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Epidural without guilt? - Page 3  

post #41 of 135

WOW. There is not enough time for me to respond to all of the statements above. But I will say a couple of things:

 

To chaoticzenmom: The "walking epidural" that I have been using routinely for 20 years no in my practice allows most women to move around uite a bit, and, yes, even to walk, if their obstetrician permits it. Fact is, most women prefer to rest comfortably in bed wile their uterus does the work and their cervix dilates. I have been asked to place epidurals late in labor for women who were in too much pain to push effectively. Women with "walking epidurals" can get in all kinds of positions and squat or whatever they need to do to enhance delivery.

 

To aleatha5: Fortunately, ethical randomized studies CAN be designed. They have been done, they are being done now, and hopefully, they will be done in the future. It's the only way we can get meaningful, reliable, data. But the unstated basis of your concern is reasonable: Since everyone knows and agrees that epidurals are without doubt the best way to releive the pain of childbirth, how can we design a study that randomizes women to a group that is denied the best pain relief?

 

To phathui5: The table you refer to is quite flawed. Many, many errors. But there certainly are risks to epidurals - some really bad risks. But there are risks to a lot of things in life. For example: there is a risk of driving to the hospital. So is home birth safer? Well, the most recent data shows a 2 to 3-fold greater risk of death for the baby at home compared to hospital. Everyone has to make their own INFORMED decision. What I have attempted to do in "Epidural Without Guilt" is make a point that is usually not made: That AVOIDING the epidural may very well be more risky than using the epidural.

 

To soso-lynn: Can we please stop speaking about the financial aspect of this? I have made it very clear that I do not benefit financially from putting in an epidural. I work in a very large department and the fee for any one particular epidural represents a miniscule percentage of our income. Obviously, if no woman wanted an epidural, it could be a different situation. But that's not going to happen. More than 70% of American women use epidurals and spinals. Others avoid them like the plague. That's their decision. An more power to them. But decisions should be based on data. Not misinformation. Not fears. Not myths. Not pressure from anyone. But really, please stop discussing the financial aspect of this. It's not the reason I enjoy placing epidurals iin laboring women. The gratification of relieving a fellow human's misery is more valuable than any financial reward. Furthermore, I know that doulas make quite a bit of money - cash in many instances - for providing care for women in labor.. But I would never impugn their motivation. I wouldn't say: "Oh, they're in it for the money" even though being a doula is obviously very rewarding financially. I believe doulas are doulas because they truly believe that they are providing an important service. So c'mon now. Enough money talk. let's stick to what's best for mom and baby, OK?

  

post #42 of 135
Quote:
Originally Posted by soso-lynn View Post

You could not be more wrong. Women are harassed from the minute they enter the hospital to get an epidural. They come in wanting a natural birth but have strangers sticking their hands up their vagina, giving them pitocin if they don't follow the schedule, force them to lie down on a bed with machines hooked up and every so often, someone will come in and tell them that the pain can all go away if they just get the epidural and stop being difficult. Women have to fight to get a shot at a natural birth. The problem is not with childbirth educators promoting natural birth, the problem is with hospitals making it impossible. That guilt women feel, they call it guilt and not anger only because people like you keep inserting guilt into the discourse. Next time you have a woman tell you she feels guilty about the epidural, try apologizing for contributing to turn the birth of her child into a medical production instead of telling her it was not dangerous.


My hospital births were nothing like this. I had amazing, glorious, natural childbirths with no drugs and no interventions of any kind. My Bradley trained hubby and I were calm and in charge of the whole birth from beginning to end and had great time with our CNM.

 

I think DrGilbert here is outta line. I ran a new mom's support group for seven years. Horrible backache and migraines were quite common after effects on the moms who had a an epidural. And the studies I've read say that the drugs run through the epi line do cross to the baby.

post #43 of 135
Quote:
Originally Posted by DrGilbert Grant View Post
 Since everyone knows and agrees that epidurals are without doubt the best way to releive the pain of childbirth, how can we design a study that randomizes women to a group that is denied the best pain relief?

 


That's hilarious and tragic at the same time.

 

 

Dr Grant, I wish we could have this conversation face to face to get to the bottom of it all. Why do you think pain relief should be common or needed for giving birth?

post #44 of 135

@dr. Gilbert Grant.  My 2nd epidural WAS a walking epidural.  But as soon as you have a complication, you're on your back.  The fast heart-rate and stalled labor was a complication. 

 

So, one epidural lowered my blood pressure and caused fetal distress and the 2nd caused a fast really fast heartrate and stalled labor.  I'm a really strong, healthy person, so I can't imagine that I"m the exception.  I suppose it's possible. 

 

I have absolutely no guilt for having the epidurals.  But I didn't have an ideal birth in my head either, so maybe that was why.  I don't know why anyone would feel guilt over a cesarean, but I know many do. 

Dr. Gilbert, you said:

"The gratification of relieving a fellow human's misery is more valuable than any financial reward."

 

This is key.  I'm sure many doctors think that's all there is to it.  Relieving misery.  But they don't see that they could be setting their patient up for failure as a result.  They want quiet, easy, pleasant, pain-free births. Who wouldn't?  I know i'd prefer that.  But that's just not how it works for a lot of women.  For many, it's the start of many interventions that make women feel robbed of the whole experience.  Giving birth how a woman wants it is very empowering.  For months after giving birth with no meds, I felt high, like I could do anything in the world.  The pain can be wonderful for some women, but doctors don't realize that in the heat of the moment.  When you see someone in pain and you have the means to relieve that pain, I imagine it would be hard not to just do what you can to relieve it. 

post #45 of 135
Quote:
Originally Posted by DrGilbert Grant View Post


Hi mntnmom: I'm the doctor who wrote the book. Here's the information you're wondering about: Many studies from different parts of the world have clearly shown that epidurals do NOT cause an increase in the cesarean rate. It's one of the things I discuss in my book, but if you don't want to read my book, just read the studies. You can search for them for free from the National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmed/

And thank you for your comment. My goal is to help women. Some want pain releif for childbirth, others don't. It's a very personal decision. But to make an informed decison, you need the facts.



Dr. Grant: I share mntnmom's question. Could you possibly provide citations for particular studies or at least suggestions about search terms? I did, as you suggest, search PubMed and the results I found were neither particularly recent nor particularly supportive of your positions.

To give you an idea, here are the articles that I found (sorry so long):

Can Fam Physician. 2006 April 10; 52(4): 419–421.
Does epidural analgesia increase rate of cesarean section?
Michael C. Klein, MD, CCFP, FAAP, FCFP


Conclusion: Contrary to the conclusion of the Cochrane meta-analysis of EA compared with narcotic analgesia, EA given before the active phase of labour more than doubles the probability of receiving a CS. If given in the active phase of labour, EA does not increase rates of CS. Meta-analysis can be helpful and timesaving for busy practitioners, but we need to be vigilant about which studies get into the meta-analyses and ask ourselves if they make clinical sense. And, unfortunately, we need to continue to read the individual studies that make up meta-analyses—especially if they are likely to actually change practice—to determine whether study conditions represent our clinical reality.

Am J Obstet Gynecol. 1997 Dec;177(6):1465-70.
Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia.
Bofill JA, Vincent RD, Ross EL, Martin RW, Norman PF, Werhan CF, Morrison JC.


STUDY DESIGN: Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted.

CONCLUSIONS: With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.

Anesthesiology. 1997 Sep;87(3):487-94.
Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor.
Sharma SK, Sidawi JE, Ramin SM, Lucas MJ, Leveno KJ, Cunningham FG.


CONCLUSIONS: Epidural analgesia was not associated with increased numbers of cesarean delivery when compared with a suitable alternative method of analgesia.

Obstet Gynecol. 1996 Dec;88(6):993-1000.
Association of epidural analgesia with cesarean delivery in nulliparas.
Lieberman E, Lang JM, Cohen A, D'Agostino R Jr, Datta S, Frigoletto FD Jr.


CONCLUSIONS: Epidural analgesia may increase substantially the risk of cesarean delivery. Although the causal nature of this association remains open to debate, prenatal care providers should routinely discuss the risks and benefits of epidural analgesia with women during their pregnancies so that they can make informed decisions about the use of pain relief during labor.

Am J Obstet Gynecol. 1993 Oct;169(4):851-8.
The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial.
Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR, Yeast JD.


CONCLUSIONS: In a randomized, controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery, primarily related to dystocia.

Am J Obstet Gynecol. 1989 Sep;161(3):670-5.
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women.
Thorp JA, Parisi VM, Boylan PC, Johnston DA.


Abstract … The incidence of cesarean section for dystocia was significantly greater (p less than 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p less than 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight. The incidence of cesarean section for fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women.

ETA: For the record, I don't think any woman should feel guilty about choosing an epidural or other pain relief. Nor do I think she should be made to feel stupid or pigheaded for avoiding one. It's a personal choice. But seeing as how it's a personal choice I'll be making in about 7-8 months, I'd like to know the facts as best I can.
post #46 of 135

Risks of epidurals- I don't think they are hidden from mainstream moms in any way.  There's plenty of them-epidural headache, risk of making a mistake and mom's paralyzed (yes, it's tiny but it IS there,) it can stall out labor, etc.  There are also plenty of benefits, the primary one is removal of the pain, but it can help mom relax enough to make a stalled labor progress, it can allow a woman to sleep when she's exhausted and labor hasn't let her sleep.

 

Guilt-guilt in getting an epidural can come from a lot of places.  Guilt that mamma "wasn't strong enough," guilt after experiencing an epidural headache that she did it to herself, etc.  Guilt can happen in not getting one-guilt that she got so out of control and if she had had an epidural she wouldn't have been (I cussed out the doctor the first time around, a friend of mine bit her spouse hard enough to draw blood) guilt that she stressed out her spouse so much, etc.

 

None of this is black and white.  An epidural ISN'T for everyone.  But, not getting an epidual isn't for everyone either. 

post #47 of 135
Quote:
Originally Posted by soso-lynn View Post

That's hilarious and tragic at the same time.

 

 

Dr Grant, I wish we could have this conversation face to face to get to the bottom of it all. Why do you think pain relief should be common or needed for giving birth?



Not Dr. Grant, but..

 

Because, for most women, labor is intensely painful.  (NB:  *Most*.)  And since the suffering itself has no particular virtue (more pain doesn't result in healthier babies or healthier moms), many people feel that, given the existence of safe and effective anesthesia, it's only humane to offer pain relief to women in labor.

 

Patients should be - and generally are - at liberty to refuse the offered relief.  But it would be cruel to withhold it, and it would be silly to pretend that a large number of women don't want it.

post #48 of 135
Quote:
Originally Posted by DrGilbert Grant View Post

Since everyone knows and agrees that epidurals are without doubt the best way to releive the pain of childbirth, how can we design a study that randomizes women to a group that is denied the best pain relief?

 

What I have attempted to do in "Epidural Without Guilt" is make a point that is usually not made: That AVOIDING the epidural may very well be more risky than using the epidural.

 

Furthermore, I know that doulas make quite a bit of money - cash in many instances - for providing care for women in labor.. But I would never impugn their motivation. I wouldn't say: "Oh, they're in it for the money" even though being a doula is obviously very rewarding financially.

1. What constitutes "best?" Safest, most effective, fewest risks or side effects? I still submit that maybe we need to change people's perception of birth as a consumer experience. Even if the common perception is that it is more akin to an athletic event. We never say, "Oh, let's give the marathon runner an injection to numb the pain in her legs." We give her food, drink, encouragement, and we know that the discomfort they feel is balanced out by endorphins and that they have trained and prepared. I would like to see women training and preparing for birth more intensively than most are able to do now, and maybe if more of them were better prepared, they would not feel that an epidural is their ONLY choice for pain control.

 

2. How is avoiding the epidural risky? What are the risks of not getting one?

 

3. Bwahhahahahahaha. Yes, doulas make a little bit of money, but in my area, I would have to take four to five clients a month to be able to hang my hat up at my day job (I charge $550 for a birth right now, so you do the math). We are waaaay cheaper than an anesthesiologist though - insurance companies, please take note!
 

post #49 of 135
Quote:
Originally Posted by DrGilbert Grant View Post
To phathui5: The table you refer to is quite flawed. Many, many errors. But there certainly are risks to epidurals - some really bad risks. But there are risks to a lot of things in life. For example: there is a risk of driving to the hospital. So is home birth safer? Well, the most recent data shows a 2 to 3-fold greater risk of death for the baby at home compared to hospital. Everyone has to make their own INFORMED decision. What I have attempted to do in "Epidural Without Guilt" is make a point that is usually not made: That AVOIDING the epidural may very well be more risky than using the epidural.

 

 

I am so sick of the constant fear mongering about home births. 

 

I have bolded your statement above - are you referring to the widely quoted study led by Dr Joseph Wax in the American Journal of Obstetrics and Gynaecology? If so please see this article "http://www.straightstatistics.org/article/home-births-unjustly-maligned".  In a review of the data it was found that the researchers "might as easily have concluded that home births have no effect on the mortality rate at all".

post #50 of 135
Quote:
Originally Posted by kcparker View Post

1. What constitutes "best?" Safest, most effective, fewest risks or side effects? I still submit that maybe we need to change people's perception of birth as a consumer experience. Even if the common perception is that it is more akin to an athletic event. We never say, "Oh, let's give the marathon runner an injection to numb the pain in her legs." We give her food, drink, encouragement, and we know that the discomfort they feel is balanced out by endorphins and that they have trained and prepared. I would like to see women training and preparing for birth more intensively than most are able to do now, and maybe if more of them were better prepared, they would not feel that an epidural is their ONLY choice for pain control.


 


I live within spitting distance of the Boston Marathon.  I watch it every year.  Running a marathon is very painful for most people - I would say that 90% of the people on the course are suffering before they reach the end.  Endorphins don't balance that out.  Every year, hundreds of people who start the race don't finish.  They're stopped by the medics because they're injured (or about to be), or they stop themselves, because of the pain. 

 

You can stop running a marathon any time.  You can't stop being in labor until you've birthed the baby.

post #51 of 135



 

Quote:
Originally Posted by kcparker View Post

2. How is avoiding the epidural risky? What are the risks of not getting one? 


Pain can do funny things to people.  It can cause stress that can acually stall out labor (or worse, I saw one birth show where the mamma in labor had a heart condition, the stress or labor was causing serious heart troubles for her)  It can cause vomiting and other physical reactions that may or may not inhibit labor.  It can cause a mamma to become disoriented and unable to think clearly to make the best decisions for herself.  It can prevent a mamma from getting sleep and rest that could be necessary for pushing out a baby.  I can cause a mamma to lose control-I mentioned my friend biting her spouse, I have heard stories of mammas kicking care providors, saying things to spouse and family members that are extreamly hurtful etc.

 

Not to mention...pain hurts.  It's no fun.  Someone said at some point that labor isn't suffering?  As a woman who has given birth 3 times, twice without the epidural, I have to completely disagree with that.  It was my experience that labor is the WORST part of the whole thing.  It sucks.  I don't like it.  It's not fun.  Giving birth is not fun for me.  It's not amazing, fantastic, empowering, or any of the other things so many women on here talk abou then they discuss their labor and delivery.  It SUCKS, for me.  The ONLY good thing about it is the baby in the end, all snuggled up in a blankie with a hat on.  All the moaning and groaning and wandering around swaying and so on is embarrassing for me, more so that displaying my vagina to push the baby out.  It's exhausting.    I am not going to say that suffering through labor is like suffering abuse or violent crimes or starvation or something like that, but IME, yes, suffering through labor is an accurate description.  If a woman doesn't want to suffer through that, who is anyone to say she should?

post #52 of 135

I question the motives behind anyone taking a stance that epidurals do not increase c-section rates based on the conflicting peer-reviewed studies that exist.  Personally, as someone who is no stranger to using peer-reviewed research, I don't think it's responsible even for a layman to draw the conclusion that epidurals don't increase c-section rates based on the statement "Many studies from different parts of the world have clearly shown that epidurals do NOT cause an increase in the cesarean rate."

 

While the above statement may be true, I question its validity in advising women on their birth decisions.  After all, as a previous poster found (and as I myself found), there also exist many studies -- in peer-reviewed journals -- that support the conclusion that epidurals DO cause an increase in the cesarean rate.  Simply stating that studies exist that prove one conclusion is not sufficient to declare that conclusion correct, in light of conflicting conclusions in other studies.

 

In addition to the weakness of reasoning that a conclusion is the correct one based on "many [unnamed, unreferenced] studies," I think that it is not responsible to simply point to the existence, or even the number, of studies that support the conclusion that epidurals have no effect on c-section rates.  After all, it may be professionally expedient for certain groups to downplay any risk of epidurals -- for example, in my perusal of the first 50 results for peer-reviewed research on the subject of epidural effects on c-sections, I found two articles that concluded epidurals had no effect on the c-section rate.  In one article, one of the two authors was an anesthesiologist.  The other article was a metadata analysis by the American Society of Anesthesiologists.  I personally would caution all women to be cognizant of the motives and possible biases involved in a study wherein the authors have a vested interest in a particular conclusion.  For example, you wouldn't want to formulate a conclusion on the safety of tricycles based on a study authored by the Association of Tricycle Manufacturers of America. 

 

Finally, while Dr. Grant appears to be a friendly person who has women's best interests at heart (and he really does seem like a nice person, from what I have seen), his professional affiliation is: Associate Professor; Director of OB Anesthesia, Department of Anesthesiology (Obstestric Anesthesia Div Dir), NYU Anesthesia AssociatesHe certainly has a vested professional interest in ensuring epidurals are viewed as safe.

 

I will be making this decision (epidural or not) for myself in about 3 months.  I encourage all women to forget this ridiculous argument that you should or should not feel guilty based on a book, or one-sided opinions.  Rather, I hope that all women educate themselves in advance, looking at both sides of the literature, using the most objective and most recent information available.  And I hope that all women make the choice that best fits their own conclusions after considering acceptable risk, personal preference, their expectations, and the potential impact on health of their child.

post #53 of 135

I just wanted to talk about epidurals a little bit and why someone like me might or might not get them.

 

In my first delivery I did want a natural delivery. But, I was also aware that as a survivor of both childhood sexual abuse and rape in my late teens, it was entirely possible that pain in that area would trigger me to a place where I would arrive at motherhood strung out, experiencing flashbacks, and generally in bad shape. I went to 8 cm without an epidural and pretty quickly, but once the transitional contractions hit, I made the decision to get the epidural. It really, really REALLY helped me. I don't think it stalled anything since I went to 10 cm like, the next contraction.

 

Risk analysis is not about just taking one study or even a bunch of studies and determining that if there's any risk whatsoever you won't do that thing. For me, the relatively minor risk of a c-section was pretty counterbalanced by starting to get flashbacky and spaced out. I wanted to be present for my delivery and my child and the epidural was the route to that.

 

Unfortunately the whole labour ended up going extremely badly and my daughter died a few days later due to lack of oxygen and  basically lack of a c-section. Was that ever a lesson in risk and where it might truly lie.

 

For my second delivery I was scared of everything, and newly traumatized by the first delivery.  I opted for an epidural in part because I wanted to be awake for a c-section, and we thought we would likely get one (since we had decided about strict rules around heart decels).  As it turned out it was a dream delivery - fast; I had the epi placed but he came down so fast I ended up lying down and getting the baby out in four pushes before anything was turned on. 

 

For my third delivery I decided since the second was so easy, there was no way I'd need an epidural. Ah, hubris. I spent almost an hour pushing a posterior baby past my pelvis - the bruise and track marks on that poor child, not to mention me.  It was awful. I am still experiencing some nightmares about sex and pain and body memories, almost four weeks later. Of course the results - healthy happy baby and reasonably healthy and happy mum - are fine. But I wish I'd gotten the epidural. I put myself in a position where I kind of torpedoed my own energy and emotional resources right when you want them the most...something I really, really felt when my son ended up in the NICU for jaundice a week later, probably related to that darn bruise.

 

So...let's not pretend there's one answer here.
 

Quote:
Originally Posted by soso-lynn View Post

You could not be more wrong. Women are harassed from the minute they enter the hospital to get an epidural. They come in wanting a natural birth but have strangers sticking their hands up their vagina, giving them pitocin if they don't follow the schedule, force them to lie down on a bed with machines hooked up and every so often, someone will come in and tell them that the pain can all go away if they just get the epidural and stop being difficult. Women have to fight to get a shot at a natural birth. The problem is not with childbirth educators promoting natural birth, the problem is with hospitals making it impossible. That guilt women feel, they call it guilt and not anger only because people like you keep inserting guilt into the discourse. Next time you have a woman tell you she feels guilty about the epidural, try apologizing for contributing to turn the birth of her child into a medical production instead of telling her it was not dangerous.

 

I know it's been said, but in all those deliveries I was never hassled about getting an epidural. If anything I was hassled about getting one the first time. The second two times there was no comment either way - it was a purely professional discussion: "do you think you would like an epidural? I can arrange for one if so."
 

 



Quote:
Originally Posted by soso-lynn View Post



If someone makes an informed decision, they will not feel GUILT. They may disappointed, they may grieve their ideal, they may be angry with the reasons that lead them to it, they may wonder how things would have went if they made a different choice, they may also feel many positive things. Guilt happens only when someone knows they did something wrong and that they could have done differently. The only reason the word guilt is associated with things like epidurals and formula feeding is because people keep telling women that all those other feelings they have are guilt. That construct has been working for formula. People are now afraid to talk about the risks of formula out of fear of making mothers feel guilty. This argument is now trying to do the same thing for birth interventions. Should we go back to twilight sleep out of fear of making our grandmothers feel guilty as well?

 


I definitely feel guilt over my daughter's death even though intellectually I know I wasn't at fault. I also spent years in therapy working to rid myself of guilt for the abuse I suffered as a child - a facet of PTSD and childhood sexual abuse which is extremely well-known and documented. The idea that women only feel appropriate guilt is a little laughable, taken in that context.

post #54 of 135


 

Quote:
Originally Posted by MeepyCat View Post

You can stop running a marathon any time.  You can't stop being in labor until you've birthed the baby.

Touche, you are right about not being able to stop labor. And you are right that people can drop out of a marathon. Epidurals aren't evil; I believe that they are a godsend for women who need them, and I am only in a position to judge my own need for one. I have simply observed that many women are not as well informed about ALL their options as they could be, and I would like to see care providers giving them more complete information than what they get now. Depending on a woman's needs and desires, an epidural might or might not be the most appropriate choice for her. I don't think that 'best' is an appropriate term to use for any pain relief option because 'best' (safest, most effective, least risky, most pleasant, or however 'best' is going to be defined) is going to be different for different people.
 

post #55 of 135


 

Quote:
Originally Posted by happysmileylady View Post



 

Quote:
Originally Posted by kcparker View Post

2. How is avoiding the epidural risky? What are the risks of not getting one? 


Pain can do funny things to people.  It can cause stress that can acually stall out labor (or worse, I saw one birth show where the mamma in labor had a heart condition, the stress or labor was causing serious heart troubles for her)  It can cause vomiting and other physical reactions that may or may not inhibit labor.  It can cause a mamma to become disoriented and unable to think clearly to make the best decisions for herself.  It can prevent a mamma from getting sleep and rest that could be necessary for pushing out a baby.  I can cause a mamma to lose control-I mentioned my friend biting her spouse, I have heard stories of mammas kicking care providors, saying things to spouse and family members that are extreamly hurtful etc.

 

Not to mention...pain hurts.  It's no fun.  Someone said at some point that labor isn't suffering?  As a woman who has given birth 3 times, twice without the epidural, I have to completely disagree with that.  It was my experience that labor is the WORST part of the whole thing.  It sucks.  I don't like it.  It's not fun.  Giving birth is not fun for me.  It's not amazing, fantastic, empowering, or any of the other things so many women on here talk abou then they discuss their labor and delivery.  It SUCKS, for me.  The ONLY good thing about it is the baby in the end, all snuggled up in a blankie with a hat on.  All the moaning and groaning and wandering around swaying and so on is embarrassing for me, more so that displaying my vagina to push the baby out.  It's exhausting.    I am not going to say that suffering through labor is like suffering abuse or violent crimes or starvation or something like that, but IME, yes, suffering through labor is an accurate description.  If a woman doesn't want to suffer through that, who is anyone to say she should?


All of this is true. If you KNOW you have a heart condition, get the epidural or even a planned c-section if that is what will keep you and baby safest and healthiest. If you are in pain that you are not able to cope with and recover from, by all means, get the epidural so that you can meet your baby with joy instead of suffering like an animal. If you are exhausted, I will encourage you to get an epidural so you can rest and gather strength for pushing. Like I said before, there are plenty of reasons why women get epidurals, but to make a blanket statement that "it's LESS risky to get an epidural than not to have one..." I don't buy that generalization any more than I buy "getting an epidural is an extremely risky choice to make and you should try to avoid it at all costs." I don't think that developing a short temper or kicking a care provider (who might have been doing something painful or invasive) constitutes a risk against which one needs to make a preemptive strike by getting anesthesia.

 

And, my issue is not with whether or not labor is suffering, it is with Dr. Grant presuming to know what labor is like and saying on national television, "Labor is the worst pain you will ever feel. Labor is suffering." This may be true, it may not be true, and what is true for me (not suffering) might not hold for you (whole experience sucked). But it is not fair for him (or you, or me, or anybody else) to define what labor is like "for women." It's a spectrum, and care providers have (I think) a burden not to plant seeds in women's minds that labor will be the most hideous event of their lives. Education, support, encouraging women to be active participants in care decisions, and trusting them to make the choices that are most appropriate for them...not so hard.

post #56 of 135



 

Quote:
Originally Posted by kcparker View Post


 

Quote:
Originally Posted by happysmileylady View Post



 

Quote:
Originally Posted by kcparker View Post

2. How is avoiding the epidural risky? What are the risks of not getting one? 


Pain can do funny things to people.  It can cause stress that can acually stall out labor (or worse, I saw one birth show where the mamma in labor had a heart condition, the stress or labor was causing serious heart troubles for her)  It can cause vomiting and other physical reactions that may or may not inhibit labor.  It can cause a mamma to become disoriented and unable to think clearly to make the best decisions for herself.  It can prevent a mamma from getting sleep and rest that could be necessary for pushing out a baby.  I can cause a mamma to lose control-I mentioned my friend biting her spouse, I have heard stories of mammas kicking care providors, saying things to spouse and family members that are extreamly hurtful etc.

 

Not to mention...pain hurts.  It's no fun.  Someone said at some point that labor isn't suffering?  As a woman who has given birth 3 times, twice without the epidural, I have to completely disagree with that.  It was my experience that labor is the WORST part of the whole thing.  It sucks.  I don't like it.  It's not fun.  Giving birth is not fun for me.  It's not amazing, fantastic, empowering, or any of the other things so many women on here talk abou then they discuss their labor and delivery.  It SUCKS, for me.  The ONLY good thing about it is the baby in the end, all snuggled up in a blankie with a hat on.  All the moaning and groaning and wandering around swaying and so on is embarrassing for me, more so that displaying my vagina to push the baby out.  It's exhausting.    I am not going to say that suffering through labor is like suffering abuse or violent crimes or starvation or something like that, but IME, yes, suffering through labor is an accurate description.  If a woman doesn't want to suffer through that, who is anyone to say she should?


All of this is true. If you KNOW you have a heart condition, get the epidural or even a planned c-section if that is what will keep you and baby safest and healthiest. If you are in pain that you are not able to cope with and recover from, by all means, get the epidural so that you can meet your baby with joy instead of suffering like an animal. If you are exhausted, I will encourage you to get an epidural so you can rest and gather strength for pushing. Like I said before, there are plenty of reasons why women get epidurals, but to make a blanket statement that "it's LESS risky to get an epidural than not to have one..." I don't buy that generalization any more than I buy "getting an epidural is an extremely risky choice to make and you should try to avoid it at all costs." I don't think that developing a short temper or kicking a care provider (who might have been doing something painful or invasive) constitutes a risk against which one needs to make a preemptive strike by getting anesthesia.

 

And, my issue is not with whether or not labor is suffering, it is with Dr. Grant presuming to know what labor is like and saying on national television, "Labor is the worst pain you will ever feel. Labor is suffering." This may be true, it may not be true, and what is true for me (not suffering) might not hold for you (whole experience sucked). But it is not fair for him (or you, or me, or anybody else) to define what labor is like "for women." It's a spectrum, and care providers have (I think) a burden not to plant seeds in women's minds that labor will be the most hideous event of their lives. Education, support, encouraging women to be active participants in care decisions, and trusting them to make the choices that are most appropriate for them...not so hard.

Oh, don't get me wrong, I don't think blanket statements are ever appropriate.  Peanut butter is safe to eat....well except for those with peanut allergies.   Everyone should go to college...well except those who have life goals that don't require college.  No one can say it's automatically less risky for any one specific  person to have an epidural, any more than anyone can say it's automaticallly more risky for any one particular person.  I was mearly responding to the question of what risks are there of not getting one.  Just because you think that potentially physically assulting a care provider isn't a risk worthy of anesthesia doesn't mean someone else feels the same way.

 

 

As to the second part, again, the issue of blanket statements applies here.  NO one should be telling women what labor is like...because each labor is different.  Not just from person to person, but from labor to labor even.  Just like people, men or women, shouldn't be putting it in anyone's head that labor is the worst pain ever, no one should be putting it in anyone's head that if they just breath right, change positions enough, get in the tub etc, that it's not that bad.  I have seen all sorts of posts where women talk about how the pain of labor blindsided them.  Women have been traumatized by how painful it is.  Education should come from both sides of the coin, making sure that women know that it might not be that bad, or that it MIGHT be that bad.  Educate them to try that there are a large variety of pain relief methods to try, from walking to epidurals, and what the risks and benefits of all of them are, THAT is the best option. 

 

post #57 of 135

 Education should come from both sides of the coin, making sure that women know that it might not be that bad, or that it MIGHT be that bad.  Educate them to try that there are a large variety of pain relief methods to try, from walking to epidurals, and what the risks and benefits of all of them are, THAT is the best option. 

 


The problem with simple education on the risks and benefits is that it does not take into account the fact that, in most hospitals, in most families, making those choices is not easy. I have seen many women who understood the risks and did not want an epidural end up with one because their partner was beside himself panicking while she was screaming or because of a vaginal exam that told her she was not up to par. Educating women about what they will need to fight to avoid the epidural is one thing and he does yield some limited success (just look at all the women here who managed to get their natural birth in hospitals), the only way to make a true difference is to get rid of those obstacles. That does involve an entire paradigm shift for many care providers and institutions so instead we end up with people trying to minimize that "guilt" (which should be really be felt by those hospitals and not their patients) and grasping at statistical trickery to convince people that there really is no problem.

post #58 of 135
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Originally Posted by soso-lynn View Post



Quote:
Originally Posted by happysmileylady View Post

Guilt is an emotion, it doesn't follow logic.  Just because someone reads all the information and makes a choice based on that information doesn't mean that they are 100% comfortable with it.  Perhaps they feel that they were really only choosing between the lesser of two evils or that neither choice is right but they don't have any other options.  And yes, it's totally possible to feel out of options even with all the information.  When you are in labor, in the most pain you have ever felt in your life and your options are continue in that much pain or get meds you were once opposed to, well, neither choice is all that fantastic. 



That is exactly why we need a better system and why we need to work on changing cultural perceptions of birth. Simply trying to convince women that epidurals (and all the rest) are not risky after all is counter-productive.

We may need to change the system and work on changing cultural perceptions of birth. I don't, however,  believe that the extreme pain some women experience during childbirth is simply a result of cultural perceptions or the system. I know too many women who transferred to the hospital at high physical, emotional and financial cost after a planned home birth with supportive midwives to discount the sheer exhaustion and pain some women go through while bringing babies into the world.


 

post #59 of 135
Quote:
Originally Posted by soso-lynn View Post



 Education should come from both sides of the coin, making sure that women know that it might not be that bad, or that it MIGHT be that bad.  Educate them to try that there are a large variety of pain relief methods to try, from walking to epidurals, and what the risks and benefits of all of them are, THAT is the best option. 

 


The problem with simple education on the risks and benefits is that it does not take into account the fact that, in most hospitals, in most families, making those choices is not easy. I have seen many women who understood the risks and did not want an epidural end up with one because their partner was beside himself panicking while she was screaming or because of a vaginal exam that told her she was not up to par. Educating women about what they will need to fight to avoid the epidural is one thing and he does yield some limited success (just look at all the women here who managed to get their natural birth in hospitals), the only way to make a true difference is to get rid of those obstacles. That does involve an entire paradigm shift for many care providers and institutions so instead we end up with people trying to minimize that "guilt" (which should be really be felt by those hospitals and not their patients) and grasping at statistical trickery to convince people that there really is no problem.

The fact that you make the assumption that I am talking about educating women on what they need to fight to avoid it, is part of the problem and part of where the guilt come from.  The purpose of the education is to help women make choices, not automatically to avoid epidurals.  Many women look at the risks and decide that the epidural is for them.  And that's ok.  But being told that the education is to help them avoid it certainly implies that they are not supposed to want it, hence where guilt comes from. 

 

And once again, there's the assumption that a fight has to take place at all.  If you go into any situation expecting to have to fight, you are probably going to get a fight.  But if you go into the situation with an open mind, you are more likely to get your way without any opposition at all.  It's been my experience on this board that a lot of folks here go into birth at a hospital expecting a fight and are looking for opposition that isn't necessarily there.
 

post #60 of 135
Quote:
Originally Posted by happysmileylady View Post



Quote:
Originally Posted by soso-lynn View Post



 Education should come from both sides of the coin, making sure that women know that it might not be that bad, or that it MIGHT be that bad.  Educate them to try that there are a large variety of pain relief methods to try, from walking to epidurals, and what the risks and benefits of all of them are, THAT is the best option. 

 


The problem with simple education on the risks and benefits is that it does not take into account the fact that, in most hospitals, in most families, making those choices is not easy. I have seen many women who understood the risks and did not want an epidural end up with one because their partner was beside himself panicking while she was screaming or because of a vaginal exam that told her she was not up to par. Educating women about what they will need to fight to avoid the epidural is one thing and he does yield some limited success (just look at all the women here who managed to get their natural birth in hospitals), the only way to make a true difference is to get rid of those obstacles. That does involve an entire paradigm shift for many care providers and institutions so instead we end up with people trying to minimize that "guilt" (which should be really be felt by those hospitals and not their patients) and grasping at statistical trickery to convince people that there really is no problem.

The fact that you make the assumption that I am talking about educating women on what they need to fight to avoid it, is part of the problem and part of where the guilt come from.  The purpose of the education is to help women make choices, not automatically to avoid epidurals.  Many women look at the risks and decide that the epidural is for them.  And that's ok.  But being told that the education is to help them avoid it certainly implies that they are not supposed to want it, hence where guilt comes from. 

 

And once again, there's the assumption that a fight has to take place at all.  If you go into any situation expecting to have to fight, you are probably going to get a fight.  But if you go into the situation with an open mind, you are more likely to get your way without any opposition at all.  It's been my experience on this board that a lot of folks here go into birth at a hospital expecting a fight and are looking for opposition that isn't necessarily there.
 


That was meant as " Educating women about how they will need to fight if they want to avoid the epidural..."

 

Every single woman I have met who went into the hospital without a resolved determination to fight for a natural birth ended up with an epidural. I even witnessed a doctor trying to hold down my sister as the baby was crowning to get the epidural in because she had a fast labour and it was a big race to get it done in time...

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