a catheter, for efs sake, how dignity robbing is that? - left me cold.

There are a whole raft of alternative forms of pain relief - reflexology has a particularly good track record - which mean that giving birth can be pain free but you can remain in control.

I was pretty lucky as labour was short and incredibly pain free considering - but then my whole pregnancy and birth were midwife led and midwives are great respecters and informers of women's choices.

Here are just two comparative examples from Europe. In Switzerland (where my wife and I had our baby), the pediatrics community often favors epidurals. I won't go into all the arguments (many of which I have forgotten), but they generally feel that it is better to start things off for both the baby and mother (breast feeding, recuperation etc.) without all the stress and fatigue that accompany labor.

In The Netherlands, however, you'll be lucky to get an epidural even if you want one. The system generally doesn't promote it or even offer it as a general procedure.

The point is that health systems have biases that either hinder/or promote certain practices and, therefore, can limit birthing and childcare options. Unfortunately, parents are left to deal with it.

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