Monday, June 27, 2011

Labor is not an ICU event

I think some of you will remember the post I wrote a while ago, in response to an anaesthesiologist praising epidurals. Well, last week I stumbled across another article by the same doctor, titled "There is a Limit to Suffering" (translation mine), coupled with a prominent picture of a great big needle which is meant to be stuck in the laboring woman's spine. Reading his column got me ticking so I just had to sit down and pass on to you ladies some tidbits of the medical wisdom he so generously shares, along with my comments. 

The first claim that made me raise my eyebrows is that the natural birth process is accompanied by pain which is "usually unbearable". I think this is at odds with the undeniable fact that we were biologically made the endure the pain of labor, and in fact have endured it for many generations - right until sedation and later epidurals came into the picture and we were somehow convinced we "can't" do without them.

The doctor states that "in the past, labor pains were thought to be necessary to develop the strong bond between mother and child", but does not dig any deeper into this hypothesis - perhaps because, if he did, he would have to tell us that natural labor contractions are caused by the release of oxytocin, which is also known as the "love hormone", and plays an important role in releasing milk during lactation. Thus, it makes perfect sense when we hear about the upsurge of love and euphoria reported by many mothers who have had natural birth, and also experienced on a lesser scale during breastfeeding. This doesn't mean that mothers who had had C-sections, or adoptive mothers, or mothers who can't nurse for some reason, do not love their children. But consider that the practice of keeping newborn babies in a nursery away from their mother is also a relatively new one, just like practice of chemical pain relief during labor. I see here a link which cannot be so easily dismissed. 

Fortunately, I may add, many hospitals around the world now recognize the value of early attachment between mother and child and promote babies staying with their mothers immediately after birth. This makes so much sense. A mother doesn't need to have her baby taken away from her so she can "rest". Instead, she needs everything to be done so that the only thing which remains for her to do is lean back and snuggle her newborn. 

He writes, "the process of birth is safer and easier [with an epidural]". Here I am utterly baffled. The pain might be gone, of course (though not always, as many women have complained about epidurals poorly administered and working only partially, while depriving them of the ability to efficiently move around and relieve pain in other ways). However, I fail to see how it is that epidural makes the birth process safer. On the contrary, it is widely known that having an epidural raises the risk for prolonged labor, fetal distress and C-sections. 

He also claims that epidural anaesthesia "does not influence the progress of birth in any way, and does not harm the baby's health". Now this is just a blatant lie, which can be counteracted by countless medical as well as anecdotal evidence. Epidural, as a rule, makes contractions slower and the whole birth progress less effective, thus often making it necessary to administer pitocin, which together all too often snowballs into emergency C-section. "Well, at least you have a healthy baby in your arms", the mother is consoled. And in the aftermath of birth, who has the time or energy to dig deeper and see whether the surgery could have been, perhaps, avoided? Often, the mother thinks about it again only when she becomes pregnant once more and suddenly discovers that she has become "high risk", and is many times pressured to have a repeat C-section, which is much riskier than the first time around.

The author of the article is an anaesthesiologist and an ICU director, which is perhaps why he lacks sufficient knowledge about normal physiological processes - or if he doesn't, it means he is deliberately deceiving his patients, which is just vile. I am all for the freedom of women to choose epidurals if they so wish, but I believe the choice should be truly informed.

14 comments:

Kate said...

AMEN!

Dove said...

Thanks for sharing this. Our first baby in due in September and I have always planned on have a pain-med free childbirth. I am having friends who just had babies tell me about how 'wonderful' the epidural was and there is no reason 'not' to get it and 'why put yourself through that (natural birth) etc'. They make me feel like I WON'T be able to do it when I've always felt confident- woman have been giving birth for thousands of years, why can't I?!? Anyway, posts like yours are definitely helpful.

Jessica said...

I thoroughly agree!

Miss Tatiana said...

Love this post! Thank you for sharing-- I will be getting married in less than a month and we're hoping for children early in our marriage. I have always felt it would be better to avoid any unnecessary chemicals being added to my body-- which could then be put into my baby's body. It just does not make sense to mess with something God created.

Melanie said...

until sedation and later epidurals came into the picture and we were somehow convinced we "can't" do without them

I'm reading a book (Get Me Out by Randi Hutter Epstein) and apparently doctors convinced women that they couldn't deal with the pain of childbirth due to their class. That is, poor women could deal with labour since they didn't actually feel pain but the middle and upper class women couldn't handle it since they were "too delicate". Other methods came up later on, but that was the first.
Fascinating!

(Also, I'm due with my first at the end of August and I'm looking forward to a natural birth. I have all the "good" reasons, but one is that the epidural needle terrifies me. I don't want that thing anywhere near me, let alone in my spine!)

Kate said...

Sounds to me as if he'd rather be in control of the entire birth process and not have the mom distracting him from extracting the baby! I'm looking into switching my OB. He always pushes for inductions even though there's absolutely no medical need for one.

Lady Anne said...

Oddly enough, pain management for childbirth was always something mothers prayed for. Various things were tried; a mother was given a cone of chloroform, which would fall away from her face as she began to lose consciousness. Self-administered and self-regulated. I have medical book around here someplace from 1905, with other suggestions, but can't put my hands on it. Ah, well, it'll turn up.

Clergy - totally male, of course - preached against this. "Mankind was born to suffer, as the spark flies upward," (Someplace in Job, I think.)As long as it wasn't them, it was fine.

Anyway, Queen Victoria, who was the titular head of the Church of England, knew a thing or two about childbirth, having nine children, pulled herself up to her full four foot ten, grabbed the Archbishop of Canterbury by the top vest button and announced "We are not amused", and that pretty well settled THAT problem.

Ganeida said...

Well I've had 5 by natural childbirth, including a *high risk* pregnancy [twins] & I'm with Sheila Kitzinger[sp?] There's something about the natural process that becomes a dance between mother & child. The child is the one who releases the hormone that triggers the onset of labour. Labour actually massages the child & does something for the brain as well. Women release endophines that give a natural *high* * help us deal with the pain & creates an alert state in mother & child to aide bonding in that first hour or so after birth. Meddling with any of that disrupts a very delicate process & only a man with his eye on his Sunday golf game would suggest pain relief/epidural/cesar for the heck of it. Daft! Besides, what they never tell you, is an epi can cause paralysis ~ & not the temporary kind. Nearly everything the mother takes crosses the placenta & affects the baby one way or another. To say otherwise is to grossly misrepresent the truth!

Carol said...

Labor is painful--and depending on a variety of factors it is more painful for some women than others. There is also an emotional aspect to labor. Some practitioners enhance a woman's ability to work with labor while others promote fear. Fear increases pain.
I had 13 years of hospital experience when I began to attend home births. In the home women were in an environment of comfort. We assisted them with massage, warm showers, warm baths and guidance with helpful positions. I was amazed at how well women coped with pain. Natural endorphins do kick in if other medications have not been given. I believe that you have to see a woman labor at home with a skilled and supportive care-giver to understand how well God has designed women for childbirth.
My first labor was approximately 36 hours and I gave in to my doctor's insistence that I get an epidural. I had a cesarean section.
My daughter's first labor was similar to mine, lasted over 36 hours. She had caregivers that supported her with comfort measures. She chose not to have any medication and she had a normal birth of a healthy baby.
On my blog I have posted a link to an article (Science and Sensibility) that discusses the lack of exposure to normal birth that many doctors have.

Amy said...

I loved this part of your post: "A mother doesn't need to have her baby taken away from her so she can "rest". Instead, she needs everything to be done so that the only thing which remains for her to do is lean back and snuggle her newborn."

I wish everyone (including my own doctor) felt this way! This was beautifully stated. :)

Anonymous said...

It's great that all you ladies had a natural birth. For my first, I made it up until transition labor. My goodness, that was painful! I was in 60 hrs of labor. By the time transition started to kick-in, being up for 2 entire nights and almost 3 days, I was beyond exhausted. I am so thankful I got an epidural. I finally got to rest at least for a little. I don't think I would have made it. Once I got the epidural, I actually progressed quickly and went from 8cm - 10 cm dialation in an hr. I think my body was just in need for rest. Baby was in great shape and arrived healthy, about an hour of pushing. So, I think it depends on the labor. If I had a shorter labor, maybe I would have went without the epidural. But, I thank God that we have the pain medication if need be.

Anonymous said...

I'm with the wise ones. All sorts of creatures have been born on this earth without the benefit of an epidural anesthesia. There's no one to say that there should be no pain in this world, except a mystified Buddha when he took a look outside the palace, and then he started his journey of knowledge.

Now, I think the opposite tact is also indiscriminate and perhaps easily as unrealistic (and a little more scary). We had a new anesthesiologist start working in the OB department. Staff nurses overheard his comments about mothers on Medicaid, saying in effect he would deny placement of epidurals and minimize use of opiates so that the laboring mothers might think twice about delivering another child at age 16 years old.

The ethics of male obstetrical anesthesiologists administering spinal analgesia sounds like a good topic to expound upon?

Sharon said...

Thank you for the post. Before I had my first child, I was convinced not to have an epidural. I was adamant about not having one and having a completely drug free labor. I didn't even have an IV...at first. I had brought my music, birthing ball, etc. Then I had a very, very painful labor due to my baby not being positioned correctly. My back hurt so much, I didn't even notice the contractions. While the contractions came and went, the back pain didn't. During my labor, I repeatedly vomited and had to be administered oxygen. Eventually, at 8 cm, I consented to an epidural (they never pressured me to have one though). Yes, I was almost there but by that time I had lost the strength to continue. Once I had the epidural, I feel asleep. I'm glad I did, otherwise I probably would have been too tired to properly welcome my little one into the world. The nurses were very encouraging and assured me that if she had been better positioned I could have had a natural birth. I doubt I will in the future though. I can't wait to have another child but I do not wish for the excruciating pain that came with my first.

I didn't have any complications from the epidural like I thought I would. I was able to nurse right away and my baby never left my side the entire hospital stay. She was wide awake and alert from day one and still is.

I no longer think of myself as a failure for finally giving in to the epidural. Maybe some women are stronger than me...o well...blessings to them. I don't measure myself against them or consider myself in a competition. I am grateful for the many choices in childbirth. It has come a long way.

Anonymous said...

Hi,

Just wondering if you've read 'Birth Without Violence'? It's by Grantly Dick Read, and refects many of your own opinions about natural birth.