Sunday, December 19, 2010

Purposeful pain

In the past couple of years, following the births of my two daughters, I became passionate about natural birth. The credit for this, like for many other things, goes to my dear husband who first prompted me to research the little known risks and side effects of popular pain relief methods (epidural) and birth interventions (the giving of pitocin to induce or augment labor and artificial breaking of waters to name only two).

This past weekend, I was irritated to no end by a one-sided and biased article written by a well-known Israeli anesthesiologist. The article was titled “Pain is Pointless” (translation mine), and promotes the use of epidural during birth. I won’t say names but it makes no difference – the following attitude is common to pretty much all doctors and even nurses on the L&D staff.

“We see birth as a natural and positive process…”

… So far so good…

“… and therefore it is needed to limit its unpleasant parts and allow the laboring women and those surrounding her to enjoy the beautiful side of birth.”

(Translation: the L&D staff are not supposed to deal with vocal, demanding, unsedated laboring women. The beautiful side of a birth with an epidural is peace and quiet in the corridors. Surely you don’t want to deprive the doctors and nurses of that?)

And yes, birthing is so natural and positive that you couldn’t be possibly thinking about doing it without pain relief!

“… Is the pain dangerous?... The answer to this isn’t simple. The harsh pain is accompanied by physiological changes in the woman’s body, and sometimes these changes can negatively affect the fetus.”

Physiological is the key word here. Why would a normal muscular and hormonal reaction of labor negatively affect the baby, when it is perfectly designed to get the baby out? The estimated doctor fails to explain.

Pain caused by labor contractions, which the doctor so aptly compares in the beginning of his article to pain caused by inflammation, injury or surgery, which can and should be treated to alleviate suffering, differs from other kinds of pain by the fact that it has a purpose. Unlike what the headline implies, it is not pointless. Remaining in full consciousness of her body helps the woman know what is going on, which stage the labor is in, and instinctively assume positions that help the natural process of birth.

“… we should also take in account the psychological damage the pain might cause the laboring woman. The effect of acute, prolonged pain on the laboring woman’s mood is added to the unstable psychological state of many women in labor.”

Unstable and dangerous, and must be taken under full medical control – that is how many doctors see the laboring woman, and that, in my opinion, is a great pity. The psychological state of the laboring woman is not unstable. It is sensitive. It is altered. It is on a different level of conscience. All of this is part of the natural hormonal process aimed at helping the woman birth, both physiologically and psychologically.

“Today there are various forms of epidural anesthesia, including one that allows the laboring woman to get off the bed and walk around.”

(We don’t offer this in our hospital but why bother with details?..)

“Epidural anesthesia does not cause harm to the mother or baby, but improves the condition of both.”

How exactly epidural helps the baby isn’t explained, and neither are the very real possible side-effects of it. Now, I know some women choose to have an epidural during birth. It is entirely up to the mother – but what about offering informed choice? Are you afraid you’ll be out of job if women hear about the real risks of what you are promoting? Sure, nobody usually dies because of an epidural, but the risks are there – prolonged labor, increased risk of c-section, prolonged back pains, more difficult recovery and damage to the pelvic floor muscles from badly controlled pushing to name only a few.

The esteemed doctor also states that epidural allows to smoothly make the transition from “natural birth” (I love how doctors use that term for every birth that isn’t a C-section, even if there are a million interventions and a needle stuck up the immobilized woman’s spine!) to C-section – without bothering to note that epidurals raise the risk of C-sections, as has been confirmed by various studies.

The article implies that either you have an epidural during labor, or you suffer uncontrollably – without mentioning that there are safe and natural methods to get through contractions while making pain bearable, including very simple things such as hot water (which you ran out of last time I was having a baby in your hospital, but never mind) and the change of positions.

I have been blamed several times for “hating” doctors following my posts on natural birth. Nothing could be further from the truth. Doctors do holy work and save lives every day – including anesthesiologists whose skills are needed during a surgery. But I think medical schools fail to educate doctors to view birth in the right way – not as a medical emergency, but as a truly normal, natural process which happens on its own, without the need for an anesthesiologist.


Lady Anne said...

I dunno. I wasn't even given a choice when my daughters were born - they are all in their mid- to late-forties - but pain relief during childbirth was developed at the request of laboring women. It was something for which they had been begging for millenia.

In fact, when it was first offered, the clergy preached against it, saying the Bible tells us in Job that "mankind was born to suffer, as the sparks fly upward". Queen Victoria, who had nine children and knew a thing or two about childbirth, was also the titular head of the Church of England. She pulled herself up to her full four feet, nine inches, grabbed the Archbishop by the middle vest button (which was as high as she could reach) and said something to the effect that "We are not amused", and he relied, "Yes, Your Majesty, you are absolutely correct, Your Majesty" and that took care of THAT little matter.

To each her own, I suppose. It's grand to start off natural, but I don't think mothers should be put down if they give in and ask for some relief.

Linda said...

Labor is called labor for a reason-it's work, hard work, aching muscle, panting breathing, exhausting work. So is running a marathon. Why does no one suggest doping marathon runners so they don't experience so much pain? Why isn't their pain pointless. Runners experience mood changes too when they run; fatigue, thirst, frustration, anxiety all take their toll. Runners have to push their mental as well as their physical capacities to the limit. Doctors aren't warning us about the unstable mental states of marathoners. Extreme physical exertion causes the brain to produce endorphins: the runner's 'high.' It happens during unmedicated childbirth too. The 'pain' of giving birth to a child is not like surgery, it is like that of a physically taxing athletic event. But the medical establishment won't grant women the acknowledgment that such achievement deserves. No they have to medicated, managed and 'delivered' by the hero doctor.

Anonymous said...

Hear, hear! Very well put. Unnatural 'surgical' pain is infinitely different from natural labor pains. I cracked jokes all the way through my natural home birth...although the epi didn't sound so bad at times ;)

Clara said...

While I agree with you - God created our bodies to go through the birth process naturally - there are times when our bodies suffer the consequences of the fall (sin) of mankind (not talking about personal sin here, but rather the degradation of mankind because of sin), and medical intervention is necessary even in child-birth. This medical intervention is the reason fewer women die in labour and delivery today from times gone by. Yes natural (truly natural) is best, but that pain can actually cause a woman to fatigue to the point of danger to her life and that of her baby, and in those situations I think it is not fair to judge those women for needing medical intervention.
Sometimes birth does not happen naturally, needing no intervention, as your last statement claims... Sometimes it DOES become a medical emergency. When I delivered my son, I was very glad to have a doctor there as I began hemorrhaging VERY fast. Without the doctor and his interventions, I would not be here today, I would have bled to death.
However that being said, I do agree with you that a lot of doctors do view birth the wrong way - I have known of doctors who refused to deliver babies without the mother having an epidural - I do not agree with that, and have never had an epidural myself. But I did need pain relief in both my deliveries though because I was faitguing to the point of danger.

Lori said...

I've been studying about this subject a lot! That's part of why I'm considering to be a Doula- so that I can help women make these informed decisions!

Katie Gregg said...

Please do remember that, for a woman with gestational diabetes, labor pains can push blood sugar levels dangerously high. A woman in this situation can choose to forego an epidural, but then she will likely need insulin, creating a risk that the baby will be born with low blood sugar.

I was in this situation, and do not regret choosing the epidural. My son was born with safe blood sugar levels, which would not have been the case if I had needed insulin (my blood sugar was very, very high - well over 200 - but after the epidural dropped to safe levels almost immediately).

Anonymous said...

I know that everyone's birth experience is different so I don't want to impose my beliefs (based on my experiences) on anyone else. However, I will say that the epidural helped me. I had elevated BP with both my babies. I labored without much success with both...despite using the relaxation techniques I had learned. When the epidural was given, my BP went down (to normal) and my body relaxed. Both babies were born within an hour or so and were ready to nurse right away. I do know this is not always the case, however.

Kate said...

No risks from epidurals? Huh?! I'm walking proof! My 2nd miscarriage was incomplete and I was bleeding to death. Because I had a heavy dinner just before I miscarried, they had no option but to give me an epidural for my D&C. The anesthesiologist was working fast (apparently, I was getting pretty close to death) and poked a hole in my spinal column. This caused a leak of my spinal fluid and the fluid around my brain thus causing my brain to bump against my skull every time I moved too much or stood up. I was horizontal for a week. If I stood up, the pain was horrific.

I know women who've had epidurals and had to have a catheter put in because their bladders stopped working!

I know of a woman who had an epidural that somehow numbed her from the waist UP! She couldn't even talk and felt the entire labor anyway with no feeling or ability in her upper body!

No risks? HAH!

leah Brand-Burks said...

"I think medical schools fail to educate doctors to view birth in the right way – not as a medical emergency, but as a truly normal, natural process which happens on its own, without the need for an anesthesiologist."

To me, this is the root and key to this problem. You are exactly right. Good post, Anna.

Amelia said...

i'm so glad that there are others that don't plan on using an epidural. I don't trust doctors and all their medicine and pain killers. (surgery I do trust but things like vaccines I don't). You're blog is so encouraging!

Susan said...

Thank you Anna. I always love your posts. I am amazed at how good you English typically is but wanted to give you a hint that I think that you mean your doctor is "esteemed" not "estimated."

SubWife said...

While I personally would opt for pain relief, I really didn't appreciate how pain medication was pushed onto me during my first labor. The patient theoretically has choices, but one must be very vocal about them, which is unfortunate.

Anonymous said...

Because, Linda, painkillers would hinder the runners' progress. Painkillers for childbirth are not the same; no comparison.

Kimberly said...

I agree completely with what you said in this post. The doctors have the best of intentions, but are lacking knowledge of what unmedicated birth is REALLY like. All they hear are horror stories of deaths in the old days and how modern managed birth is better.

I wanted a homebirth to avoid the hospital (since hospitals are institutions and thus very inflexible-and birth needs flexibility!)but was unable to get a midwife. I live in Canada and we have a doctor shortage so I get what I get and have very little control over what that person is like. I'm praying for a kind hearted doctor who uses tools judiciously-sometimes an epidural is needed (rarely but there are good reasons to use one) and I want a doctor who knows their stuff but is also willing to NOT use their stuff.

kittty said...

I have had 3 natural births (no epi, no pain relief) all 28 hours plus...back labor.... I tore terribly with my first two. I felt it all tear. Obviously I still did it the third time, but used a midwife. A midwife makes all the difference...I didn't tear the third time because I was allowed to move into different positions. With my obgyn I was on my back...during back was the worst.

That being said. I believe SOME women truly need an Epi, but the majority do not.

It is a MEDICAL PROCEDURE, as much as some will try to make you believe it is not. A medical procedure is only necessary for those in need of it. Not every laboring woman is in need of it.

I never had one, but I wish I had had some sort of numbness when I had a fourth degree tear, and felt all of it. Moderation, is key, and this is not practiced in obstetric field.

Kolfinnas korner said...

i've had one of with meds and one without. by far I say the one without was by far the easiest to recover from.

Anonymous said...

I would bet that if your husband were the one giving birth, he would not be researching the negative effects of epidurals.

Many, many, women have had healthy babies using epidurals. I think we should give thanks for modern medicine, especially if we have benefited from it in other respects. In other words, if you use Novocaine at the dentist, it sounds hypocritical to criticize epidurals at birth.

Kathleen said...

Susan, I noticed that too, but she got it right in the 3rd-to-last paragraph. :)

Anna, I think your final paragraph just about sums it all up. I think if doctors (and nurses) don't have or aren't given the "big picture," they might see every disruption of homeostasis as a medical problem.

On a related note, some of you may find this video feature interesting: It's about an obstetrician (who happens to be an Orthodox Jew) and how he handles high-risk pregnancies.

Anonymous said...

Unless you've been to medical school (or read a curriculum), I think it's hard to criticize what is taught there. You don't really know!

Because you didn't have complications or excessive pain does not mean other women don't. Let's be grateful for the pain medication that godly men and women have given us! Women used to die in agony from this "natural process." Would you want such a death for your daughter or sister?

You do unnatural things every day. it's silly to pick the "natural" things (when you don't really need help) and then pick the "unnatural" things when you do need help.

Amy said...

I planned on having natural deliveries (no pain meds) for both of my children, but both babies were breech, so I was forced to have c-sections. This is still such a painful thing to think about, because I feel like I missed out on something my body was created to do. I never even got the chance to go into labor, and that saddens me so much. I prayed and prayed that God would turn my second one so I could experience a normal delivery, but it never happened. I feel like my rights were taken away, even though I know how dangerout it would be to have a complete breech delivery without a c-section (especially for my second pregnancy). My second c-section took twice as long (if not more) than the first, and I found out later that the first doctor damanged my uterus very badly during my first c-section. So many people willingly cover up any pain they feel during labor, while I would love to know what it even feels like to go into labor. --As for risks with epidurals, I still have numbness that has not gone away from when my youngest child was born 15 months ago.

Anonymous said...

Cancer is also natural. So are brain tumors. They all occur naturally--such things have existed for centuries. Not everything that is natural is good.

There are women who have died from the agony of childbirth.

Jo said...

All women should be given a choice and can decide if they want painkillers or not. Women should not feel that they must take pain killers or feel guilty about not taking it. It all comes down to choice.

Mrs. Anna T said...

There were several anonymous comments, and I don't know whether they were written by one person or not (though I suspect they were). Next time you want to argue, do have the courtesy to identify yourself so I at least know to whom I am responding.

"painkillers would hinder the runners' progress. Painkillers for childbirth are not the same; no comparison."

As a matter of fact it is a very GOOD comparison. Epidurals can and do stall the progress of labor, which calls for the use of pitocin, which calls for more drugs via epidural. It's like a snowball of usually unneeded interventions.

"I would bet that if your husband were the one giving birth, he would not be researching the negative effects of epidurals."

I will be always grateful that my husband *did* the research on birth interventions. He did that out of concern for my health and for the baby, and it's only thanks to him that I have experienced two beautiful natural births with easy recoveries. If it weren't for my husband, I would still be sure I can't give birth without an anesthesiologist.

"Many, many, women have had healthy babies using epidurals."

Many smoke and don't get lung cancer. Does it mean smoking is risk free?

"Women used to die in agony from this "natural process.""

Women used to die from birth-related complications such as excessive hemorrhaging or infections - not from labor itself.

"Cancer is also natural. So are brain tumors."

If something occurs "naturally" (and by the way, cancer is highly related to the very *un*natural modern lifestyle and nutrition) does not mean it is a *normal* process. Cancer, infections, even cavities are disruptions in the physiological balance of our bodies. Labor is not a disruption. It is a normal and purposeful process. Interfering with it when it isn't strictly necessary has a very harmful potential.

Mrs. Anna T said...

Amy, I'm so sorry for your birth experience. My sister-in-law's baby was breech and she fought tooth and nail not to have a C-section. The baby could not be turned due to a certain defect in the shape of her uterus, and she was told probably all her subsequent babies will be breech. Anyway, there is one (just one!) hospital in Israel where they do breech vaginal deliveries for first-time mothers (and two more that do it for second-timers). She wanted a completely natural delivery but they insisted on an epidural in the final stages of labor, due to a risk of emergency c-section. Anyway, the important part was that she did not have a c-section. I know that not every breech can be delivered vaginally without it being risky, but many can. The automatic c-section for breech is a policy that is currently being revised in many countries, including Israel.

Mrs. Parunak said...

AMEN! Wonderful analysis! I especially liked your point about making an informed choice. Women should be free to choose epidurals, but they should have all the information about the risks and the alternative methods of pain relief so that they're actually choosing and not just being manipulated.

Amy said...

Anna - Thank you for your comment about your sister-in-law. Even though she had to have an epidural, I am so thankful that she was able to avoid having a c-section! I fought tooth and nail, also, but I wonder now if I tried hard enough. I was even told by a doula I know to ask for an ultrasound at the last minute just in case the baby turned. They listened to me, but not without being made to feel like I was inconveniencing everyone . I hope that someday, I will be around to see these policies change! I am so grateful for women like you who make these subjects known, because many women do not know what their "rights" as a patient really are. Many of us, (at least in the United States) are raised to trust doctors without questioning anything. Childbirth really changed my view on that! Thank you, again, Anna.

Carol said...

Good post! I am wondering about the status of midwives and doulas in Israel. Could you choose to have a home birth?

Anonymous said...

I agree that there can be too much of a rush to medicalise childbirth. That said (and I speak as the daughter of a woman who gave birth to her children at home) we must be careful not to run in the other direction. In many countries, for example, gas-and-air is used extensively for pain relief in childbirth. It is cheap, effective, has no harmful side-effects (some women find it doesn't work, others find it makes them a little nauseous, but these effects stop as soon as one stops taking it) and it is controlled by the labouring woman. In my country it is available to women giving birth in every situation - there's no good reason it shouldn't be, because it is a safe, long-tested, reliable and useful means of pain relief.

And yet in some (developed) countries, including the USA, this pain relief is not available. That it is not is an appalling indictment of how medical care in childbirth is too often not focussed on what is best for the woman and the baby, but a medical establishment. I believe that women who need them should be able to choose epidurals, but women who just need moderate pain relief should not be forced into them because the safe alternative is unavailable.

Nineveh_uk @ LJ

Anonymous said...

Had I had a home birth, both my child and I would be dead. He was too big and I never fully dilated. I am far from religious - any religion - but I am sure that even you would prefer to live and save the life of your child, rather than bleed to death on your bathroom floor.
I spent 76 hours in labor, with no pain killers and then an emergency c-section. Three women I know decided to have their babies at home and all children 3 ended up dying, and now there is a law in Australia pretty much prohibiting home birth.
I am sure it is not your intention, but I don't quite understand why very religious people are so judgemental of other people's choices.
Birth is an amazing experience no matter how you choose to have it.
Suzanna - in Australia, NSW

Anonymous said...

I am torn between two views here.I have had 2 C-sections and 4 normal deliveries.I've had epidurals for all the 'normal' ones-but they haven't worked.Not one bit.According to the doctors my spine isn't straight and it stops the pain relief.The pain has been excruciating in the last two deliveries due to the fact that they were so quick.So whilst I would dearly love to have a labour that didn't make me want to die,I have given up on pain relief.If God blesses us again with a baby I plan to go pain relief-free,simply due to the fact that there is no point in my case to have it.Greetings to annaT from Finland: )))

Carol said...

To Suzanna in Australia:

After a woman has been in labor for 24 hours it is wise to go to the hospital. Home birth is safe when there is a plan for transfer to the hospital if signs indicate a difficult delivery.
It is wrong for all women to have their labor induced--it is wrong to think that all women should give birth at home. Each situation needs to be evaluated.
The problem in the United States is that there is not a good communicating bridge from home to hospital. The hospital is high tech and sometimes stressful for women that want to labor naturally. Sometimes women that choose to labor at home don't have good access to a hospital when they need it. Communication between hospitals and home birth attendants needs improvement.
Women should have a voice in the way they give birth--and every woman is different. At the same time it is important to note that interventions (especially early and unnecessary ones) tend to have a snowball effect. One thing leads to another.
It makes me sad to see a wide divide between the home birth practitioners and hospital practitioners. Women are better served when they work together. Hospital practitioners could learn some things from home birth midwives and vice-versa.

Rebecca said...

I fully agree with you. I just stumbled across your blog and jumped at your "natural birth" label. I have had a cesarean (long story, but it was supposed to be a home birth and things weren't going well so we went to the hospital, induced, eventually broke down and did the epidural, and of course that led to c-section) and then I had a VBAC at home. It was amazing.

It may be true that pain relief was developed on request of laboring women, but that does not mean it is the best thing. We like all sorts of things that aren't best for us. I like to sit all day and crochet instead of cleaning my house. My son would rather eat chocolate than real food all the time... etc. Labor pain does have a purpose, and when we mess with that we run risks of real complications.

Women's bodies were designed to labor naturally. If there wasn't some benefit to a natural birth, God would not have stuck us with it and left us for centuries without any alternative. In our society of comfort and luxuries, and immediate gratification, we have almost lost all ability to see that sometimes, pain and hardship can actually be good. There is so much more I could say, but I'll leave it at that... for now. :)

Thanks for your post.