Why are women with partners more likely to opt for drugs in labor? - Page 3

[Lucy&Jude'sMama]

My partner and I didn't take classes. He wasn't the most wonderful birth partner but I'm more of an independent birthie anyways so that works. However when it came to pain medication. The first time I didn't even ask for it. This 2nd time was a lot faster and therefore a lot more intense so when drugs were mentioned I perked my ears up... But my partner was right there and knew I didn't want drugs so he automatically told them we didn't want them. Now... That's great but during I remember being a little annoyed by him at that moment. Hahaha so I guess the study doesn't apply to me.

[lemonapple]

I had a long labor...very uncomfortable right from the beginning thanks to back labor. I thought I didn't need a doula because my partner was very on-board about a natural birth...midwives, birth center, etc... Basically, what I wanted, he intended to help me get. 

Buuuttt...he was frankly no help whatsoever during the nearly 24 hours of "early" labor. He basically slept the whole time because he didn't think there was anything he could do as I wasn't so uncomfortable that he thought it was serious. Nevermind that I was too uncomfortable to SLEEP myself! lol, We were finally transferred over to the hospital for pitocin, and it's my theory that the pitocin wasn't necessary. We were on it for an hour? maybe? and I had dilated to 6 cm from a HARD WON 3cm. I had the pitocin turned off and I birthed my son naturally with the suddenly AMAZING support of my husband in just 8 hours. 

My theory is that I was actually really unprepared for back labor. It took me by COMPLETE surprise and felt like NOTHING I'd ever read. I spent the first 12 hours kidding myself that it was just Braxton Hicks and walking non-stop. I needed someone to understand what I was going through, to sympathize, to massage, to make me eat, to get me EXCITED about what was happening and somehow rest up for the next stages. Instead dp SLEPT! In the hospital, he had to act the role of support...and did a beautiful job, but I needed that to happen in the beginning! Had we waited longer at home, I imagine I would have been even more exhausted/probably angry at him and less likely to suck it up and stick to my own plans. 

We're planning a female-only birth next go around. Having trained as a doula, I know that's exactly what I need to birth...female understanding and companionship. I imagine the same help I think that sort of birth would get me must be true for single women....the experience of my son's birth and my doula work with single women is that their support person is normally a close female relative or female friend. And, even if the support woman hasn't gone through a birth, she's likely to exude excitement, sympathy, and even crack jokes...not to mention , they get right in there with the touching! And, maybe I'm going on a limb here, but the support women I see EXPECT there to be noise, sweat, blood, and discomfort. Things I'm not always sure the most prepared man REALLY is ready to handle.

[tireesix]

OK, for baby number one, DH was there and I ended up with pharmacological pain relief because I wanted it, I think part of the decision was because he was worried and didn't know what to do and was concerned about me but man, that labour hurt!!!!!!!!

Baby number 2 was a homebirth, I used gas and air but it ran out before DD2 was actually born and I only managed to have about a 1/4 of a can anyway because it wasn't working properly. DH didn't like seeing me in pain but he was mighty proud of me managing to birth with so little relief.

Both the above births were pretty hard going but:

Baby number 3, another home birth but no one was around, DH was either asleep, having a coffee outside or in the bath, I saw him for perhaps an hour during the 5 hour labour lolol. MW wasn't around until 10 mins or so after the birth and DH appeared from his bath about 5 mins after the baby was born. While again it hurt like hell, it was the easiest birth by far, so, I do kinda believe the Michel Odent thing about guys not being around during labour, I found it much easier. DH has always been very pro home brith, he was also very proud when ever I birthed with little or no pain relief and he has always been impressed about me birthing in silence (I don't know why because he always complains I am not noisy enough during sex?????). With DD3 I just felt able to be a bit more free, I was less inhibited (still very quiet because I didn't want to disturb anyone), it was just more comfortable. I would have loved for DH to be there, maybe it wasn't the lack of DH being around but the lack of having a MW around that made it easier because I wasn't being poked and prodded????

I reckon there are numerous reasons, women not liking there husbands seeing them in pain, men not liking to see their partners in pain, women wanting to appear more 'dignified' or summat during the birth in front of their husbands.

[Chavelamomela]

Originally Posted by Mommy2Austin 

Originally Posted by TCMoulton 

Originally Posted by Chavelamomela 

Dr. Michel Odent has spoken out against men/husbands being in the delivery room FOR MOST CASES.

Now, this is not referring to our DH's who are awesome birth partners.

But I can tell you, that for many men, their nature, as men, is that when they see their loved one in pain, they want to DO SOMETHING to help.  For some, who have been properly prepared with a Bradley class, or read "The Birth Partner" they will step up to the plate and put their energies to facilitating an active labor.

For other men, they will look at their wife in pain, look at the doctor, back at the wife, and say "Doctor, she's in pain - DO SOMETHING!"  and then the epidurals and interventions begin...

1) This is a HUGE assumption to make - that only the partners of good crunchy MDC members are worthy birth partners and honestly, is a bit offensive.

2) My husband, who was by my side for both of my labors, had no part in making my decision to receive an epidural and I highly doubt that a doctor or midwife would act on the demands of a dad to "do something" for his wife/partner's pain.

1) I honestly don't think she meant it in that fashion, just that Michael Odent's words weren't meant to say that NO HUSBANDS/PARTNERS should ever be allowed in the delivery room, and that those of us with husbands/partners who were really awesome in the delivery room shouldn't take it to mean they shouldn't be there. Has nothing to do with being on MDC or being ultra crunchy or anything.

2) You would be surprised by how many Drs./Nurses would act on a father's demands...maybe not by straight up giving the wife meds, but putting serious effort to convince her she needs it/wants it and falling into consent. Happens more than you'd think.

Thanks Mommy2Austin for explaining.  My words had nothing to do with MDC-specific/crunchy/hippie birthing moms (or whoever you think I was referring to).  I was referring to those exceptionally supportive, wonderful and super-terrific husbands that have been there as crucial support for their wives' natural labors.  Some of us have those types of men, others don't, and its not a criticism of either, just an observation (nor is it a connection to how crunchy that person is...).   I was referring to Michel Odent's advice, because in general, it DOES have merit - that most husbands may not belong in the birthing room, but allowing for exceptions such as those husbands who have been crucial birth support for some women.

[raelize]

ITA with mommy2austin. i hb both my kids, but i know with the first i was so focused on everyone else, i didn't do that work i needed ot and it was HARD and long.  withthe second i had learned tojust seclude myself and it worked very well. i am sure there were other factors that made dd2's birth easier, but i was better able to handle it when i was alone.

[MegBoz]

Originally Posted by MeepyCat 

It's not even that necessarily:  a woman with an epidural (snoozing in bed or chatting with her support people, hooked up to monitors that read out at the nurse's station) is a lot less work for the nurses than one who is up and walking, feeling every contraction, moving around so the monitors slip, and asking for help with comfort techniques. 

Yup, exactly! That same mama also won't be moaning or screaming in pain. I've heard stories of nurses telling mamas to be quiet because they're disturbing the other patients!

I would imagine the mama with the epi is also easier to deal with in terms of being "obedient" with things like submitting to hourly vaginal exams & has less room to protest giving pit to or doing AROM in order to speed things up (& hospitals really seem to 'push' birth & usually want to speed it up.)

[MeepyCat]

Originally Posted by MegBoz 

Originally Posted by MeepyCat 

It's not even that necessarily:  a woman with an epidural (snoozing in bed or chatting with her support people, hooked up to monitors that read out at the nurse's station) is a lot less work for the nurses than one who is up and walking, feeling every contraction, moving around so the monitors slip, and asking for help with comfort techniques. 

Yup, exactly! That same mama also won't be moaning or screaming in pain. I've heard stories of nurses telling mamas to be quiet because they're disturbing the other patients!

I would imagine the mama with the epi is also easier to deal with in terms of being "obedient" with things like submitting to hourly vaginal exams & has less room to protest giving pit to or doing AROM in order to speed things up (& hospitals really seem to 'push' birth & usually want to speed it up.)

Y'know, that description really does not match my experience of hospital birth at *all*.  Having the epidural actually facilitated my refusal of pitocin - because I was alert, calm and undistracted by pain, I was able to object immediately and coherently when the subject came up (and the nurses even backed me).  The only vaginal exams I had were on request (I wanted to know if I was dilated enough to push).  I wasn't particularly obedient (or quiet at the end), and no one said a thing.  They helped me push for five hours, and two nurses and one doctor stayed three hours past the end of their shifts to see me through.  My second delivery is a whole 'nother kind of war story (emergency surgery), but everyone was really nice during that too.

I know that I'm lucky in having had good experiences, but I want to point out that they do happen - the hospital staff is not automatically the enemy.

[pregnant@40]

In my case, I had both an epidural and my partner present for my son's birth b/c I wanted all the support I could get. To me, having both the epi and hubby felt like a complete experience for me, and helped me relax and enjoy the process.

[mmaramba]

Having skimmed the thread, I'd have to agree with some of the likely contributing factors discussed here:

1) Single mothers and young mothers (21 or younger-- who are also more likely to be single and vice versa) are more likely to be treated as lower priorities and even (on occasion) "punished" with the delay of anesthesia.  On the positive side (also leading to less use of drugs), if these women are neglected/given less "attention," (including intervention) they may also be able to get into a labor groove and cope well enough with labor pain on their own.  As a corollary, though it is anecdotal, it sometimes seems that young FTMs (who are less likely to have male partners) have been less polluted with ideas about the necessity of epidurals, and are more likely to rebel against authority and do what they want, which may include avoiding big scary needles.  If they haven't heard 1000 stories about how they NEED epis (because an 18 year old has had fewer peers with kids than a 30 year old), they may cope better overall. 

2) Women with male partners are less likely to be able to "let go" and be uninhibited (think of all the women mortified of their husbands seeing them poop, or even seeing the baby come out at all), creating higher levels of stress and therefore pain, etc.

3) Women with male partners are more likely to want to calm their partners' fears about pain and "imminent disaster."

4) Male partners have a tendency, on average, to be more willing enforcers of the policies of those in positions of authority.  Especially given that they have never been in the position of birthing themselves, they are even more likely than women to believe that doctors/hospitals only ever do and suggest things that are safe and beneficial.  Thus, the more pain relief is pushed, the more men are likely to also push it to their partners (again, just on average).

5) Married and long-term partnered women are more likely to have better insurance and thus given the "full treatment."

[2lilsweetfoxes]

When I went through labor with baby #3, I was at the absolute limit--my dd (age 7) and ds (age 5) were freaking out at the sight of mamma in labor and in pain).  And, I knew I only had a few more hours left, so let's get some drugs (aka, an epidural) so that I can  "enjoy" the labor.  (suffice it to say, I had the baby a few minutes later, no drugs...not even time to get the IV inserted)

[soso-lynn]

Parents who are in a couple need to compromise. Women who otherwise would never think of mutilating their sons will do it in exchange for the right to co-sleep or some other thing. This process of continually having to compromise can make women less in tune with their instincts and more likely to end up with interventions. I am sure that many women here have had to fight their husbands for a homebirth or a VBAC. It seems that the one who needs to provide evidence is always the one who wants to deviate from the norm and right now the norm is to get an epidural. Single women only need to convince themselves while in couples, two people need to be on board.

[AlexisT]

Originally Posted by Super~Single~Mama 

Thats an easy one - insurance pays for interventions, they don't pay for people not to get interventions - Birth is a business, hospitals make more money off of birth, than anything else (I read that somewhere, don't know where).  But they wouldn't make money off of it if they weren't getting paid by the intervention - a woman who gets no epi, no pit, no IV, has her baby and walks out 6-8 hours later, well, they don't get much in the way of $$ for her birth.

Maternity is a net loss for hospitals. This is why many hospitals have closed their L&D departments. It's only a money-raiser in the sense that maternity services are more consumer oriented and the customers have the ability to be choosy. Hospitals sell their maternity services because they want to create loyal customers for services that are profitable (cardiac care and oncology lead the table; maternity and ER are the big losers). The NYT had a table the other day showing what a NJ insurer paid for various procedures. An SVD went for $2-3K. Medicaid will pay half that. If L&D had to be self-sufficient we would not be seeing the shiny new wings with private LDRPs. The payments for the interventions add to the gross total, but that doesn't mean it covers the cost of providing them. Birth is a business, but it's not a very good one.

Money does come into it in terms of utilization. If you're going to provide a 24/7 anesthesiology service, which patients want (forget epidurals--they don't want to be waiting for the anesthesiologist in an emergency) you need to have enough demand to justify the cost of keeping that anesthesiologist in the hospital. Most nurses and doctors don't actively make that kind of calculation--an administrator will crunch the numbers and decide what's economic to provide. But it has been demonstrated that availability of services and procedures affect the care that HCPs provide. When a hospital gets a new CT scanner, they do more CT scans. HCPs practice according to the standards of their peers, whether it's a conscious effort (as in hospitals where the head of department starts a program to reduce use of a procedure) or unconscious--copying what they see. Money is part of the cultural matrix, but it is not a conscious decision.

[happysmileylady]

Originally Posted by 2lilsweetfoxes 

When I went through labor with baby #3, I was at the absolute limit--my dd (age 7) and ds (age 5) were freaking out at the sight of mamma in labor and in pain).  And, I knew I only had a few more hours left, so let's get some drugs (aka, an epidural) so that I can  "enjoy" the labor.  (suffice it to say, I had the baby a few minutes later, no drugs...not even time to get the IV inserted)

You know, I wonder if this might also be a contributing factor...the other kids.  I don't know statistics but I would guest that when compared to each other, women who are married/have long term partners, are also likely to have older kids.  When I had my last one, my middle one was 2 and I knew there was no way that I could have had her in the room at all.  So she wasn't present, I didn't see her at all the entire time I was in labor, until I had the baby.  I think that other women in the same situation might choose seeing their kids while in labor, over no meds.

[sunnygir1]

Other than what's been mentioned, I don't see any reason for that to be true.  I guess I was conscious of my husband's discomfort, but it never crossed my mind to take medication to alleviate it.  And my husband never suggested it either.  The hospital staff offered once, but that was all.

I feel like if the husband/partner were the only person there who knew the laboring woman it might be a little more likely that she would than if a doula, mother, or sister were there because the woman might feel more "pressure" (or "support") to do the right thing or tough it out in front of another mother or natural birth professional.

[GoBecGo]

The Michel Odent article is an interesting one.  One of the reasons he gives is that men seem territorial and stressed - he doesn't seem to recognise that he makes these observations from a position between the man's partner's thighs!  He also doesn't advocate male Ob's not being around for labour.  I think he is a wonderful intelligent man and has made many fabulous observations in the cause of normal birth, but i also think he is human and also can be a victim of subjectivity.  How many UPing women report their husband was territorial and stressed during their births?  It's such an intimate situation, and very hard for ANYone to negotiate, male or female.  How is the husband supposed to act when another man gives his partner a VE which obviously causes her pain? How is he meant to act when he sees his partner in pain and feels he is being observed by the strangers who staff the hospital they are at?  

I prepared my DP not by warning him of blood or gore or poo, or by telling him about screaming or agony.  I told him to imagine i was running a marathon.  Imagine i trained for a long time, and really really wanted to run this marathon.  I said, i need you to be my supporter, my cheerleader.  I need you to know that the pain i will go through is pain i embrace as part of the task of the marathon.  I need you to view that pain as part of my achievement, not an optional thing i should avoid.  We are both runners/exercisers and both have trained through moderate discomfort to be fit for things we really wanted to achieve.

It worked.  He was amazing, start to finish.  He was low-key but attentive.  Light-hearted but careful with me.  He responded to my requests instantly and throughout whenever he felt disconnected from me or concerned he would come and be with me a little and we would reconnect (two strong memories of the birth - one in the middle of the night, i was contracting only every 10minutes and dozing in between and i would wake and groan at each contraction - he was sleeping, spooning me, but would wake and tighten his arms around me every time, i felt completely anchored and loved, and later on, when i was nearing full dilation, i bellowed through a contraction and when i opened my eyes his concerned face was close to mine, i smiled at his funny frowny concern and he laughed and we were Us again).  We were at home, in HIS house, and the MW was our welcome guest.  

I would have to see the study to guess whether it was socio-economic/pain-as-punishment-for-naughty-girls or women trying to appease partners, but i will say that i have worked in hospitals and the number one reason i have seen for staff offering pain relief is that they are human, they don't like to see suffering, and want to alleviate it (i'm in the UK, epidurals COST the system and make no money).  My own MW is independent and carries, theoretically, gas and air, but she is in a unique position of being able to build a personal relationship with her ladies, so she is much better able to support them without the use of drugs.

[BarefootScientist]

All of the things mentioned here are interesting ideas, and I would have to see the study to really form an opinion, but I did want to point out that we are most likely talking about a general population of birthers here, not necessarily people desiring a natural birth. So we, as people posting on the "Birth and Beyond" board at MDC may be looking at it from a different perspective. Something like 70% of the people in this country (was it a US study?) get epidurals right? So it's safe to assume that the percentage of people who are committed to natural birth are at least a minority. So perhaps they WANT epidurals. Which gets into the single women being treated not-as-well argument.

Not only that, but I think the average DH is just not a good birth partner. I know a lot of you mentioned the wanting to fix the pain aspect but not even that - just that they have no idea what to do! Most women are not in the least prepared for labor, and neither are most partners. We even took a basic hospital-based birth class for our first, and my DH was totally useless in labor. I wonder if a lot of the issue might be that there is such a huge expectation on men to be such a supportive presence, and they just don't know what to do. If a woman buys into the cultural expectation that her DH is supposed to be her rock during labor, she could end up being disappointed, and getting a lot less support than she was expecting. That could certainly contribute to the choice of an epidural, IMO.

That's what I think.

[CBEmomma]

I'd like to see a detailed study about that, would be interesting. When I was a Doula I mostly worked with married moms, only had a few single clients. I noticed a trend with the husbands that they wanted their wives to take pain medicaiton so they didn't have to see them in pain. Their wives taken pain medication was mostly for the husbands piece of mind. I worked with several homebirth couples and the husbands seem to cope with their wives in pain a lot better, maybe it was because they were in a familiar place and had more options to move around.

[elanorh]

Originally Posted by BarefootScientist 

All of the things mentioned here are interesting ideas, and I would have to see the study to really form an opinion, but I did want to point out that we are most likely talking about a general population of birthers here, not necessarily people desiring a natural birth. So we, as people posting on the "Birth and Beyond" board at MDC may be looking at it from a different perspective. Something like 70% of the people in this country (was it a US study?) get epidurals right? So it's safe to assume that the percentage of people who are committed to natural birth are at least a minority. So perhaps they WANT epidurals. Which gets into the single women being treated not-as-well argument.

Well, despite the 70% rate (or is it higher?) - I don't think that all 70% go in wanting the epidural, or not committed to a natural birth.  When I was pregnant with dd1, about 1/3 of my friends who'd had babies told me OMG YOU MUST GET AN EPI.  And about 1/3 told me - go natural (excepting my family, who are all NCB folks and would seriously skew the numbers as we're a large family). 

I've several friends who wanted a natural birth but "hospital happened."  So they ended up with pitocin, pitocin and epi (or other pain med), or etc.  They researched it, they took the classes, they thought they were prepared - and they had an epi anyway.  :(  One friend who's had 6 babies has described her experiences - she went in wanting natural births.  First two were inductions that rapidly became epidurals.  Five involved pitocin.  ONE was completely natural, no pitocin to 'augment' contractions, no epidural.  Her recollections of how things went down (and again this is all anecdotal although it involves several different hospitals) is that her natural birth was assisted by several nurses who were supportive.  They believed her, and when she was struggling to manage pain, they suggested alternate strategies (walk, birth ball, etc.).  Her last birth, she made it nearly to transition before deciding she wanted an epidural.  She said that in retrospect, having *had* births without epidurals and one without pitocin, she should have known to get up and move around, etc. to manage pain --- but she was in laborland and didn't think of it.  And the nurses wouldn't let her limit their fetal monitoring, and disrupted her 'zone' in labor asking all sorts of questions, and when she was in pain immediately told her she should get an epidural, etc.  In this case, a husband who'd seen several babies born with epidurals and didn't think it was a big deal - and a mom in pain and a staff who thought she ought to just get it already, all contributed. 

I've read that something like 80% of births in American hospitals use pitocin to manage labor prior to birth --- that alone ought to be increasing the likelihood of a mother requesting an epidural, regardless of her intentions before she arrived at the hospital and was given the pitocin! 

It would be interesting to know how many mothers hope for a natural labor -- and how many go in planning for their epidurals.  Anecdotally, from among my friends, I'd say that about half of my friends wanted (or were at least open to) natural labor, and about 1/3 were in the "give me drugs before the labor even starts" category.  But not all of my friends who wanted natural labor got it - two recently had c/s, in fact, one for breech and one for "cascade of interventions = failure to progress."  Both were really excited about a natural, intervention-free birth.  But, both were pregnant with their first and not comfortable taking the leap to work with a birth center or homebirth midwife. 

One thing I found interesting with one of my friends who had an epidural - she is very, very modest.  As in, kissed her husband for the first time on the wedding altar.  She labored in a birth center for over 24 hours before a hospital transfer.  Got an epidural, and had her baby shortly afterwards.  I am convinced that she was inhibited by giving birth in a strange place etc. with strange people - and once she wasn't able to feel/control as much, she relaxed and gave birth.  She went on to have two more babies, both natural births. 

[BarefootScientist]

elenorh, absolutely, it's true that we can't say that all 70% of women who get an epidural intended to when they started out.  Of course.  But I don't think we can say that most of them intended natural birth either.  I really think the norm in this country is a managed, take the pain away birth.  Your friends may not really be an unbiased sample.  Of course, my experience isn't either.  I did try to do a quick search to see how many women WANT epidurals and couldn't find anything...but my point was that the norm and the expectation is an epidural, so our viewpoint here of seeing epidural as non-ideal may be off-base from what the women in the study were thinking.  At least that's the general feeling I get from our culture.  I could be wrong.

ETA:  Ok, I did find a babycenter poll.  Real scientific, I know.  ;)  It asked, "will you have an epidural during labor?"  55% said yes, 23% said no, and 21% said I don't know yet.  So less than 1/4 of women were committed to natural birth.  Even if all the "I don't know"s became committed to natural birth, that's still less than half of the total. 

[Lady Lilya]

My SIL planned to have a natural birth.  She knew that I had had one (at home).  She ended up with an epidural.  Afterwards, she asked me how I could possibly have done it without pain meds.  I told her that from what I hear it is a very different sort of experience in a hospital, and you can't really get into the state of being where it is easier to deal with the pain.