Thursday, March 27, 2008

Let's talk about pain

With some of the buzz around this recent article Epidurals: Time to stop labouring over 'natural' childbirth, I thought I would add a few thoughts and mention some older blog posts worth revisiting.

Okay, first thing: the obstetric anesthesiologist quoted in the article discusses the "lucrative natural childbirth industry" and claims that "Natural childbirth has become a multimillion-dollar industry." First, we have to put this into perspective. He gave no sources for those figures, but I suspect he is referring to childbirth educators who work for organizations such as Bradley or Lamaze. Thing is, childbirth educators make no more or no less money if women take drugs during labor; their work occurs prenatally. If a woman declines pain medications during labor, no one profits. But if she accepts an epidural, a lot of people do: in particular, the hospital, the pharmaceutical company, and the anesthesiologist. I sense some anxiety from the author of Enjoy Your Labor over the viability of his profession if women choose natural childbirth. He has a very vested interest in encouraging as many women as possible to accept epidurals, because that, after all, is what pays his mortgage.

Second, he claims that "much of the information that women receive is incomplete or inaccurate." This phrase implies that natural childbirth advocates--whoever they might be--are the ones doing the withholding. I would argue that the opposite is more often the case; those with a vested interest (monetary or otherwise) in promoting or administering epidurals have an obligation to share all of the possible risks and side-effects of epidural anesthesia. (By the way, Dr. Sarah J. Buckley has written an excellent article reviewing the risks in Epidurals: Real Risks For Mother and Baby.) How often do women receive full informed consent about this procedure, meaning a thorough discussion of all risks, benefits, and alternatives? I do not know, and I would appreciate input on this.

Third, there's all this talk about the "natural childbirth industry" as if it is one unified conglomerate. Who exactly makes up this "industry?" Childbirth educators? Certainly childbirth educators discuss the risks and benefits of pain medications, as well as non-pharmaceutical alternatives, but that is only a small part of their job. Doulas? Not really, since doulas attend births in all settings and encourage the mother to make her own decisions. I really don't know who else might be part of this "lucrative industry" that he claims is profiting heavily from women's non-use of epidurals.

Last, the article itself was poorly written and poorly organized. The sections do not flow well together, and the transitions from one point of view to another were totally lacking. The article relied almost entirely on quotes or paraphrases from other authors, with little explanation or discussion of the ideas. The university rhetoric teacher in me gives it a thumbs-down.

Now, on to some of my old blog posts:

In a different approach to pain relief, I linked to Britain's National Institute for Health and Clinical Excellence, which recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." NICE found that birthing pools were the most effective non-pharmacological form of pain relief and second-most effective overall (with epidural anesthesia being the most effective but having more risks than water immersion).

In my Comments on To The Contrary, I briefly mentioned some of my own experiences of pain during labor. I wrote a long post about pain two weeks after Zari's birth called Some thoughts about a four-letter word.

In my review of Jennifer Block's Pushed, I ended with two quotes about the role that hospital policies play in creating pain. On the same topic, it's worth reading this recent blog post on NYC Moms about how epidurals are for tolerating the hospital; labor is the easy part.

Food for thought had some discussion about pain medications and whether or not they were pushed/encouraged by hospital staff. Several comments from blog readers on this topic.

In Labor and marathons, I examined the similarities between the two events and how attitude and beliefs greatly influence the way we experience and interpret them.

Speaking of marathons, I want to end with a plug for Elemental Mom's post Only One Word. She argued that we just don't have language adequate to describe the sensations of labor, so we use the word "pain" as a distant runner-up. I love how Laureen described labor pain as purchasing an endorphin rush! A quote from her post:
What we’re lacking is the linguistic differentiation, in two syllables or less, to say "pain that is the sign of pathology and illness and needs to be obliterated by any means possible" and "pain that is your body’s way of kicking in an endorphin payoff down the road."

Got that? I’m not enduring labor pain. I’m purchasing my endorphin rush, one sensation at a time.


  1. Ha! You don't have to go any further than the original quote. "Natural Childbirth Industry" Ha Ha! I don't think it costs any money to have a baby naturally, isn't that the whole point!? It's nature! I am glad for your post but I won't be reading the original article. I have chewed my nails enough for one day. Ridiculous crap...

  2. Dr Grant says "Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth."

    I have to look up those studies, 'cause I've been believing the opposite for many years. And I don't think you could've found a baby in any better shape than mine was after my unmedicated birth, so that reinforced my false assumption.

  3. Most studies compare epidural with non-epidural pain relieving drugs (e.g. IM injection of opiate ("pethidine" in the UK)) and it's not at all suprising that babies are in better shape with epidural than with systemic pain relief. However, this is not a comparison with unmedicated birth.

  4. Epidural does not equal painless childbirth. I want to know who is perpetuating that story and beat the snot out of him/her.

    Most Obs want a woman in labor before they place an epidural. It is far easier to augment labor than induce labor.

    However, the anesthesia guys at my hospital don't have to drum up business. I think they would like a decrease of the work load actually.

  5. Oh, so much to say and not sure how to go about it! Epidurals! Studies! Ack!

    First of all, I totally agree that they dont tell you much in the hospital, and if/when they do, you are very likely to be in a very low-receptivity situation to hearing anything from some mumbling anesthesia guy, WHILE the nurse is urging you to "curl your spine, honey, you need to curl your spine" while you are sitting up during a contraction (Likely pit induced at that) trying to "hold super still" -- what kind of a scene is that? (Been there 3 times)
    they mumble some crap at you about how you might get a headache and youre gonna feel some tingling and then thats about it.

    I had an epidural that absoltuely did NOT "Work". this was after I was already well on that roller coaster ride to Tortured Turtle-Ville (Pit, IV's, Blood pressure cuff, Fetal monitors, inside and out, catheter, tiny bed, Nubain, Stadol) and now, this epidural that felt like it had concentrated all of my labor pain into my left hip. Hideous! "Sometimes they dont take, honey" was about all they could offer me, and after several more doeses of "a little something to calm you down" in the IV, I appeared to be asleep ("Mom is resting comfortably, now, Dad if you wanna go get a sanck or anything") but was in more pain than ever and now unable to articulate it at all. A little later they come in telling me that I am at 10, and to give us a good push, I just sort of stare at them, confused, and the doctor says "looks like a section" to someone. Zip zoom we go down the hall, my reproductive future forever altered for nothing, really.

    This tirade is against so many things. Pit inductions for no reason, extremely ovber managed childbirths, AND the dream that epidurals take it all away so you can ENJOY your paralyzed (if it works!) birth. F all of it, I hate it all, it is so wrong on so many levels. I dont know where thses studies come from, they are so so skewed, natural childbirth INDUSTRY? What industry, some little classes first time Moms might take about hee-hee-hoo breathing, what are those, like 30 bucks?

    On another note, I must admit how sad/jealous/frustrated I get when I read these things (usually from the UK, Australia, etc) recommending water births, when they just are not available here for hardly any woman who is birthing outside of the home. So many hospitals have these jacuzzi tubs, but I am telling you, almost everyone is "risked out" of having an un-corded, un-tethered birth that I have ever met. Even at birth centers, I have a few friends who had slightly elevated temps or BP's and --bam!--, no water birth. Makes me wanna move to England, maybe.

    Well, Thank you for letting me go off venting and for continuing to wrote such great stuff, Rixa.

  6. isn't it nice that NYU Medical Center is entirely pro-bono, right, apparently? too bad the meanies in the natural childbirth industry are so darned mercenary about the whole thing.

  7. I have been thinking a lot recently about pain during labor, and specifically the fear of pain during labor recently as so many of my friends have headed off to the hospital to give birth and I also just attended a BFW class with several first-time pregnant moms. So many of us, who have never experienced labor before, are exposed to many, many horror stories about how painful it is. The truth is, at least for people my age, who are delivering now and in the last several years, so FEW births are allowed to happen naturally. The majority or induced, managed, and medicated from the get-go, which, of course, makes the experience more scary and therefore more painful. Labor and birth can be very painful if you are strapped on your back, being pumped with artificial hormones, and being told by everyone who comes into the room that you are really not all that capable of doing this without some sort of intervention.

    I think if more women were able to experience birth with more support, less fear, and the ability to be able to do what their body tells them to do during the labor and pushing phase, we would be surprised at how manageable and even the joyful the "pain" can be.

    Just my two-cents.


  8. What saddens me is that Dr Grant and his readers discount, or would disbelieve, that *that* pain in L&D that begs to be numbed, is very different in nature from the pain I felt as I was sinking deeper and deeper into my self-hypnosis and into the cushions of the couch in my very own quiet, dark, peaceful living room. I'm okay with calling mine pain as long as we can all agree to call theirs agony or torture instead. And he's right; of course no one should have to agonize or be tortured!

    The Times Online article you link to at the top, Rixa, has a comment by a woman who says she got Odent's prescription for the ideal birth setting because the staff sent her husband home and she was left to labor without support in a dark, empty ward used for L&D overflow where the nurses sneered at her when she begged for relief. Understandably, she is literally shellshocked years later. Humanized childbirth has become such a foreign concept that people can't grasp that it's not the darkness that matters, or the solitude, it's the mother's feelings.

  9. "I'm okay with calling mine pain as long as we can all agree to call theirs agony or torture instead. And he's right; of course no one should have to agonize or be tortured!"

    Exactly. Right after Zari was born, I said, "That was hard work but totally doable." I didn't have a pain-free labor, but that wasn't my goal anyway. I *did* have a labor that was full of endorphins, in which pain was one of the many things I was feeling. Most importantly, I wasn't suffering even though I was feeling pain.

    That woman's comment shows a fundamental mis-reading of Michel Odent is saying. Yes, both solitary confinement in a windowless room and snuggling in your comfy bedroom at night have "privacy and darkness" but no one would agree that they are identical experiences!

  10. I have been musing about the language of pain recently too and posted earlier this month about needing more words for pain.

    I have to LOL about the super profitable "natural childbirth industry." I'm curious about where all those millions are located! It reminds me a book review I read once that claimed the only reason formula companies can't tell the "truth" that formula is really as good as breastmilk is because of all the "propaganda" from LLL and the formula companies are afraid of "backlash" from La Leche League if they tell the truth. Uh huh. LLL's $200,000 annual budget can really compete with the billion dollar formula industry and I'll bet that LLL would be surprised to know they wield such fearsome power over formula companies!

    Okay, so I digress.

    Interesting post!


  11. I can't believe anyone is taking this article seriously. It's advocating anesthesia and it's by an anesthesiologist, good grief!!

    "Hard work but doable" is how I think about my labor. It definitely hurt, and I didn't enjoy all parts of it, but at no time did I feel overwhelmed by it, like it was true suffering. It just hurt. I labored in water and had the support of 2 doulas and a midwife, and those things helped me know that I would get through it, and that it would end. Honestly, I'd relive my birth (21 hours, about 10 of active and intense labor and pushing) right now if it meant I wouldn't have morning sickness during my next pregnancy!! Now THAT is torture.

  12. Having given birth for the first time recently, I'd just like to say that it wasn't "painful" per se. The back labor was tough, but as soon as that was over, the contractions and pain felt more productive rather than a nuisance. I will totally go the UC route again.

  13. Tophat--did I just hear that you had your baby? Did I read that comment right? If so, congrats!!!!!

  14. Yes, can someone please let me in on how I can hook my birth services up with those millions please? Because I was under the impression that when I start my midwifery business I'll be well below the 6 figure mark, at BEST! ;)I wouldn't mind making some millions to bring natural birth to women round here.

    My own labors, at home, were surely hard work but doable. My hospital inductions absolutely needed medication. But then, why is that surprising considering that I was already being 'medicated' with pit and AROM? Once again Joy, I feel your pain. Stadol is the devil's drug. I felt ALL the pain, I was just no longer coherent enough to handle it. I was screaming and thrashing and completely out of control. What a way to bring a baby into the world. And if the majority of women are seeing pit in labor, no wonder doctors and labor nurses think that's what 'natural childbirth' looks like.

  15. I happened by your blog through a friend of a friend. Very informative. Thanks!


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