22 February 2008

Bring on the epidural.

"More and more women are planning on getting epidurals, and I don't blame them," said Dr. Jerry Konialian, a fertility specialist at Northridge Hospital Medical Center, who has delivered thousands of babies since 1985.
"They were not common 20 years ago, but now they are demanding it. You don't even have to suggest it. It's wonderful, and it's safe. I tell my patients who do question it, `You wouldn't have a tooth pulled with no local, so why would you want this huge baby pulled out of you with no anesthetic?"'
A discomfiting point of view at a time when having a baby is riskier than ever, despite women living in a time when technology and medical advances are at their peak. No one is disputing that birth hurts. Women should be able to choose an epidural if they want one. However, I find it really appalling that obstetricians might be encouraging women to have epidurals under the assumption that a woman's body is incapable of birthing a baby without intervention. Moreover, the assertion that women are just giving up on natural birth in favour of anesthesia is ridiculous. Birth is very complicated in a hospital and women's 'choices' are often circumscribed by the context; if a doctor says she needs to have an intervention, many women are reluctant to dispute an expert opinion. Moreover, a number of women are so scared to give birth (tokophobia) they decide during the pregnancy that they do not want to feel any pain.
As I discussed a few posts ago, epidurals can slow labour right down and are just a link in the chain of interventions that often lead women down the path to an unwanted caesar. Having an epidural is no joke. It is essentially a spinal block and there are a number of risks:
*forceps or vacuum extractor are required more often (20-75%)
*may slow labor, requiring Pitocin (synthetic oxytocin)
*increases the chances of a cesarean delivery by two or three times
I don't think any woman takes this decision very lightly.


River Eden Doula said...

"You wouldn't have a tooth pulled with no local, so why would you want this huge baby pulled out of you with no anesthetic?"

Argh, I hate that argument. When you have teeth pulled, its due to disease. Childbirth is not a disease! A better analogy is: when your teeth fell out as a kid, did you need an anesthetic? Just like birth, you only NEED anesthetic if you are getting that kid pulled out of you.

AvoidTheRedShoes said...

What an ignorant man. Many people become doctors because they want to "rescue" and "help" people. Many of these physicians, including nurses on staff, feel very uncomfortable hearing a patient moan or scream from labor pain. "Just get the epidural" is commonly heard from "professionals". I really think it's more for their comfort level than the woman's.

Anonymous said...

Sorry but I just think that this comment (and those who agree in the comments and call it "not a disease" and "ignorant") are part of the greatest oppression of women since we lacked the vote.

No it isn't a disease. And yes you CAN physically give birth without one. Labor is irrevocable so even if it is the equivalent of having your eyeballs removed through your ears the pain won't actually kill you. Is that a good argument for bashing epidurals?

I think we can safely say that women know that they can go without one. Once that baby's in there its coming out with or without drugs. So what we need are support people who SUPPORT the most comfortable birth possible.

It isn't a disease but it hurts like hell and we have ways to stop that which are very safe. No nothing is 100% safe in childbirth or anything else but interestingly the women who want to "avoid or minimise" drugs in labor usually end up with something "just to take the edge off" which is a lot more dangerous to the baby than an epidural. Look into the risks of gas or opiates. Epidural anesthesia is the safest form of pain relief in labor if you're going to have any and people need to know that because it isn't as quick as a jab of pethidine if they decide they want it.

The doula-movement has a lot to answer for. How many thousands of women are you condemning to a painful birth experience? I had an epidural with both my children and I actually ENJOYED the birth. It actually did not hurt one bit with the second (just a little stinging and out of breath), and with the first only the first hour yelling for the epidural was traumatic, after that it was bliss.

I think women need to know they can actually watch their kids being born without any pain at all.

And if you can do that why in HELL would you CHOOSE agonising pain? THAT is why the comparison with tooth pulling is valid - because you have a CHOICE and the pain is no longer NECESSARY.

This rubbish about it's natural so you don't need pain relief - well that's a question between NEED and WOULD DAMN WELL LIKE isn't it? Natural or not has nothing at all to do with how much it hurts.

doingsomethingaboutit said...

I guess it is all a matter of perspective no??? i mean if you believe that the pain is just there to ruin your life and your experience then of course you are going to numb it. But if you believe that the pain is a tool you can use to give your baby the safest and gentlest entrance into this world then you are going to do everything within your power to avoid any kind of intervention whatsoever, especially the narcotics and epidural... I also have to say that "anonymous" your understanding of a doula is a bit off. A doula is meant to support a woman through childbirth no matter how, where or with whom she chooses to birth. A doulas job is to provide access to accurate,evidence-based information so that every birthing woman can make a fully informed and empowered choice. At the end of the day, a doulas goal is to hear her client say "my body rocks!" no matter if she has birthed at home sans drugs or via elective cesarean section...
Personally, the idea of an epidural makes me cringe, especially the fact that it is being pushed on many women in hospital because of convenience for the staff. The hospital in my area is making a concious effort to get the epidural rate up to 80% so they can "afford" to have an anethesiologist on call 24 hours a day...(which is nonsense because there already is at least one on call all the time) this whole idea has to make you sick no matter how you choose to give birth because the only motive behind it is money, nevermind about the wellfare of mothers and babies... another example of how there is really only the illusion of choice in hospital...

Anonymous said...

Avoidtheredshoes - "I guess it is all a matter of perspective no???"

Exactly. Which is why your comment "what an ignorant man" is so insulting to women who choose epidurals.

MY perspective as a mother is that pain is never ever "a tool you can use to give your baby the safest and gentlest entrance into this world" because a) it isn't actually necessarily safer than no dugs, I'll get back to that, b) it isn't a tool, its a price, even if you do believe no drugs is somehow better for the baby.

Let's not kid ourselves, if we suddenly found that some women were born with a naturally acquired ability to give birth painlessly we'd want to know how to spread the good fortune. The pain doesn't actually serve any purpose. It just happens to be inevitable in nature at the moment.

I think my understanding of a doula is pretty spot on actually. You're right it ISN'T what they claim - "to provide access to accurate,evidence-based information so that every birthing woman can make a fully informed and empowered choice." or there wouldn't be New York Times articles about doulas walking out on mothers in labour who asked for epidurals.

Signing up for a doula is a commitment device to make you go through with something that you know you're going to regret - so maybe its time to examine whether that regret is well founded and whether commitment devices are really the best idea.

I think epdiruals OUGHT to (but are NOT) pushed on women who are too stupid to know they're safe, effective and have benefits for the baby as well as the mother. As far as I'm concerned its like trying to prevent people from smoking - you could argue free choice should rule entirely and any pressure one way is wrong - or you could say one way is clearly better and we will encourage people to take it.

BTW I don't think women are forced into epidurals. I have had 2 children, 1 in Australia, 1 in the US. Both times I had nurses drag their feet and not promptly enact my decision to get an epidural. How dare they? Because they've bought your propaganda that women should "hold out as long as possible" or avoid them altogether.

To return to the unacknowledged benefits of an epidural - if nurses and doulas were about evidence based choices they'd know that babies born to mothers with epidurals actually have better oxygenation (an excellent indicator for other health benefits) because of the ease and low-stress of the birth on the mother. For babies on the margin that can be lifesaving not that that is necessary to show its a wise choice.

Please tell me which hospital is trying to get its rate to 80% so I can deliver there next time! I think that is a great idea. One of the main problems women making this informed choice have is a shortage of anesthetists so that we wait in agony until they are available. This is made worse by nurses and midwives pressuring us to "wait as long as we can without asking". If you wait to ask until you can't stand it anymore you can be assured of waiting even longer for a Dr to do the epidural plus 15 mins for it to be effective. Ask early and you need have no pain, and have a safe comfortable and relaxed birth.

You say the only motive is money behind the hospital decision. I would say I don't care wht the motive is, it leads to better care for women and happier births. It does NOT lead to more cesearians or longer labours, check out the 2005 and 2006 research showing epidurals can actually shorten your labour or have a negligible 15min either way effect.

The point here is that no one can ever force you to have an epidural. We've all grown up with just say no (to unwanted sex, peer pressure, drugs whatever). But not having the facilities to give every woman who wants one the prompt pain relief she asks for is a serious infringement of her rights. Why prefer women who like painful birth over women who like pain free birth? Sounds like preferring the idiots over the intelligent to me.

thinkingwoman said...

I've just come across this particular blog...I just wonder, since when is an epidural "proven" a safe way to give birth to a baby? I'd like to see the research-based evidence on that--because as a researcher myself, I haven't. There are a lot of potential problems with epidurals including internal bleeding on the spine, infection of puncture site, lumbar puncture, increased chance of cesarean section (which kills
3x more women than vaginal birth), injury to mother due to the inability to feel pain and make adjustments, injury to the baby with the use of forceps or vacuum-extractor delivery of baby (70 lbs. of pressure on a baby's neck), long-term severe back pain from the epidural block and the potential 1/5000 cases result in a maternal death or permanent paralysis. Not to mention that epidural drugs are found in infant spinal fluid. The research is just coming in about the permanent damage done to a baby's system by drug use in labor and delivery. If you want to read about the real risks of medical intervention, try "Why Women Die" a UK yearly report on maternal morbidity.

As for pain in childbirth--yes, to some women it is painful. But, surprise! For some women, it is orgasmic--literally. 21% of women (not on drugs) get to experience at least one birth as orgasmic. Birth effects each woman differently and pain is increased or decreased based on one's attitude. It is ESPECIALLY difficult for those who are induced with pitocin, cytotec, even prostaglandins--their labors are much more intense, their contractions are harder, last longer and have shorter breaks inbetween. This intensifies everything. There are a lot of unneccessary causes for pain in labor, like induction or body position (lying on your back), baby's position, etc.

Pain in different situations has different purposes; when due to injury, it has the purpose and function of Stop! Protect yourself!--If you cut your finger with a knife, the pain lets you know you're bleeding. If you stick your hand on a hot stove, the pain of burning tells you to pull your hand off. Pain tells you to do something!!

Most women think this way about birth pain too; but many don't realize that natural birth pain is not like injury in that it can be completely eased by attitude, atmosphere, knowledge and learning that this is what our bodies were made for. Fear intensified my labor; learning to let go, relax my muscles and quit fighting eased it. I find it sad that women have been taught that their own bodies are "out to get them". Being told that our bodies are too incompetent, weak or fragile to do what they're made for without help is what's oppressive to women, NOT knowing my female body is fully competent, whole, capable and strong enough to function on it's own.I

Anonymous said...

thinkingwoman - check out the 2005 and 2006 research from Northwestern and somehwere I can't recall which proves epidurals DO NOT cause c sections or longer labors, even when given as early as the onset of labor. As usual those who want women to suffer (and brand it empowerment) have ignored the facts.

GatorMommy said...

Anonymous, I love you! Really. The massive amounts of misinformation and scare tactics used by the doula crowd never ceases to amaze me.

I am due to deliver in about 10 weeks time and will be asking for an epidural as I walk in the door.

I appreciate those who are weary of the doula hype. If we all unite, maybe fewer women will fall victim to the those women that one OB I know calls "Nature Nazis."

To the others: A spinal/lumbar punch is not the same as an epidural! One goes into the actual lumbar area of the spinal column, which the other goes on top of the dura mater ... hence the name epi (on top of) dural (of the dura). Exactly what kind of other propaganda are you give to women as "information"?

Furthermore, there are plenty of things that are "natural" which we can thankfully avoid today. We have antiemtics to stop nausea and vomiting (both completely natural), we have antihistimines to combat those pesky allergy symptoms, we have decongestants and antitussives to help us cope with colds, etc. Just as the above-mentioned issues are symptoms of something, so is pain a symptom of impending child birth. I proudly fill my scripts for Zofran, Phenergan, Loratidine, etc. when I am sick, so why should I forego pain medication during birth?

So, to my obstetrical staff -- when I walk in, bring on the Zofran, the epidural, and the IV fluids ... oh, and pass the remote. I will want to watch Sports Center (and possibly Game Day) during the wait for the baby's arrival.

(Excuse any typos ... it's very late and I am going to bed without proofing my post.)

Anonymous said...

God give me strength. Introduce me to a woman who had an orgasm during birth and I'll either smack her in the face for being a lying bitch or show you a really expert LSD user. Either way she'll add nothing to the discussion so quit the Ina May nonsense and get back to facts.

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