Epidurals: science and sensibility
There was a fascinating post on Nursing Birth today about the giving and taking of informed consent for anesthesia (epidurals, etc.) for labor and birth. Already, there is a very eye-opening discussion brewing among her readers.
I really liked the way the author, who is an anonymous practicing labor and delivery nurse, is willing to really talk about epidurals. It can be tempting to gloss over the impressive pain relief that an effective epidural can provide. But if we do this, then any discussion of alternatives to complete numbness can seem to some that we’re just telling women to needlessly suffer. We need to tell women they can have pain without suffering, and that doing so may help them meet some very significant needs.
It is OK for women to need
- a chance to feel every ounce of her urge to push. It might be exactly the force that is needed to get her baby out, in which case numbing this intense energy means she won’t be able to birth her baby without help (which may come in the form of an episiotomy, a vacuum or forceps extraction, or even a c-section).
- to safely avoid infrequent or rare (but still possible) side effects. If she’s the one – in a hundred, or a thousand, or a million – who experiences the side effect, she is the one who experiences the consequences, too. In addition to injury or illness, these consequences include the increased possibility that she and her baby will have to spend some number of moments, hours, or days apart after the awesome journey they have just taken together – birth. Time that they could have spent together.
- the ability to physically feel her baby be born and to experience her birth as her own power and strength. Women can and do draw on this power when they face challenges in parenting, relationships, work, physical endeavors, and society. Perhaps all women shouldn’t take the decision to trade that lightly.
People will argue (each side citing evidence) about whether and how much epidurals can result in harm. In the meantime, we have impressive research on the safety and benefits – both physical and emotional – of the kind of birth where a woman, soaking in the strength, confidence and trust of the circle of people helping her, moves and sways and groans and grunts and curses and breathes her baby out, and experiences a hormonal state that she will never again achieve until the next time she gives birth.
Our culture’s image of a woman giving birth without pain drugs is one where that woman is suffering, “behaving badly”, and feeling desperately out of control – not a woman who is powerful and ecstatic. As long as this is the case, women will want their epidurals and they should be supported in getting them. In our system, too often laboring without an epidural is suffering, because the woman can’t move around as much as her body needs to, and she can’t eat or drink, and she has an IV in her arm and two monitor belts around her waist, and there are strangers present, and not enough of them know how to really meet her where she is with the intensity and pain and help her through it.
I think many people see epidurals as a means to an end. We have focused quite a bit on the means – touting how well breathing a certain way, soaking in a jacuzzi, or self-hypnosis “works”. Now I think we should begin also focusing on the “end” – the prevention of safely avoidable injury and so many other benefits, some of which are frustratingly intangible, even to those of us who have experienced them.
“Our culture’s image of a woman giving birth without pain drugs is one where that woman is suffering, “behaving badly”, and feeling desperately out of control”
This could be a stand-alone post. The dichotomies between rational and irrational, masculine and hysterical run deep in medical history. I’ve been sitting on a quote from an old obstetrics textbook for a long time that addresses what you have discussed in this post. I’ll dig it up when I’m finally on my own Internet connection after moving.
Thanks for yet another great post.
Jill-I completely agree. With my first delivery in a hospital known for high interventions and an almost 100% epidural rate, the staff was very uncomfortable with me moaning and groaning in pain (and I had an epidural, just felt everything because of back labor). They wouldn’t even make eye contact with me. When I delivered my second with a midwife, her and my L&D nurse treated every moan, groan and yell as if it was perfectly natural, and helpful in getting the baby out. I remember my midwife saying “Go ahead and grunt this baby out if you want to. What ever works for you.” And it did work
Jill – I’d love to see the quote when you get a chance, and good luck with that move! I assume you read “The Birth House” by Ami McKay? It’s so great, and even though it’s fiction, it’s very enlightening about the history of the rise of physician dominance (over both women and midwives) in women’s health. Judy from Giving Birth with Confidence and I had the very cool pleasure of interviewing Ami when the book came out. http://www.givingbirthwithconfidence.org/?p=89
RR – the difference between your two births is so telling of the way attitudes of staff can affect how a woman experiences her labor, and how much she is able to follow her instincts. Vocalizing is so important for getting a baby out. Who decided that the right way to have a baby is in silence??? Thanks for visiting and commenting.
As a birth doula, I am constantly amazed that medical professionals can cite rare but serious side effects to justify a procedure they are encouraging (e.g., complications from post-dates pregnancies as justification for induction), but then turn around and assure women that epidurals are “perfectly safe” for them and their babies. As Amy points out, if a mother is “the one – in a hundred, or a thousand, or a million – who experiences the side effect, she is the one who experiences the consequences, too.” Explaining, in an unbiased way, the risks and benefits of ANY procedure is the only way to ensure truly informed consent.