Epidurals

[Rifka]

The answers to Question #63161 bugged me. I don't think the questioner meant to overgeneralize. I suspect they really didn't understand why anyone would choose to go without medicine for such a painful event. I had the same question a month or so ago, and I felt similarly before I spent some time researching and realizing that there were pros and cons to each. In addition, I have heard some women talk about natural birth like it was a badge of courage. I can understand why mothers would want to birth naturally, and why they would feel proud of their accomplishment, but that doesn't mean they have to make those who get epidurals feel like they are scum. There's nothing wrong with getting an epidural. The writers could have been a little more sensitive in their responses.

Also, a second point of irritation was the emphasis on epidurals leading to C-sections. The authors made it sound like epidurals are highly likely to lead to C-sections. I know plenty of women who have had healthy, normal births with the help of epidurals. In fact, this study indicates that having an epidural doesn't necessarily increase the risk of a C-section birth: http://www.msnbc.msn.com/id/6980795/ns/ ... -sections/. Granted, the study wasn't done against natural births, but it did show that epidurals early in labor didn't increase the risk of a C-section for the mother. So let's be fair to both sides. There are pros and cons to both.

Ok, I'm done venting. Feel free to send me all your hate mail now.

[Rifka]

Also, just because the body is equipped to deal with the pain of natural childbirth doesn't mean a woman has to or should deal with the pain. The body is also equipped to deal with the pain of a sore throat or sprained ankle, but that doesn't mean it's bad to take medication to ease that pain. Obviously, I'm not equating labor with a sore throat. There are differences. But, I think the argument that the body is equipped to deal with labor and therefore shouldn't need medication for it is a stupid one.

[NerdGirl]

I pretty much agree with you, Rifka, although I do think that Sky Bones in particular did a good job of explaining why she choose to birth the way she did, which was hopefully what the questioner was looking for. I personally would like to try unmedicated childbirth if I ever have the opportunity, but I don't think there is anything wrong with a woman having a baby however she wants to have the baby. I won't necessarily do it with all of my hypothetical future babies, but it's something I would like to try. I don't think there is anything more noble or natural about having a baby without pain medication, and the only reason I want to try it is because I honestly want to know what it feels like. I'm kind of weird like that. But there is nothing wrong with having pain medication or a c-section unless someone is trying to force you to have those things when you don't want them and they are not necessary.

My mom had c-sections with both me and my brother, me because things didn't progress as they should and it was necessary and my brother because it she wasn't comfortable with the idea of a VBAC. I actually really don't like the term "natural childbirth" and wish that people would instead use terms like "unmedicated" and "vaginal delivery". I don't feel like my life has been negatively impacted in any way because of how I was born. My mom actually had to have a general anesthetic when I was born because the local anesthetic wasn't working and they need to get me out immediately, so she was unconscious when I was born and ended up with a really bad infection and didn't even get to see me for several days. People say that it's really important for mothers and babies to start bonding right away, and that's great when it's possible, but my mom and I have always had an incredibly good relationship despite our lack of early bonding time. I think it's important to remember that birth is just the beginning, and regardless of what choices you make about how to give birth (or if things go wrong and you can't have the kind of birth you wanted), you will still have many more choices to make to have a good parent-child relationship. People should just have the kind of birth that they are most comfortable with, but plan for emergencies that might change things. There isn't one magical answer that is right for everyone, and as long as you are doing everything you can to ensure that you and the baby are safe, no one needs to feel either guilty or superior about they way they gave birth.

[C is for]

"An epidural is a proper Christian woman's only chance to get wrecked."

/complete non-contribution to the discussion

Edit: Also, since this is a response to a question, I'm moving it to Reader Response.

Edit again: Aw man, you can tell I read this discussion before I read the question. Anyway, this is the actual Community quote.

[Carrapicho]

While I wouldn't say that I necessarily detected this in the responses to this particular question, I will mention that I have definitely sensed almost a sense of superiority in a lot of women who didn't use pain meds for childbirth. Cries of "Your body is designed to do this!" and "Oh, I was able to go completely natural" seem almost designed to make me feel like I failed because I had an epidural. Well, guess what? I wasn't planning on having it, but I don't regret it at all and it sure came in handy. I was induced a couple weeks early due to pre-eclampsia (pregnancy-induced high blood pressure), and so I was on pitocin for a good 5 or 6 hours before I had the epidural. Not that I have anything to compare it to because I've only given birth once, but pitocin is KILLER. Those contractions HURT. And I was one of those lucky women for whom the epidural didn't work all the way, so I still felt post-epidural contractions depending on how I was laying down. There was never any danger of my needing a C-section, even with the induction and epidural, both of which are "unnatural" things to include in a childbirth.

Anyway, I just had to chime in that, yes, a woman's body is designed to have a baby, but I would like to make a general plea to the women out there that have this attitude: you are not better than me because you were able to "tough it out" without pain meds. You may feel that that was better for you and your baby, but that does not mean I did not also feel the pains of childbirth and that I didn't work hard to have my baby. The original question makes perfect sense to me--I've known so many women that think they should be looked up to and given a badge of honor for not having pain meds. If you can do that, great. More power to you. If you can't, fine. Give birth the best way for you and we'll all have beautiful babies when it's over.

[Katya]

While I wouldn't say that I necessarily detected this in the responses to this particular question, I will mention that I have definitely sensed almost a sense of superiority in a lot of women who didn't use pain meds for childbirth.

Definitely. And it's a sentiment that comes up often enough that it makes any discussion of the topic difficult because people are already on the defensive as soon as the subject is raised.

[Dragon Lady]

I… didn't get the same feeling you guys got. Tell me one writer who is looking down upon people who get epidurals. The questioner asked why on earth anyone wouldn't get an epidural and they answered that. I'll bet if someone asked why on earth someone WOULD get an epidural, you'd get a similar response. Heck, Sky Bones even said flat out that she doesn't judge anyone who chooses a different method than she does.

[enter defensiveness Katya predicted. ]

But I do want to point out that the judgmental mentality goes both ways. Just saying you're planning on natural childbirth often elicits "You're crazy! You wouldn't go to the dentist without anesthesia! Stop trying to be a hero!" Guess what, folks? That's not why I want a natural childbirth and if you'd ask, I'd be happy to tell you my reasons. I was made to feel like an irresponsible, stupid, crazy person on several occasions because people would ask who my OB was and I'd say I had midwives which immediately made me one of those people. I finally stopped saying anything unless specifically asked, and I often had change-of-subjects ready in case I felt any negativity in the reaction. So I'm either holier-than-thou or crazy. I guess there's no middle ground?

The reactions in this thread make me feel judged because I had a natural vaginal birth (though, not unmedicated. I was induced). Even though I have nothing else against other people getting epidurals. But I guess I have to specify that I have no problems with epidurals unless I'm seen as feeling superior.

Though, for what it's worth, I am proud of what I did. I feel so powerful and amazing. But just because someone hikes to the top of the Great Wall and feels awesome about it doesn't mean they look down their noses at the people who take the tram.

[Dragon Lady]

Ok. That last sentence, upon rereading, makes me sound like an awful person. I'm not trying to compare an epidural to taking a tram. Labor is difficult no matter the method. Many people labor for days before going to the hospital and getting an epidural. And that means they had days more pain than I did. I had 2 hours of pain. Period.

I guess what I was trying to say is that childbirth is a passion of mine. I spend a lot of my time devoted to it. I've done a ton of research. I spent a lot of time practicing and "training" if you will. Most people aren't as passionate about it. They're passionate about having a baby. They spend their time researching nursery colors, parenting techniques, etc. They don't care about the actual labor part. They just want that part over with because it's necessary to get their baby. AND THAT'S TOTALLY FINE. So when they get an epidural because they don't want the pain, good for them! They know what they want and they did it. Kudos! I, on the other hand, am fascinated by the birthing process and thus focus my energy on that. I love reading birth stories. Love it! So when I accomplished something that I had focused so much energy on and am super proud of my accomplishment, why do you assume I (or others in my situation) look down on other people who don't have the same passion?

[krebscout]

I had a c-section with my first and a vbac with my second. I labored for 42 hours, and between Saturday and Monday afternoon I had about five total hours of sleep under my belt. Then I got the epidural and took the most blessed nap of my life. It sped up my progress, too. I loved my epidural. Still hurt like heck, though.

Maybe I should try for an unmedicated birth just so I can sample each kind. But...not sure I want to.

[Dragon Lady]

I didn't realize you did vbac! I knew you wanted to, but last I remember, the doc here said you couldn't. I'm happy you got your wish!

[Katya]

[enter defensiveness Katya predicted. ]

So I'm either holier-than-thou or crazy. I guess there's no middle ground?

That's the nature of highly charged topics. We stereotype people as holding extreme viewpoints instead of evaluating each contribution individually.

[Marduk]

I'd just like to come into this discussion and say:

I have no comment. This is just so rare, I had to point out that I had no strong feelings one way or the other.

Sorry for the interruption. Continue with your regularly scheduled discussion.

[Yellow]

So, I just wanna say that if I ever end up having a baby, I'm definitely doing it via C-section.

But that's mostly due to the lack of other options.

[Dragon Lady]

So, I just wanna say that if I ever end up having a baby, I'm definitely doing it via C-section.

But that's mostly due to the lack of other options.

I am totally judging you now. [sniff]

Except, not really, because as I stated during Dragon Baby's birth, if you want another child, either you have to do it, or we're adopting. So if you have to have a c-section to do it, I'll be right there holding your hand.

[krebscout]

I didn't realize you did vbac! I knew you wanted to, but last I remember, the doc here said you couldn't. I'm happy you got your wish!

Thanks! I had to switch from a close obgyn to some midwives an hour away to find someone who would try vbac (this was in Washington, not Utah), but I'm glad I did it.

[Rifka]

I… didn't get the same feeling you guys got. Tell me one writer who is looking down upon people who get epidurals. The questioner asked why on earth anyone wouldn't get an epidural and they answered that. I'll bet if someone asked why on earth someone WOULD get an epidural, you'd get a similar response. Heck, Sky Bones even said flat out that she doesn't judge anyone who chooses a different method than she does.

Hypatia's whole answer seemed to be looking down on epidurals to me. She practically equated getting an epidural with getting a C-section. As for Sky Bones, I didn't think she was looking down on epidurals, I just thought she was unecessarily snarky towards the reader at the beginning of her answer: "I have a feeling that your question may have been spurred from my response in Board Question #63089. If that is the case, then next time feel free to throw insults directly my way instead of making misconstrued generalizations about all women." However, she did say that if she was wrong, she apologized for being a bit snarky, so I guess she realized that bit was a little bit rude. I did go back and read all the answers after I read the question the first time, and I realized that I liked Gimgimno's a lot. I thought he did the best job of being fair to both sides and not putting one above the other.

The reactions in this thread make me feel judged because I had a natural vaginal birth (though, not unmedicated. I was induced). Even though I have nothing else against other people getting epidurals. But I guess I have to specify that I have no problems with epidurals unless I'm seen as feeling superior.

I'm sorry if my response made you feel judged, DL. It wasn't meant to. I have nothing against women that go for unmedicated childbirth, I just have something against those that have a holier-than-thou attitude about it. You definitely aren't one of those and I say kudos to you for performing such a great feat.

[Hypatia]

Rifka, if you would like to assume that my answer boiled down to epidural = C-section, that is entirely your choice however the phrase, "significant risk," doesn't normally carry a 1:1 correlation. But, hey, read it as you like.

I would love to see the study you mentioned which shows there is no correlation between epidural use and c-sections because I've read many other studies which show just the opposite. If you would like to reference these studies, they are all mentioned in the documentary The Business of Being Born (which every pregnant woman should watch).

And since everyone seems to think that natural-birth advocates look down on epidural users, here is some fuel for your so-far unnecessary fire: Hey all you womens out there! You are stupid heads! Who takes drugs?! Don't you care about your babies!? Losers!

Have fun.

[Dragon Lady]

Thanks, Rifka. Now that I've got defensiveness off my plate… Let's get back to real discussion.

I've actually discussed this topic with Hypatia, and that might be where she was getting some of her information from. Like I said earlier, I have heard multiple OBs say that getting an epidural increases the likelihood for a C-section for precisely the reasons she stated. It's becoming routine to give women pitocin when they're in labor because childbirth has become a routine procedure and it costs the hospital more money to let people labor for 24 or 36 hours. So they try to get it done with on their time tables. Pitocin is an artificial version of oxytocin, which is what causes contractions. The more the contractions get going, the more likely the body is to respond and say, "Oh hey! I guess I'm in labor. I'd better start contracting here." However, pitocin lacks the ability to cross the blood/brain barrier, so the brain doesn't get the memo for quite awhile to produce the other hormones involved (like more oxytocin, among others that I can't remember) that make laboring easier. So you get the bad without the good. Then when your body does start contracting on its own, you have artificial contractions on top of natural contractions. Contractions go in waves. So if you have a pitocin peak during a natural break and vice versa, you have non-stop contractions. Which your body isn't made to handle. Childbirth was designed with breaks in between contractions. Or you get pitocin peaks on top of natural contraction which makes every contraction twice as hard. No wonder so many people want epidurals! The body wasn't made for that. I was induced with pitocin, which didn't work until they broke my water and I started contracting normally. But they weren't sure that my contractions would keep going on their own if they turned off the pitocin, so they made me keep it. And my contractions were killers. I asked for pain meds, I'll admit. But I was too far along for them to do much good. So I opted out of them. But I begged them to at least turn the pitocin down halfway, which they grudgingly agreed to, so long as I agreed that if I slowed down too much, they'd turn it back up. So I agreed. The difference it made was night and day. It was still painful, but I could actually relax between contractions instead of whimpering and wanting to die.

Anyway, so because of the increase in pitocin in routine labors, more women opt for epidurals. But, like Hypatia said, in most women, epidurals slow down labor, so they up the pit, etc. Often they can find a good balance and all is well in Zion. Often they can't. Which then results in "Failure to Progress" (because pumping a pregnant woman full of drugs isn't great for too long, or because the hospital is on a time crunch) and the woman is whisked into the OR for a C-section.

I am not saying that all C-sections are based on that. Not at all. My sister had a c-section after 5 vaginal births because during the tail end of labor, the baby turned breech. But the simple fact that the US has a c-section rate of over 30% (estimates say we're probably up to 33%) and the recommended limit set by WHO is 15% tells me we're doing something wrong. Especially since many other 1st world countries are doing quite well at staying under that limit.

And yeah, maybe Hypatia didn't do a fantastic job showing that A can lead to B, but A does not equate B. But it is definitely a reason that many women choose not to get epidurals. It was one of my major reasons. (Which is why she and I had a conversation about it.) And I read a lot of birthing blogs and know that it's a major reason for a lot of women. The risk of starting down that road is just too great for our comfort. So in effect, Hypatia did answer the question. That is a reason why people choose no epidural. She knew for a fact that that's why I chose it.

[Digit]

The 2000 Cochrane meta-analysis2 that compared EA with narcotics did not show increased rates of cesarean section (CS) associated with EA. For many practitioners this came as a surprise; in practice EA certainly seemed to increase rates of CS, especially when used before the active phase of labour. Earlier studies5,6 had shown a modest increase in rates of CS when EA was compared with other methods of analgesia. One trial showed such a large effect that the trial had to be stopped.

EA=Epidural Analgesia, CS=Cesarean Section.
But from the study referenced at the end of that last quote:

When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a significant prolongation in the first and second stages of labor, an increased requirement for oxytocin augmentation, and a significant slowing in the rate of cervical dilatation. Epidural analgesia was associated with a significant increase in malposition (4.4% vs 18.8%, p < 0.05). Cesarean delivery occurred more frequently in the epidural group (2.2% vs 25%, p < 0.05), primarily related to an increase in cesarean section for dystocia (2.2% vs 16.7%, p < 0.05).

Kind of like life, conflicting results and no big red blinking answers.

Sources cited:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481670/ <-First quote's article
http://www.ncbi.nlm.nih.gov/pmc/article ... figure/F1/ <-A direct link to a chart in the first quote's article
http://www.ncbi.nlm.nih.gov/pubmed/8238138 <- Link to study with results conflicting with the Cochrane results

[Sky Bones]

So, um, Rifka... you are aware that I usually read this forum, right?

And just so you know, #63161 was submitted within an hour of #63089 posting, hence my defensiveness.