To Dr. Grant, regarding the content of the video:
It's not that epidurals automatically lead to c-sections, but they are part of a constellation of interventions that collectively lead to an increased risk of a labor that is not as efficient and effective as it could be. You get induced with pit, it hurts like He##, you want relief. You get an epidural. The epidural causes a fever, a section is called for potential maternal infection. You feel you are in too much pain, so you get an epidural. Contractions slow down, so they hang pit. and start titrating it up. The pit. causes the baby to go into distress, a section is called for that reason. The epidural means mom is stuck in bed, and the fetus' descent is arrested because she can't move to push. A section is called for CPD or FTP. Having an epidural takes away a mother's mobility and her body's ability to tell her HOW to move. If getting the baby down and out is all about an incremental set of movements between mother's body and baby's, being numb from the waist down is a barrier to doing that labor dance. SO, it's incumbent upon hospital staff to make sure mom is getting moved every hour or so, rolled from side to side, put in a Texas Roll (Trochanter, Exaggerated Sims), encouraged to be mobile even in 2nd stage - use that squat bar with a rebozo to pull on, get her up on her knees, draped over a birthball and pushing that way. If moms had better support to help them mimic what they'd be doing if they didn't have an epidural, there would be fewer dysfunctional labors.
I also have to agree with the other MDCers that "society" does NOT tell women that it's bad to have an epidural. Look at all the mainstream media portrayals of childbirth - "dangerous screamfest" seems to be the order of the day.
Re: there not being a 'right' time to get an epidural. I would say that if a woman's body has not established a good, active labor pattern (no matter what her dilation is), then it would not be an optimal time to get an epidural - it's too soon to make that intervention. What if she gets an epidural in early labor and then labor peters out? Then you are on to the pit. and more committed to medical interventions. If you don't have the epidural, labor peters out, you go home and sleep. You want labor to have a good head of steam and want the mom to have made good cervical change before you go for pain relief. I think it's important also to do what you can to encourage that baby to rotate and descend and be in as good a position as possible before you take away that mom's full mobility. If the main goal of the epidural is to take away sensation, then I guess it's never 'too late' to do one, but I think a lot of moms who make it through transition and get to second stage might be able to push more effectively without an epidural, and at that point, it would behoove the HCP to talk with mom about the benefits of having vs. not having. If mom has a pathological fear of pushing, maybe it's still a good call. But if the doc. wants to help mom reduce chances of tearing and (again) give baby and mom the best options for making that descent through the pelvic outlet happen, mobility is your very good friend. Also, not having an epidural can help moms push with more control and maybe tear less...
Re: pain is subjective. Yes, it is. I had two unmedicated births and used primarily movement, hydrotherapy, and vocalizing to dissapate the energy of the contractions. They were intense, but not painful, per se. But I have worked with women who had back labor that clearly tipped into the category of suffering. So, I would NEVER tell a mom what she needs. It's her body and her mind, and she will know if she needs relief. It is my job to make sure they have good information BEFORE the labor about what to expect, coping techniques, risks and benefits of interventions, etc. If a mother goes into the labor feeling confident, powerful, and prepared, (and with a support team she trusts), her perception of pain will be diminished in comparison to a woman who goes in scared, tense, expecting labor to feel like she's being ripped apart by an alligator, and who is ignored or belittled or told she "has to" do X, Y, or Z. So, again, I say it is incumbent on providers to help women be in the first category, not the second. Reduce the fear, you reduce the perception of pain. Reduce the stress, you improve mom's ability to relax. The issue of pain can be dealt with through movement, massage, using a shower or tub, acupressure, hypnosis or guided meditation, progressive body relaxation. It doesn't have to be managed medically.
Dr. Grant, I have to take issue with one of your statements. SUFFERING DOES NOT GO ALONG WITH LABOR. As a man, you CANNOT know what labor is like. Labor is not suffering. I found it to be a time out of time, a fresh unfolding moment by moment with joy, doubt, intensity, moments of pain, moments of feeling connected to the entire Universe and the Eternal. You CANNOT say that it is suffering. You haven't done it, and to say that it is suffering makes you just one more person dictating what a mother's experience will be. Delivering a baby was NOT the most painful experience I have ever had. Honestly, the sinus headache I had last winter after taking two airplanes to get from Iowa to California (with a 3 1/2 year old and a 1 year old and no other adult and the attendant stress) was waaaaay worse than labor. It had me crawling on the floor, puking, and seeing spots, and it was unrelenting. Contractions at least give you breaks between them when you can relax and even catnap. I would go through labor 10 times before I'd go through that again.
"It helps the obstetrician or midwife achieve a good vaginal delivery." Whoa there, host dude...the WOMAN and BABY are the primary participants in this whole delivery gig. It's not a situation in which the OB HAS to manage. Much of a good vaginal delivery involves sitting on your hands, doing nothing but letting the woman do her birthing thing. Do you have to coach somebody in how to poop? Smooth muscle has its own knowledge...
Having the information and being in control is important, you are right. But give them full information about ALL their options for coping with pain. I also still don't know where this "society tells women" thing is coming from -- Ricki Lake? You are obviously advocating for them to get pain relief. And our society is ALL ABOUT avoiding any kind of pain - physical, emotional, financial. I think that epidurals are like ANY OTHER intervention that a laboring woman could be offered. There is an appropriate and timely use for them, and then there are times when it is NOT appropriate to use them. If mom cannot relax and is fighting the labor and not allowing it to come and do its work, the epidural lets her body disconnect from her brain and dilate the rest of the way. If she's been in labor for 36 hours and is reaching the point of exhaustion, the epidural lets her sleep so she conserves energy and can push the baby out.
Labor is at least as much a mental/emotional/psychological event as it is a physical one. I strongly believe that when women are well informed and feel safe and secure in their own power, a normal labor is something that is a "totally survivable experience." Contractions come and go, there are moments of intensity and doubt, moments of laughter and pleasure too. It is a momentous event, and whether a woman labors unmedicated, has an epidural, or a c-section, it is always a miraculous and deeply spiritual event. We need to better attend to this aspect of birth in the hospital setting.