Monday, October 14, 2013

Circus of the Epidurals

My husband and I are long-time fans of the British TV sitcom "Coupling," which ran for four seasons from 2000 to 2004. The fourth and final season followed one of the character's pregnancy and eventual delivery, and one episode, entitled "Circus of the Epidurals" discusses the character's desire for a natural childbirth, and her boyfriend's inability to understand why in the world she would want to forego drugs.

"There's pain, and there's pain relief," he says. "This is not a test anyone should fail!"

The episode is hilarious, and there's no question that it accurately reflects the basic tension between those who desire natural childbirth and those who can't understand why you'd want to "be a martyr" and refuse an epidural when it's right there and available to you. Why would you want to experience pain when you don't have to?

While I enjoy watching this and all of the other episodes of "Coupling," the amount of education I've had on this particular subject does make me want to throw things at the screen. First of all, the female character makes no effort to explain to any interested party why she wants a natural childbirth. (I'm avoiding names to try and limit the spoileriness, in case you decide to investigate the show - available streaming on Netflix!) The closest she comes is, "The pain of childbirth is part of being a woman," to which her boyfriend replies, "Yes! And it's the part we can fix!"

Now, since about the 1970s, there has been a movement toward "natural childbirth," as we well know. It became a trend to eschew any available methods of pain relief, including twilight sleep, Demerol, other narcotics, and epidural, in order to be fully present for the birth of your baby. Medical research has also demonstrated that the use of interventions such as epidurals may attach risks to the birth that otherwise would not exist. While, certainly, "Because I want to experience natural childbirth" is a perfectly valid reason for refusing pain relief, there are also scientifically sound arguments for avoiding or delaying interventions during birth and instead turning to "natural" methods of coping with the pain of labor and delivery.

The prevailing attitude of Western medicine is that our lives are substantially improved by removing pain and treating disease. And I have absolutely no argument with that stance in most cases. However, birth is not a disease, and the pain associated with childbirth is not necessarily an indication that something is wrong. Thus, while normally I'm all about feeling better, experiencing less pain, and reducing discomfort, the process of childbirth, when allowed to progress without intervention, without medication, without probes and monitors, and without interruption, has better outcomes than if we try to "treat" it.

I'm not saying we should never use pain relief, never do surgery, never use the available technology to assist in birth. No one is arguing that infant and maternal morbidity and mortality have not plummeted over the last century, largely due to improvements in medical technology and knowledge surrounding pregnancy and childbirth. However, there is still room for improvement, and mounting evidence suggests that likely over 90% of women will be able to give birth safely and successfully to healthy babies without any medical intervention at all. Allow her the space and time to labor, give her a clean and safe environment in which to birth her baby, have an experienced and well-trained birth attendant by her side, give her a supportive labor coach or two, and she will birth her baby in the most natural and ideal way possible, which will benefit her in her recovery and her baby in his development.

Studies have shown that the use of epidural, especially when in place for a long period of time (more than 10 hours), can interfere with a baby's ability to effectively breastfeed in the first day or two of life. Studies have shown that the use of epidural increases the "need" for Pitocin to augment labor, as the use of the epidural drugs and the fact that the woman is then required to remain on her back may slow labor contractions. Restricting a woman's movement during labor, forcing her to give birth lying on her back, and the use of sensation-dulling medications make it more difficult to push effectively and get the baby into an ideal birthing position. This increases the risk of c-section due to "failure to progress", "long labor", or "large baby." In addition, even if the baby is birthed vaginally, the risks of perineal tearing or episiotomy are increased, which may complicate the mother's recovery. The drugs in the baby's system may dull his sucking reflex and make him more lethargic, contributing to early breastfeeding difficulties. And, finally, the need to push IV fluids to maintain the mother's blood pressure when an epidural is administered may cause edema (swelling) in the mother's breasts within 12 to 24 hours of the birth, making it more difficult for her tiny new baby to latch and suck effectively at the breast, which can delay increased milk production and create a need for formula supplementation where none would otherwise have existed.

The point is, while many women desire a natural childbirth for non-medical reasons, many, many women have solid, evidenced-based reasons to eschew medical intervention and strive for a drug-free birth, for their safety and the health of their babies. Epidurals aren't going away, and many of the risks are manageable or can be mitigated by taking other steps such as allowing immediate skin-to-skin, encouraging rooming-in, and providing in-hospital breastfeeding support, but when women are made aware of these risks, they can make an educated decision as to how much risk they are willing to take on.

My personal desire to avoid the epidural is not a point of pride; it is not a hippier-than-thou exhibition; it is not out of an "I am woman; hear me roar" attitude. It is fear. Plain old fear that getting an epidural might cause a cascade of other interventions that would lead to an undesirable outcome for ME. It's important to note that what I find to be an undesirable outcome, other women may not. This is why women need to be informed, listened to, and included in the decisions made during their births.

So, thanks, "Coupling," for the laughs, but I'll stick to science, and not sitcoms, for birth education!

1 comment:

  1. Pregnancy and birth are not diseases, Mothers to be need information which is available easily these days.....should they choose to be educated....birthing knowledge help a safe delivery of a healthy baby, and a healthy mother to be able to care for her baby efficiently.
    Like many other aspects of our health, we are improving....all is not as "natural' as we wish, but is a good price we are paying for safety in life of another individual who has no choice of what mother decides, but has to live with the consequences of her decision.
    I do not advocate the use of epidural or any other intervention....but just to remember to have confidence in a trained care giver, and have a good understanding of her/his views before the birth starts, so if the "natural" process has to be compromised in the interest of safety, open minds and wisdom should prevail, rather than the dogma of "natural" at any cost.