The Empowering Epidural

Empowerment - making one stronger and more confident, especially in controlling their life and claiming their rights.

wikipedia picture

Let's get one thing straight from the start - noone can empower another person when it comes to the humanistic experience of empowerment. Empowerment is, by definition, one finding ones own strength. So, I cannot empower you... but, you making a choice that feels good and resonates within you can be empowering to you. It is your power of making that choice that feels good. 

I am a huge advocate of low intervention, no pain medication birth. In healthy and low risk birth, less intervention (medications, tools, equipment, etc..) means less inherent risk. But just because I believe in that truth does not mean that it is going to be true for every birthing journey. Not every birthing journey stays healthy and low risk, not every birthing journey couldn't benefit from weighing the pros and cons of an intervention and erring on the side of the intervention. So, that is where we start. 

The Empowering Epidural

I always start with the nitty gritty. Epidurals, like all interventions, should be used as tools to achieve a desired outcome.  In prenatal appointments, I provide women with a sheet that details the risks involved with getting an epidural. In childbirth classes, we role play getting an epidural and all that comes with it. Each time, I tell women 'this is not to scare you, this is to give you information about a procedure that you might decide you want, or your birthing journey might require you to get'. 

So let's talk about that some, shall we? 

B*E*S*T Doula Service has an epidural agreement very like my own that I give to clients. You can see it here. I love that they outline what will be required if you choose an epidural vs what might happen with the epidural. This is very important information to share with clients because it takes the 'I didn't know' and the 'if I'd only known' out of the experience. I cover with them: 

• It will require continuous fetal monitoring
• It will require at least one IV bag of fluids to be given prior to getting the epidural
• It will require a blood pressure cuff to read your BP every 15-30 minutes (depending on the hospital's protocols)
• It will require that a pulse oximeter to be placed on your finger for at least 30 minutes during administration
• It will require that your partner and doula leave the room for administration (in nearly all area hospitals)
• It will require a urinary catheter to be administered (depending on the hospital, some leave it in, others empty your bladder and then remove it. It may increase your risk of UTI or bladder infection, require antibiotics, or cause trauma to the urethra).
• It will restrict your mobility during labor. Depending on other possible risk, you will be limited to the bed, and perhaps your back. 
• It will provide a level of numbness... some women it fully numbs them to the point they cannot move their bodies from the ribcage and down without assistance, some women can feel quite a bit of discomfort even after the epidural and move without assistance).
• It will deprive both baby and you of your natural production of endorphins, which allow for both of you to cope with pain (both during labor and you, postpartum).

That way, if their organic experience requires, or they request, an epidural, they know this information and nothing surprises them about it. We also talk about the possible risks, so that they can fully accept them, weighing the pros and cons in the moment having already read and understood the possible risks, and make an empowered choice free of the fear of unknowns. 

Another thing I always suggest is watching one. Why? Well, for the same reason we encourage women to watch birth: it takes the mystery out of the experience. 

When might a woman choose an epidural? 

• For pain management - some women simply want to have that control over their experience. Although the control over pain requires they relinquish control over their bodies and their functions, many women accept this and feel this is  best suited for their needs. 
• For emotional and mental clarity - some women who have had sexual trauma or birth trauma in their past prefer to labor and birth with an epidural. We talk through their desires, including the fact that it might be triggering based on it taking away mobility and possibly requiring mom to feel 'tied down' and on her back. If she feels confident about the choice, we usually try to move the equipment and tubes/wires all onto one side of the bed so that she can feel less restrained. 
• For rest - a number of women cope marvelously well with labor and only even consider an epidural to rest... this is usually the case when she is going on days without sleep. 
• For a reset - this would be the case when moms labor pattern becomes 'dysfunctional' from maternal exhaustion (cntx space or stop, sometimes with ROM, but stay intense, usually after long early labors, and dilation stalls along with it). In certain situations mom and her provider might feel an epidural combined with pitocin will be the best thing to get her a vaginal birth.
• As a tool for vaginal birth - if the woman is unable to relax her legs and pelvic floor to allow for dilation to occur, or if she is beginning to run a fever and, although contractions are strong and dilation is occurring, she needs baby to be born sooner than later and opts for a more aggressive augmentation, she might choose an epidural as a tool to help her achieve a vaginal birth. 

In all of these situations a woman can feel empowered that she chose an epidural that fit her needs for her birthing time when she is fully educated and understands the possible outcomes, and the desired results. 

The one situation where I find women routinely don't feel good about their choice? 

• For fear - fear of the future (how much longer will this take? I don't think I can do this much longer), of the pain (how much more painful is this going to get, I can't take too much more painful), fear of an intervention (I heard pitocin is horrible, if we add that, I can't do it... I can't stand those cervical checks, one more and I want an epidural), or of the experience (if it feels like this now, how will it feel later? My friend told me pushing felt this way and that's scary to me). 

In these cases, we try to get to the root of these fears and dispel them. I remind them that any choice made in fear is not a good choice, even if you would make the same choice without fear. So we attempt work through that fear to see if they still feel the same about the intervention afterward. 

Have you had an empowering epidural? Did you experience an un-empowering epidural? Do you know what might have made the experience better or helped you make a different choice? 

"My" Epidural

Just a little bunny trail I am on today...

Have you ever noticed that when a woman who plans and prepares for a medicated, highly 'obstetrically' intervened birth, she refers to getting an epidural as "my" epidural, not "an" epidural? 

So why is there ownership of the epidural?  Even the L&D nurses refer to it as "your" epidural, or "her" epidural.

"Are you ready for 'your' epidural?"

It is the only time I can think of off the top of my head that someone refers to pain medication as "mine."  If I have a headache, I don't say, "I took 'my' ibuprofen."  I say, "I took 'some' ibuprofen."

I also notice that these same women refer to their labors and contractions as "the contractions" or "the pain"... they don't claim ownership of it, they dismiss it.

On the other hand, most unmedicated birthers will refer to their bodies sensations as "my" labor, "my" birth, "my" contractions.... She claims it. And she dismisses the other, "I thought about "the" epidural, but only for a moment"...

Likewise, women who choose a cesarean will say "my" cesarean. While women who don't want a cesarean tend to say "the" cesarean/surgery...

Like everything, this isn't cast in stone, there are many exceptions to this observation... but has anyone else noticed this?

hmmm...

If you have never seen an epidural being placed, check out Patti Ramos' super helpful epidural page.

A Quick History of Medication in Maternal Health Care - (and the Business of Being Born)

originally posted on 5/12/07

Taking the lead from another great blogger I read often - try to find her ;o) - and from a recent viewing of the Business of Being Born - I wanted to touch on the dark blemish of American Obstetrical practice - routine medication for birth. (BTW, it is funny that this was shown as a screening in the midst of a High Risk conference for Vanderbilt - on the heels of a recent development plan).

While watching the Business of Being Born - a WONDERFUL look at childbirth practices in the US - I was struck by one very apparent thing: doctor's know nothing about bodies and birth. They know everything about risk - and, as one OB nurse told me, their job was to take away pain and have a healthy mom - not to get the best outcome.

That mentality was prevalent back in the late 1800's - early 1900's when OB's infiltrated the childbirth field and it is prevalent now. FRIGHTENING! Why is it frightening you say? Let me expound...

Let's start with the advent of anesthesia in general. It all began on October 16, 1846, at the Massachusetts General Hospital in Boston, in a room now called the Etherdome, when William Morton administered the first successful public demonstration of ether anesthetic. This was a great breakthrough for SURGICAL needs, and the news spread around the world quickly. So quickly in fact, that within a month the first modern anesthetics had been given on both ends of Europe, and within six months in Australia and China.

One doctor who heard of the use of ether was James Simpson. Breaking out of his social class, he put himself through medical school and later became the chairman of obstetrics at the University of Edinburgh. He is best known for the forceps which he devised to counter his initial use of ether on maternal patients.

His first maternal patient was a woman whose pelvis was deformed by rickets (a common issue in that time from malnutrition) who delivered on January 17, 1847. These deliveries can be especially difficult because of the manipulation needed to get a baby out of a deformed pelvis.

There was a great concern, though, for this use of ether because of the knowledge that ether often stopped contractions. As well, most babies born from ether-administered mothers had ether-smelling breath, ether smelling placentas, and tires/lethargic/unresponsive babies. So, Dr. Simpson created forceps, to pull babies from their mother's wombs before they were 'too drugged' and to minimize the incidence of failed labors due to ineffective or stalled contractions. Then why was it continued?

To understand the merging of surgical breakthroughs and maternal downfalls, we need to look at the social climate of the time. Two major events were happening: childbirth was taken out of the home and into the hospital (where disease and infection ran rampant), and the feminist movement was on the rise.

"Early feminists campaigned for social reform of all types, for the abolition of slavery and the abolition of the use of alcohol. They were also concerned about improvements in health care, particularly for women and children. They had good reason to be concerned. Although death rates for men and women had been falling throughout the nineteenth century, risks of a woman dying in childbirth had not decreased. In New York City, for example, 15% of deaths of women between the ages of 20 and 40 were related to childbirth. Although deaths from other causes had decreased, deaths from childbirth had not. By 1900, 30% of the deaths of women in this age group were attributed to childbirth." - now remember that those deaths were NOT due to childbirth - but malnutrition causing complications in birth, deliveries being moved to hospitals where illnesses and disease ran rampant, and before the advent of antibiotics - IT HAD NOTHING TO DO WITH MIDWIFERY and THE SAFETY OF HOME BIRTH.

Suffragettes saw maternal health care as a significant area that needed improvements. The only problem is that they focused on the labor of childbirth (pain/discomfort) rather than the true source of the maternal and fetal demise of the time. Not to fault them as the information and scientific breakthroughs were not accomplished yet; in their early industrialized minds, pain equated illness and death.

(Maternal death rates dropped slightly in the US between 1880-90, when doctors rooted out the nature of childbirth fever in relation to cleansing practices in the hospitals. They started washing their hands between women's beds and the death rates dropped. Then, the numbers steadily rose again until 1940, when they dropped once again (steeply and greatly) with the introduction of antibiotics).

Queen Victoria used ether when she delivered Prince Leopold in 1853. From Inside Surgery:

"Queen Victoria went into labor on the morning of April 7, 1853. As her physicians readied her for the birth of Prince Leopold, John Snow positioned a handkerchief moistened with 30 drops of chloroform over her nose and mouth. The Queen had an immediate response to it. Over the next fifty three minutes he reapplied the anesthesia fifteen times, using between 15 and 20 drops each time. The birth was without complication and the child was pronounced healthy, although at the time no one knew that he was afflicted with hemophilia.When accounts of Queen Victoria's labor anesthesia reached the general public, John Snow became an instant sensation and was much in demand by the social elite of London."

The National Twilight Sleep Association was formed in order to support the use of a new maternal anethesiac development begun by a young obstetrical doctor by the name of Carl Gauss. Around 1900, Gauss combined two drugs that had been in the medical armament for a long time to treat childbirth pain. One main component was morphine, used to alleviate pain during surgery. It had, thus far, been avoided in obstetrics because of its effect on the uterus, its effect on the newborn, and its effects on bleeding and infection. The other drug was scopolamine, which causes amnesia - in the past, these had been used as poisons in high doses. Hamlet's father was killed by one of scopolamine's cousins.

Gauss mixed these two drugs and administered them in 'small doses' to his patients - the morphine provided relief from pain while the scopolamine provided the women with amnesia of their labors and what was done to them. The problems? Oh, there are many!!! Scopolamine caused women to lose their inhibitions. They would have no memory of what went on, nor did they realize what was happening, so most of them screamed during labor. They became uninhibited and psychotic. They would thrash about on the bed, causing injuries to their heads. So, their heads were wrapped with blankets or towels, turban-like. They would attempt to claw at the walls or their medical providers, so they were put in straight jackets or their wrists were strapped to the beds. Then, so that they would not fall out of bed, they were put in 'labor cribs' - and were allowed to labor, screaming, tied down, blinded and bound - often in their own urine and feces, and sometimes for days on end, until it was time to birth. The women had no memory of this, the husbands were not allowed in to see their wives, so they didn't know what was happening - and everyone was happy.

Gausses concoction was tried out first in Europe and was found to be less than satisfactory for maternal care. It would probably have died out there had it not been for an infamous article in McClure's magazine. Two female reporter's who were also staunch feminists, accompanied their friend to Germany, where she was traveling to be 'treated by Dr. Gauss'. The woman was administered Twilight Sleep and was ecstatic with it. She simply woke to a baby - with no memory of the labor or birth. The three women decided to liberate American women through Twilight Sleep.

Every woman wanted to have that type of birth. Medical research was not sought as to the safety, and feminist drive demanded quick results. So - the U.S. because predominantly a Twilight nation between the years of 1914-1945 (although my grandmother recounts her story of TS in 1956 and there are reports as late as the 1980's).

Thankfully (and sadly because of what it took) this time in American history quickly collapsed when Frances Carmody died under Twilight Sleep. Although there had been numerous women who had died under Twilight Sleep, she was the wife of a Brooklyn lawyer and happened to also be a huge rally organizer for the Twilight Sleep Campaign. Her husband and her OB assured everyone that her death had nothing to do with Twilight Sleep, but, with a key organizer gone from the game, at the very time she was using something she was promoting, the campaign began to fall apart.

Women began to have windows of remembrance, and by 1948, the baby boom got into full swing and the huge number of women having babies while under Twilight Sleep raised the issue of comfort at a cost. Women began reporting their birth trauma - both physical and emotional/mental. Moms began to speak out. And, in 1958, an article headlined "Cruelty in Maternity Wards" ran in Ladies' Home Journal. It detailed the "tortures that go on in modern delivery rooms.". The response? A flood of women sent the magazine their own horror stories. "I've seen patients with no skin on their wrists from fighting the straps," a nurse from Canada wrote.

"Just let a few husbands in the delivery rooms and let them watch what goes on there," said one reader from Detroit. "That's all it will take — they'll change it!" An Indiana mom claimed, "The whole thing is a horrible nightmare."

Women began desiring and demanding safer births - the OBs were fraught with the problem that they could not guarantee a medicated, but safe, birth. So, in the 1960's and 1970's - many women went back to natural birth. This was short lived, though, as Obstetrician's saw income diminishing... Cue the epidural.

Mothers giving birth in the late 1970s and '80s had more options than ever. They could have a medicated or unmedicated birth. They could deliver in a freestanding birthing center, a hospital, or at home (in most states). They could be attended by a midwife, an obstetrician, or both (in some states). And, through all of these options, they could have their husbands by their side.

What led up to the advent of the epidural? In 1898 German doctor August Bier injected cocaine into his assistant's spinal column. It numbed his lower body, but the next morning he awoke with horrible vomiting and headaches (cue the spinal headache). It took the next 80 years to perfect this. But, by the 1970s, lidocaine was dripped into a tube inserted by needle into a woman's spinal column. By the 1980's, it was all the rage! The hitch? The procedure numbed women to their chests, causing breathing issues and, at times, heart problems.

My question - and the question that Ricki posed in her documentary is this:

What will we find in the near future is the clinically proven downside to epidural births? We NCB advocates already know of the obvious, though seemingly unimportant to many women when compared to an easy labor, risks... But think of it...

- In the late 1880's early 1900's it was chloroform / ether - which inhibited neonatal breathing attempts, caused forceps to be necessary (which caused many horrible scarring issues with babies), maternal reproductive harm, and heart failure routinely.
- In the early to mid 1900's, it was forceps - which were necessitated from the use of 'knock 'em out medications. These scarred women's cervix's, making them incapable of dilating at all or efficiently in later pregnancies, tore ears, noses, and scalps off of babies, and created severe perineal and labial scarring in women. Forceps are still used today!
- In the mid 1920's, it was Twilight Sleep - causing maternal mental, emotional, and physical trauma, more of the same as chloroform did, AND caused a number of incidences of stillbirths.
- In the mid 1950's-60's, it was thalidomide, prescribed to pregnant women routinely - causing the widespread incidence of 'flipper babies' - children who were born with severe malformities, including phocomelia (short limbs and deformed extremities).
- In the 1970's, it was early spinal/epidurals where the needles were too large and the puncture too deep, causing a whopping 50% of women to get debilitating spinal headaches that, at the time, were not treatable.
- In the 1990's, it was Cytotec, used to induce labor (off-label and unapproved). With a HUGE risk rate, it can/did cause stillbirth, neonatal distress, uterine rupture, severe postpartum hemorrhage, and more. Cytotec is still used today!

What do all of these things have in common? NONE of these procedures are tested before they are tried out on pregnant and laboring women. We are used as guinea pigs. So, my, and Ricki's question, again, is: What will we find in the near future is the clinically proven downside to epidural births? And, at what cost?

We have a huge increase in ADHD, ADD, Autism, early and late-onset Jaundice, asthma, and allergies/intolerances... how can we know that these are not a result of our maternal health practices now? We can't. BECAUSE, we are a society driven on comfort and ease rather than health and well-being. Well-being does NOT equate to ease or comfort. And, until we demand better health care, we are doomed to repeat history on different levels - until we learn to choose better for our bodies and our babies and leave the testing to the REAL guinea pigs.

See here and here (pic) for more information on this history.

*Edited to add the great information sent to me by some readers!

If We Can't Make It Illegal...

Approx. read time: 3 minutes 30 seconds
It's no surprise with the increase interest in homebirth and unmedicated birth that the ACOG and AMA have reiterated their "long-standing opposition to home births"

On August 19, 2009, though, the American Association of Anesthesiologists came out with a "What Every Expectant Woman Should Know" 'fact' sheet.

Craig Palmer, M.D., Chair of the Committee on Obstetrical Anesthesia, American Society of Anesthesiologists states,

“While the Internet has vastly increased the quantity and accessibility of medical information, it has also fostered the spread of misinformation about pain management and childbirth. The goal of this campaign is to provide the public with accurate, impartial, and scientifically-supported information to help expectant mothers make choices that are right for them.”

(emphasis mine)

'Misinformation' abounds on the internet, according to this statement. It also states that the general public has more access to medical information... so... does that mean that the medical information out there is wrong? It seems that this statement is a little errant. The information that childbirth professionals interested in true and informed consent would like to share with every woman, such as doulas, childbirth educators, and midwives, is rooted in medical studies and their conclusions that, because of the internet, are more readily accessible to the public.

I also have a bit of a problem with the comment that the ASA is offering impartial information. If you have a financial interest in something, it cannot be impartial.

If the increased exposure on alternative pregnancy/childbirth options decreases the number of women seeking medicated births, especially since national findings put average hospital revenue for hospital-based births at 66%, it is no surprise that the ASA is rallying with their 'fact sheet'. I mean, if you can't take away their options the next best thing is to give nice blanket statements on the safety of your source of income, right?

Here are some of their 'FACTS':

'Fact': Pain management during labor and delivery is a personal choice for women. Women should not feel pressured to either accept or refuse pain management treatment during labor.

I agree... but then why I have I been to numerous births where doctors, nurses, and anesthesiologists continually attempt to coerce women into using medication during their labors even when they have made it abundantly clear they don't want it?

'Fact': Pain during labor is different for every woman and depends on a variety of factors. Some women need little or no pain relief medication, while others find that pain relief medication gives them better control over their labor and delivery.

Better control for the mother? I, and anyone who has ever been in the labor room, can tell you that having medication introduced to the process takes away a woman's control of the process. She might have better control of her pain, but not the process; she gives up her autonomy, being confined to the bed, the bedpan or catheter, the IV pole, the EFM or IFM and blood pressure cuff.

'Fact': Except in rare and exceptional cases, pain management has no impact on labor. In the overwhelming majority of cases, there is no impact on the mother, the baby or the labor delivery process. The decision whether to use pain management treatments is largely a question of the comfort of the mother. Furthermore, contrary to myths frequently cited on the Internet, there is no credible evidence to show that epidurals (or other pain management procedures) slow labor, cause C-sections or lead to a higher incidence of depressed babies.

hmmm.. for my response on that, see the medical sources cited below showing complete contrary information.

FACTS, with cited sources, can be found on:

• Wikipedia
• Kim James' site, broken down into baby side effects, labor side effects, and maternal side effects
• Transition Into Parenthood (with more recent studies)
• And, if you would prefer to go to the horse's mouth, feel free to check out places like Medscape (this one talks about breastfeeding issues), JAMA, and even the ACOG site (this is a good source). Unfortunately, if you go to the ASA website, there are not many recent studies on epidural effects on mothers, babies, and labors/births (hmmm).

Again, I'm not out to make every woman have the birth I would choose, it is about making informed, non-coerced, educated decisions. And ultimately, healthier, safer, beginnings.

FACT: I would like well-rounded and all information to be provided to women so that they can make fully educated and informed choices for their, and their babies, health.

Pain in Labor - a Midwife's View Under Fire

I hadn't heard about Midwife Dr. Denis Walsh until I was looking up current childbirth news this morning (one of the sad byproducts of working M-F; I can only 'research' on the weekends).

And what I see is astounding and saddening.

He has submitted a work to Evidence Based Midwifery that discusses the topic of pain in labor and it's purpose. You can read an article on it here, another here, and another on it here.

I applaud him. He, as far as I can see, has not written anything malicious or inaccurate. He talks about the usefulness of feeling labor, the chemicals released as a result, establishing a good labor pattern, aids in stronger infant-maternal bonding, and generally has a natural purpose in the process.

Nothing that has not been mentioned already in other articles like this and this. He even states that sometimes epidurals are useful, but of course, one of the articles above states that his comments make women who fall short of a 'normal birth' feel stigmatized.

The rest of the articles are followed up with statements such as "I dare him to say that to a woman in labor", "When he pushes a baby out of HIS body, maybe we'll give a damn what he has to say!", and more, much more. Defensive, aren't we? Do a google search for his article and you will find him slammed from all angles (or see Rixa's post for additional links to more articles on him) - it's a free for all!

Think of it: he's a man (sets him up for attacks from prideful, defensive, or angry women), he's a midwife (which sets him up for attacks from the main-stream medical community), and he's a male midwife (which even sets him up for failure in many natural childbirth communities).

It amazed me to see that this poor man has been strung up like a pinata from both the Obstetrical community as well as feminists. Even some fellow midwives didn't spare the firing squad. And you know what, all of this hubbub and no one actually has his submission piece yet!

Which is why I was relieved to see this blog post.

Denis Walsh is not the slimy pig-man who’s out to demonize women who choose pain relief, as the Daily Mail (or the BBC, for that matter) would have us believe. He’s a midwife who wants midwives to act as advocates for women: to put the needs of the labouring woman on the map, rather than letting the midwive’s own needs as professionals or the the baby’s (purported) needs push all mention of the woman’s well-being out the window. I, for one, am very thankful I’ve read his work in preparation for the birth of my second child.

I applaud his yet-to-be published piece and cannot wait to read it! From what I can see on the news now, he advocates alternative pain management options to better healthier, safer health care options for women in labor - evidence based health care. What shame is there in that? None. Shame on the nay-sayers instead!

*** Additional linkies here and here.

The Profit of Pain Relief

Well, let's get straight to the point: hospitals make a lot of money from epidurals. This article gives particular insight into this hostile fight over finances... now don't miss it:

“According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry.... Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so."

Ok - so, we have a vested financial interest in a woman not getting pain medication? Yes, you are right, my vested interest is to support a safer, more effective labor and birth for mom and baby while preserving her physical body and autonomy as much as possible, but we are not making a living off of this, NCB is not a lucrative industry by a long shot... What Mr. Grant fails to tell you is that we don't have thousands of dollars to loose per birth, as he does, if a woman refuses pain medication. No wonder he wrote his completely inaccurate book, Enjoy your labor: A new approach to pain relief for childbirth

How many of you can remember a nurse coming in every hour to ask you, “Are you ready for your epidural now?”. Sometimes, it is even more of a demand, "Well, we know what you want, but sometimes it is about what we need to do and how it is going to happen." (yes, I have heard that one personally). Ever wonder why the push so much? In America, an epidural costs anywhere from $800 to $2500, depending on the hospital and community. The United States spends more money on birth ($50,000,000,000/year) than any other nation in the world... and that is without getting better results.

The average medicated hospital birth costs $7,500 - $12,500 and that can mean double for cesareans. It is not conspiratory to see that this provides nice profits for obstetricians, anesthesiologists, and the drug companies that market to these hospitals. Did you know that many pharmaceutical companies offer incentives and bonuses for the 'top sellers' in any given hospital or practice? In fact, my OB told me that one such rep offered a new plasma TV to the OB with the most medicated births in the first month of the new year from the hospital I was planning on birthing at. As I have said time and time again, the majority of hospital policies are based on financial goals and protection from litigation.

Ok, back to that wonderful article:

"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth."

(Let me reiterate, his book is full of misinformation, and this article is no different. I am only hitting on a few of the lies therein) . Contrary to his claim, medical studies have shown that pain in labor and birth is beneficial to the process and allows for a safer and healthier outcome. I know I have cited it before, but check out Dr. Buckley's wonderful article on this phenomena.

If you want pro-epidural substantiation of this fact, see this video. The poor CNM talks out of both sides of her mouth saying that epidurals are safe for labor and birth and alludes to them not slowing down/stopping labor, or raising the incidence of cesareans and yet, the flash-board says, first, "Myth: Epidurals are unsafe and I should wait as long as possible to get one.".. and then is followed up with "Fact: pain causes body to release stress hormones that cause muscles to contract not relax"...

Well DUH! that is the whole point, thank you for proving it for me. Epidurals cause your uterus to RELAX because your body does not feel the discomfort associated with it and does not, as a result, contract the uterus as efficiently - causing an increase in the use of pitocin, instrumental delivery, and cesarean.. all of which are profitable to some degree or another. I know what she was trying to say, that tension can inhibit progression of labor, but she fails to acknowledge the uterus is just one. big. muscle. A relaxed uterus does not contract, which does not dilate, which does not birth.

One woman hit the nail on the head when she said "Epidurals are for tolerating hospitals, labor is the easy part". With hospitals 'requiring' that a woman dilates 1cm every 2 hours or she will be given pitocin, which, in turn, makes contractions less tolerable, requiring women sit or lie on the bed for continuous fetal monitoring, making contractions less tolerable and dilation slower, requiring women to have multiple vaginal exams, which mentally discourages women and causes tension (both of which discourages dilation)... it is no wonder that they are making the nice profit that they are.

Now things begin to line up... why women are being refused VBACs because of hospital policy or individual practice, why a nurse refuses to adhere to one request out of many on her birth plan: that medication not be routinely offered, why the AMA refuses to acknowledge that home birth is as safe as hospital birth for low-risk women and why they are attempting to outlaw home birth all together, and why hospitals across the board are pushing for the 'safety' of medication in birth... profit.

But, you shouldn't take my word for it. After all, we NCB advocates are in such a lucrative industry, and have selfish vested interest for you birthing our way....

Delivery Method Affects Brain Response to Baby's Cry

This article came to me quite timely after find it on Karen's blog:
Delivery Method Affects Brain Response to Baby’s Cry

When my own daughter was born by Caesarean section delivery, I was surprised how uninvolved I was in the process. My body was numb, and my view of the surgery was blocked by a sheet. When I finally heard a baby cry, it took a minute for me to realize that the sound belonged to my own baby.

Karen reports something similar...

I know that from my personal experience, I felt very detached in my mothering with my first child, who was born via c-section, when she would cry. With my second child, who was born via vbac, I couldn't tolerate hearing him cry. I would act immediately (well, most the time). I have chalked this up to the toll the difficult labor and recovery with the c-section, that it just took a lot out of me, emotionally and physically; whereas with my second, I felt victorious and energized, and I had energy to spend mothering my child.

I say this was timely, because I had just spoken with a wonderful woman who had an epidural with her two previous children and was now seeking a natural birth. Now I know that this particular article is talking directly about vaginal vs. cesarean births, but I would like to see vaginal unmedicated vs vaginal medicated vs cesarean as the conversation with this woman raised some interesting dialog.

One of her previous experiences, in particular, she had gotten the epidural, had her little girl, and then, after being given her baby, kept thinking 'how long until I can give her back'.

She felt bad that she was, for lack of a better explanation, not that interested in her babe at first site. As she said, it was like a dream. Only after her epidural wore off, and when her babe was brought to her a second time, did she really feel like she was meeting her little girl for the first time.

Sarah J Buckley, whom I have referenced before, has two great articles called Pain in Labor: Your hormones are your helpers and Ecstatic Birth.

In them, she talks about how a woman's body creates this marvelous cocktail of hormones that help her throughout labor, postpartum, and with newborn immediate bonding. When epidurals, synthetic induction hormones, or cesareans are performed/introduced to the laboring woman, these hormones production are stunted.

Oxytocin is the hormone that causes the uterus to contract during labor. Levels of oxytocin gradually increase throughout labor, and are highest around the time of birth, when it contributes to the euphoria and receptiveness to her baby that a mother usually feels after an unmedicated birth. This peak, which is triggered by sensations of stretching of the birth canal as the baby is born, does not occur when an epidural is in place. Administration of an epidural has been found to interfere with bonding between ewes and their newborn lambs.

Synthetic oxytocin is often given by drip- that is, directly into the bloodstream- when labor contractions are inefficient. Oxytocin given in this way does not enter the brain, and so does not contribute to the post-birth “high”, and in fact can lead to desensitization to the mothers own oxytocin production.

... Again we must ask: What are the psychological effects for mother and baby of laboring and birthing without peak levels of these hormones of pleasure and co-dependency?

Epidural pain relief has major effects on all of the above-mentioned hormones of labor. Epidurals inhibit beta-endorphin production,15 and therefore also inhibit the shift in consciousness that is part of a normal labor. This may be one reason why epidurals are so acceptable to hospital birth attendants, who are not prepared or trained to deal with the irrationality, directness, and physicality of a woman laboring on her own terms.

When an epidural is in place, the oxytocin peak that occurs at birth is also inhibited because the stretch receptors of a birthing woman’s lower vagina, which trigger this peak, are numbed. This effect probably persists even when the epidural has worn off and sensation has returned, because the nerve fibers involved are smaller than the sensory nerves and therefore more sensitive to drug effects.

... Another indication of the effects of epidurals on mother and baby comes from French researchers who gave epidurals to laboring sheep. The ewes failed to display their normal mothering behavior; this effect was especially marked for the ewes in their first lambing that were given epidurals early in labor. Seven out of eight of these mothers showed no interest in their offspring for at least 30 minutes.

There is good indication, from the article on cesarean vs vaginal bonding, as well as the articles by Dr. Buckley, that we are starting to make good strides to understanding the endocrine, psychological, mental, and emotional repercussions of our medicalization of childbearing women and processes.

Good information to, hopefully, cause us to pause and reconsider our birthing practices and what we optimally want out of our birthing time. Because, as I have said before, it is not 'just about the process' - the journey, the process, is for the health of the baby/mom (not just physically), and just happens to include the experience?

If You Give A Woman An Epidural

You all know the book "When You Give a Mouse a Cookie"? Well, here we go....

Red Pomegranate, once again, makes me pause...

Why Unmedicated (natural)?

Birth itself is hard work. That is why it is called labor. No matter how you have a baby - it is hard work. NCB, OTOH, is hard because it involves the woman taking an active rather than passive role in her labor and birth. She must work through the labor and work with the labor - working with her body and her particular birth experience to bring forth a child. This most commonly involves little to no intervention from medical staff (nurses, OBs, MDs, MWs, etc...) and relying on the woman and her support people to work through the hard work called labor.

The reason, I believe, so many women decide on medicinalized labor or surgical birth is that it is 'easier'. We are a culture of ease. We want things fast and easy. The fastest easiest way to lose weight, the fastest easiest way to make money, the fastest easiest way to have a baby. But - you loose so much in getting things easier. The number one thing in getting things the easy way is not appreciating the end result. The second thing you loose in getting things easier is that you don't learn and grow (mature and develop) from getting things the easy route. What do you gain from loosing weight the easy way? You don't learn better eating habits, you don't gain a healthier lifestyle, statistics show these ppl gain the weight back more often than those who work hard at loosing the weight... this is just one example. And these are only two of the things lost in 'easier' births.

That said, if you plan on an epidural - it does not mean you will have an easier or better labor. Around 1/3 of my clients, their epidurals don't take at all, are inadequate (they still feel discomfort and were not planning on it OR they have patches of pain), or have dire side effects paired with them (depressed respiration, decreased bp, short-term paralysis, spinal headaches, infection, etc...). As well, if you plan on a c-section, it does not mean that it is without pain. Women who have Cs have a harder time in recovery, have long term consequences (scar tissue, increased incidence of infection, increased incidence of ectopic pregnancy and miscarriage in subsequent pregnancies, increase incidence of hysterecomy).

As Dr. Robert Bradley says "It is not good to fool with Mother Nature".

It is proven that there is a greater bond, and less incidence of PPD when an NCB occurs. Also, there are higher doses of oxytocin and other biological and chemical productions that occur during an NCB (check out this article and this article). There are other benefits as well. Psychologically, a woman feels a sense of accomplishment and strength. Children who attend an NCB come away with a deeper respect for life, their new siblings, and have a healthier view of sex and and their bodies. Physically, there is an easier, faster recovery, and less incidence of serious complications. Risk is cut out of the picture and women are shown to actually celebrate their births - rather than look back on them in fear and avoidance.

I was recently asked why, though there are so many risks, women still opt for medicated births... my answer was this:

I firmly believe it stems from the culture we live in. In addition to and as a biproduct of that, I believe it is also because we have lost trust in our bodies, ourselves, and the natural process. Check out Healing Birth Healing the Earth. We want a diagnosis and subsequent 'cure' for everything. We are missing 3 or more FULL generations of women (in most families) who understand and can teach the next generation of women about true labor. Birth is dying; as in, birth as nature intended is dying. There are a few women (and the numbers are growing) who know these inherent truths and are reclaiming their trust in birth and their bodies, are educating themselves to the risks of Obstetrical deliveries, and have decided that the risks, not only of the medications used, but of the experience lost, do not outweigh the benefits and instead, opt for natural childbirth.