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#1 of 135 Old 02-10-2011, 07:23 AM - Thread Starter
 
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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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#2 of 135 Old 02-10-2011, 11:08 AM
 
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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

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#3 of 135 Old 02-10-2011, 01:07 PM
 
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Well, I know from experience that getting an epidural can actually STOP labor completely.  AND I've also seen it drop the fetal heart rate so that there was little choice but to do an emergency cesarean.  BUT, I have also seen studies on this topic - here is one...but there are many.

 

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

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#4 of 135 Old 02-10-2011, 01:42 PM
 
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I wish I knew what studies he was referring to when he says these things.  It would be really interesting to look at them (assuming they aren't just bibliography salad). 

 

I think that there is a lot of guilt presented about pain relief in labor, and this subsequent attitude that if you had anesthesia, any problems you have with recovery or nursing are troubles that you brought on yourself.  Some people say illogical and alarmist things - like Dr. Sears (IIRC), who says that there is no anesthetic that is proven 100% safe for pregnant women and babies.  Which is true and all, but he fails to mention that there is nothing that has ever been proven 100% safe for *anyone*.

 

Beccadoula, I looked at your link, and one thing I think is important to note is that the article it contains is not a study.  It has not received the peer review that scientific studies receive before formal publication.  I don't think it could stand up to such review.  At least one of their claims is inadequately substantiated by the supporting footnote.  I haven't had much time to review, but on the basis of one paper concerning complications of anesthesia at a rural Canadian hospital, the authors of the linked article claim that epidurals carry a 23% rate of complication  (this is from footnote 2, which appears quite early in the article).  Ideally, such a statistic would be drawn from an examination of reports covering a larger population, say from the statistics provided by a variety of hospitals, or from government statistics, to limit the possibility that the referenced population was a statistical outlier because of (for example) incompetent or undertrained anesthesiologists, or obsolete or poorly maintained equipment.

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#5 of 135 Old 02-10-2011, 03:49 PM
 
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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

With all due respect, this whole, "Let's pretend epidurals are not risky so people won't feel guilty" line is the same old line used by formula companies to get people to give up breastfeeding. Who exactly is feeling guilty? Doctors who perform unnecessary interventions should feel guilty. The institutions who perpetuate the fear of childbirth should feel guilty. Women who have epidurals (which are still the vast majority) are either victims of this system, in which case they should fell anger instead of the guilt you are trying to manufacture, or they are making an informed choice. People don't feel guilty when they make an informed decision, regardless of other people's opinion.

 

I don't have the time to look at the specific studies you are using to make your argument but when c-section rates are outrageously high as they are now, women are often doomed either way. That does not mean epidurals are safe, it simply means that the policies in hospitals are so horrible that it is impossible to isolate which one of all the epidurals, inductions, active management interventions, constant monitoring, inability to move and other non-evidence based things being done are responsible for the dismal c-section rates as well the infant and maternal morbidity and mortality rates that should make each American OB feel guilty.
 

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#6 of 135 Old 02-10-2011, 06:04 PM
 
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Well, I know from experience that getting an epidural can actually STOP labor completely.  AND I've also seen it drop the fetal heart rate so that there was little choice but to do an emergency cesarean.  BUT, I have also seen studies on this topic - here is one...but there are many.

 

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

 

It's interesting to hear your experience. In some women, I've seen labor seemingly stop after an epidural was given, and other patients I’ve seen labor accelerate dramatically after an epidural has been given. But these observations-  yours and mine - prove NOTHING about what epidurals do to the process of labor, NOTHING. If you really want to determine the effect of epidurals on the duration of labor you need to conduct a prospective, randomized study. That would be science. Your observations and my observations not scientific evidence. They are anecdotal.

Now, with regard to the “study” you quoted, let’s be clear: it’s not a “study.” It is a review (and not a very good one, for that matter). It’s outdated (the most recent cited study in it is from 1997). I had to smile, though, when I read this sentence about the dangers of epidurals: “A dangerous allergic condition with shock (called anaphylaxis) can occur. (reference 54).“ Why did I smile? Because the quoted case of “anaphylaxis” was not anaphylaxis at all. It was due to a latex allergy, and the report was officially withdrawn in 1993. Interesting how the authors of this review didn’t mention that fact.

Valid, well designed scientific studies are the key to understanding our world. Outdated and poorly researched reviews don’t help; they only confuse people.

 

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I wish I knew what studies he was referring to when he says these things.  It would be really interesting to look at them (assuming they aren't just bibliography salad). 

 

I think that there is a lot of guilt presented about pain relief in labor, and this subsequent attitude that if you had anesthesia, any problems you have with recovery or nursing are troubles that you brought on yourself.  Some people say illogical and alarmist things - like Dr. Sears (IIRC), who says that there is no anesthetic that is proven 100% safe for pregnant women and babies.  Which is true and all, but he fails to mention that there is nothing that has ever been proven 100% safe for *anyone*.

 

Beccadoula, I looked at your link, and one thing I think is important to note is that the article it contains is not a study.  It has not received the peer review that scientific studies receive before formal publication.  I don't think it could stand up to such review.  At least one of their claims is inadequately substantiated by the supporting footnote.  I haven't had much time to review, but on the basis of one paper concerning complications of anesthesia at a rural Canadian hospital, the authors of the linked article claim that epidurals carry a 23% rate of complication  (this is from footnote 2, which appears quite early in the article).  Ideally, such a statistic would be drawn from an examination of reports covering a larger population, say from the statistics provided by a variety of hospitals, or from government statistics, to limit the possibility that the referenced population was a statistical outlier because of (for example) incompetent or undertrained anesthesiologists, or obsolete or poorly maintained equipment.


Excellent points, MeepyCat. That non-peer-reviewed "review" is easily dismantled. The problem with such publications is that they are quoted, and people tend to take them at face value.
 

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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

With all due respect, this whole, "Let's pretend epidurals are not risky so people won't feel guilty" line is the same old line used by formula companies to get people to give up breastfeeding. Who exactly is feeling guilty? Doctors who perform unnecessary interventions should feel guilty. The institutions who perpetuate the fear of childbirth should feel guilty. Women who have epidurals (which are still the vast majority) are either victims of this system, in which case they should fell anger instead of the guilt you are trying to manufacture, or they are making an informed choice. People don't feel guilty when they make an informed decision, regardless of other people's opinion.

 

I don't have the time to look at the specific studies you are using to make your argument but when c-section rates are outrageously high as they are now, women are often doomed either way. That does not mean epidurals are safe, it simply means that the policies in hospitals are so horrible that it is impossible to isolate which one of all the epidurals, inductions, active management interventions, constant monitoring, inability to move and other non-evidence based things being done are responsible for the dismal c-section rates as well the infant and maternal morbidity and mortality rates that should make each American OB feel guilty.
 


I must disagree with your statement that: "People don't feel guilty when they make an informed decision, regardless of other people's opinion."  I've cared for many thousands of women during childbirth over the past 25 years and I'll tell you my experience: guilt is a real feeling for many of them - it's just the way it is. I think it's unfortunate, to be sure, but it's a result of societal pressure that they shouldn't get an epidural. Just yesterday a couple was telling me about their "childbirth education course" and the intense pressure to avoid an epidural at all costs. Women feel PLENTY guilty about this - not all women - but a lot of them.

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#9 of 135 Old 02-10-2011, 06:56 PM
 
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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

With all due respect, this whole, "Let's pretend epidurals are not risky so people won't feel guilty" line is the same old line used by formula companies to get people to give up breastfeeding. Who exactly is feeling guilty? Doctors who perform unnecessary interventions should feel guilty. The institutions who perpetuate the fear of childbirth should feel guilty. Women who have epidurals (which are still the vast majority) are either victims of this system, in which case they should fell anger instead of the guilt you are trying to manufacture, or they are making an informed choice. People don't feel guilty when they make an informed decision, regardless of other people's opinion.

 

I don't have the time to look at the specific studies you are using to make your argument but when c-section rates are outrageously high as they are now, women are often doomed either way. That does not mean epidurals are safe, it simply means that the policies in hospitals are so horrible that it is impossible to isolate which one of all the epidurals, inductions, active management interventions, constant monitoring, inability to move and other non-evidence based things being done are responsible for the dismal c-section rates as well the infant and maternal morbidity and mortality rates that should make each American OB feel guilty.
 


I must disagree with your statement that: "People don't feel guilty when they make an informed decision, regardless of other people's opinion."  I've cared for many thousands of women during childbirth over the past 25 years and I'll tell you my experience: guilt is a real feeling for many of them - it's just the way it is. I think it's unfortunate, to be sure, but it's a result of societal pressure that they shouldn't get an epidural. Just yesterday a couple was telling me about their "childbirth education course" and the intense pressure to avoid an epidural at all costs. Women feel PLENTY guilty about this - not all women - but a lot of them.


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.


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#10 of 135 Old 02-10-2011, 07:24 PM
 
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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.

 

this is not factual nor supported by any evidence.

 

if you can't support your claims then it makes it difficult to take your argument seriously.

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#11 of 135 Old 02-11-2011, 04:57 AM
 
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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 felt no pressure to  get one at my hospital.  It's a very mainstream hospital with a high C section rate.  When I said during preregistration that I was not planning on getting the epi, the only response was the nurse asking me if I wanted to specifically request one of the rooms with a jacuzzi. After that, no one ever batted an eye.  Many women can't get epidurals for various reasons, even besides not wanting one.


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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

With all due respect, this whole, "Let's pretend epidurals are not risky so people won't feel guilty" line is the same old line used by formula companies to get people to give up breastfeeding. Who exactly is feeling guilty? Doctors who perform unnecessary interventions should feel guilty. The institutions who perpetuate the fear of childbirth should feel guilty. Women who have epidurals (which are still the vast majority) are either victims of this system, in which case they should fell anger instead of the guilt you are trying to manufacture, or they are making an informed choice. People don't feel guilty when they make an informed decision, regardless of other people's opinion.

 

I don't have the time to look at the specific studies you are using to make your argument but when c-section rates are outrageously high as they are now, women are often doomed either way. That does not mean epidurals are safe, it simply means that the policies in hospitals are so horrible that it is impossible to isolate which one of all the epidurals, inductions, active management interventions, constant monitoring, inability to move and other non-evidence based things being done are responsible for the dismal c-section rates as well the infant and maternal morbidity and mortality rates that should make each American OB feel guilty.
 


I must disagree with your statement that: "People don't feel guilty when they make an informed decision, regardless of other people's opinion."  I've cared for many thousands of women during childbirth over the past 25 years and I'll tell you my experience: guilt is a real feeling for many of them - it's just the way it is. I think it's unfortunate, to be sure, but it's a result of societal pressure that they shouldn't get an epidural. Just yesterday a couple was telling me about their "childbirth education course" and the intense pressure to avoid an epidural at all costs. Women feel PLENTY guilty about this - not all women - but a lot of them.


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.


That is not universally true. I had a hospital birth and was not pressured to get an epidural (in fact, no one ever mentioned it at all because my birth plan said not to), forced to lie down, or rushed through labor.


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http://video.foxnews.com/v/4508326/epidural-without-guilt/?playlist_id=86894 

 

   I hope this doesn't violate anything. This doctor wrote a book. I agree that women should be able to choose epidurals, and make their choices without guilt. But he references "lots of studies" that disprove the "myth" of a link between epidurals and ceasarean rates, and a couple other things that don't make sense. Does anyone know what he's talking about?

   I don't want to bash this guy. He seems genuine in his desire to help. But I would like to discuss his information, as there are moms who will read his book.


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.


 

With all due respect, this whole, "Let's pretend epidurals are not risky so people won't feel guilty" line is the same old line used by formula companies to get people to give up breastfeeding. Who exactly is feeling guilty? Doctors who perform unnecessary interventions should feel guilty. The institutions who perpetuate the fear of childbirth should feel guilty. Women who have epidurals (which are still the vast majority) are either victims of this system, in which case they should fell anger instead of the guilt you are trying to manufacture, or they are making an informed choice. People don't feel guilty when they make an informed decision, regardless of other people's opinion.

 

I don't have the time to look at the specific studies you are using to make your argument but when c-section rates are outrageously high as they are now, women are often doomed either way. That does not mean epidurals are safe, it simply means that the policies in hospitals are so horrible that it is impossible to isolate which one of all the epidurals, inductions, active management interventions, constant monitoring, inability to move and other non-evidence based things being done are responsible for the dismal c-section rates as well the infant and maternal morbidity and mortality rates that should make each American OB feel guilty.
 


I must disagree with your statement that: "People don't feel guilty when they make an informed decision, regardless of other people's opinion."  I've cared for many thousands of women during childbirth over the past 25 years and I'll tell you my experience: guilt is a real feeling for many of them - it's just the way it is. I think it's unfortunate, to be sure, but it's a result of societal pressure that they shouldn't get an epidural. Just yesterday a couple was telling me about their "childbirth education course" and the intense pressure to avoid an epidural at all costs. Women feel PLENTY guilty about this - not all women - but a lot of them.


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.



 



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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.

 

this is not factual nor supported by any evidence.

 

if you can't support your claims then it makes it difficult to take your argument seriously.



 



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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 felt no pressure to  get one at my hospital.  It's a very mainstream hospital with a high C section rate.  When I said during preregistration that I was not planning on getting the epi, the only response was the nurse asking me if I wanted to specifically request one of the rooms with a jacuzzi. After that, no one ever batted an eye.  Many women can't get epidurals for various reasons, even besides not wanting one.


 100% agree with the two responses.  The hospital I gave birth to my 2 younger ones at never ever once asked if I wanted an epidural, either time.  They aren't really a high intervention hospital though.  My first, much older, was born in a pretty high intervention catholic hospital, which fits the stereotype, and still, no one asked if I wanted an epidural.  They did ask a couple of times if I wanted any pain meds, but it wasn't pushy at all, more a matter of multiple nurses asking the same questions at different times because they weren't reading chart notes.

 

And, I did end up with an epidural with my second.  I was having a lot of back labor, had been in labor for over 3 days and was totally exhausted and DH was having a really hard time seeing me like that.  He was the one who "pushed" the epidural, not the hospital staff.  And afterwards, I felt, maybe not guilty, but as if I had let myself down.  Like I had given up, like I had not tried hard enough.  And, ask you can see, I still apparently feel the need to justify my choice. 

 

My third was without an epidural, and in the thick of labor, I couldn't quite remember why getting the epidural was so bad, and if I go on to have a 4th, I am not convinced I won't get one.  And my decisions are fully informed. 

 

Just because a decision is fully informed doesn't mean the person making the decision is 100% confident in the decision they have made.  Nor does it mean they like the choice they made even if they intellectually feel that it's the right one.

 

 

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Just because a decision is fully informed doesn't mean the person making the decision is 100% confident in the decision they have made.  Nor does it mean they like the choice they made even if they intellectually feel that it's the right one.

 

 


 

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?

 

Anyone who says that there is more pressure not to get an epidural than to get one do't live in reality. Look at the numbers; people who chose epidurals are not a persecuted minority. Go in any group of women outside of mdc and other alternative communities and try to talk about birth. Look at the reactions of people around you when you mention natural birth. This forum would not exist of proponents of natural birth were bullying everyone to follow their ideal. You would not be hearing about women being birth raped or forced to change providers several times just to be treated like intelligent human beings. Of course, it is not the universal experience of all women, especially not those who are part of this forum. Just because a few of you did not feel pressured into consenting to unnecessary interventions (when consent is even asked for), it does not mean that epidurals are not ubiquitous and the entire medical system is not making it hard for women to have natural births.

 

The only valid point brought up by this doctor is the fact that women do not have all the facts. Hospitals pay lip service to the idea of natural birth with jacuzzis and other details. They talk about interventions as options and choices but they don't tell women that signing up for a hospital birth means dismal chances to achieve that, regardless of their intentions. If hospital classes told women that they will be treated as sick, that they will be under pressure to induce past X weeks, that modified US-style active management will be used, that they will be asked to birth in unnatural positions and that the combination of all that makes them very likely to end up with a less than ideal birth, then women would know what they are getting into. As it stands now, women are not being told the whole story by their doctors and hospitals. There is a lot more to this than deciding to get an epidural or not.


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The dictionary definition of guilt is more expansive than yours. Why do you think that is? Maybe your definition is too narrow and doesn't capture the entire human experience.

Guilt: a feeling of responsibility or remorse for some offense, crime,wrong, etc., whether real or imagined.

Don't tell other women how they should feel or why they feel the way they do. It's not respectful.

 

Yes, I imagine that if you hang out in natural birth circles you'll hear that there are women who feel like they were pressured to have epidurals. It's kind of a self-selecting group, isn't it? People displeased with hospital birth experiences are going to look elsewhere. That doesn't negate the experience of other women who were NOT pressured to have epidurals. Have you conducted a comprehensive survey to back your claim that the majority of women who get an epidural did so because of pressure from their health care providers?

 

You admit you haven't read the doctor's book, but you're confident that he only makes one valid point. Interesting.

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Anyone who says that there is more pressure not to get an epidural than to get one do't live in reality. Look at the numbers; people who chose epidurals are not a persecuted minority. Go in any group of women outside of mdc and other alternative communities and try to talk about birth. Look at the reactions of people around you when you mention natural birth. This forum would not exist of proponents of natural birth were bullying everyone to follow their ideal. You would not be hearing about women being birth raped or forced to change providers several times just to be treated like intelligent human beings. Of course, it is not the universal experience of all women, especially not those who are part of this forum. Just because a few of you did not feel pressured into consenting to unnecessary interventions (when consent is even asked for), it does not mean that epidurals are not ubiquitous and the entire medical system is not making it hard for women to have natural births.

 You have an oxymoron here.  If it is the ENTIRE medical system against natural births, how can it not be a universal experience to feel pressured out of it?  IOW, if there ARE women (and IME, not just a select few) who don't feel pressured, how can the ENTIRE medical system be pressuring women out of natural births?

 

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Wow, go read what I said. Seriously.

 

Guilt comes form within. As your definition says it comes from feeling responsible or remorseful. Women have very little power and control over what happens to them in hospitals so any guilt they feel is manufactured by people who keep telling them that it is all a choice and that the risks are minimal anyway. It is just like when a woman formula feeds, she will be told that it is her choice and that she should feel ok with it because it's really not that bad. The truth is that any given individual has very little choice in the matter when the entire system is designed for them to fail.

 

There is plenty of data that shows that the biggest predictor of what interventions someone will get is where they give birth. You cannot have hospitals with similar population that have very different c-section, epidural, induction stats and still argue that it is all about the women making those choices. Have you looked at the WHO's documentation on acceptable rates of intervention?

 

I don't know what you guys are not getting here.
 

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The dictionary definition of guilt is more expansive than yours. Why do you think that is? Maybe your definition is too narrow and doesn't capture the entire human experience.

Guilt: a feeling of responsibility or remorse for some offense, crime,wrong, etc., whether real or imagined.

Don't tell other women how they should feel or why they feel the way they do. It's not respectful.

 

Yes, I imagine that if you hang out in natural birth circles you'll hear that there are women who feel like they were pressured to have epidurals. It's kind of a self-selecting group, isn't it? People displeased with hospital birth experiences are going to look elsewhere. That doesn't negate the experience of other women who were NOT pressured to have epidurals. Have you conducted a comprehensive survey to back your claim that the majority of women who get an epidural did so because of pressure from their health care providers?

 

You admit you haven't read the doctor's book, but you're confident that he only makes one valid point. Interesting.




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#18 of 135 Old 02-11-2011, 07:18 AM
 
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Thank you, hells_librarian, for your comment. I chose to entitle my book Epidural Without Guilt because I have found guilt to be a common feeling among many women who choose to use or not to use epidurals. But that's just the title - I discuss other aspects of pain relief for childbirth that are seldom, if ever, considered.

It's interesting to read these posts. Clearly, there are some people who have formed opinions and are totally unwilling to open their minds to other possibilities, but it's heartening to me that others are indeed interested in entertaining ideas with which they may not agree.

By the way, at my hospital, we don't force epidurals on anyone. It would be silly of us because we're all on salary. As I explain "We're not looking for work!"

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 Have you looked at the WHO's documentation on acceptable rates of intervention?



The WHO did away with those recommendations quite a while ago now.  They now have no specific numbers.

 

Gently, I think that maybe your definition of the word "guilt" is different from how the rest of the world uses it.  WHich is fine: language is, to some extent, subjective.  (Just like pain, actually: my 10 may not be your 10).  But please stop telling the rest of us that we're wrong, when, objectively, we're using the word correctly.  You can look into pretty much any great work of literature for examples of how doing the right thing can cause guilt.  Making tough decisions is a fundamental human experience, and if you've truly never felt an ounce of guilt about any informed decision you've made, that either shows an unconventional use of the word, or a certain lack of empathy about how your actions might affect others or your environment.


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Thank you, hells_librarian, for your comment. I chose to entitle my book Epidural Without Guilt because I have found guilt to be a common feeling among many women who choose to use or not to use epidurals. But that's just the title - I discuss other aspects of pain relief for childbirth that are seldom, if ever, considered.

It's interesting to read these posts. Clearly, there are some people who have formed opinions and are totally unwilling to open their minds to other possibilities, but it's heartening to me that others are indeed interested in entertaining ideas with which they may not agree.

By the way, at my hospital, we don't force epidurals on anyone. It would be silly of us because we're all on salary. As I explain "We're not looking for work!"


So, the only reason you think hospitals would promote interventions is if their pay is directly related to them? That is quite an insult to your profession.

 

Do you really, honestly believe that every woman who comes into your hospital with some hope left of avoiding unnecessary interventions will be fully supported? Do you believe that every woman in your care who gets an epidural makes a fully informed decision where all the options are presented to her? If so, I would love to know your stats. What is your induction rate, how many of your patients are given drugs to augment labour, how often are vaginal examinations done, do you practice active management, what restrictions are routinely placed on your patients (monitors, supine position, not allowed to eat, etc, do you direct them to push, what is your c-section rate, do you perform episiotomies, do you offer quality advice on getting the baby in a good position before labour starts, what is your rate of assisted deliveries?


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#21 of 135 Old 02-11-2011, 07:50 AM
 
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 Have you looked at the WHO's documentation on acceptable rates of intervention?



The WHO did away with those recommendations quite a while ago now.  They now have no specific numbers.

 

Gently, I think that maybe your definition of the word "guilt" is different from how the rest of the world uses it.  WHich is fine: language is, to some extent, subjective.  (Just like pain, actually: my 10 may not be your 10).  But please stop telling the rest of us that we're wrong, when, objectively, we're using the word correctly.  You can look into pretty much any great work of literature for examples of how doing the right thing can cause guilt.  Making tough decisions is a fundamental human experience, and if you've truly never felt an ounce of guilt about any informed decision you've made, that either shows an unconventional use of the word, or a certain lack of empathy about how your actions might affect others or your environment.


If there truly is a guilt epidemic, shouldn't the focus be on getting people to take responsibility for their decisions and fixing the system that fails them instead of trying to argue why things are just fine the way they are. 

 

I make some unconventional choices and even if the entire world was telling me I was wrong, I would never feel guilty. I might feel duped if I later realized that I had been lied to about the facts. I might be disappointed if things don't work out but I would only ever feel guilt if I knew I willfully did something I knew was wrong. Other people can't make you feel anything. 


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#22 of 135 Old 02-11-2011, 07:55 AM
 
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I think that's what this book is trying to do: fix the system that makes women feel guilty for perfectly valid choices.


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#23 of 135 Old 02-11-2011, 08:05 AM
 
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I don't have a lot of time to read everything that comes out, but I think I will pick up this book. It addresss some issues I've been wrestling with, though from a different point of view.

I'm an LPN who originally went to nursing school to become a Certified Nurse-Midwife, having had both of my babies in a free standing birth center with CNMs. Unfortunately, I became discouraged during my OB clinicals after seeing women treated very poorly who wanted to avoid epidurals or other interventions, and who wanted to breastfeed exclusively. I became interested in home birth as a realistic and viable alternative only *after* witnessing several hospital births and post-partum care. CPMs do far more homebirths here than CNMs, so I would need to change my career path. Maybe it says something that I've spent the last 4 years working with geriatrics rather than pursuing my original dream.

I've since moved to a different city and I've heard that hospitals here treat patients much better than in the rural ones I had previously experienced. I'm considering becoming a doula, but I don't know how likely it is for conflict to arise between patients and hospital staff, or how I would deal with it. Would I be able to accept those who make different decisions than I would, or would I be one of those doulas who pushes my own beliefs on others and leaves them feeling guilty rather than supported?

Its very hard to leave personal experience at the door with an issue such as childbirth. As a professional, how do you differentiate between educating people about their options and leaving people feeling pushed toward (or away from) someone else's ideal?
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#24 of 135 Old 02-11-2011, 08:07 AM
 
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I think that's what this book is trying to do: fix the system that makes women feel guilty for perfectly valid choices.



That is the opposite of what I said.

 

I want to fix the system that is preventing women from making informed choices and that is marketing its failures as guilt for their patients.


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So, the only reason you think hospitals would promote interventions is if their pay is directly related to them? That is quite an insult to your profession.

 

Do you really, honestly believe that every woman who comes into your hospital with some hope left of avoiding unnecessary interventions will be fully supported? Do you believe that every woman in your care who gets an epidural makes a fully informed decision where all the options are presented to her? If so, I would love to know your stats. What is your induction rate, how many of your patients are given drugs to augment labour, how often are vaginal examinations done, do you practice active management, what restrictions are routinely placed on your patients (monitors, supine position, not allowed to eat, etc, do you direct them to push, what is your c-section rate, do you perform episiotomies, do you offer quality advice on getting the baby in a good position before labour starts, what is your rate of assisted deliveries?



 



I cannot tell you how many times i have read threads here at MDC where people insinuate that Dr's push epidurals because they bring in more money. Certainly not a new concept here.
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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. 

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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.


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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.


So is not being at all open to the possibility that past risk assessments might have been wrong. 
 

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#29 of 135 Old 02-11-2011, 09:05 AM
 
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I don't think that there should be any guilt involved in this decision.  I don't believe for a minute though that epidurals are risk-free and I have had one natural birth that would have been a cesarean if I'd had an epidural.  I needed all kinds of positions and sensations to get my 4th baby ( 10lb 4oz malpositioned) out.  I'm pretty sure you can't sit up on a birthing stool with people all around you when you've got an epidural.

 

I've had 2 epidurals.  The first one caused major itching and some blood pressure issues.  The nurse said "Don't worry, anything we cause, we can fix."  What?  Cause?  Fix??  And I was stuck, numb in a bed with no way to help myself as a first-time birther who couldn't feel any of the pushing sensations.  I felt scared, helpless, stuck and itchy. I had to be given pitocin.  The baby's heartrate was decelerating and there was talk of having to get him out quick, so I got a huge epesiotomy .  I had to wear an oxygen mask.  It was awful.  My husband thought I was going to die and he was helpless beside me.  All of this caused by the epidural and all of the interventions that go along with it.

 

Second epidural I had at 8cm.  My heartrate sped up to match my daughter's and they had to turn it off.  It stopped my labor and then I had to have pitocin..then the epidural wore off and I had to push on my back with no pain meds.  All of the pain that the epidural was helping with was suddenly gone and there was no gradual build-up as normally happens in labor.  Just full force, pitocin enhanced pain while on my back. 

 

3rd birth, natural in a tub, almost pain-free, no blood pressure issues, itching, speedy heartrate issues, just perfect 9lb 4oz baby.  My husband said he'd never felt so involved in the birth and it really helped his bonding. 

 

4th birth, baby stuck, lots of pain, lots of positions, moving around, midwife on her knees working with me with her hand up there adjusting whatever she could.  I had to push from places I didn't know I had and certainly couldn't have found if I had an epidural. 

 

I think it's fine to choose an epidural if that's what you think you need, but they do come with risks.  I've seen people bed-ridden for weeks while trying to get rid of the epidural headache.  Yeah, that's a great way to start your relationship with your baby, flat on your back for weeks in pain. 


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#30 of 135 Old 02-11-2011, 09:11 AM
 
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I believe that as a midwife I need to evaluate all the literature, even if the conclusions do not line up with my ideologies. This is the only way I am able to educate my clients and allow them to make truly informed decisions.  I am anxious to read this book and the studies it is based on because it does go against what I have been taught.   I am very curious to see whether the women in the no-epidural group were able to get up, move around, etc., or if they were confined to a bed with monitors in the same way the women with epidurals are . I think epidurals have there place, and it would be nice to be able to reassure clients who need them. 


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