Ten lies my natural childbirth educator told me

Several people have expressed reluctance to join a Facebook group entitled Fed up with natural childbirth on the grounds that they have no objection to choosing unmedicated birth, or more generally, no objection to women making whatever choices they prefer. But natural childbirth is not simply a specific set of choices; it’s a philosophy that idealizes a specific set of choices and makes value judgments about women who choose differently. Moreover, it is a philosophy that rests on specific empirical claims; claims that are disingenuous, untrue, or occasionally outright lies.

Below is a list of the most popular NCB falsehoods and lies, the ones that are promulgated by natural childbirth celebrities and organizations, and faithfully transmitted even by purportedly neutral childbirth educators:

#1. Childbirth is inherently safe.

This is an outright lie. Childbirth is inherently dangerous. Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women. For babies, the day of birth is the single most dangerous day of the entire 18 years of childhood.

This lie is a bedrock assumption of natural childbirth philosophy. On this false belief that childbirth in nature is inherently safe rests the claim anything that modifies childbirth must be dangerous or not as good as childbirth in nature.

#2. Fear causes the pain of childbirth.

This stems from a spectacularly racist lie. Grantly Dick-Read, the father of the NCB movement, was a eugenicist whose primary goal was to prevent “race suicide” by encouraging white women of the better classes to have more children. He claimed that primitive (i.e. Black) did not have pain in labor, in keeping with the pervasive racist beliefs of the age that Black women were hypersexualized, and gave birth without pain because they did not fear their natural role. Grantly Dick-Read based his entire philosophy on this lie, hence the title of his book, Childbirth Without Fear.

Contemporary natural childbirth advocates no longer make the absurd racist claims, but they are stuck on the notion that the pain of childbirth is inherently controllable by the mind, and that the mind can therefore be trained to minimize and manage the pain.

#3. Labor is not inherently painful.

This bizarre claim rests on a false assumption that labor pain is qualitatively different than other forms of pain. It’s not. It is exactly like any other form of pain, is initially received by the same types of neurons, passes exactly the same way up the spinal cord to the brain, and is perceived by the brain in exactly the same way as any other form of pain.

#4. Epidurals are dangerous and unnecessary

NCB advocates insist that epidurals are unnecessary because the pain of labor should be managed in other ways, or better yet, should be endured. The claim is both philosophical and empirical. The philosophical claim rests on the naturalistic fallacy and belief in essentialism. The naturalistic fallacy is the claim that because something is a certain way in nature, it ought to be that way all the time. Essentialism is the belief that women share an essential nature and are “empowered” by expressing that nature.

NCB also insist that epidurals are “dangerous” to both baby and mother. That’s nothing more than a lie, created by grossly inflating the purported risks of epidurals.

#5. Interventions are “bad.”

Obviously, if you operate under the mistaken belief that childbirth is inherently safe, it is impossible to recognize the benefits of interventions. However, if you recognize reality, that childbirth is inherently dangerous, interventions represent nothing more than preventive medicine. Knowing that complications are common and often preventable, it follows quite logically that pregnant women should be monitored for a variety of complications so they can be prevented, or treated early when there is the greatest chance of successful treatment.

Since NCB advocates insist that interventions are generally worthless, they are forced into the bizarre position of arguing that medical professionals deliberately offer worthless practices and technology because they are benefiting financially.

#6. Inductions are dangerous and unnecessary.

This lie was adopted by NCB advocates only recently. It flows inevitably from two other mistaken beliefs, the belief that childbirth is inherently safe and the belief that since there are no inductions in nature, there must be no need for inductions.

NCB advocates bemoan the rising induction rate while conveniently ignoring the fact that the stillbirth rate has dropped as a result.

#7 Cesareans are almost always unnecessary.

Again, this is nothing more than an empirical lie. It is well known that in countries where the C-section rate is under 5%, mortality rates are appalling. Indeed, in countries that have C-section rates less than 10%, mortality rates are still extraordinarily high. At a minimum, then 1 in 10 women derive major benefit from a C-section. That is hardly a procedure that is unnecessary.

#9. Vaginal birth is inherently superior

This is a philosophical claim that rests on the naturalistic fallacy. Since everything that is natural is “better” and vaginal birth is natural, it must be “better.” Most women consider that a birth that results in a live baby and live mother is inherently superior, and for a significant proportion of women, that birth is a C-section.

#10. Women who love their babies choose NCB

This is the most hateful claim, but a claim that flows inevitably from all the other lies. When you erroneously believe that natural is inherently safe and that everything else is inherently dangerous, interventions wrongly take on the specter of unnecessary risks. When you wrongly believe that epidurals are dangerous, opting to treat your own pain implies that you value your feelings over the risks to your baby.

***

Natural childbirth advocates will be the first to tell you that NCB is not merely a vaginal birth without pain medication. It is a belief system that necessitates choosing vaginal birth without pain medication and without interventions of any kind. As we have seen, it is based on a variety of philosophical and empirical claims that range from false to outright lies. Natural childbirth explicitly idealizes certain childbirth choices and derides others. More importantly, it asserts that women who make those idealized choices are better women and better mothers than everyone else. And that’s why I’m fed up with natural childbirth.

  • Dr Kitty

    For anyone who has problems understanding the blood-brain barrier and epidurals.

    In epidurals and spinals local anaesthetics like bupivicaine and marcaine are injected around the spinal cord, where they stop the nerves sending pain messages. The drugs even stay around a particular part of the spinal cord, and don’t usually travel higher than we want them to.

    HOWEVER IV local anaesthetic is usually life threatening, because it causes cardiac arrythmias.

    The reason why an epidural infusion of marcaine, over a period of several hours is safe, while a few mls of IV Marcaine is potentially fatal is because the epidural marcaine won’t leak into the blood stream and get to the heart.

    Same goes for any opioids (usually fentanyl, sufentanyl or duramorph, not straight morphine sulphate).

    Whether or not YOU personally consider your labour pain to be severe enough to warrant epidural analgesia is a personal decision, but concerns about foetal exposure to opioids severe enough to cause respiratory depression requiring naloxone is such an unlikely event that most reasonable patients would not factor it into their decision making.

    • Molly B

      Respiratory depression can occur in Mom which can cause decels in fetus resulting in diagnosis of fetal distress and lead to cesarean.

      • The Bofa on the Sofa

        You are going to have to explain something to me.

        1) How does respiratory depression in the labouring mother cause decels? Can you explain how decels depend on the mother’s respiration?

        2) If the mother is suffering from respiratory depression, how can they do a c-section? I’m not an anesthesiologist, but don’t they have to get her breathing properly before they can actually do surgery?

        • Molly B

          1) Respiratory depression in mom decreases oxygen flow to fetus resulting in decels.
          2) Oxygen and other measures can be provided to mom but since epidural meds cant be stopped with immediate results sections can become necessary as decels are interpreted as emergency in some circumstances.

          • The Bofa on the Sofa

            Oxygen and other measures can be provided to mom but since epidural meds cant be stopped with immediate results sections can become necessary as decels are interpreted as emergency in some circumstances

            Why would that be? They know that mom is in distress, why would they do surgery before stabilizing?

            Again, I am not an anesthesiologist, but this doesn’t make sense.

          • Molly B

            Its not that Mom would be in distress, Fetus would be in distress. Fetal decels

          • The Bofa on the Sofa

            If the Mom has depressed respiration and/or crashing BP, which is a side effect of an epidural, then she would be in distress.

          • Molly B

            I didnt say crashing BP. I said drop in BP. There is a difference. Also waiting until Mom is stable isnt always an option because Mom may not be able to be stabilized.

          • sapphiremind

            Neo person here – We wait until Mom is stabilized. They aren’t going to cut mom open for a c-section to take the baby out if it is going to kill her unless she’s already dead. Something about it violating some sort of ethics and oath we take…?

            Anyway. They intubate mommy, push fluids, blood and pressors like mad if needed and what the baby needs more than anything in that case (if it is deceling from maternal reason) is mom to be stabilized.

            Hell, we had a mom go on ECMO not too long ago. If they had tried to take the baby first, it would have killed her and it would have taken a lot of consents, possibly court orders and ethics consults to get that done.

          • Guest

            Man, I’m a relative lay person, but even I know that’s not how that happens. If mom’s BP drops they push meds. If the baby is having oxygen issues they actually put oxygen on mom, flip you over, etc. My best friend had an epidural that made her pass out (bp dropped to 80/20). She didn’t have her c-section for another 8 hours and it was because she’d been stuck at 5cm for 8 hours.

            I know you think your educated, but you’re not. I’m not either despite spending many hours reading about this stuff. An OB is going to spend thousands and thousands of hours studying this and then observing and actually practising the things they learned. Even if you spent a hundred hours on this your knowledge is just inadequate. You clearly don’t understand anatomy, physiology, and chemistry, to name a few.

            Can you provide even one example of this scenario ever happening? I worked in an L&D for 2 years as a secretary – so anecdotal – but I never once heard of something like that happening (epidural followed by crash section).

          • Molly B

            Me

          • guest

            Yep. I had an induced birth and eventually an epidural. I didn’t get my epidural right away, I waited until I realized the pain was too much for me. After that, my daughter had worrisome heart decels. First my midwife had me change positions and moved the fetal monitors around. Then she called in the doctor on duty, and he did the same. I don’t know how long this went on, but my guess is at least a half an hour. When none of that worked, they told me that they thought a c-section was the safest option at that point. There was no epidural-decels-OMG CUT HER OPEN NOW to it at all.

            I know Molly B will probably say my daughter’s decels were because of the epidural, but since mine worked perfectly and none of the anesthetic got to her, I don’t see how. I had no blood pressure drop myself. The far more likely reason for it was that labor was intensifying (that’s WHY I got the epidural just then) and my little premature four pounder just couldn’t take it. Or perhaps she could take it – all might have been fine with a vaginal birth. But I saw no reason to play games with her life, so I consented to the c-section as soon as the doctors recommended it.

          • Molly B

            BP didnt drop so how is that the same as what we are discussing? I sounds to me like fetal distress was more likely due to a natural anomaly or hyper uterine stimulation caused by induction. Also baby was preterm has to be factores into what you are saying

          • guest

            No hyper uterine stimulation, Molly. Why do you always assume medical procedures are the cause of everything? This is exactly why it relates: you find fault in every medical birth practice just because you want it to be at fault. My labor and delivery looks like the cascade of interventions everyone was warned about. It wasn’t that at all! Had I gone natural, one or more of us would very likely have died. The interventions were the seatbelt that saved our lives, not the distraction that caused the accident in the first place.

          • Molly B

            I do nt always assume medical procedure are the cause. If you read what I wrote I gave two non medical possibilities for it as well…that 2-1

          • Guest

            No, you didn’t. You suggested hyper uterine stimulation caused by induction or natural anomaly (that’s two possibilities) in spite of the fact that I already told you what I think caused it – but you can’t accept that I have a lot more information about my own birth than you do, so you had to make up reasons why I am wrong.

          • Molly B

            or due to preterm baby (3). Also induction medications stimulate the uterus resulting in longer, stronger contractions than normal labor contractions

          • guest

            I said it was prematurity, not you. And told you it was NOT because of the induction. I’ve seen no solid evidence that induced contractions are stronger when properly handled, but in any case we’re talking about MY labor now. I was there; you weren’t. It wasn’t the induction.

          • Molly B

            Actually I stated that the fact that baby was preterm also had to be factored into it. So, yes I did.

          • guest

            No, you took the reason I gave for it, and made up two other reasons because my stated reason wasn’t good enough for you, for some reason.

          • Molly B

            I had epidural ater 18 hours of labor within 1 hour BP dropped, baby deceled, given oxygen, deceled a second time into 20’s along with2nd BP drop, didnt work rolled to OR for cesarean.

            Women are not alway told that BP drop can lead to decels in baby and need for emergency cersarean.

            Full disclosure is needed.

          • guest

            Sounds like a natural anomaly to me, and I’m as qualified as you to say so.

          • Nick Sanders

            And you don’t think the 19 hours of labor had anything to do with it? Anything at all?

      • swbarnes2

        If you HONESTLY wanted to clear up your position, it would be very easy. Post what you think the mg/kg does in an epidural is, what mg/kg does you think gets into a woman’s bloodstream, and then post what you think is the mg/kg that a fetus receives when an epidural is used in labor. Then post what mg/kg dosage you believe is required to get whatever effects you claim the medicines in epidurals cause.
        If you refuse to put any hard numbers to your claim, people will draw conclusions.

        • Molly B

          To state ‘what I think’ is only setting myself for other to say ‘site it’. Therefore I will site a NIH article that state anesthesia shows up in newborn urine 36 hours after birth. This mean that the fetus does receive the anesthesia and since a fetus is alive they are effected by meds the same as anyone else.

          http://www.ncbi.nlm.nih.gov/pubmed/3578847
          also:
          http://www.ncbi.nlm.nih.gov/pubmed/10617697
          and:
          http://www.ncbi.nlm.nih.gov/pubmed/7225300

          • The Computer Ate My Nym

            From the abstract of your first reference: “No bupivacaine was detectable in neonatal plasma 24 hr after delivery.”

            The second reference was about maternal fever and its effects on newborns, which can be associated with epidural anesthesia but is hardly an inevitable feature. The paper concluded that the effects were transient, though long term follow up to ensure that there are no lasting effects would be reasonable.

            The third is a 35 year old paper from a time when the dose of medication given in epidurals was considerably higher.

            Incidentally, you are aware that bupivacaine is not an opiate, right?

          • guest

            Molly B is incapably of understanding epidurals. She’s demonstrated that repeatedly. I’m still waiting for her to explain who there can be informed consent when the patient can’t understand the procedure. We’ve spent *days* trying to explain it to her. If she were a woman in labor, she’d be well past needing one by now. Maybe that’s what she wants: Epidurals are technically available (so she can still claim to be for patient choice), but the consent process takes so long that no woman will ever get on before labor is over.

          • swbarnes2

            Just dropping citations isn’t helpful. We need NUMBERS. You need to show that the amounts present are high enough to have any effect.

            Your second link is about elevated temperatures, not about epidurals.

            Your third link is 35 years old. The first is about 30 years old. Is this really the best you can do? You are banking your reputation as an educated person on the grounds that nothing has changed in the practice of epidurals or the evidence in 30 years?

          • Daleth

            The two studies you cited about epidural drugs being present (in tiny amounts) in babies’ urine date from, respectively, 1981 and 1987. Can’t you find anything more recent? No? Did it occur to you that the reason you can’t find anything more recent is because the drugs and doses used to do epidurals and spinal anesthesia have changed since then?

            Specifically, the drugs have changed and the doses have gone down.

            So you’re citing studies about a medical practice that nobody does anymore. What makes you think that’s relevant to the practice that’s done these days?

          • MaineJen

            Molly, what you’re trying to say is “cite it.”

          • Roadstergal

            From paper #1 (1987): “No bupivacaine was detectable in neonatal plasma 24 hr after delivery.” And from the Discussion, “The key finding is that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts.” Basically, what everyone has been saying – trace amounts can leak through, but they are trace and transient and, as per the studies discussed below, have no measurable effect on the fetus.

            Paper #2 is studying transient effects maternal fever has on the newborn. They specifically say in the Methods: “Epidural analgesia was not part of the trial protocol.” They noted that febrile women had larger babies, longer gestations, and longer labors than afebrile women, which confound any analysis they could have made with epidurals if they had wanted.

            Paper #3 is so old (1981) it isn’t available online. If you’ve read it, by all means post the PDF – but I’m guessing you don’t read papers, you just look for keywords in the abstract that seem to support your pre-determined conclusion. All I can tell from the abstract is that it wasn’t blinded and there was no control group – it doesn’t even say the size of the group, it could have been 5 babies – so even as an evaluation of the state of late ’70s pain control, it’s not terribly informative.

            So, one paper that says not much, one paper that says even the state of epidurals thirty-plus years ago was pretty safe for the fetus, and one paper that doesn’t have anything to say about epidurals.

          • Nick Sanders

            And a poppy seed bagel will make you fail a urine test for opiods. But it’s not going to affect your breathing unless you choke on it.

  • Molly B

    Had OB appointment today. Dr said any narcotic administered to a laboring mother regardless of the mode of delivery can get into the blood stream and can cause negative side effects to fetus. Asked about morphine specifically. Said it used on low doses but still has risks to mom and fetus. In the case of severe respiratory depression from things like allergic reaction or medication interactions Naloxone is kept on L&D Unit and can be administered as needed.
    Done. Fuck all of yall who want to make 30 responses in one day a d then no one takes the time to read my other responses to other people so now no one has a clue what is going on and keeps trying to argue things that have already been resolved. Enjoy yourselves. I have better things to do than sit on here all day writing outdated responses to people. Get lives, get jobs, good luck.

    • fiftyfifty1

      You, for sure, should NOT have an epidural! You don’t WANT an epidural. You have heard all you want to hear about epidurals and you are going to say NO!

      Good for you. Now go away and leave other women alone.

      • Roadstergal

        Seriously, can we just chip in $0.50 each to get Molly B a “I didn’t get an epidural or vaccinate my kids, so I’m a better mom than you” shirt and be done with it?

        • Molly B

          No but we can get you an I pass judgement and make claims about people that are untrue based on a preconceived notion of one single opinion someone has and automatically classify in them as an member of a certain group of thinkers
          #1 I have had an epidural before. I’m fact I have three children. One by epidural, one by cesarean, and one by vbac.
          ALL of my children have received vaccines to some degree except those which they have medical contraindications to.

          • guest

            “I’m fact I have three children.”

            I thought you never posted in online forums unless you were certain you wouldn’t make any grammar errors?

          • Roadstergal

            That was AK. I know, it’s hard to tell them apart, as they co-parachuted and share many of the same odd ideas.

          • guest

            Well at least one thing in this absurd debate is consistent, at least.

    • Nick Sanders

      Much like you pointed out that “not routinely used” isn’t “not used”, “can” is not “will”.

      • Molly B

        Someone on here earlier said to me that naloxone was only used for drug overdoses and not on L&D Unit. That’s what the comment was in reference to.

        • Nick Sanders

          That has nothing to do with what I said.

          • Molly B

            Then what “can” and “will” were you referencing?

          • Nick Sanders

            “can get into the blood stream and can cause negative side effects to fetus”

          • Molly B

            “Can” is still not “cant” therefore risk to fetus is there no matter what your opinion or my opinion is on the amount or severity. The risk is still there.

          • Nick Sanders

            And? Trying a new food for the first time carries a risk to the fetus, so does getting in a car, or having a metabolism. If the point is to avoid all risks to the fetus, no matter how small or what other risks they replace, the only option is for no one to ever get pregnant again.

          • Daleth

            Postpartum depression, which can be caused by not having an epidural (we already discussed those studies so I won’t repost the links), is in itself a risk to the fetus. The risk is inadequate bonding, neglect, and in severe cases, physical harm, because a depressed mom is not up to being a mom.

            Do you really think being cared for by a severely depressed woman for many months is safer for a baby than the risk of slight, very temporary breathing problems–which any hospital can take care of, no problem–for an hour or so after birth? Why?

        • Monkey Professor for a Head

          Are you referring to Dr Kitty’s comment? Because that’s not what she said at all. She was replying to your statement that neonatal opiate toxicity from epidurals was so common that an antidote was invented. She was pointing out that the antidote in question (naloxone) was developed for the treatment of non obstetric related opiate toxicity.

    • Who?

      Good luck with the baby. Don’t make yourself too many big promises before labour-it can be a wild ride.

      • Molly B

        This is my fourth child. 1 prior induction and epidural, 1 Cesarean, 1 VBAC. I’m well aware of all risks and what goes on.

        • Who?

          So you know it can be a wild ride.

          It’s a shame you’re so focussed on this one thing, and on risks which are way smaller than the risks of a normal delivery, which presumably the doctor spent most of the day explaining in excruciating detail. Three previous pregnancies and deliveries are not nearly enough to know more than practically nothing about it, as I’m sure you’d agree.

          • Molly B

            No I would say that I am well informed in the possible outcomes of birth, risks of natural birth and risks of medical interventions. And its not thre previous pregnancies…..its three previous births.

          • Who?

            I think it’s sweet that you imagine that three personal experiences give you a wide understanding of any physical experience, particularly one as complex as pregnancy and delivery.

            You’ll see, if you care to read my comment above, that I referred to ‘pregnancies and deliveries’, so thanks for the unnecessary correction there.

            You’re very good at rewriting others’ remarks with a view to insinuating the remarks are wrong.

          • Molly B

            If you have no real comment then dont comment. Your wanna be southern f u charm doesn’t do crap for me

          • Irène Delse

            My, my. Some people get nasty when their BS is called out.

          • guest

            Funny, that.

            I’m going to get myself a t-shirt that says “I <3 My Epidural."

          • Charybdis

            Epidurals rock. So do well baby nurseries, pacifiers and formula.

          • guest

            Oh, yes. We had a NICU stay, and thank goodness because there was no well-baby nursery otherwise. I don’t think I would have left the hospital with my sanity otherwise.

          • Molly B

            Actually my bs wasn’t called out. My personal experiences have given me.insight into the issue at hand. My research because of my personal experiences has made me informed. Also its upsetting when someone who has posted on other articles that they don’t even have kids thinks they can tell me what my personal experience is having 3 has or has not afforded me. Who? It making a call.aboit something they have ZERO knowledge of

          • guest

            “I got pregnant and read a bunch of stuff on the Internet,” says Molly B. “Therefore I am an authority who can tell other women what they should be doing, because I know better than medical professionals.”

          • Molly B

            I have given birth to three children and educated myself through reputable nonbiased sources, therefore I feel qualified to tell women that they should seek full disclosure from medical personnel/midwife in regards to informed consent.

          • MaineJen

            Full disclosure…like those consents I signed before getting both of my epidurals? Pretty sure that was full disclosure. And pardon me very much, but I felt that pain relief was very much necessary. Made my deliveries 100% better, I was awake and alert and so were my babies. I knew there was a miniscule chance I could have a bad reaction to the epi, but taking that chance was worth it to me. There are also risks associated with unmedicated delivery, wouldn’t you agree?

            You don’t feel pain relief is necessary! Good for you. Not sure why you’re trying to tell others what to do.

          • Molly B

            When I say necessary I am speaking in the term of medical necessity. No doubt your epidural were very much wanted and appreciated by you. I have no doubts about this as a epidural recipient myself and also med free birther with another child (not by choice), but based on your statement that they were solely for labor pain relief they were not medically necessary

          • momofone

            What qualifies you to determine medical necessity?

          • Molly B

            If pain was relief was necessary for childbirth then women would not be able to birth without it.

          • momofone

            That’s not what I asked.

          • Sarah

            Does it not occur to you that it’s possible for something to be medically needed by some women and not others? The ability of some women to give birth without pain relief tells us nothing whatsoever about whether another woman, perhaps dealing with malpositioning or exhaustion or both, might require.

          • Roadstergal

            My friend had her VBAC all nacheral and unmedicated because what you’re spouting about the Dangers of Epidurals is the party line among midwives in her country. The pain was so prolonged and intense that she blacked out, and had flashbacks in nightmares for months. I guess actually remembering the birth of her son wasn’t really necessary. Certainly it wasn’t important enough to give her informed consent about.

          • fiftyfifty1

            “If pain was relief was necessary for childbirth then women would not be able to birth without it”
            Ah, I see that you are not familiar with the term “medically necessary”. You see, it’s not the same as “absolutely necessary”. There are lots of things that are medically necessary that humans have done without in the past. Pain relief in general is one. It’s quite possible to do a surgery without anesthesia. You can tie the patient down, or punch him in the head and knock him out, or get him passed-out drunk. But doctors (and insurance companies) consider anesthesia to be medically necessary anyway.

          • guest

            Can you imagine if insurance companies were allowed to refuse coverage on the basis of absolute necessity rather than medical necessity?

            And once upon a time, they did refuse to cover the cost of epidurals.

          • MaineJen

            I had to pay for my epidural. My husband had to pay for his too. I have no idea if what I was paying was the whole shebang, or just a portion of the cost (I don’t look at those statements too closely; I’m depressed enough as it is), but I know that insurance either doesn’t pay the whole thing or doesn’t pay for it at all.

          • guest

            Ug, are they still doing that? That sucks.

          • guest

            If medical care was necessary for bullet wounds, then people would not be able to survive one without it. And yet, some of them can.

          • sapphiremind

            We used to do surgery on babies without pain meds. Do you think we should stop using them? I mean, we can just paralyze them so they don’t squirm.

            bee-tee-dubs, one magical thing about an epidural that is also a rare thing, but important, is that if something goes horribly wrong and they have to crash section you, if you have an epidural, they don’t have to put you under general anesthesia. You want to talk about affecting the baby? General anesthesia knocks the baby right out. I see thousands of babies from epidurals and never notice any difference in their breathing or behavior. General anesthesia babies are limp noodles that can’t breathe.

          • The Computer Ate My Nym

            Heck, we used to do surgery on adults without pain meds. Therefore pain meds are unnecessary during surgery. The people who complain about the cost of medical care will be very pleased: Anesthesia is expensive!

          • MaineJen

            Thanks for assuming my epidural was only for “my own selfish comfort,” and not for relief of, say, uncontrolled pushing on an incomplete cervix, which may have caused swelling and actually complicated my labor. And so what if it was for relie of pain? Relief of pain is a medical necessity in and of itself.

            When my husband had major abdominal surgery, no one even thought of suggesting that his epidural wasn’t “medically necessary,” even when it caused a dip in blood pressure during his surgery.

            So why is pain relief in men considered a medical necessity (and it damn well was), but pain relief in women experiencing an equally painful event is considered “not medically necessary?” This is the worst kind of sexism and it makes me so angry.

          • Molly B

            Did the consent outline the risks and benefits? I read my consent for each child ( I signed consent for everything with the knowledge that anything can happen and I can verbally refuse whatever I want to refuse).
            One of the anesthesia consent and the one for current pregnancy simply states That I consent anesthesia including epidural/IV/General and that all the risks and benefits have been explained to me. they are not anywhere in writing on the consent form. Consent for is a half page with signatures for other consent including video, photography, recording, allowing equipment reps in OR and allowing students and resident in room during childbirth or surgery and allowing residents to perform surgery under supervision of Physician.

            That is not informed consent. Not in the case of what hospitals are wantin gme to sign. They e ven tried to tell me that I couldnt get a paper copy ahead of time because consent were signed electronically on comp when woman presernted to hospital in labor…

            SideNote: I have crossed out certain things on this current consent.

          • MaineJen

            Well you sound like an absolute treat to care for.

          • Molly B

            My job is not to make my hospital stay pleasant for the medical staff. It is to birth my child in the way that I feel is best for me and my child. That includes talking to anesthesia ahead of time and determining a plan of care for anesthetics should I choose to use them since I have had bad outcomes in the past. That include not allowing unnecessary people in my Room or OR if I don,t want them there and that includes not allowing my privates or my child to be filmed or photographed if I dont that done and that includes not having a resident perform surgery on me if I dont want a resident to perform surgery on me. Its my legal right.

          • guest

            Talk to your anesthesia all you want; it won’t affect the outcome.

          • Charybdis

            Medicine is not ala carte, nor is it a buffet or Burger King.

          • Amy Tuteur, MD

            What reputable non biased sources?

            Based on what you’ve been writing, you’re not educated; you’re just regurgitating propaganda.

          • Molly B

            ACOG AJOG NIH WHO British Med Journals etc

          • guest

            You are a complete and total idiot, is what you are. Having children and reading a few online articles doesn’t make you an expert in anything except, perhaps, self-righteousness.

            If that’s how it worked I could have self-published my book and read some Google Scholar articles to earn my PhD.

          • Molly B

            Apparently you are the idiot who cant read because I specifically stated that I was not an expert.

          • guest

            Then shut up already and stop claiming that you know how epidurals work and what the risks are.

          • Linden

            I guess I’m just going to have to go with what Dr Amy is saying, because she actually is an expert. Thanks for clearing that up! For a moment there, I couldn’t decide who to trust: a woman who’s given birth to a few kids, or the woman who’s given birth to a few kids, been educated in one of the best universities in the country on this topic, attended births in their thousands and works tirelessly for the safety of women and babies even now.

          • momofone

            “I’m not an expert, but I know more than those who actually are.”

          • Charybdis

            Further downthread she admits her pissitivity level is cranked up because doctors are not letting her dictate the parameters of her second VBAC.

          • rosewater1

            If you solicit opinions-from anyone-you need to be prepared that you’ll hear opinions you won’t like.

          • The Bofa on the Sofa

            That’s why I never ask anyone what they think. I don’t care. All that matters is what I think.

          • momofone

            Ah. Well, how dare they. She’s an expert, don’t they know?

          • momofone

            Finally found her post. Four OBs. At least three who are thanking their lucky stars that she moved on. Made me think of something I saw by a woman who had been to seven veterinarians in the past six months with her sick dog. I’m sure the issue is the vets’ not knowing their business. (If I don’t stop rolling my eyes, I’m sure they’re going to get stuck like this.)

          • Who?

            ‘Pissivity’ has now entered the Who? lexicon.

            Part of me feels bad for Molly, now that the real trouble is revealed. However, even that part of me wants her to get her big girls pants on (so to speak) and realise that given the baby is coming out, one way or the other, it might as well be in the way recommended by the experts she has sought out. Go hard or go home.

          • Roadstergal

            I don’t have a part that feels bad. She comes here trumpeting to the skies the risks of epidurals to the fetus – and then we find out that the reason she’s doing that is because she wants to take the far more pressing risk to her soon-to-be-baby by risking surgery under GA – or not timely surgery in the first place – if she has a catastrophic rupture for her VBAC. “Hypocritical” doesn’t even start.

            I’d feel a little bad if she were just bitching about not liking the VBAC requirements. Hell, if she were understanding the reasons and willing to go through it, but just bitching about having to, I would be right there nodding sympathetically.

          • Amy Tuteur, MD

            You think giving birth to three children makes you knowledgeable about childbirth? That’s like saying you’re educated about aeronautics because you took 3 plane trips.

            Being educated about childbirth means learning obstetrics and delivering hundreds of babies, not having a handful of births.

          • Molly B

            No saying I have flown a plane three times make me educated in aeronautics is like saying having given birth three time makes me educated in giving birth. I never claimed to an expert.

          • Irène Delse

            This is getting pathetic.

          • Amy Tuteur, MD

            In other words, you doesn’t make you educated.

          • Molly B

            No, I am educated, just not an expert and even experts make mistakes so expertise does not relieve you of being human, having bias, or making mistakes.

          • Monkey Professor for a Head

            You are educated. But you railed against doctors not treating epidural related hypotension with naloxone when epidural related hypotension is not caused by opiates. You seemed to think that opiates can cause fetal distress via respiratory depression in utero. You think that even the tiniest trace of opiate getting to a fetus is dangerous, ignoring the fact that most adverse effects of opiates are dose dependent. But you are educated.

            I don’t think anyone here is against informed consent. But they disagree with what you think the risks are. I have already asked you once, and you sidestepped the question, but if you had to educate a woman on epidurals as part of informed consent, what exactly would you say?

          • Molly B

            At a minimum, then 1 in 10 women derive major benefit from a C-section. That is hardly a procedure that is unnecessary.

            Yet the US cesarean rate is 3 out of 10.

          • AllieFoyle

            What is your point?

          • Molly B

            Have you read her article? Also, the comment was not directed to you so…

          • Sarah

            She hasn’t got one.

          • Empliau

            How many babies derive benefit from it? And what is major? Is a 7% brain function loss minor? Seriously, wtf?

          • Monkey Professor for a Head

            Let me give you a hypothetical example to try and illustrate why the c section rate is what it is. Let’s say there are 100 pregnant women with condition X. We know that if these women deliver their babies vaginally, 10 babies will die. We have no way of knowing in advance which babies will die. If they deliver by c section, then likely none will die. Given these circumstances, most doctors would recommend c section, and most women would agree. This will result in 90 “unnecessary” c sections, but will result in 100 alive healthy babies. In order to avoid those 90 “unnecessary” c sections, you would end up with 10 dead babies.

            Our current level of technology lets us determine which babies are at increased risk during vaginal birth (note, it is never no risk), but it does not enable us to know exactly which c sections are “necessary” and which ones are “unnecessary”. It’s a delicate balancing act between the risks of vaginal birth and the risks of c sections to the individual mother-fetus pair. Where would you draw the line.l? Until you understand this, all your opinions on the c section rate are meaningless.

          • Molly B

            This scenario does not account for all ceseareans only select group of women who have cesareans

          • Monkey Professor for a Head

            I guess it doesn’t cover maternal request c sections. Which is a comparatively small proportion. But I think it illustrates the reasoning behind most medically indicated c sections.

          • Daleth

            What group of women getting c-sections does Monkey Professor’s scenario not account for?

            It looks to me like the scenario covers every woman who gets a c-section (emergent or scheduled) for a medical reason. For instance, among all women who have emergent c-sections due to fetal distress, as well as all women who have planned c-sections due to the baby being breech or transverse or due to having had a prior c-section, we know that out of 100 or 1000 or whatever vaginal births, a certain number of babies will die or be brain damaged. We therefore recommend c-sections for all these women because we don’t know–we literally have NO WAY of knowing for sure–which of these women are going to be the lucky ones and which will be the unlucky ones.

            So the scenario covers every medically justified c-section. And it even covers the tiny number of women who opt for a c-section with no medical indication for it, because women with no risk factors can still experience shoulder dystocia, placental abruption or cord prolapse during vaginal birth, so for every X number of women with no risk factors who give birth vaginally, some babies are still going to die or be brain damaged who would not have been if mom had delivered by c-section.

            I’m just not seeing how this is a “select group” or how any group of women who deliver by c-section is being left out of the scenario. Can you explain?

          • Molly B

            Also pain relief is unnecessary in labor…though greatly appreciated by many…thats why its call ELECTIVE

          • Charybdis

            See, that is a bass-ackwards way of shaming women who opt for pain relief. Saying it is UNNECESSARY is uncalled for. Saying that it is ELECTIVE and that you can have it if you want it is different than saying it is flat out unnecessary, but hey, you whining little wimp, you can have pain relief during labor and delivery if you want.

            But know, first and foremost, that it is UNNECESSARY.

          • Molly B

            No. Pain relief is not necessary in a laboring Mom but Im not faulting anyone for accepting it. Are you seriously trying to say that think no one can birth child unless they have pain relief that every womans body will not allow here to labor with medication?

            No. Because thats not true. A womans body can labor and birth without the meds but it hurts….like hell. And if a woman wants pain relief then hey thats her choice, maybe she doesnt want the au naturale experience and as a mom who has had a med free birth I cant blame her on ebit. I just want people to make sure they are getting all the info first.

          • AllieFoyle

            >>Pain relief is not necessary in a laboring Mom

            In your opinion, is pain relief ever medically necessary? When? How do you determine the necessity or lack thereof?

          • Molly B

            Based on the level of pain the person is experiencing, but that doesnt mean a doctor or nurse should push any intervention on a woman who doesnt want it no matter how much pain she is in.

          • momofone

            Offering is not forcing. They can offer; she can decline.

          • AllieFoyle

            How do you determine the level of pain someone else is experiencing? Really, I want to know. Presumably you think pain relief is medically necessary in some situations, but not ever in a laboring mom.

          • AllieFoyle

            I suppose it depends on your definition of necessary. Many medical procedures/interventions are not strictly necessary but are offered to relieve suffering or improve quality of life. Relieving severe and potentially traumatic pain certainly seems to me to fall into that category. If your ONE experience of unmedicated childbirth was not severely painful then I suggest that you simply consider yourself lucky.

          • Molly B

            Stick with the Laboring Mom and lets nor drift into other areas such as hospice care. I am tired of lengthy arguments with people who want to argue up broken bones and other bs.

            In a healthy laboring Mom pain relief is elective

          • momofone

            “I am tired of lengthy arguments with people who want to argue up broken bones and other bs.”

            And yet, despite your exhaustion, you persist.

          • Molly B

            My labor and birth was painful. I thought the pain would kill me, but unfortunately I was not in a hospital as I had planned to be in one and I was unable to get to one.
            But what if the intervention causes problems that make you scared or traumatize you? Trauma is possible no matter what you choose.

          • AllieFoyle

            Interventions are recommended or requested and accepted or declined. Unlike going unmedicated and avoiding interventions, which has risks that are much more rarely addressed by informed consent. No one claims that there aren’t risks to interventions, but the reason interventions are offered in the first place is that they offer the potential of allaying or minimizing risks and trauma. People feel that there is a legitimate need for pain relief during labor and epidurals are the result of that. Why you think your one unmedicated birth and internet research makes you more qualified to decide when pain relief is necessary is beyond me. You’re literally discounting the experiences and expertise of countless women and doctors.

            And I’ve already dealt with the physical and emotional trauma of what happens when people don’t offer interventions (usually because they share your biased mindset). The dangers of epidurals (which are only given with signed consent forms) is not, IMHO, even close to the most pressing concern in maternity care at the moment.

          • Molly B

            Not being offered interventions is wrong unless a mother has specifically asked not to be offered interventions. Even then If a doctor thinks the intervention has become medically necessary he or she should discuss that with Mom.
            Also, please note that I stated my unmedicated birth was not by choice.

          • AllieFoyle

            So why aren’t you equally up in arms about women who aren’t offered interventions? I don’t think you’re being honest about your intentions. You’ve already stated that you don’t believe pain relief for childbirth is really necessary. You came here specifically to argue that epidurals are dangerous and that women would choose not to have them if they were fully informed even though you have no idea how epidurals work and your beliefs are based solely on personal experience and picking and choosing stuff off the internet out of context. You’re not interested in informed consent. You’re interested in giving people your uninformed opinion about epidurals so that they will try to avoid them. The end.

          • Molly B

            Because Im almost certain if a woman wanted med she would damn sure make sure everyone knew it. I stat ed that I dont believe it is medically necessary.
            I did not come to argue that epidural are dangerous. i never said they were dangerous and I have already had a discussion with you specifically regarding how the whole epidural thing got started and what my position was on interventions, informed choice and full disclosure.
            Dont try to go there

          • AllieFoyle

            Don’t try to go where?

            If you didn’t come to argue that epidurals are dangerous then what is the point of your first twenty or so posts in which you did try to enumerate the risks of epidurals that you thought women weren’t being told about?

            I wanted meds and I didn’t get them either time thanks to jerks like you who think pain relief isn’t necessary.

          • Monkey Professor for a Head

            “Epidural have risks associated with them such as possible paralysis, permanent nerve damage, spinal headaches (think migraine on steroids), depressed breathing with can effect mom and fetal heart rate etc. Though most of these are not common they are still inherent risks. Think about it…a needle is being placed in an opening in the vertebra and into the spinal cavity. Thats pretty serious stuff there.”

            This is your first post here (it also had a section copy and pasted from the product insert for morphine sulphate, I omitted that to save space). But you didn’t come here to argue that epidurals are dangerous

          • Molly B

            No i came here to argue that SkepticalOB telling women that natural birth is dangerous and interventions are safe is wrong. BOTH HAVE RISKS. Most people are familiar with epidural so I used that and an example.

          • guest

            Waking up in the morning has risks. Possibly even more risks than getting an epidural.

          • Molly B

            Site your source

          • guest

            Read the obituary column of any newspaper.

          • Charybdis

            Most people are already aware that “medical things” have risks and that those risks are discussed with you before “things happen”. You can’t even get blood drawn without hearing about potential issues (if you feel faint, tell me, if you feel sick, tell me, don’t lift heavy things for X amount of time, or the site can start bleeding again, I’m drawing 3 tubes of blood, etc). Before you get a vaccination, the potential risks and side effects are discussed. Things to watch out for, how to report an adverse reaction, etc. People KNOW that medical anything has potential risks and are prepared to accept or reject them as they see fit.

            On the other hand, the NATURAL BS also has potential risks, but no one is talking about them. Because it is NATURAL, then it must ALWAYS be fine and there will be no bad side effects/outcomes, because natural is always better. Women have been having babies since forever and the human race has continued, so labor and delivery are perfectly safe. Things like 3rd and 4th degree tears, a fractured coccyx, cervical tears, PPH, pelvic floor damage, urinary and fecal incontinence, prolapses, a ruptured uterus, placental abruption, retained placenta, uterine atony, infections, amniotic embolism, aneurysms, muscle and ligament damage, etc are very real and potentially devastating risks of vaginal delivery. These things are not really discussed with pregnant women, because somehow, natural things will not hurt you. Not talking about the risks of vaginal delivery does not qualify as informed consent and people view it as fearmongering, because, you know NATURAL IS BETTER AND WILL NEVER HARM YOU.

            That is what Dr. Amy is arguing for: women to have ALL the information about possible risks and less than desirable outcomes for both CS and vaginal birth and all those options entail. True informed consent, not just fearmongering from the Natural At All Costs side (Epidurals! Opioids! Needles jabbed into your spine! Meds from epidurals can adversely affect the baby! CS is inevitable if you are in a hosptial and get an epidural! Not listening! Pushing/pressuring you to have pain relief! All bad things happen in a medical setting!).

            And how is presenting the risks of vaginal birth considered dangerous? People don’t really think there are any.

          • Irène Delse

            ^So much this.

            I’m living currently with chronic pain, hopefully not definitively but let’s say it’s slow to get better. However, this is the improved situation: two months ago, I had surgery of the knee to relieve what was then excruciating pain. The surgeon suggested an operation but it wasn’t strictly necessary: some people would rather take pain medication and/or do PT. Well, I had tried PT and it didn’t help. My GP also gave me a prescription for codeine – but I really disliked the side effects, and anywa

            y opioids are not something you want to take every day for the long term. So I chose surgery: a medical procedure with its own risks, but with a good shot at making my pain better. So far, it’s worked: I have recovered a near-normal degree of mobility, and the pain is a lot more manageable.

          • Who?

            Great the operation went well. Dad had a double knee replacement about 5 years ago, it was a wonderful lifechanging surgery. He’s now out and about all the time, and not in pain.

            Modern medicine is amazing.

          • Irène Delse

            Thanks. And that’s great for your dad.

          • Empliau

            Well, until the 19th century, people survived (often, not always) amputations without anaesthetic. Maybe we shouldn’t use it for diabetics losing limbs, combat injuries … it’s unnecessary. And yet I think, offered the choice between agony or pain relief, that I know what most would choose.

            Nobody here cares what you do. Have your baby unmedicated. Just don’t think that it makes you better than someone else who chooses an epidural. Also, you should really leave explaining how epidurals work to the adequate mother, who administers them. Her expertise is valuable. Yours is confined to relaying what you understood your doctor to have said, which may or may not be what your doctor actually said. Human memory is unreliable, and you have no relevant training (and no, your three experiences of childbirth don’t count. I have been driving safely for 40 years, but I can’t fix an engine!)

          • Molly B

            You are a freaking idiot. Severing a limb is not the same thing as birthing a child.
            I never said women should not have the option. In fact I have stated more than once that I am all for having options.
            I never once said how I would be birthing my child or whether or not I would be using pain relief medications.

            Being an Anesthesiologist with children does not make you an adequate mother. It makes you a mother who is an anesthesiologist

          • Empliau

            I consider being called a freaking idiot by you a badge of honor.

          • Empliau

            I should clear up any possible confusion: theadequatemother is an anaesthesiologist who posts here. There is a link to her blog on the right, where you can read about what epidurals are and how they affect the fetus. I put spaces because I dislike the little red underlines when programs diagnose spelling errors.

          • Molly B

            Pushing for me to read an article by someone who is being vouched for on a site run by someone I dont agree with is not going to happen. I have read NIH ACOG and WHO all of which have stated a known connection between epidurals and negative fetal outcomes. I will stick with that.
            That being said the negative outcomes are not every bay or every frequent, but they do exist and women need to be made aware of the risks.
            A doctor saying “Epidural are safe” Is not full disclosure. It is up to a mother to determine whether she risks to benefits ratio is a good fit for her and for that she needs to be fully informed and doctor have a responsibility to provide that information.

          • Empliau

            If you cannot tell the difference between a suggestion and pushing I am not surprised you feel you have not experienced informed consent.

          • LibrarianSarah

            Pushing for me to read an article by someone who is being vouched for on
            a site run by someone I dont agree with is not going to happen.

            And that’s a problem. Refusing to read a source simply because “I don’t (or more accurately) agree with them” is pretty much the definition of Confirmation Bias and is one of the major components of information illiteracy in today’s society.

            If you had REASONS why theadequatemother is not a valid source of information that would be one thing. But you would have to have read her blog in order to know that.

            But I can’t have children so what do I know about the proper use of information.

          • Irène Delse

            A blog you don’t agree with – but keep coming to. Interesting. But it’s unfair of you to refuse to even read the posts by theadequatemother simply because her blog is featured here. As an anaesthesiologist, she knows inside out how epidurals work, and I’ve always found her explanations clear, complete, precise and above all helpful. If you imagine that it only amounts to “a doctor saying epidurals are safe”, you’re sadly mistaken. Time to rethink your position!

          • MaineJen

            They are on the same pain scale…

          • Who?

            Well no but they both hurt-not that I’ve lost a limb, but smart people who know all about it say it does. They both change your body in many ways, and have effects that you live with forever. I guess giving birth is something you think in advance about, whereas most amputations probably happen quite quickly from decision to deed.

            One of the big differences though is no one would suggest that amputation without pain relief is good for anyone.

          • Daleth

            Severing a limb is not the same thing as birthing a child.

            You’re right. It’s actually much faster and, compared to many women’s labors, less painful–an amputation is over and done with in maybe 30 minutes (including the time to sew everything back up), and the actual cutting part only probably takes maybe 2-5 minutes depending on what limb we’re talking about.

            Who can’t bear horrific pain for a mere 2-5 minutes? Pain relief for amputations is clearly “unnecessary.”

            But seriously… you have no right to say whether it’s necessary or not. That call is to be made by each individual woman, not by you.

          • Molly B

            Because being a driver and being a mechanic are not the same thing.

          • guest

            And being a mother and being an OB-GYN are not the same thing, do you not see that?

          • Molly B

            I do see that. But being a mother and being informed and advocating for informed consent and full disclosure is not claiming to be an OBGYN.

          • guest

            No, it means that you don’t know a damned thing about what you’re talking about. If you can’t understand what it is that you want a consent form for, you shouldn’t be advocating for one – for starters, because you can’t have informed consent until you understand what you are consenting to.

          • Empliau

            Actually, I really like my analogy. We learn the rules of the road, we push when it’s time, etc. On the other hand, I don’t know everything that can go wrong, nor how to fix it when it does; my doctor and my mechanic, depending on whether it’s childbirth or my car, are the ones who truly understand. I leave the mechanics of childbirth to doctors and the mechanics of cars to mechanics. That’s why I trust them – because they are the experts.

            As the great Blackadder said: I am one of those people who are happy to wear cotton, but have no idea how it works.

          • Molly B

            So you trust any mechanic who tells you anything then??

          • Nick Sanders

            Well, if there were several national and international mechanics’ organization , whose very existence depended on the quality and credibility of their advice and the knowledge and ethics of their members, and they all said more or less the same thing, and had all these trials and studies full of data on which they based what they were telling me…

          • Who?

            I like it too.

            It’s too exhausting to try to be an expert on everything. Find good and well qualified people who you can work with, and let them do the hard work: mechanics, hairdressers, doctors, builders, gardeners and on it goes. Use the time you save to get even better at whatever it is you actually need or want to do, secure in the knowledge that the other stuff is in hand.

          • Nick Sanders

            Are you blind to irony, or have you just never heard of the concept?

          • Erin

            Having had a big headed baby spend 75 hours trying to exit via my spine with my first contraction hurting as much as my last, I would debate that statement. I’m good with pain usually, I don’t bother with local anesthesia for fillings etc because I hate the numbness more than the pain. I didn’t need any medication post emergency c-section and I got up and dressed myself 4 hours after surgery. My labour pains almost killed me though, I’ve never ever known pain like it and that’s the thing…we all labour differently. My Mother went from 1cm to 10cm in under 4 hours and described it as twinges. A Friend of my MiL’s said she never had any labour pain at all until the baby was crowning, my back to back baby hurt like hell.

            I’m a huge believer in women having access to pain relief if they need/want it but saying it’s unnecessary is in my book wrong. It might be and certainly I managed without for 60 odd of those hours (not through choice I assure you) but seeing statements like that, which don’t always take into account how much labour pains can vary (as can the length of labour), contributes to women ending up with PTSD/PnD.

          • Molly B

            Saying it is not necessary is not saying it shouldnt be offered.

          • Erin

            I’m well aware of that. However when people go around saying its unnecessary, it makes (some) women feel like they failed when its necessary for them. Its a very common theme at the Birth Trauma group I attended.

          • Who?

            No needle at the dentist? Wow. You must have a good relationship with them-I don’t think our dentist would want to do that.

            I don’t care for the dribbling after, but I just go to my happy place while they work then go quietly home to dribble in private for a couple of hours.

          • Erin

            Its the NHS…saves them time and money so win/win.

            When I was a teenager my dentist (different one) had a poster telling you to be careful whilst numb and the centre piece was someone who bit their lip off. It terrified me and put me off anesthesia.

          • Who?

            It’s a wonder you get to the dentist at all.

            There were no needles when I was a kid, and the drill was slow. I really don’t like the dentist but the lovely needles make it possible for me to sit in the chair without sweating through whatever I’m wearing at the mere thought of what’s coming up next.

          • Erin

            I get more freaked out by the thought of someone putting their hands in my mouth and the possibility that my breath might smell than anything else.

            I have weird priorities. My husband still tells everyone who will listen that my major concern in the run up to my emcs wasn’t that I might feel pain (a concern of the anesthetist because of the location of my epidural…lower than he wanted) or wasn’t that I might die (apparently a concern of everyone else in the room) but having discovered that my son was fine, just stuck and I was the one with issues, my only problem was that any belly fat I may have would be too disgusting for them to have to fish a baby out of. Despite their assurances that I wasn’t fat, I kept apologizing randomly until I passed out.

            Unfortunately things went down hill from there.

          • Who?

            We’re all different. Sometimes when something big is on it’s easier to focus on the ‘little’ stuff.

          • Linden

            Pain relief is also “unnecessary” in impacted wisdom teeth removal, passing kidney stones and viral meningitis, but doctors give it anyway, because they are not effing sadists.
            Foxtrot Uniform if you think it wasn’t necessary that I receive pain relief during my birth. What an appalling person you are. You’ve gone from “we need to inform women of the risks!” which you can’t adequately quantify to “pain relief isn’t necessary for childbirth” Your internalized sexism could not be clearer for everyone to see.

          • The Bofa on the Sofa

            You weren’t around when I underwent my dental implant this last half year. It started with an extraction, and ended up with an implant and a crown.

            For the extraction and the implant, I was given pain meds, but never asked if I wanted any. They just gave them to me.

            Is that elective?

            Make no mistake, I appreciated it. In fact, for the extraction, I asked for more because it wasn’t enough.
            But I was never given the option to forego it.

          • guest

            Ha. I had one earlier this year. Pain relief was discussed before things started, but mainly to find out if I was allergic to novocaine. I doubt the surgeon would have been willing to do the procedure without pain relief, but if I were unable to take any known form of pain relief, maybe someone would. We’ve certainly heard of the occasional crash section without anesthesia, but it’s an absolute last resort.

            I’m still waiting to scrape together the money for the implant.

          • rosewater1

            Come again?
            It may be unnecessary for you. If so, great. But who are you to say it should be so for everyone? YOU wouldn’t want someone deciding that you had to get an epidural…but you can say that everyone should go drug free???

          • Sarah

            What’s that meme with the James Bond picture and the gynaecologist slogan?

          • Roadstergal

            I don’t know, but please post it. I loved Daniel Craig as Bond (and the UST with Dame Judi’s M – sorry, I’m weird).

          • Who?

            I really do not get the Daniel Craig thing. At all.

            Dame Judi is fab. Did you know that she was told, as a young actress, that she wasn’t pretty enough for television?

          • Roadstergal

            Ugh, I unfortunately can believe that.

            For Daniel Craig, it’s not his physical attractiveness, it’s what’s in the head. I mean, a guy willing to do this:

          • Who?

            That’s fairly cool, for sure.

            Just sent it to my son who is a huge DC fan.

          • The Computer Ate My Nym

            That’s like saying you’re educated about aeronautics because you took 3 plane trips.

            I’ve been on 3 plane trips and I say a plane on a conveyor belt will take off!

            Actually, I say that because planes lift with their wings, not their wheels, but I’m sure my experience on planes led me to that conclusion, not my having taken physics.

          • Who?

            You have been stalking the wrong Who?, I have two (now adult) children.

          • Who?

            I have no idea what you are talking about.

            Which makes two of us!

          • Molly B

            Do you have biological children? Have you ever given birth?

          • AllieFoyle

            Can’t speak for OP, but I have biological children, have gone through L&D multiple times, and have done my own “research” (in quotes because I realize my reading doesn’t even come close to the experience and breadth of knowledge that a trained OB/GYN has, even though my professional education and training has included research and stats), AND I still think you are woefully misinformed when it comes to epidural anesthesia and labor pain. Why do you insist on spreading fear based on misinformation?

          • Molly B

            What fear is being spread? The epi meds have risks to fetus. How is that causing fear? If women have not been told that before then I would highly question their level of informed consent.

          • AllieFoyle

            What risks do epidural meds have for the fetus?

            I’m not suggesting they are zero, but what are they actually? Initially you were talking about things like addiction, teratogenicity, fetal overdose requiring naloxone, which aren’t really an issue with epidurals, and now you’re switching the goalposts to the idea that maybe an epidural could cause fetal distress and lead to a c-section. I can’t really say that that never happens, but it doesn’t seem likely that it happens often, and I really don’t see a c-section as necessarily a bad outcome in and of itself. Do you?

            What are the actual risks of epidurals that you think women should be told about as part of informed consent? Do you think that women should be told about the risks of going without epidurals as well?

          • Molly B

            What are the benefits of epidural anesthesia?
            Allows you to rest if your labor is prolonged.
            By reducing the discomfort of childbirth, some woman have a more positive birth experience.
            Normally, an epidural will allow you to remain alert and be an active participant in your birth.
            If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
            When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
            The use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.

            What are the risks of epidural anesthesia?
            Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
            You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.
            After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
            You might experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
            You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed such forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
            For a few hours after the birth the lower half of your body may feel numb. Numbness will require you to walk with assistance.
            In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
            Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries and episiotomies.

          • guest

            Not discomfort. Unbearable pain. Torment. Discomfort is a room that is slightly too warm.

          • Monkey Professor for a Head

            I agree. I felt like my sacrum was going to rip open. I wouldn’t call that discomfort.

          • guest

            I didn’t even get to transition and I couldn’t take it anymore. I’ve been uncomfortable many times in my life but never needed pain relief like I did then.

          • BeatriceC

            I literally fell off a mountain when I was 17. Approximately 30 feet straight down and bounced and rolled another 70 or so yards into a ravine (how the hell I’m still alive, nobody really knows). That recovery was a cakewalk compared to labor.

          • MaineJen

            …where did you get that? Epidurals do not lead to more c sections, nor do they prolong labor. At best, that’s outdated information.

          • Who?

            It’s a copy of the text of a document that Molly linked to earlier.

          • guest

            She copied it word-for-word from here: http://americanpregnancy.org/labor-and-birth/epidural/

          • The Computer Ate My Nym

            Interesting that nowhere in this, I presume, proposed informed consent for epidurals is the main benefit of epidurals mentioned. The word “pain” is mentioned only in terms of recovery from c-section. Nowhere does the proposed form state that labor is painful.

            I have experienced both labor and recovery from c-section. Labor pain is a 10/10 on the pain scale. C-section recovery was maybe a 4 at its worst. I really wish I hadn’t believed the hype about how c-section recovery is worse than labor. If I hadn’t been scared by that hype, I wouldn’t have taken opiates post-op unless I had severe pain (which I never did) and might have spared myself an extremely unpleasant bout of constipation.

          • guest

            Molly B plagiarized this from here: http://americanpregnancy.org/labor-and-birth/epidural/

          • Megan

            Don’t forget about the risks of not getting adequate pain relief. My pain before I got my epidural was so severe that it caused fetal tachycardia from all of my circulating catecholamines (which also cross the placenta).

          • Molly B

            Initially I presented an article to show that narcotics pass the placental barrier. Other people made an issue about the entirety of the article my repeated statements that the article was only to show narcotics pass the placental barrier. I have also repeatedly stated the issue from the beginning is informed consent and full disclosure

          • Daleth

            What happens to narcotics that are taken orally or via injection/IV–which is what you posted about–is not something anyone here disagrees on. If the narcotics go right into mom’s bloodstream, then of course it matters whether they cross the placental barrier, because (to put it in plain English) mom’s bloodstream is going to take the drugs to the placenta. It matters particularly because the doses that you need to take orally or by IM or IV to even make a dent in labor pain are HIGH.

            But that does NOT tell us what happens to much smaller doses of narcotics that are injected straight into the mother’s epidural space. Drugs that are taken that way only make it into the bloodstream, if they make it at all, in tiny amounts. As a result, at most the fetus is going to be exposed to the even tinier amount that manages to cross the placenta. That was true even back in the 1980s, according to the 1987 study YOU posted that found “that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts.” (http://www.ncbi.nlm.nih.gov/pubmed/3578847). It’s all the more true with the drugs and techniques used these days.

          • Who?

            I have two children, and have given birth twice.

            Your point?

          • Monkey Professor for a Head

            Dr Tuteur has had 4 babies vaginally I believe, 2 medicated and 2 unmedicated. So even discounting the whole medical degree/years of practice as an obstetrician, she must be more qualified than Molly B.

          • Molly B

            My focus is on informed consent and full disclosure the epidural thing is only to show that women are not always given full disclosure

    • Charybdis

      Wonderful. Sounds like you got the answers you were wanting and looking for. It doesn’t sound as if the doctor gave you any different information than you were getting here, you just found it more palatable from him/her than from folks here.

      And for the record, you were the one who dug up a five year old post and gave it new legs. I certainly hope you remembered to ask about the risks associated with non-medicated vaginal birth, because, as you have been banging on about ad nauseum, you cannot make a completely informed choice without ALL the potential variables being addressed. Or you found a doctor who would cater to your preconceived notions regarding pain relief during labor and delivery and are happily smug having “proved” the folks here wrong or misinformed in some way.

      Thanks for playing! Door’s that way>>>>>>>>>>

      • Molly B

        The only point I had was that narcotic pass the placental narrier even with epidurals and have potential risks to fetus and that women should be given full.disclosure about epidurals.

      • Molly B

        Actually more than one person on here said that the narcotic in an epidural dont enter the blood stream.

        • Daleth

          What we said is that epidurals, unlike every other way of administering narcotics, are administered directly into the fluid around your spine and NOT into your circulatory system. The meds don’t even normally travel elsewhere in your spine, much less elsewhere in your body.

          What your doctor said is that they CAN travel from the epidural space elsewhere, not that they do. That’s what I said several days ago: if the needle nicks a vein on the way in, for instance, or if there’s difficulty inserting the needle and the hole in the sheath around the spine ends up bigger than it needs to be, the meds can leak–that is, tiny amounts of the already tiny dose can leak–and get into mom’s bloodstream. From there, they will travel to the placenta and, in incredibly tiny amounts, cross it.

          The effect of such minuscule amounts on the baby, though, is nothing even remotely close to the effects of oral, IM (injected) or IV pain meds. Those doses are much higher than epidurals, and unlike epidurals the dose goes right into mom’s bloodstream.

  • Molly B

    Epidural have risks associated with them such as possible paralysis, permanent nerve damage, spinal headaches (think migraine on steroids), depressed breathing with can effect mom and fetal heart rate etc. Though most of these are not common they are still inherent risks. Think about it…a needle is being placed in an opening in the vertebra and into the spinal cavity. Thats pretty serious stuff there.

    http://americanpregnancy.org/labor-and-birth/epidural/
    After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloroprocaine, or lidocaine.

    FENTANYL
    http://rcp.nshealth.ca/sites/default/files/clinical-practice-guidelines/fentanyl.pdf

    MORPHINE

    8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Teratogenic Effects (Pregnancy Category C)

    No formal studies to assess the teratogenic effects of morphine in animals have been conducted. It is also not known whether

    morphine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Morphine should be

    given to a pregnant woman only if clearly needed.

    In humans, the frequency of congenital anomalies has been reported to be no greater than expected among the children of 70 women

    who were treated with morphine during the first four months of pregnancy or in 448 women treated with morphine anytime during

    pregnancy. Furthermore, no malformations were observed in the infant of a woman who attempted suicide by taking an overdose of

    morphine and other medication during the first trimester of pregnancy.

    Several literature reports indicate that morphine administered subcutaneously during the early gestational period in mice and hamsters

    produced neurological, soft tissue and skeletal abnormalities. With one exception, the effects that have been reported were following

    doses that were maternally toxic and the abnormalities noted were characteristic of those observed when maternal toxicity is present.

    In one study, following subcutaneous infusion of doses greater than or equal to 0.15 mg/kg to mice, exencephaly, hydronephrosis,

    intestinal hemorrhage, split supraoccipital, malformed sternebrae, and malformed xiphoid were noted in the absence of maternal

    toxicity. In the hamster, morphine sulfate given subcutaneously on gestation day 8 produced exencephaly and cranioschisis. In rats

    treated with subcutaneous infusions of morphine during the period of organogenesis, no teratogenicity was observed. No maternal

    toxicity was observed in this study, however, increased mortality and growth retardation were seen in the offspring. In two studies

    performed in the rabbit, no evidence of teratogenicity was reported at subcutaneous doses up to 100 mg/kg.

    Nonteratogenic Effects

    Controlled studies of chronic in utero morphine exposure in pregnant women have not been conducted. Infants born to mothers who

    have taken opioids chronically may exhibit withdrawal symptoms, reversible reduction in brain volume, small size, decreased

    ventilatory response to CO2 and increased risk of sudden infant death syndrome. Morphine sulfate should be used by a pregnant

    woman only if the need for opioid analgesia clearly outweighs the potential risks to the fetus.

    Published literature has reported that exposure to morphine during pregnancy is associated with reduction in growth and a host of

    behavioral abnormalities in the offspring. Morphine treatment during gestational periods of organogenesis in rats, hamsters, guinea

    pigs and rabbits resulted in the following treatment-related embryotoxicity and neonatal toxicity in one or more studies: decreased

    litter size, embryo-fetal viability, fetal and neonatal body weights, absolute brain and cerebellar weights, delayed motor and sexual

    maturation, and increased neonatal mortality, cyanosis and hypothermia. Decreased fertility in female offspring, and decreased

    plasma and testicular levels of luteinizing hormone and testosterone, decreased testes weights, seminiferous tubule shrinkage,

    germinal cell aplasia, and decreased spermatogenesis in male offspring were also observed. Decreased litter size and viability were

    observed in the offspring of male rats administered morphine (25 mg/kg, IP) for 1 day prior to mating. Behavioral abnormalities

    resulting from chronic morphine exposure of fetal animals included altered reflex and motor skill development, mild withdrawal, and

    altered responsiveness to morphine persisting into adulthood.

    8.2 Labor And Delivery

    Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not

    Reference ID: 3075779

    recommended for use in women during and immediately prior to labor. Occasionally, opioid analgesics may prolong labor through actions

    which temporarily reduce the strength, duration and frequency of uterine contractions. However this effect is not consistent and may be offset

    by an increased rate of cervical dilatation, which tends to shorten labor. Closely observe neonates whose mothers received opioid analgesics

    during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced

    respiratory depression in the neonate.

    8.3 Nursing Mothers

    Low levels of morphine sulfate have been detected in maternal milk. The milk:plasma morphine AUC ratio is about 2.5:1. The

    amount of morphine sulfate delivered to the infant depends on the plasma concentration of the mother, the amount of milk ingested by

    the infant, and the extent of first-pass metabolism. Because of the potential for serious adverse reactions in nursing infants from

    morphine sulfate including respiratory depression, sedation and possibly withdrawal symptoms, upon cessation of morphine sulfate

    administration to the mother, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of

    the drug to the mother.

    8.4 Pediatric Use

    The safety and effectiveness and the pharmacokinetics of Morphine Sulfate Tablets in pediatric patients below the age of 18 have not

    been established

    • Yes, epidurals have risks. We know this. They tell you those risks before they place the needle. Those risks are low, as you pointed out, but they do exist. Using opioids at all has risks, but we do that because pain really, really hurts. Would you suggest that we not give IV morphine to a man with a broken bone because there is a small risk of complications from the morphine?

      There wouldn’t be any teratogenic effects because the whole point of the needle-in-spine thing is to avoid getting drugs into the bloodstream and fetus, so that part of your post is irrelevant. In fact, your entire discussion of opioids is irrelevant because how epidurals work negates all those concerns. That’s a feature, not a bug.

      Furthermore, your quote only discusses chronic use of opioids (to treat chronic pain, or when abused), use of morphine sulfate for labor pain in not-epidural form, and non-epidural morphine use in breastfeeding mothers. Obviously, none of it applies to epidurals.

      • Molly B

        Not all the risks of an epidural are always explained to a mother and there lacks informed consent. ANY narcotic including ones administered through a spinal cross the placental barrier. A small amount of the epidural narcotics does enter the blood stream and these pass through the placental barrier to the fetus. Most medications/drugs also have a higher toxicity for the fetus. I am aware that my article is about street drug use of morphine but morphine in a pill and morphine sulfate are both morphine and both are narcotics that can result in addiction and BOTH have known impacts for the fetus. In regards to morphine sulfate there are potential side effects to fetus including bradycardia (drop in HR/BP) and decreased oxygen flow to fetus which will in most cases trigger physician recommendation for a cesarean section.

        • Azuran

          Find me 1 woman who ever got addicted to morphine after an epidural. Possible addiction is a worthless argument when it come to epidurals.

          Teratogenic effect are a mesure of safety during the development of the baby. An epidural or even IV opioid during birth is not going to have any more teratogenic effect on a term baby that it’s going to have on an adult who takes 1 dose of the drug.

          Sure, epidurals have risks and every woman needs to be properly informed of this (very low) risk. But many of those ‘risks’ you pointed out are very long stretches.

          • Molly B

            My argument was not about addiction in relation to morphine via an epidural. It was that the drug crosses the placental barrier.

            “An epidural or even IV opioid during birth is not going to have any more teratogenic effect on a term baby that it’s going to have on an adult who takes 1 dose of the drug.

            Sure, epidurals have risks and every woman needs to be properly informed of this (very low) risk. But many of those ‘risks’ you pointed out are very long stretches.”

            Part of FDA Insert

            http://medlibrary.org/lib/rx/meds/morphine-sulfate-16/page/3/

            MORPHINE
            8 USE IN SPECIFIC POPULATIONS
            8.1 Pregnancy
            Teratogenic Effects (Pregnancy Category C)
            No formal studies to assess the teratogenic effects of morphine in animals have been conducted. It is also not known whether
            morphine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Morphine should be
            given to a pregnant woman only if clearly needed.
            In humans, the frequency of congenital anomalies has been reported to be no greater than expected among the children of 70 women
            who were treated with morphine during the first four months of pregnancy or in 448 women treated with morphine anytime during
            pregnancy. Furthermore, no malformations were observed in the infant of a woman who attempted suicide by taking an overdose of
            morphine and other medication during the first trimester of pregnancy.
            Several literature reports indicate that morphine administered subcutaneously during the early gestational period in mice and hamsters
            produced neurological, soft tissue and skeletal abnormalities. With one exception, the effects that have been reported were following
            doses that were maternally toxic and the abnormalities noted were characteristic of those observed when maternal toxicity is present.
            In one study, following subcutaneous infusion of doses greater than or equal to 0.15 mg/kg to mice, exencephaly, hydronephrosis,
            intestinal hemorrhage, split supraoccipital, malformed sternebrae, and malformed xiphoid were noted in the absence of maternal
            toxicity. In the hamster, morphine sulfate given subcutaneously on gestation day 8 produced exencephaly and cranioschisis. In rats
            treated with subcutaneous infusions of morphine during the period of organogenesis, no teratogenicity was observed. No maternal
            toxicity was observed in this study, however, increased mortality and growth retardation were seen in the offspring. In two studies
            performed in the rabbit, no evidence of teratogenicity was reported at subcutaneous doses up to 100 mg/kg.
            Nonteratogenic Effects
            Controlled studies of chronic in utero morphine exposure in pregnant women have not been conducted. Infants born to mothers who
            have taken opioids chronically may exhibit withdrawal symptoms, reversible reduction in brain volume, small size, decreased
            ventilatory response to CO2 and increased risk of sudden infant death syndrome. Morphine sulfate should be used by a pregnant
            woman only if the need for opioid analgesia clearly outweighs the potential risks to the fetus.
            Published literature has reported that exposure to morphine during pregnancy is associated with reduction in growth and a host of
            behavioral abnormalities in the offspring. Morphine treatment during gestational periods of organogenesis in rats, hamsters, guinea
            pigs and rabbits resulted in the following treatment-related embryotoxicity and neonatal toxicity in one or more studies: decreased
            litter size, embryo-fetal viability, fetal and neonatal body weights, absolute brain and cerebellar weights, delayed motor and sexual
            maturation, and increased neonatal mortality, cyanosis and hypothermia. Decreased fertility in female offspring, and decreased
            plasma and testicular levels of luteinizing hormone and testosterone, decreased testes weights, seminiferous tubule shrinkage,
            germinal cell aplasia, and decreased spermatogenesis in male offspring were also observed. Decreased litter size and viability were
            observed in the offspring of male rats administered morphine (25 mg/kg, IP) for 1 day prior to mating. Behavioral abnormalities
            resulting from chronic morphine exposure of fetal animals included altered reflex and motor skill development, mild withdrawal, and
            altered responsiveness to morphine persisting into adulthood.
            8.2 Labor And Delivery
            Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not
            Reference ID: 3075779
            recommended for use in women during and immediately prior to labor. Occasionally, opioid analgesics may prolong labor through actions
            which temporarily reduce the strength, duration and frequency of uterine contractions. However this effect is not consistent and may be offset
            by an increased rate of cervical dilatation, which tends to shorten labor. Closely observe neonates whose mothers received opioid analgesics
            during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced
            respiratory depression in the neonate.
            8.3 Nursing Mothers
            Low levels of morphine sulfate have been detected in maternal milk. The milk:plasma morphine AUC ratio is about 2.5:1. The
            amount of morphine sulfate delivered to the infant depends on the plasma concentration of the mother, the amount of milk ingested by
            the infant, and the extent of first-pass metabolism. Because of the potential for serious adverse reactions in nursing infants from
            morphine sulfate including respiratory depression, sedation and possibly withdrawal symptoms, upon cessation of morphine sulfate
            administration to the mother, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of
            the drug to the mother.
            8.4 Pediatric Use
            The safety and effectiveness and the pharmacokinetics of Morphine Sulfate Tablets in pediatric patients below the age of 18 have not
            been established

          • Box of Salt

            Hey Molly B,
            could you paraphrase the parts of that insert you think are the most relevant?

          • Molly B

            8.2 Labor And Delivery

            Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not

            Reference ID: 3075779

            recommended for use in women during and immediately prior to labor.

            Closely observe neonates whose mothers received opioid analgesics during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced
            respiratory depression in the neonate.

            Naloxone is rarely offered….its off to the O.R. with you.

          • The Computer Ate My Nym

            Naloxone is generally only given when someone is in respiratory distress and about to die from opiate overdose. The reason is that it blocks the opiate receptors, meaning that the patient has NO pain relief at all and cannot get pain relief for some time because their receptors are blocked. It is so unpleasant that occasionally people who are being treated with opiates for pain are simply intubated and put on breathing support until the opiates wear off to avoid the period of intense and unrelievable pain.

          • Monkey Professor for a Head

            I think you’re confused. The part of the insert you reference speaks about using naloxone to treat respiratory depression in the neonate. Yet you say that women are taken to the OR instead of being offered naloxone – I presume you mean to have a c section. A baby in the womb cannot be in distress because of respiratory depression because they are not breathing air – they are getting their oxygen through the placenta.

          • Charybdis

            The amount of opioid in an epidural is very small and unlikely to require Naloxone.

            However, if you are getting Stadol, Demerol, Fentanyl, Dilaudid, etc via IM/IV route, then there are potential effects to the baby, as the dosage is higher and absorbed into the bloodstream .

          • Dr Kitty

            He’s the thing Molly- teratogenicity, literally, “creating a monster”- is only possible during pregnancy while a foetus is developing.
            So, first trimester.

            Teratogenitcity is IMPOSSIBLE after all organs are fully formed, so it isn’t a risk of intrapartum analgesia, even big whacking doses of IV morphine won’t be teratogenic, because the foetus is fully formed.

            Epidurals allow very low doses of opioids to provide very effective pain relief. They do NOT have a risk of teratogenicity.

          • Monkey Professor for a Head

            Can’t up vote, so I just want to second this!

          • Molly B

            I was not the first one to make an argument for teratogenic affect. My point was that the meds cross the placental barrier and have side effects for the fetus in labor.

          • AllieFoyle

            Why do you keep posting the FDA drug insert for oral morphine? What does that have to do with epidurals?

            I think (?) you are trying to show that opioids in the maternal bloodstream can cross the placenta, but the whole point of epidural anesthesia is that only a small amount of medication is necessary and it largely stays out of the maternal circulation, and therefore very, very little can be passed on to the baby. The possible drop in BP (a real and acknowledged risk) is a different phenomenon altogether.

            The information you keep posting has to do with ORAL opioids, which do enter the bloodstream in appreciable quantities and could be passed on to the infant and cause respiratory depression, etc. The whole point of giving epidural pain relief is that by administering the medication to the epidural space you only have to use small amounts that don’t transfer into maternal or fetal circulation in dangerous amounts.

            And of course, at term, teratogenicity is not a concern.

          • Molly B

            The second sentence of the insert and Section 8.2 Specifically

          • Azuran

            and again. This refers to chronic use of morphine during the early or whole pregnancy. 1 dose given during the birth will not have any kind of effect on the baby’s development.
            It could cause sedation or the foetus, which is why epidurals are preferred as the dose that actually makes it to the fetus is extremely small.

          • Molly B

            Epidural can also cause drop in bp of mother resulting in fetal distress and an emergency cesarean that may not of happened otherwise.

          • demodocus

            that would have been nice for me, since mine was too high both times, despite having uncomplicated pregnancies.

          • Azuran

            The very super long text you posted also said this: ‘Occasionally, opioid analgesics may prolong labor through actions which
            temporarily reduce the strength, duration and frequency of uterine
            contractions. However this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor.

            So…..It may shorten or speed up labour depending on women.

            Thing is, as we all said: No one here is claiming that epidurals do not have risks. And if a women thinks that a less painful labour in worth a slightly increased chance of a c-section (got any actual number or source on that claim?) than it is absolutely her right. Pain itself can also have effect on the blood pressure of the mother and could also have negative effects on the baby, btw.

          • Molly B

            Yes pain relief regardless of the mode of delivery. Most women are not full informed of these risks. No one tells a woman, we can give you this medication for pain but it the side effect can increase your chances of a cesarean delivery. If your blood pressure drop we can give you a medication to counter act it but here are the risks and benefits of that medication to you and the fetus.
            Women need to know. I truly believe that some women would ask more about other measures of pain relief it they were more informed. Other may feel that the benefits of the pain relief outweigh the risks and this also a perfectly acceptable and personal choice, so long as on both ends of this the woman is given full disclosure to make her choice.

          • Monkey Professor for a Head

            If you were to take consent from a woman prior to an epidural, how would you explain the risks and benefits?

            I haven’t worked in the states, but, if you’re interested, this is the standard consent form for where I used to work in Australia.
            https://www.health.qld.gov.au/consent/documents/anaesthetic_05.pdf

          • Molly B

            I would explain all the risks and their likelihood (common vs rare, not %) can happen if those occur and how they can be corrected and the major risks associated with the corrective measures. I would explain the benefits in full as well, though most Doc seems to explain the benefits quite well.

            This is a consent form for Texas.
            Consent requirements do vary by state here so its quite a to each his own situation although there are rules establishing minimums

            http://www.anesthesiallc.com/publications/anesthesia-industry-ealerts/529-texas-statute-requires-anesthesia-informed-consent

          • Monkey Professor for a Head

            That all sounds very nice (although I do suspect that might be a little underhand dig at doctors). But I would be interested in the actual words you would use.

          • Heidi_storage

            Very nice. Simple, concise description of the epidural, the risks being clearly laid out (and classified by rarity of occurrence).

          • Heidi_storage

            So informed consent, according to you, looks something like this: “Before giving you this epidural, please be aware: It doesn’t always work. Also, it may stall your labor and increase your risk of cesarean delivery. Opiates in the epidural will cross the placental barrier to your baby. Some studies indicate that newborns will have trouble feeding after an epidural. Your blood pressure may drop to dangerous levels, and this could affect the baby. You could develop a severe headache, which may persist. You might be paralyzed.”

            Yeah, that’d be some excellent informed consent to give to a woman in pain from labor contractions.

          • Molly B
          • Monkey Professor for a Head

            That shows an association, but it does not prove causation. There may very well be other factors at play. You’ve already been given one example of a confounding factor – babies in a suboptimal position can cause more painful labours, which would mean that more epidurals would be requested.

          • The Computer Ate My Nym

            Do we need to have that discussion about causation and correlation again? Because this looks like a classic case of confusion between correlation and causation.

            The key point about this study is that it is a population based study. So let’s look at the population: women giving birth in hospitals in New South Wales. I note immediately that their epidural rate is lower than is typical in the US, which suggests that standard of care is not to offer an epidural as pain relief in all or most cases, as it is in the US. Therefore, it is likely that epidurals are only given when the woman is having issues already.

            Now, certainly it is possible for a woman having a perfectly normal labor to be unable to tolerate the pain and want relief. She may well decide that an epidural is the best solution for her. However, if she is having severe pain, it is more likely that she is having issues, possibly including obstructed labor or fetal malpositioning, than if she is not. So the epidural population is enriched for women who have, at least, malpositioning and fetuses of dubious ability to be delivered vaginally.

            Finally, this is one study on one population. Other studies on other populations have found the opposite: that there was no difference in risk of c-section rate with epidural analgesia. What reason do you have to say that this study should be considered definitive over the others?

          • The Computer Ate My Nym

            Not to mention the issue that a c-section is not, in and of itself, a bad outcome. C-sections have their risks, but they have their benefits as well. Avoiding an epidural to avoid a c-section and having the woman end up with PPD and chronic pain seems to me a bad trade.

          • Charybdis

            The blood pressure drop is temporary and can be countered with some epi relatively quickly.

          • Molly B

            Temporary yes but many doctors will insist on surgery if the CTG shows signs of distress. Naloxone is not always given or even mentioned as an options

          • Monkey Professor for a Head

            Isn’t the hypotension usually caused by blockade of the sympathetic nervous system from the local anaesthetic agent. Naloxone would only counteract the opiate, so would not be a particularly effective treatment.

          • Charybdis

            They are aware that a temporary drop in blood pressure can occur with an epidural, so that is why they have things they can do to bring the blood pressure back up: increase fluids to the mother, administer epinephrine, roll the mother on her side, etc.

            The drop in blood pressure is caused by the blocking of the sympathetic nerves by the local anesthetic used in the epidural. Naloxone reverses the effect of opioids, so it would NOT be used, as the amount of opioid medication used in an epidural is very small.

            I’m not exactly sure what you are wanting or trying to prove. We understand that epidurals are generally very safe and quite effective in addressing labor and delivery pain for women. They are not 100% safe and/or effective, because NOTHING is 100% safe and/or effective. The dosages of the local anesthetic agent and the opioid agent are very, very small, as they only have to work right there on the spinal nerves to block the pain signals from reaching the brain. Since the medications are administered locally, into the epidural space, the medications do not have a direct entry into the bloodstream, so they do not have an effect on the baby. We cannot say 100% that NO medication gets into the mother’s bloodstream, because again, nothing is 100% certain. But, since the original dose to the mother’s spinal nerves is very small to start with, the amount, if any, that gets into the mother’s bloodstream is smaller than the original dose. Now, unless you subscribe to the homeopathic mind set, the amount of opioid, if any, that reaches the baby is extremely, extremely small and unlikely to have a deleterious effect on the baby, even if the mother needs a subsequent dose in her epidural catheter.

            If the mother’s blood pressure drops, it is generally temporary and easily remedied by increasing fluids, rolling the mother onto her side and/or administering epinephrine. The drop in blood pressure is a direct result of the local anesthetic agent on the sympathetic nervous system, it is not because of the opioid used in the epidural. So, Naloxone use would not be indicated in that case. It is not generally mentioned as a treatment because it is not necessary: they are not mainlining heroin into the mother’s epidural catheter.

            So, to sum up: epidurals are not 100% safe, but nothing is 100% safe. They are VERY safe and very effective in treating labor/delivery pain and the risk to the baby is very, very small because the amount of medication used is small and locally confined to the mother’s epidural space. The mother’s blood pressure can drop because of the effect of the anesthetic agent on the sympathetic nerves. This drop is temporary and common enough that the medical staff is ready to deal with it using various measures (fluid, epi, rolling onto side, etc). Naloxone is not used because no one is overdosing on an opioid. Epidurals do not automatically mean you are going to have a CS.

          • Irène Delse

            I’m amazed at the way epidurals and CS have been demonised, especially their rebranding as something vaguely harmful to the baby . Last time a woman in family had a baby, her OB discussed the possibility that she would have a C-section, due to the baby being breech. She phoned me in tears (I’m the go-to person for scientific questions on my family…) and asked what I know of the risks. Assuming she was anxious about the operation, I gently told her: “Well, it’s surgery, but doesn’t have particular risks, in fact they don’t even have to put you under GA, it should be fine.” I was very surprised when she replied: “No, I mean the risks for the baby.”

            What’s going on? In the 1980s, I was hearing stories about epidurals making women numb from the waist down, and that was used as a way to promote “natural” childbirth. But then epidurals have become safer and carry less side-effect for the woman, so I guess the alt crowd have switched to rumour mongering about issues to the baby.

          • The Bofa on the Sofa

            She phoned me in tears (I’m the go-to person for scientific questions on my family…) and asked what I know of the risks…I was very surprised when she replied: “No, I mean the risks for the baby.”

            As opposed to having a breech baby? Sheesh!

          • Irène Delse

            Exactly. The weirdest thing is, she did understand a breech presentation was risky by itself, and she hadn’t intended to refuse the C/S, she just was terrified by it all.

            It was all moot, anyway: a few days later, the baby turned by herself and my relative was able to give birth the “normal” way, in peace with herself. She even agreed to an epidural during labour… a thing she hadn’t planned to do. But it’s hard to ignore the pain of “your body turning inside out” (direct quote here)!

          • Molly B

            Please look up FDA info regarding opiods in epidurals and also effects of epidurals (with any medication in them) to fetus/baby and.risks to fetus/baby. Please make.sure your sources are reputable. I’m not asking you to post the info or.even tell me.if you looked it up. I’m just asking you to check it out for yourself. Acog nih who ajog etc

          • guest

            Oh, look, it’s the “many doctors” fallacy again. Molly, PROVE to me that “many” doctors perform unnecessary c-sections because of a temporary and correctible blood pressure dip due to an epidural.

          • Heidi_storage

            That’s funny; when my blood pressure dropped, the doctor gave me some epinephrine, rather than yelling for a section. Must be an anomaly.

          • The Computer Ate My Nym

            This is true. It is also true that epidurals can end tragically. I know of a total of one case where the woman had a catastrophic decrease in BP and ended up in a persistent vegetative state. The baby, incidentally, was absolutely fine.

            Failure to provide adequate pain relief can also end in tragedy. I know of several cases of PPD related to unrelieved pain in labor and at least one suicide attempt probably related to same.

            The standard consent form for an epidural mentions the risk of BP drop, among other risks, including the risk of death. No responsible anesthesiologist would put one in if the woman in labor refused to consent after hearing the risks.

          • Molly B

            I understand your points and they are well taken. That being said PPD and PTSD occur in childbirth due to numerous reasons and in both modes of delivery.
            Not everyone is given a consent form to sign or read. Many who do are women presenting to L&D in active and painful labor amid a chaotic environment of puts this on, needle stick here, hooking up CTG, whats your history, vag exam etc and many dont take the time to read the form due to pain and chaos. They just want to get to their room and lay down and have a moment to think and to breathe.
            Full disclosure is also not always given. If you are told that it could cause a drop in your BP are you told of how this will effect the fetus? Are you told of what the possible outcomes are and all the alternative methods of correction if BP becomes a concern or fetal distress at onset of low BP?
            Not everyone is informed. I personally know of someone who was not told of the risks of the epidural beyond “You have to stay very still or this could paralyze you” Moms BP dropped within 30 minutes of being given epidural. She was placed on oxygen, fetus deceled multiple times within 15-20 of onset oxygen therapy and baby was delivered my emergency cesarean.
            Not every woman has complication with epidural, not every fetus has complication with epidural, but many women are not told all the risks and options of various treatments and intervention during labor and delivery and this is concerning.

          • Monkey Professor for a Head

            I agree with you that informed consent is very important and should always be obtained before any procedure (excepting of course, emergencies where this may not be possible). But it is important that people are given accurate information about the risks and benefits. That information should be provided without emotion or moralising attached.

            I am curious as to how you would lay out the information that you feel a woman should receive prior to consenting to an epidural. I suspect your answer would be revealing.

          • The Computer Ate My Nym

            True, but the rate of PPD is lower with both epidurals and c-section compared to “natural” labor. Shouldn’t these data also be included in the consent form if your complaint is lack of full disclosure? Or perhaps as part of the discussion of the risk of refusing analgesia?

            I don’t know how your consent process went, but I actually consented for an epidural both in advance, when I was not in pain and had all the time in the world to consider the risks and benefits (which were fully presented, including the very rare risk of permanent damage to me or the baby and of death, again either) and again when the procedure was actually done at my request. (Well, okay, my midwife suggested it, but I agreed.)

            Is inadequate consent sometimes given? Certainly. Just like in any other medical procedure. But there is no particular evidence that I have seen that there is a specific problem with inadequate consent around epidurals.

          • Daleth

            I can’t remember if this risk was covered in my consent, but did anyone ever tell you that if you do NOT have an epidural and you end up needing an emergency c-section, then:

            – You’re at high risk of needing general anesthesia (because you don’t have an epidural that they can top up for the surgery);

            – General anesthesia goes into your bloodstream immediately and will sedate the baby;

            – General anesthesia has an exponentially higher risk of killing or injuring the mom? (Still a low risk, but dramatically higher than any risk from an epidural.)

          • demodocus

            your hospital makes people lie very still with an epidural? Neither of mine did.

          • The Computer Ate My Nym

            I would assume that Molly means while the epidural is being placed. You do have to be still while it is being placed.

          • Charybdis

            True, I wonder how much of this is an example of “Doctor said “THIS”. I heard “THAT” and you can’t convince me otherwise, because I was THERE.

            You know, because anything but the mother’s side of the story is outright wrong, manipulative, and skewed to an interventionist viewpoint.

            Not that the mother’s side of things is EVER skewed, manipulative and totally anti-interventionist.

          • Nick Sanders

            The more I talk to her, the more convinced I become it has nothing to do with any misunderstanding and everything to do with not letting the facts get in the way of a good narrative.

          • The Bofa on the Sofa

            The more I talk to her, the more convinced I become it has nothing to do with any misunderstanding and everything to do with not letting the facts get in the way of a good narrative.

            The more I read, the more I come to the conclusion that I don’t know what the “narrative” even is.

          • Nick Sanders

            “Epidurals bad, doctors lie, opiates everywhere.”

            Something like that.

          • demodocus

            but you sit for that…

          • Roadstergal

            I was talking to two friends who have had children – one American, epidural both times, and the other Dutch, two typical Dutch homebirths with no pain relief. The latter dwelled rather extensively on the “freedom to move around” thing ) and it really sounded like she was trying to find some silver lining for not being allowed pain relief. She talked about her first birth being so painful that she had to get to a distance in time where she had forgotten about how horrible it was before she had her second.

            For both women, the second birth was easier, and it was barely three pushes for the US friend with the epidural. Listening to the NCB folk, it should have taken her days. 😛

          • Molly B

            All hospital do when the anesthesiologist is inserting the needle and until he removes it leaving only the cath in place. If your hospital did not have you stay very still during this time I am quite surprised

          • demodocus

            you said lie very still, i was sitting, so i’m confused. Also, they did warn me and the be very still part is only a few minutes, even when interrupted by a contraction or three

          • Molly B

            When epidural needle is being inserted some have Mom.lay on side others have Mom sitting up.

          • AllieFoyle

            I agree with you about the importance of informed consent, but I disagree that the risks of epidurals are neglected more than other decisions. Personally, I felt that I was acutely aware of the risks of medical interventions and that there was great pressure on everyone involved to “avoid interventions” as a general principle. The part of the informed consent conversation that was most missing was about the potential benefits of various interventions and the risks of forgoing them. I went to a hospital-affiliated CNM practice and was never told that epidurals were not routinely offered at my hospital. Nor was I given any options to avoid a painful, difficult, dangerous delivery with a large baby. So I couldn’t choose a prophylactic c-section or epidural anesthesia because “interventions are dangerous” but I had to suffer excruciating pain, pelvic injury (and subsequent surgery), and my baby had shoulder dystocia with the risks of oxygen deprivation, damage to brachial nerve, and even death.

            So, yes to informed consent (I suggest a comprehensive pamphlet given out well before labor), but let’s make sure that we include all the risks and all the benefits of both intervention and non-intervention and we don’t just focus on demonizing one aspect of the process.

          • Sarah

            Nothing to say about the risks of not getting pain relief when a woman needs it, then?

          • guest

            Not every woman shows up at the hospital never having heard of epidurals and ALREADY DECIDED whether or not she wants one.

          • guest

            Bah, that got mess up. But the point is that most women ALREADY KNOW about epidurals *and* the possible complications, and they arrive knowing whether or not they want one anyway. And some will arrive with one idea and change their minds, and they have the right to. That’s no reason to scaremonger women about epidurals.

          • Molly B

            Most women do not receive one dose. They are topped up throughout labor.

          • Monkey Professor for a Head

            Evenso, that’s very different than chronic use throughout pregnancy.

          • Azuran

            my point remains, a few doses in the span of a labour is neither going to cause teratogenic effect nor addiction in the mother nor the foetus. So those are not a concern for the safety of epidurals.

          • Molly B

            Again, as I have stated many time the article on addiction was to prove to one person that opiods do cross the placental barrier. Teratogenic affects is not the only concern. The increased likelihood of a cesarean delivery or other complications due to epidurals is the issues. Also your original point was specifically that “1 dose given during the birth will not have any kind of effect on the baby’s development.” Complications during labor inc fetal distress due to epidural meds and fetal development are two separate issues.

          • Azuran

            And again, Teratogenis effects is not ‘not the only’ concern. is is ABSOLUTELY not a concern.
            So, basically you posted: XYZ are the effects on adult, it can cross the placental barrier, therefore XYZ are the effects on the baby.
            It doesn’t work this way. Addiction doesn’t matter in this case, teratogenic doesn’t matter. And you talking about those is just trying to scare people and add more fake argument in your favour to try and make your point more valid. You shouldn’t even be mentionning any of those things because they are irrelevant no matter if opiod cross the placental barrier. If you want your arguments to be taken seriously, don’t drown them in false claims and useless data.

          • Molly B

            AGAIN…addiction and teratogenic effects was NOT the point or argument. That portion as I have said many time was to point out that oipiods cross the placental barrier. Period. Opiods cross the placental barrier is not a false claim.
            I have removed the section on addiction and teratogenic effects so long as you realize that the opiods cross the placental barrier.

          • Daleth

            I have removed the section on addiction and teratogenic effects so long as you realize that the opiods cross the placental barrier.

            Are you going to remove all your posts when you realize that:

            (1) Epidural meds don’t get into the woman’s blood stream, and thus don’t even have the opportunity to cross the placenta, unless they leak out of the epidural space (the fluid-filled area around the spine where the needle is placed). That usually doesn’t happen.

            (2) Even when epidural meds do leak and do make it into the blood stream, the amount that crosses the placental barrier is minuscule and has approximately zero effect on the baby, both because the dose given to the woman is tiny compared to oral or injectable opioids and because the minuscule fraction of that dose that leaks out is even tinier.

          • Molly B

            No because evidence I have provided states that it does in fact cross the placental barrier. If you are going to do a partial quote make sure you dont the change the meaning of the whole communication in the process. I stated that I was removing it since everyone was stuck on the addiction part and not the part that I pointed out was the basis for my posting that particular section which was that opiods do cross the placental barrier.

          • Daleth

            A substance can’t cross the placenta unless that substance is in the mother’s bloodstream. The umbilical cord is not connected to the mother’s epidural space and the spinal fluid in that space, where the epidural medication goes, is not in any way connected to the mother’s circulatory system; blood doesn’t flow in and out of there.

            That’s why epidurals, unlike injected or oral opioids, provide pain relief without making the woman high and without any risk of addiction: because epidural meds don’t travel around her body and end up affecting her brain. They generally stay where the anesthesiologist puts them, with perhaps a tiny amount of leakage.

            *IF* the needle nicks a vein on the way in *AND* the meds leak out of the epidural space into the surrounding area, then a small amount of the meds could get into the circulatory system and whatever’s left after mom’s body metabolizes them could get to the baby. That does happen, no doubt about it. But because epidural meds are delivered directly to the space around a woman’s spinal cord, the dose needed to achieve pain relief is lower than the dose that would be needed orally or by injection.

          • moto_librarian

            Christ, you are willfully dense, aren’t you, Molly B? Yes, theoretically, the substance can pass the placenta, but only if it actually enters the mother’s bloodstream! You are asking doctors to disclose something that simply doesn’t happen when an epidural is administered.

          • AllieFoyle

            FFS, opioids can cross the placenta, yes! No one disputes that. Don’t take opioids if you are pregnant and don’t need them. What you don’t seem to grasp is that the opioid meds need to be circulating in the woman’s bloodstream in order to cross the placenta. The advantage of an epidural is that the medicine IS NOT placed in the bloodstream, so there is very little, if any, to be transferred to the baby. The drug monograph you are referencing refers to morphine given orally or injected — it has nothing to do with an epidural!

          • Molly B

            You say opiods via epidural do not cross placental.barrier and when they do the risks to fetus is approximately zero. Provide a source for this argument.

          • Daleth

            Do you understand that to even get to the placenta, a substance has to be in the mother’s bloodstream?

          • Heidi_storage

            If you’re not worried about addiction and teratogenic effects, why do you keep belaboring this bit about the opioids crossing the placental barrier?

          • Azuran

            I never refuted that opioids cross the placental barrier. I’m a vet, I use opioids, I know they do. But ‘crossing the placental barrier’ in itself is not an argument and isn’t a risk by itself.
            Before you can decide it’s it’s really a bad thing, you have to know how much it crosses the barrier when it’s given IV to the mother and also when it’s given as an epidural. At what maternal dose does it result in a foetal dose that causes problems to the foetus. If it does, how big of a risk is it and what can you do about it? It also happens that one of the best advantages of opioids is that there are also drugs to reverse their effects. If a mother has adverse effect to opioids, you can reverse them, if a baby is born under the influence of opioids, you can give it reversal drugs as well, reducing the risk even more. So, really, risk to the foetus is a lot more complicated than ‘it crosses the placental barrier’

          • Molly B

            Crossing the placental barrier is a risk especially when as you pointed out there are drugs to counteract bad side effects to the fetus which means this had happened often enough that an anecdote needed to be found.
            So your arguments is more drugs to counter drugs that likely weren’t necessary in the first place and mom probably didn’t provide true informed consent on? That sounds good for baby!

          • Monkey Professor for a Head

            “So your arguments is more drugs to counter drugs that likely weren’t necessary”

            I think that’s a revealing statement. Pain relief is not necessary.

          • Molly B

            Um…no.it is not always necessary. Would I let someone perform open heart surgery on me without pain management….absolutely not. Would I labor without pain meds…yeah. Do all women have the same opinion on pain management during labor as me…absolutely not and that is awesome! We have choices and the right to choose for ourselves! Medical professional should provide full disclosure so our choices are truly informed choices. Many women are not given full disclosure or.true informed.consemt. Period end of story. This was.more.or less.rhe entire point of what I had to say but people want to drag shit out (inc me) to argue various side points and branched.

          • Monkey Professor for a Head

            So you don’t think that the epidural was “likely unnecessary”? Or do you think that most women who receive epidurals do so against their wishes?

          • The Computer Ate My Nym

            But anesthesia in open heart surgery is more dangerous than that used in labor. I think you should be told in great and condescending detail how dangerous and stupid your decision to have anesthesia during open heart surgery is. In the name of full disclosure. Did you know, for example, that some analgesics can cause the iron in your red blood cells to change to the wrong form, resulting in your suffocating*? Was that on the consent form, hmm…You must have gotten an inadequate consent, then.

            *Methemoglobinemia.

          • Heidi_storage

            I have seen no one on this thread argue against informed consent. If that is the point you’re trying to make, then congratulations, everyone agrees with you. What they DON’T agree with is exaggerating the risks (and downplaying the benefits) of epidurals, such that patients may choose either a less effective or less safe alternative, or experience severe psychological distress from foregoing pain relief.

          • Azuran

            You know what else crosses the placental barrier: Water and oxygen. So no, crossing the placental barrier by itself is not a risk.

            The fact that an antidote exists absolutely does not mean that the mother was not informed of the risks, or that we just use administer it blindly at dangerous doses because you can reverse it if anything goes wrong. That not how any of this works.
            But it does make the use of the drug safer because IN CASE the mother is for some reason hypersensitive to it or has a bad reaction to a standard dose of the drug, because then we can reverse it.
            It is absolutely not a case of ‘pushing more drugs to cover more drug’ But between using 2 drugs, one which you can reverse and one you cannot, the one with an antidote is safer.

          • AllieFoyle

            That is the point of the epidural — to administer the medication in such a way that mother gets pain relief with very little medicine making it into circulation, thus minimizing the baby’s exposure.

            Naloxone is used for opiate overdose in many situations. It has nothing to do with L&D, really. Babies simply do not get enough opioids from maternal epidurals to need rescue Naloxone — that’s why it isn’t used for that. It is used for babies whose mothers have gone without epidurals and then receive injected pain relief like Nubain, Stadol, etc. So if you are concerned about newborns being exposed to opioids, you should advocate against those medications, not epidurals.

          • Dr Kitty

            Shock horror!
            Opioids can can respiratory depression!!!!
            An antidote had to be found!!!!

            Yes, it did.
            But it wasn’t newborns with respiratory depression due to epidurals that led to the creation of naloxone.
            It was good old fashioned junkies dying of heroin ODs.

            You assume the the intrapartum epidural “likely wasn’t needed”- why is that?
            People in severe pain generally need pain relief in order to be coherent and comfortable.

          • namaste863

            We get it, already. Opioids (When they’re used) cross the placental barrier. So the hell what? When injected into the epidural space the amount that makes it into the mother’s bloodstream, let alone the baby’s, is far too small to do a damn thing. The effect on either is negligable to non-existant.

          • Linden

            Specify, using a graph if you like, the dose vs risk for the baby. Please be specific. Your feelings aren’t enough. If you want women to be informed of the risks, you need to have the knowledge to do so.

          • Molly B
          • Irène Delse

            Hello? This page isn’t a reference to what you’re talking about, it’s general information about epidurals. There isn’t much about risks to the baby except some “research is ambiguous but” verbiage. And no source given.

            I find that underwhelming.

          • Who?

            It also doesn’t address the dose v risk issue that Linden specifically asked about.

          • Molly B
          • Molly B

            8.2 does not refer to chronic use! It is specific to the use of opiods during labor. Hence the section being titled “8.2 Labor And Delivery”

          • Nick Sanders

            Specifically, one opiod, morphine sulfate. From that, you have tarred all epidurals with the same brush, regardless of what they actually contain.

          • Molly B

            As others have also sated Epidural I assumed that you as well would follow that the discussion was in regard to morphine sulfate via epidural….

          • Nick Sanders

            Except it’s far from the only, or even primary, ingredient in epidurals.

          • Molly B

            To state this so late in game….grasp at straw much?? Obviously the opiod is diluted and 100% morphine is not being injected ….

          • Nick Sanders

            I didn’t say it before because you have already been told this by others. I’m not grasping at straws, I’m getting exasperated with a person who WILL NOT LISTEN and continues on hammering points after they have been shot down repeatedly.

            NOBODY gets 100% morphine. It’s a hospital, not some abandoned tenement full of druggies shooting up. But even when the epidural contains opioids, which is not every time, they are a secondary medication, not the primary one, and is in an extremely small dose. You have been told this more than once, yet you continue to act as if an epidural is just morphine and saline. At this point, you remind me of nothing so much as one of those antivax idiots who goes on and on about the “massive quantities of aluminum” in vaccines.

          • Molly B

            Everyone on here is stating their viewpoints. Personally I dont care what narcotic is being used. It’s the point that full disclosure needs to be given and this sis often not done…as I have said several time already. And yes, actually I am antivax, to a degree. No.i dont not believe that there are massive amounts of aluminum in vaccinations. I also believe we that people should be given full.disclosure and to have their choices with regards to their healthcare and body respected.

          • Heidi_storage

            Why am I not surprised that you don’t like one of the most effective public health measures in human history?

          • Molly B

            I realize that there is more to.an.epidural.than morphine. I have had one before for a.surgical procedure. Also, dosage strengths vary by medications. 100mg of.one med.may be a starting dose and 10mg of another could be deadly. A low dose of particular med such as a starting dose can still.be powerful and can still have severe side effects. I already told you I really could care less what narcotics is being used its.the fact that women are not given full.disclosure. It full disclosure scares them oh well. They have the right to know and its not up to the doc to decide how much info they should get or to be bias towards one side or. the other. Last pregnancy I asks OB what the risks were to my child.if I chose epidural pain relief (I already knew side effects). I was told that there was no.risks to fetus, period. We all.know this is not true. Yet doctors tell women things like this. My friend.was told a 4th cesarean was perfectly safe and routine procedure….full disclosure and respecting a patients rights to make informed decision should be a priority not an “if I don’t.think it will make.them choose something other than what I recommend”

          • Monkey Professor for a Head

            I think Nick is referring to the local anaesthetic agents (which are different to opiates) rather than any diluting agents. Those local anaesthetic agents provide much of the effect of epidurals. They are also the reason why epidurals cause hypotension – which is why naloxone (as you suggested) is not useful in that situation. Before you try and educate us all on the risks of epidurals, you may want to learn a bit more about what they actually involve.

          • Nick Sanders

            I think Nick is referring to the local anaesthetic agents (which are different to opiates) rather than any diluting agents.

            I was. 🙂

          • Molly B

            I would.like to know who previously posted this fact as you said it has been brought up on this discussion before.

          • Molly B

            Morphine or opiods.in general. Read the article your sited from American.preganacy. It states that anesthetic.is used and I many cases morphine or one other are drug to lessen high doses.of anesthetic. Plus saline. Done

          • Azuran

            If you only wanted us to read 8.2, why post the whole thing?

          • Molly B

            I am so tired of telling you the same stuff over and over.
            AGAIN….the beginning was to show you evidence that opiods cross the placental barrier. The rest was to show evidence of my point regarding medical use in labor.

          • The Computer Ate My Nym

            What about section 8.2? That opiates can cross the placental barrier? Yep. That’s why epidurals are preferred to IV opiates for pain relief: Lower dose, given directly into the CSF means lower levels in the blood stream and lower fetal exposure. What was the point, then?

          • Monkey Professor for a Head

            I think Molly B is working on the assumption that even the most minuscule trace of opiates is potentially harmful. Perhaps she is not familiar with the concept of dose related adverse effects.

        • Nick Sanders

          https://www.ncbi.nlm.nih.gov/pubmed/22161362

          Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores.

          • Molly B

            Same article…

            https://www.ncbi.nlm.nih.gov/pubmed/22161362

            However, epidural analgesia was associated with …and an increased risk of caesarean section for fetal distress.

          • Box of Salt

            Molly B, I’m going to turn this on its head for you.

            Do you think it’s possible that a baby poorly positioned for vaginal delivery might result in a longer, more painful delivery for its mother?

          • Monkey Professor for a Head

            368 days ago today, I was in labour with an OP baby. I can testify that it was agony.

            I was repeatedly told by midwives for 12+ hours that I wasn’t really in labour (they wouldn’t examine me to confirm – when they did I was at 7cm) and that I couldn’t have any pain relief. It was traumatic, and I’m still a little angry about it. If a woman does not want pain relief, then that’s fine, but if analgesia is desired, it should not be withheld without a very good reason.

          • Molly B

            Your experience was a terrible one and to my knowledge uncommon. Stories like yours truly upset me in regards to the lack of proper care you were shown my the medical staff.
            No one is saying that pain relief should be withheld from anyone who desires it.

          • AllieFoyle

            Well, actually, I’d say that a lot of people are saying that epidurals aren’t desirable or necessary because they interfere with “natural childbirth,” which is seen as a good unto itself. Check out the practices in many of the northern european countries that natural childbirth proponents want us to emulate — it is very difficult to get an epidural in many of those countries.

            In some research studies epidurals are counted as a negative effect or outcome. Nevermind that it may have been seen as a profound positive by the women who requested one.

            And in my (former) local hospital, midwifery care is promoted as the norm, and epidural anesthesia is not available, no matter how much pain a woman is experiencing.

            I have never ever understood the people who get upset about epidurals being offered. If a woman doesn’t want one she can simply decline. It’s the woman in terrible pain who wants an epidural but doesn’t get one that seems more troubling to me.

          • Molly B

            My argument is that women do not receive full disclosure to truly provide informed consent. I have stated before that pain relief should not be withheld from a woman who wants it. Only that she be told of all the risks and benefits in full of the medications.
            It is sad that a hospital would refuse pain relief to women across the board. It is also sad that other hospitals demand certain women.receive certain pain medication/managements across the board. It is also sad that women.are not alway given full disclosure in regard to their pain management choices

          • Linden

            How about informed consent about the fact that the risk of PPD and PTSD is increased without adequate pain relief? Do you support doctors and midwives in making this clear to women?

          • Molly B

            That’s a load of bull. Well a half load to be exact. PPD and PTSD also occur in women who have had adequate pain relief but wound up having multiple intervention or emergency cesarean after interventions. It’s not about pain, its about the way a woman perceives her Labor and birth

          • Irène Delse

            Citation needed. You’re the one making assertions without evidence, here.

          • Who?

            Exaggerating the risks of an epidural, as you are doing, doesn’t help in the decision making process. A woman who is scared out of an epidural by your misinformation, and believes there is no safe and effective pain relief for labour might well be very frightened going in to labour.

            Would you feel you had done a good day’s work if, based on your ‘information’ a woman decided the best thing to do is have a general and a cs, to avoid the whole issue?

          • guest

            I would have been a lot less fearful if it hadn’t been drummed into me that epidurals cause a “cascade of interventions.” Once I experienced the pain, I got one anyway, but I could have avoided weeks of anxiety if I had been correctly informed about epidurals.

          • Molly B

            I am not exaggerating a risk. Exaggeration is saying 75% of women who receive epidurals will have drop in BP or respiratory distress and cause fetal decels requiring emergency surgery.

            I am saying hey there is a chance that some.women.can have complications from epidural that result in fetal.distress and cesarean deliveries and all women.should be informed.of all the risks.and benefits of interventions and of not receiving an.intervention by the doc

          • Amy Tuteur, MD

            You lack basic knowledge about risks. You think what you read on the Internet — propaganda from the natural childbirth industry — is accurate. Getting information about childbirth from the natural childbirth industry is like getting information on solar power from the oil industry. You need to be less gullible.

          • Charybdis

            It is NOT about how a woman “perceives her labor and birth”. It is about the fact that labor and childbirth freaking HURT and that women should not be denied pain relief when they ask for it. Notice I said WHEN they ask for it, not MANDATORY.

            If you feel like you can have a baby by using breathing, balls, showers, baths, walking, changing positions, squatting, downward dog, hypnosis, whatever coping mechanisms you wish, go right ahead. But if, and only if, you decide somewhere in the middle that the pain is too much and you would like pain relief, then YOU SHOULD GET IT IMMEDIATELY.

            Cesareans are not the evil thing here. Are some traumatic? Sure. We have a regular poster whose CS was a shambles. Some have to be done as a crash CS, using general anesthesia, which will affect the baby, because there is no epidural in place. Most CS’s are reasonably pleasant experiences, especially if they are planned.

            Positive thinking and visualization alone will not make the birth of a baby painless and easy for the mother. Stop implying that it does.

          • Molly B

            #1 I never said a woman shouldn’t get pain relief if she wants it.
            #2 I ever said alternatives to pain medication make labor painless.
            Do not put words in mouth.
            It is about how a woman perceives birth. If to one woman her birth was excruciating and she wanted pain relief and didn’t or wasn’t able to get it, then yes that can be traumatic. If another woman didn’t want medical pain relief and it wad forced on her or she was rolled into an.OR in an.emergency fearing for her or her baby that can be traumatic too.
            I am not pro medication or pro “natural birth”
            I do not know why people keep fighting with me calling me anti-vac and anti this or that. I am simply anti not being informed. I agree that doctors dont tell a woman everything that can go wrong in a vaginal delivery but I am also aware that people have brought up the argument with me on here of whether or not a doc should have to tell a woman everything that can ho wrong with an intervention.
            It is common knowledge that woman can die in childbirth. I do not feel it is common knowledge what the risks to intervention are. Yes many women, if not most, know that there are risks to inventions but do they know what those risks are?
            And saying that you know is not most women, its only you.

          • AllieFoyle

            The problem is not informed consent, it’s that you want women to be told things that aren’t true in order to sway them to the choice you think is best. Misinformed consent, if you will.

            What is your goal here? To help women? Save them from suffering? Help their babies?

            I suppose that by pushing women to avoid epidurals you might help some people, but there will invariably be others who are not helped and end up going without pain relief that would have made their labors more positive experiences or spared them trauma of varying severity. And I believe that the psychological trauma of unrelieved pain can have a real, lasting impact on a person — which is especially worrisome for a new mother who will be providing care and nurturing around the clock for a newborn.

            I’m also going to disagree with you that the idea of childbirth being deadly is commonplace. Maybe people are aware that childbirth used to be dangerous, but few people today see it that way. But I’d guess that many pregnant women have heard quite a lot of rhetoric around the supposed dangers of interventions and superiority of natural childbirth. I certainly did. If the propaganda scales are tipped one way or another, I’d say that things are biased in favor of exaggerating the risks of interventions and ignoring the dangers and disadvantages inherent in the natural process.

          • Molly B

            Any intervention carries risks. Women are not always told all the risks. I do not take a.stand on medicalized vs NCB.
            Only that women should.be given full disclosure.

          • guest

            NO ONE is forcing pain relief on laboring women. Stop making up strawmen to cloud your argument.

          • Molly B

            Actually doc told me that if I want to vbac (2nd vbac mind you) I must have an epidural or sign AMA form and pay for.the entire hospital bill myself or agree to schedules cesarean. But no one is ever forced, right??

          • swbarnes2

            I’m sure you could have told them not to give you any medication through the epidural, they just want it in place because obviously you are at a substantially higher risk for needing an emergency C-section, and GA is a big risk.
            Surely you are prepared to rattle off the risks of GA off the top of your head, since you are so deeply informed as to all the potential risks of childbirth?
            But no, they still weren’t forcing you to do anything, except to be financially responsible for the consequences should you choose to ignore their advice. I thought that’s what you wanted; for women to accept responsibility for their medical choices.

          • Who?

            You were offered 2 options. Both unpalatable. And I get that’s tough. Forcing you, though? No.

            You can choose to stay home and have the baby, you can choose to turn up in labour at emergency and see what you get, you can choose to keep looking for a doctor and hospital to meet your wishes. A second opinion could be useful as part of the third option.

            What you can’t do is insist that anyone provide you with medical treatment against their professional judgement or the requirements of their employment. It is your absolute right to refuse treatment, should you wish to do so. It is not your right to treat medical professionals like short order cooks and waiters.

          • Molly B

            This is my 4th OB for this pregnancy, because I want to VBAC. I am currently being seen at a Level III trauma center which should my Doctor quoted 1.8% chance of Uterine Rupture with a 30% chance of that 1.8$ being catastrophic I am in the best place I can be.
            Doc clearly said that AMA was because of fear of lawsuit should somethimg go wrong, but not because it was medically inadvisable. He is comfortable with VBAC if i sign AMA because that it what the legal Department requires for VBAC Moms. That is wrong on many levels. It also intimidates Moms into a cesarean who worry about having to pay the hospital bill although ACOG clearly state that up to 2 prior cesarean is ok and even better if mom has had prior vaginal deliver.
            Doc said that epidural could not be unmedicated cath ‘just in case’. He wants me on surgical level of meds and to lay in bed not mving, but they will gladly prop me on my side.
            I even asked about not scheduling section and alloowing for spontaneous labor before section, this was also shot down. I am not being given much a choice now am I?
            Its “Standard of care per ACOG says this, but fuck all that, we want you AMA and laying on a bed with high doses of epidural meds….just in case.
            Because I dont want to get sued in the 0.6% chance you have a catastrophic rupture (30% of 1.8%)
            Oh and you have to pay for it yourself and you still have to have an epidural even if your AMA

          • Who?

            It sounds complex.

            And I know it’s hard when you do your homework and do everything right, and things still don’t work out the way you want them to.

            What you are being offered is a first world safety net, strung up to the hospital’s specifications. It seems like what you want is a first world safety net, strung up to your specifications. The maths tells the doctors that your style of safety net won’t allow them to do their best job for you, so they can’t agree to it. One of the things that allows your hospital to be at the level it is is the policies and insurance. It’s rotten when they don’t suit you, but without them a hospital like that wouldn’t exist.

            If you want the hospital, you will need to choose to accept their rules. It’s in your hands. You can carry on being angry, knowing you are, in the end, going to take their advice, and accept their requirements, or you can square your shoulders and get on with enjoying being pregnant and looking forward to your expanded family. With a filter over the bits in between you’re not happy with. Big picture-that baby is coming out one way or another, and you get one go at it. Make it count for something real.

            It’s not the choice you want, but it’s the one available to you.

            Nothing is guaranteed, and nothing is promised. But if what you really want, on the other side of the delivery, is a live, undamaged baby, and for yourself to be as well as you can, please take your doctors’ advice, because doing so is your best chance.

          • guest

            It’s sort of like how I wasn’t given a choice about having general anesthesia for my appendectomy. My god, what monsters those doctors are, forcing me to have GA when there is no other suitable option!

          • Roadstergal

            Ah, so it all comes out.

            Nature has dealt you a shitty hand in the context of the number of babies you want to have. The best medical care that gives the best chance of survival for your baby and yourself would involve you doing things you don’t want to do, so you’re on a screaming campaign against the one bit you feel is most ‘elective,’ the epidural. (And you know why that’s on the table, yes? Taking a miniscule amount of risk to yourself re: the epidural vs a much larger risk to yourself and a massively larger risk to the baby with general anesthesia if things go pear-shaped?)

            So, if the best medical care that gives the best chance of survival for your baby and yourself isn’t what you want – if what you want is an unmedicated VBAC at all costs – stay home. If you rupture, the baby dies, but no big, that’s obviously not the point. At home, you won’t get an epidural or a C/S, period, and that’s what you want above all else.
            BTW, you have no problem with drunk driving? Because driving drunk with your kid in the car is an orders of magnitude lower risk to the kid’s life than the chance of you having a catastrophic rupture.

          • fiftyfifty1

            “This is my 4th OB for this pregnancy,”

            If a doctor tells you something you don’t want to hear, it’s very reasonable to get a second opinion. But when you are on your 4th opinion and still not hearing what you want to hear, then the problem isn’t them, it’s you.

          • Box of Salt

            Molly B “my Doctor quoted 1.8% chance”

            You think you are one of the 98, don’t you?

            Will you be able to live with yourself if you are wrong?

          • AllieFoyle

            Why do you think the doctor wants you to have an epidural if you plan a VBAC? What did the other three OBs say about it?

          • Erin

            I imagine for the same reason it was it was discussed with me, assumption of failure and not having to use general anesthesia in an emergency. However in my case it was presented as an option, to have it as a condition is in my opinion horrific
            .

            Speaking as someone whose birth plan is frowned upon by pretty much everyone I know (Doctors and Natural birthers alike), I think there needs to a middle ground.Explain the risks and let women make their own minds up maybe.

          • Irène Delse

            Gee, with a 1.8% risk of uterine failure, plus a non-negligible risk of needing an emergency CS, I would wish my patients had an epidural from the get-go. If I was evil, I’d ask them if they agreed to surgery without anesthesia in case something bad happened. (Granted, that last one would be illegal, but still.)

          • The Computer Ate My Nym

            This is my 4th OB for this pregnancy, because I want to VBAC.

            So you went through three OBs before finding one that was willing to risk his or her license on your risky plan. And it doesn’t bother you at all that it took that many tries to find an OB willing to agree to it?

            Doc clearly said that AMA was because of fear of lawsuit should somethimg go wrong,

            Yes, and when do doctors fear lawsuits? When their patients insist on risky plans that have a high chance of going disasterously wrong. You quoted your OB–the one who agreed to try the VBAC without pre-existing epidural–as saying that you had a 0.6% chance of a catastrophic uterine rupture, which carries a high risk of death for both the baby and for you as well as a high risk of requiring a hysterectomy, transfusions, and a whole lot of other things far riskier and more invasive than an epidural. Would you fly on an airline that had a record of 6 crashes per 1000 flights? I wouldn’t, not even if they had five star chefs making their in flight meals.

            Not to mention that a belligerent patient is a risk factor for a lawsuit in and of itself, regardless of quality of care.

          • Charybdis

            Now, now, she’s not “belligerent”, she’s “educated and informed”. She has already stated that it is not her job to make her hospital stay pleasant for the medical staff. Wait, here’s her post….

            My job is not to make my hospital stay pleasant for the medical staff. It is to birth my child in the way that I feel is best for me and my child. That includes talking to anesthesia ahead of time and determining a plan of care for anesthetics should I choose to use them since I have had bad outcomes in the past. That include not allowing unnecessary people in my Room or OR if I don,t want them there and that includes not allowing my privates or my child to be filmed or photographed if I dont that done and that includes not having a resident perform surgery on me if I dont want a resident to perform surgery on me. Its my legal right.

            She wants it her way, no negotiating allowed. The doctor is not a concierge and dammit, she should be allowed to dictate to medical professionals how they manage the risks inherent in a second VBAC.

            Clearly the doctor she found that would even entertain the notion of a second VBAC isn’t aware of the risks involved in labor and delivery; or more precisely, these risks somehow don’t apply to HER.

          • Azuran

            And? Do you really think that we are going to take pity on you over all this? You are really privileged to be able to switch between 4 OBs to find one willing to do a VBAC

            You have the right to chose, but those choices come with consequences and you have to accept them and take responsibility for them.
            You want a VBAC, even though it’s a riskier procedure and you want a doctor to assist you in this, well then you are going to have to make some concession, princess. Such as signing a form stating that you understand the risks you are taking and that if anything goes wrong it’s not your Doctor’s fault (you are so intent on full impartial consent, well then there you have it) and allowing him to put some measures in place to safe your life should something happens.
            Honestly, what’s the point of having a doctor if you don’t want him to do anything to make this safer for you and your baby? Just stay home at this point, the result will be the same.

          • Molly B

            Having medicaid and multiple OBs in the surrounding areas that accept medicaid is not privileged.
            I dont expect anyone to feel sorry for me.
            Everyone keep saying trust the OBs and the medical system…but the medical system is telling me I have to sign AMA papers because of fear of lawsuit NOT BECAUSE THEY FEEL CSECTION IS BEST FOR MOM AND BABY.
            There is a difference between signing a waiver and signing ama. One is a promise not to sue, the other can effect if insurance pays.
            you said
            “Honestly, what’s the point of having a doctor if you don’t want him to do anything to make this safer for you and your baby?”
            Doc said VBAC was not allowed by hospital policy without a,b,c in place so that they couldnt be sued. That is notr saying its what is safest for me, thats saying its what is safest for hospital

          • The Computer Ate My Nym

            Why do patients sue? They sue for bad outcomes. Why is the hospital reluctant to give you a VBAC? Because they fear that you will have a bad outcome and sue. They want it to be crystal clear that you insisted on this course so that they have something to defend themselves with when they’re facing having to defend themselves against a grieving mother who has lost a child to a VBAC attempt or against a grieving father and husband who has lost his wife and child in the attempt. I’m sorry if that’s harsh, but that is what they are thinking. If you have a good outcome, you presumably will not sue and everything will be fine. If you have a bad outcome because of care restrictions you insisted on, the hospital wants to not be held responsible for your bad judgement. That’s what the restrictions are about.

          • Azuran

            Except that c-section IS safest for you and your baby.
            Your yourself said that you have a 1.8% chance of rupture (even a non castastrophic rupture means emergency c-section) and a 0,6% of a CATASTROPHIC rupture (which might result in you getting an hysterectomy or kill you or your baby)

            What’s your chance of serious or catastrophic complication from a c-section? I doubt it’s anywhere near those number.

          • Molly B

            Among women who have one cesarean delivery, more than 90% will deliver their subsequent pregnancies by cesarean.1 The more cesarean births a woman has, the greater risk there is for problems with future pregnancies, including problems with the placenta, the risk of uterine rupture, which can be life threatening for the mother and her unborn child, hemorrhage, and the need for hysterectomy (removal of the uterus) at the time of delivery.
            https://www.nichd.nih.gov/health/topics/obstetrics/conditioninfo/Pages/risks.aspx

          • Azuran

            And I’m pretty sure all those risks put together are still far lower than a 0,6% risk of catastrophic uterine rupture.
            And you think vaginal birth has 0 risks?
            First of all, your TOLAC might fail, you will then need a c-section which has a higher risks than a pre-labour planned c-section. Shoud you do succeed in having a vaginal birth, you still have ALL the risks of a vaginal birth, including but not limited to: tearing, shoulder dystocia, pelvic floor injury (which can need an surgery riskier than a c-section to repain), retained placenta, cord prolapse, post-partum hemorrage etc.

            I support your right to chose a VBAC. But it is not the safest option. This is why your doctors are taking so many precautions around you. You are not a martyr or anything.

          • MaineJen

            Molly. You’re quoting back to us THE EXACT REASONS we are telling you that having an epidural in place is a good idea. You’re acting like a c-section is the worst thing that could happen here.

          • Daleth

            “Fear of lawsuit” means “fear that your baby will be brain damaged or killed.” There would be nothing for you to sue them about if your baby were fine.

            And they’re afraid of a lawsuit because the birth plan you want is much more dangerous for your baby than a repeat CS would be–the risk of brain damage or death caused by a repeat CS is effectively zero, which is a hell of a lot lower than 1 in 167.

            In other words they don’t feel, they KNOW that a c-section is safest for your baby, but they are willing to work with you on doing a VBAC instead–but only if you let them take reasonable precautions to lower the risk to your baby and yourself (such as having a working epidural in place, because that means they can get your baby out ASAP, and also you won’t face the risk of death that is inherent in general anesthesia).

          • Molly B

            They are afraid of lawsuit for any vbac. I have never showed my doc a birth plan or discussed a birth plan, only what my options were

          • Daleth

            Of course they are–who wouldn’t be, with a 1/167 risk of a dead or brain damaged baby?

          • Molly B

            Having a working epidural.in place for a 1.8% chance of uterine rupture of which only 30% are catastrophic…so 0.6% is not reasonable so that’s a 99.4% chance a rupture wont be catastrophic. The number I quoted are per my doc

          • Daleth

            Yep, 166 out of 167 women in your position will not have a catastrophic uterine rupture (although all the other risks of vaginal birth remain: shoulder dystocia etc.). But every woman must weigh for herself whether she’s ok with a 1 in 167 chance of death or life-altering injury to her baby.

            For perspective, I think most people wouldn’t drive their cars if every trip carried a 1/167 risk of death or brain damage to themselves or a passenger. That’s probably why most women with prior CS choose another CS rather than VBAC. But again, it’s every woman’s decision to make for herself and her baby.

            The thing that puzzles me about what you’ve written is that you seem to not only want to have that choice (which of course anyone wants to have), but you seem to think you should be able to make the doctors do it exactly the way you want them to, rather than letting them take precautions to help prevent you from being that horrifically unlucky 1 in 167.

          • Amy Tuteur, MD

            Wait, you think women would reject epidurals if they understood the “risks” to the baby, but you are opting for a VBAC that has a massively higher risk of death?

            Why is the risk of an epidural “too high” but the risk of killing your baby with a VBAC against medical advice perfectly acceptable to you?

            Perhaps you’re the one who doesn’t understand the risks (or a are hypocrite).

          • Amy Tuteur, MD

            Thanks for proving the point I made in yesterday’s post: Women don’t understand the risks? http://www.skepticalob.com/2016/06/women-dont-understand-the-risks.html

          • Roadstergal

            How does that risk of death to your baby-to-be compare, numerically, to the risk of death to your baby from driving drunk with babe in the car?

          • Azuran

            I guess I should stop wearing my seat belt then.

            Seriously, a 0,6% chance of CATASTROPHIC outcome is really high, Catastrophic means death or severe brain damage. And your risk of rupture is actually 1.8%, and any rupture = emergency c-section. So it’s a 1.8% chance that you are going to need a crash c-section. There is no way for your OB to actually even know if your rupture is catastrophic before he’s actually doing the c-section and looking at your uterus.

            Would you shot your baby with a gun that had a 0,6% chance of having a bullet in it? Because that’s what you are doing.

          • Roadstergal

            Or would you shoot your baby with a gun that had a 1.8% chance of having a bullet in it, and a 0.6% chance of being aimed at a vital organ…

            This isn’t even getting into the odds of a non-rupture event that would require a C-section. Those risks are lower, of course, which is why the hospital doesn’t require an epidural in place for every laboring woman – but those risks are _on top of_ the rupture risk.

          • guest

            But why do you think the hospital has that policy? Because they think it’s fun? Or because their risk assessment analysis shows that it’s not safe to do a VBAC without “a,b,c” in place?

          • Molly B

            Doc said it is because docs have more control over a cesarean and its harder for.people to sue when something goes wrong

          • Charybdis

            I doubt you would even hear them or register the fact that a repeat CS is safest for you and the baby, if they have said that.

            And yes, AMA is a legal condition for certain medical situations. Situations where the doctors have explained all the risks of certain actions (leaving the ER to go home after a heart arrythmia that has not been explained, refusing care strongly recommended by the doctor/doctors, opting for non-intervention in whatever medical issue is going on, etc) and stressed that Very Bad Things can (not necessarily WILL) happen, up to and including death or permanent disability, but that you (general you) accept these potential outcomes and are rejecting/opting not to follow the best medical advice they can give. Because you do have a right to decline medical attention, as an autonomous person.

            But they also have the right to document your (again, general your) refusals for treatment, state that they will care for you if certain conditions are met that will reduce their liability if things go very, very wrong. Then they can show that they counseled the patient about what to expect with refusing treatment, explained how things could go awry, and explained why they were recommending the treatments they felt were best for your situation.

            You stated that you regularly cross out things you are not agreeing to on consent forms. The doctors and hospitals also have that right. They can stipulate what they are not willing to agree to. You just don’t like it when your method is turned back on you.

          • Erin

            I feel a bit sorry for her actually. Having to fight for the birth plan which best protects my mental health and still feeling that I can’t just relax even though they’ve put it in writing that I can have a general anesthetic is horrible so I sympathize with her situation. However her forum manner would possibly be more suited to the average competitive gaming forum.

          • guest

            I am laughing over the fact that she wants to choose a much riskier form or birth than a c-section, but she’s balking at the minuscule risk of an epidural.

            Earth to Molly: Foregoing the epidural doesn’t offset the risk of a VBAC. Let it go already.

          • Daleth

            An 0.6% chance of a catastrophic rupture means you have a 1 in 167 chance that your baby will be killed or catastrophically brain damaged. With over three million babies a year being born in the US, and 30% of them (about 900,000) being born by c-section–in other words, 900,000 women whose next babies will be born via repeat CS or VBAC–that adds up very, very fast.

            How fast? Let’s say only 10% of those 900,000 women–so, 90,000–go on to have another baby, and only half of them (45,000) decide to VBAC. Do the math (divide 45,000 by 167): that means 270 babies die or are catastrophically brain damaged who would have been perfectly healthy if mom had chosen a repeat CS.

            Do you see why doctors generally prefer repeat CS over VBAC? They don’t want your baby to be killed or brain damaged. They also don’t want to be sued, but they wouldn’t be sued in the first place unless your baby was killed or brain damaged. That’s what they’re trying to avoid, and surely that’s your goal too? So why are you mocking them and feeling so hard done by just because they’re trying to keep your baby from being hurt or killed?

            As for the epidural not being “unmedicated ‘just in case,'” that is because if you rupture there isn’t time to go from zero anesthesia to surgical-level anesthesia before the baby is severely compromised or dead. You have to already be most of the way there, anesthesia-wise. The only alternative is putting you under general anesthesia, which out of everything that can happen during an operation is the single thing most likely to kill you. Not to mention, general anesthesia knocks the baby out too, so there can be breathing issues etc. when it’s born.

          • The Computer Ate My Nym

            Not to mention that if there is a catastrophic rupture, the patient is highly likely to need blood and fluid immediately and a hysterectomy as soon as possible. Trying to anesthetize a woman who is bleeding to death from a bad uterine rupture and has no anesthesia at all does not sound to me like a good time.

          • Molly B

            “How would have been perfectly healthy if deliver by section”
            You can not guarantee that a baby born by cesarean, especially repeat cesarean will be perfectly healthy. Surgery has its own risks.to mom and baby including uterine rupture (shocking!!!) hysterectomy and death….sounds familiar….

          • Daleth

            C-section does carry risks for mom (although planned CS is much safer for her than emergency CS), but the only risk that a c-section poses to the baby is being nicked by the scalpel.

          • Roadstergal

            The risks of epidural and C/S (miniscule for the former, much lower if planned vs emergent for the latter) are all risks to the mom. The risks of rupture are to the mom and the baby, but worse for the baby (brain damage and death). So stop trumpeting about how much you care about the baby-to-be and what nonexistent effect that miniscule amount of epidural medication that might cross over is. You want to put all of the risks off of you and onto your future baby.

          • MaineJen

            I love how you are blithely dismissing the 0.6% chance here. That’s not insignificant. And um…even a “non catastrophic” uterine rupture is…not good. You know that, right?

            Listen, it’s not about a mean lawyer breathing down anyone’s neck. It’s about a doctor being afraid for your safety. There’s obviously a very good reason that the first THREE doctors didn’t think you were a good vbac candidate. And we’ve already laid out the reasons why preemptive anesthesia is a good idea in your case. So…what’s the issue?

          • Molly B

            A patient asserting their right to refuse treatment or procedure they do not want is not treating anyone like a short order cook. Employment should require a medical professional to usurp a patients rights, its unethical.
            Doc didnt say it was against HIS judgement, it was against hospitals legal departments judgement.

          • The Computer Ate My Nym

            You have the right to refuse any medical treatment you wish to refuse. This is absolutely true. However, the more restrictions you put on your care, the harder you make it for your provider to take care of you, especially in an emergency situation and the more you increase your risk of unnecessary problems.

          • guest

            “I’ll have a VBAC but hold the epidural” is indeed treating doctors like short order cooks.

          • Molly B

            I would like to vbac but I dont want an epidural is laid.out in my.patient rights per the hospital!!! It’s my legal right per federal law!!! It’s not treating anyone like a short order cook! It’s saying that I have a legal right to choose what is and isn’t done to my body and exercising those rights!

          • guest

            You weren’t forced to have an epidural. You were told that no doctor was willing to risk a crash section with no anesthesia whatsoever given your high risk. You still had the option of choosing homebirth, choosing a scheduled c-section, or having the epidural line placed. You also had the option of not having another baby if you didn’t like any of these options.

            But one option you should never have is to force a doctor to perform a procedure in a way they consider unsafe. It goes against their ethics, and usually the terms of their insurance.

          • MaineJen

            Molly, did it ever occur to you there might be a good reason for this? In the event of uterine rupture, just to name one example, they are going to want to go straight to c section, do not pass go. Having an epidural already in place is good common sense, and probably hospital policy.

            Why are they worried about uterine rupture? It’s rare, but it usually doesn’t turn out well for the baby when it does happen.

            They want you to have an epidural for the same reason they want women to do their vaginal twin deliveries in the operating room…things can and do go wrong, and they really, really want everyone to come out of this alive.

            These things are not decided on capriciously. They are in place for good reason.

          • Charybdis

            No, apparently it is all just to piss her off and inconvenience her edumacated self.

          • guest

            And even with the requirement that I deliver in the OR, I was allowed to labor in the rooms the other women got. I mean, otherwise I’d’ve tied up the OR for hours.

          • Azuran

            Except that they are not forcing ‘pain relief’. They are taking precautions so that if things go south, they can save yours and your baby’s life with minimum risks.
            What next, are you going to complain that doctors are forcing epidurals or general anaesthesia before a c-section?
            I guess my mom should have been offered the possibility of standing very still while they did vascular surgery in her brain instead of ‘forcing’ general anaesthesia on her.
            It’s horrible that I wasn’t offered the possibility of biting a stick really really hard when they repaired my open arm fracture and was instead ‘forced’ to have general anaesthesia.
            Maybe I should give pet owners the options of holding down their pets while I do surgery on them, instead of ‘forcing’ general anaesthetist on them. (and yea, I’m bringing up the fact that I’m a vet just because I know how much you like it)
            For someone who cared so much about opioids crossing the placental barrier, you really don’t seem to be that worried about needing an emergency general anaesthesia if things go south.
            Do you even realize how ridiculous and clueless you are?

          • Linden

            http://www.medscape.com/viewarticle/828860

            http://www.ncbi.nlm.nih.gov/pubmed/14995921

            Those are literally the first two links when I googled this. DrAmy also pointed at the following:
            http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx

            After all, there seems to be better evidence pointing to this effect, compared to your non-existent numbers for epidural risks for babies.
            After all, there seems to be better evidence pointing to this effect, compared to your non-existent numbers for epidural risks for babies.

          • Daleth

            Thanks, Linden. I’m just going to re-post those links with the titles of the studies, so that MollyB and others can see what they say without even having to click:

            Postpartum Depression: Epidural During Birth May Reduce Risk
            http://www.medscape.com/viewarticle/828860

            Does pain relief during delivery decrease the risk of postnatal depression?
            http://www.ncbi.nlm.nih.gov/pubmed/14995921

            Spoiler: the answer to the question posed in the second study is yes. Quote: “The adjusted risk of depressive scores at the first postnatal week was
            decreased in the epidural/paracervical group when compared with no analgesia group
            … Elective or emergency cesarean section did not increase the risk of high [depression] scores at the first week or at 4
            months postpartum.”

          • Molly B

            Those two links are about postnatal maternal depression LOL

          • Linden

            Those two links are exactly about what you said was bullshit: the link between PPD and inadequate pain relief.
            You must have the memory of a goldfish.

          • Daleth

            Those two links are about postnatal maternal depression

            Right, because that’s what we are talking about. You said it was, quote, “a load of bull” that epidurals (adequate pain relief) can reduce the rate of PPD (postnatal maternal depression). I posted links showing that it was true, not a load of bull at all.

          • AllieFoyle

            I’m all for informed consent, but I don’t know why you are focused on epidurals in particular. I’d say the most thorough informed consent processes I went through were for surgical procedures and anesthesia — which I imagine would be just like those for getting an epidural. In contrast, there was absolutely nothing about the risks of childbirth — just a blanket form authorizing care in the most generalized way, certainly nothing about options or risks vs. benefits of various courses of action. I’d like to see women better informed about all aspects of childbirth, especially the risks of forgoing interventions and the benefits of accepting/requesting them, but what you seem to be advocating is just that we tell women frightening things about epidurals that aren’t even true and ignore all the rest.

          • Sarah

            Actually, a great many people are saying that.

            And the problem with some of the rubbish you’re peddling is that it has the potential to lead both women to refrain from pain relief when they might otherwise want/need it, and clinicians to be reluctant to administer it to a woman who wants it. There is, unfortunately, a problem with epidural denial. I’ve been there/

          • Molly B

            If its rubbish then provide sources to refute it.

          • Linden

            *You* provide the source that says epidurals harm babies. You haven’t yet. Specify your metrics. Increase in risk of death in micromorts. Difference in apgar scores. Specify how much discomfort should be enforced on women to mitigate whatever risk you come up with.

          • Sarah

            I think you’ll find the onus is, in fact, on you to provide reliable sources to confirm it. Something you haven’t done very well at so far.

          • Charybdis

            But somehow you think women are being tricked or forced into epidurals by medical staff and do not listen to the woman in question. Or you don’t like the fact that epidurals are a pain relief option, or that maybe the medical staff will ask several different times about your pain level and if you would like something for the pain. Because people’s minds can change and because they said “absolutely not” in the beginning does not mean that several hours later they will still refuse pain management.

            You are evaluated and assessed throughout your labor and because things can change, including the mother’s thoughts on pain relief. You can continue to refuse any and all pain control options each time they ask.

          • Molly B

            There are many things that can cause a longer or more painful labor for a mother. The use of epidural or narcotic medications in labor is a personal choice.

          • Nick Sanders

            A choice you seem absolutely determined to scare or browbeat them into turning down.

          • Molly B

            And a choice that you seem to insist is perfectly safe and browbeat me into changing my view on. Are you not here doing the exact same thing for the other side of the podium?

          • Nick Sanders

            “Perfectly safe”? No, nothing is “perfectly” safe. What I am here to say is that the numbers do not bear out your nonsensical claims that epidurals are evil and the US should stop giving them.

          • Molly B

            What is nonsensical is you claiming that I stated epidurals were evil and the US should stop giving them. I have never said either one of these things. It’s sounds to me like you are running out of logical arguments and reverting to childish antics and false generalizations

          • Heidi_storage

            Absolutely. I see no one on this thread arguing that we should force epidurals on all laboring women.

            Personally, I suspect my epidural did slow down both my labors. Which was fine–the delay was only a couple of hours, and instead of being in agonizing, debilitating pain, such that I felt like some external force was possessing me, I was able to rest and enjoy the impending arrival of my babies. I actually did have a complication with my first epidural–my blood pressure plummeted briefly (kid was okay)–and my second took a couple of tries to insert. I am aware of the risks, and remain a huge fan.

          • Molly B

            Still standing on my feet.

          • Monkey Professor for a Head

            And you have not yet addressed the question. The fact that you are attempting to brush it off without an answer makes me think that you do not have a good comeback.

          • Molly B

            No I answered it one comment down. Your question was a bit moot as the answer is obvious.

          • Monkey Professor for a Head

            I read that, I just don’t consider that to be an adequate answer. You were either trying to dodge the issue or you did not understand why the question was being asked.

            The point Box of Salt is making is that studies done on epidurals (which are not randomised control trials) are prone to confounding factors. If a woman is experiencing an especially painful or long labour due to a suboptimal baby position, they will be more likely to request an epidural and are more likely to require intervention. Therefore there will seem to be a correlation between epidurals and complications, but that does not mean that the epidural caused the complication.

            From a study design point of view, the best way to determine if there is a link or not would be to randomise women to either receive or not receive an epidural. However there is a big ethical problem with either refusing or enforcing pain relief for a woman in labour. In fact the study that you posted states in its introduction that previous randomised control trials did not show an association between epidurals and sections, but were hampered because of the high rates of crossover between groups.

          • Monkey Professor for a Head

            Milky B, might I suggest you check out the link to the adequate mother in the sidebar. It has a series of articles written by an anaesthetist who runs through all the evidence on the potential risks of epidurals.

            I would also point out that all pain medication has side effects. However the benefits of providing pain relief in many cases outweigh the risks. Would you argue against giving pain relief to someone with a broken bone or a kidney stone? Also most side effects of opiates are dose dependent. The beauty of an epidural is that it enable a doctor to provide excellent pain relief with a much smaller dose compared to oral or IV opiates.

            Informed consent is important, but women need to be given accurate information, which is not what you are providing. And if they choose to have an epidural (as long as there are no medical contraindcontraindications), it should be provided promptly and without any negative moral judgement.

          • Monkey Professor for a Head

            Molly B, damn autocorrect!

          • Molly B

            I will look into articles.you mentioned. As for the argument of pain relief in regard to someone with a broken bone or kidney stone…
            #1 Are they pregnant? If so this should influence the pain relief measures used.
            #2 If they are not pregnant then your argument is invalid as my point is the effects to the fetus either directly or indirectly.

            What is not accurate about the information I am stating?
            Narcotic, including those given in a epidural or spinal cross the placental barrier.
            Any narcotic provided to a mother at any time.in her pregnancy including during labor has direct or indirect risks to the fetus.

          • Monkey Professor for a Head

            If a woman is pregnant and suffers from, for example, a broken bone, then as a doctor I would take it into account when recommending options for analgesia, but I would not withhold pain relief solely on the basis of pregnancy. How much should a woman suffer to avoid a small risk to a baby?

            When you talk about opiates being teratogenic and when you talk about risks of addiction, you are providing inaccurate information.

            With an epidural, the amount of opiate that will cross the placenta is tiny. As I said, most risks of opiates are dose dependent.

          • Molly B

            As i have REPEATEDLY stated the article on addiction was solely to point out to one person that the medication does pass the placental barrier

          • demodocus

            I think their point is that it’s not much and not long. If we’d gotten into an accident on the way home and the newborn broke a bone, I’d expect they’d give her effective pain relief the same way they did for her toddler brother last summer.

          • Molly B

            For the sake of argument lets say the bone was not an open fracture and did not require surgery. Would you want them to provide opiods for your newborn? If it was an open fracture or required surgery would you want to be fully informed.of all the risks.and benefits to opiod medications for your newborn if that was the doctors recommendation?

          • Charybdis

            You bet your ass I would want pain management, even in the form of opioids for my newborn (or any child, regardless of age) if they had a broken bone or had required surgery for anything. Just because they are a newborn does not mean they cannot feel pain from surgery or a broken bone and they deserve to not be in pain while they are healing.

            I am guessing you wouldn’t or would refuse it if offered by the doctors until you had thoroughly researched it, discussed it to death on teh interwebs and agonized over the decision while your child was suffering? Or would you just tape an aspirin to it and hope for the best, as no opioids would then enter your child?

          • demodocus

            Hell yes, i’d consent to opiods if recommended. I saw how much pain her brother was in when his leg was broken in an accident when he was 1. The bone didn’t poke out, but he was in agony, and they gave him oxycodone for the first several days. They have to anestetize toddlers to put the spica cast on, too. We were as fully informed as distraught parents can be. This is not a theoretical question for me.

          • Molly B

            So child didn’t just fall of the slide at playground and fracture bone. You are talking about a child who was in an automobile accident, had a severe I would assume femur break and if.in spica cast likely required femur to be manipulated back into correct position at break. Yeah that quite a bit more substantial than a simple.break

          • Who?

            What difference does it make? Child in pain equals child who needs pain relief. Qualified medical professionals advise on likely pain levels, what drugs will do what job, and what risks/benefits each have. Then the parents make a choice.

            Like adults, some kids are stoic, some are more demonstrative. The stoic child needn’t be left in pain, and the demonstrative one doesn’t need panadol every time they break a nail.

            Why would a parent choose to leave a child in agony, however the injury was caused, where there is relief at hand?

          • Molly B

            Not every level of pain requires a narcotic.

          • demodocus

            Of course not, but in my original statement I said if the docs recommended it. They most certainly did in my toddler’s case, and they hardly recommend against it in the case of labor.

          • Molly B

            But not everyone perceives their own individual pain the same way. If a woman want pain relief OK if she doesn’t OK. A doc shouldn’t pressure her either way

          • Charybdis

            Asking if a woman wants pain relief periodically during labor is *not* pressuring her into having some. Pain levels change, pain perception changes, it might not be *bad* pain, but the mother is tired of feeling it now all can certainly happen during labor.

            Asking about or reminding the mother that there is pain relief of varying degrees available to her is not pressure. It is an evaluation of the mother’s pain level and if she wants pain relief, fine. If she doesn’t at that point, that’s fine too. But she will get asked about it several times as things change. Doesn’t make it pressure to have pain relief.

          • guest

            The problem is the word “requires” here. Most injuries don’t “require” pain control. We do it because it’s cruel to make someone suffer unnecessarily, not because the pain has adverse effects (though in extreme and chronic cases, of course, it does that too).

          • Molly B

            Requite is appropriate if you read the entire statement. That not every injury requires Narcotics.

          • guest

            No, it doesn’t make sense. No injury “requires” narcotics. But it’s unethical to withhold them from patients who would benefit from them.

          • Roadstergal

            Hell, my collarbone break didn’t ‘require’ surgery. But it had a great deal of utility for me in terms of reduced pain, increased mobility, and good long-term outcomes. You can’t just say a baby emerged in the absence of pain relief and determine pain relief wasn’t necessary. There’s more to it than that.

          • Irène Delse

            You must be joking, right? Why does it matter how the accident was caused? A broken bone is a broken bone. And if you think a “simple” break (I presume you mean without displacement) doesn’t hurt, well, think again.

          • Molly B

            It’s not that it doesn’t hurt, its about the degree of pain. Would you take.narcotics for a simple headache? No. Would you take narcotics for a.severe persistent headache that was excruciating? Maybe.

          • Charybdis

            But an infant cannot use words to tell you how much pain they are in. They can only cry, fuss, scream, etc. It is difficult to determine the degree of pain they would be in. Laughing, giggling, smiling, cooing – probably not a great deal of pain. Crying, screaming, fussing, restless- probably *some* pain. Crying and screaming inconsolably -probably a *great deal* of pain.

            I have mixed tension migraines, along with “plain” migraines. I manage every headache I have like it is a mixed tension migraine, and that involves using a Schedule IV controlled drug. So, yes, I DO take narcotics for a ‘simple” headache.

          • Molly B

            A plain.migraine is not a simple headache. That is stupid to say it is. That is saying that all headaches are migraines

          • Irène Delse

            Except that Charybdis never said that migraines are the same as headaches. Try reading what people write, not what you think they wrote.

            Also, lecturing someone who has migraines on what migraines are is, shall we say, misguided.

          • Molly B

            She implied it “I have mixed tension migraines, along with “plain” migraines….So, yes, I DO take narcotics for a ‘simple” headache”
            By referencing a Plain Migraine as a Simple Headache

          • Charybdis

            I implied no such thing, nor did I refer to a Plain Migraine as a Simple Headache.

            Mixed tension migraines, at least in my case, start as a “simple” tension headache that morphs into a migraine. My “plain” migraines the classic variety that are preceded by a prodrome period and an aura that starts small, then grows to seriously impair my vision. I don’t have any way of knowing if a tension headache will morph into a migraine, so I treat ALL my “simple, tension-type” headaches as potential migraines and take the appropriate medication.

            Most people consider a tension headache to be a “simple” headache, so I was stating that I do, in fact, treat my “tension/simple” headaches like migraines and take appropriate medication. The OTC Excedrin Migraine crap might as well be M&M’s for all the good it does me. Schedule IV for me!

          • Molly B

            You said that you get tension migraines and plain migraines. That you treat both the same and so YES you do you narcotics for simple HEADACHES (you said headache, not migraine, this is saying that a simple migraine is the same as a simple headache)

            Your new clarification of the fact that you treat these simple headaches as potential migraines was not what you had stated before.

          • Charybdis

            “I have mixed tension migraines, along with “plain” migraines. I manage every headache I have like it is a mixed tension migraine, and that involves using a Schedule IV controlled drug. So, yes, I DO take narcotics for a ‘simple” headache.”

            That up there is copied and pasted from my first post. I do believe it says that I do, in fact, treat every headache as a potential migraine. Or, in other words, I do not wait to see if it will turn into a migraine before grabbing the Schedule IV controlled drugs.

          • Who?

            Our Molly regularly misquotes then misrepresents. It may be that her attention to detail is sloppy.

          • Molly B

            Since when do most people consider a tension headache and simple headache to be the same? Tension headaches are not the same as your run of the mill everyday headache.

          • Monkey Professor for a Head

            Tension headaches are the most common kind of headache. So yes, most people would consider tension headaches to be simple run of the mill everyday headaches.

          • Molly B

            You are absolutely correct! And that is the point. Not every injury has the same pain level and therefore not every pain requires the same pain relief.

          • Irène Delse

            ” It’s not that it doesn’t hurt, its about the degree of pain. ”

            Do you think it never occurred to nobody but you? Do you think women who do want epidurals don’t understand this,?

            And why do you switch from fractures to headaches as a comparison? Oh, yes, because the idea of a “simple fracture” as something that doesn’t hurt much has been exposed as a crock. So now you fall back to “simple headache” – as if being “simple” meant “not very painful”.

            Well, sorry to burst your bubble, but one can have terrible headaches that aren’t migraines and for which some people require narcotics, while some may prefer forgo them. The thing is, it’s *not* for you to decide. Strange, btw, how you go on and on about informed consent, but dismiss the pain of others! Child with a fracture? Not a big deal. “Excruciating” headache? Narcotics “maybe”. And comparing the pain of childbirth to a moderate headache is just plain ridiculous.

          • Molly B

            The reference to the headache was to make a point about the broken bone argument someone brought to me. I tried to state that not every broken bone requires narcotics and that was apparently not understood so i referenced a headache to see if that would be more understandable.

          • AllieFoyle

            I have never had a headache that was anywhere approaching the pain level of childbirth. Just equating the two makes your understanding of the potential pain involved suspect. You said you’d had a c-section, birth w/ epidural, and VBAC. Does that mean you’ve had ONE birth w/o pain meds? Why on earth would you think that your ONE experience means anything about the level of pain that other women may experience?

          • Molly B

            The headache reference was to make the point for the argument brought to me by someone else about narcotic pain relief for a broken bone.

          • Empliau

            Well, everybody is different – I had a precipitous childbirth, therefore unmedicated (they won’t give you an epidural at 10 cm). Two hours of pushing were extremely painful, but I’ve had many migraines worse than giving birth. The worst was five days in agony hiding in a darkened room. I’ve also had cluster headaches, which are their own special circle of hell. A reasonably short VB without serious complications was much easier than some of the headaches, and that is not saying that childbirth wasn’t painful. In the modern world, childbirth ends sometime (you never know when a migraine or cluster headache will end) and at the end you get a baby.

          • Empliau

            Sorry – a lot of fellow migraineurs on the thread. I should finish reading, as it was already addressed, before I post.

          • AllieFoyle

            I can’t even imagine a headache that could come close to the pain of childbirth, but I suspect that’s because I’ve been lucky in the headache department and unlucky in the childbirth department. I’d never dream of telling people that their migraine pain doesn’t require medication though. How would I know?

          • Empliau

            I know – I’m sorry, tone is always a problem. I didn’t mean to imply that you were saying migraine doesn’t require medication, only that for some of us it’s equivalent or worse. (I am not sure I would say that the two hours of pushing were worse than migraine, as it was many years ago. But the first stage of labor was definitely *way* easier than the usual migraine. ) Sadly, the migraines are still a frequent feature of my life, so that pain is more vivid.

          • Roadstergal

            I had a boss who had cluster headaches that would get so bad, he’d have to lie motionless in his home with the windows darkened to be able to bear it at all. He was on warfarin to try to control it, speaking of meds with side effects… yeah, I can’t imagine.

            (He was a neurologist, ironically enough. Like how my immunology professor had vitiligo.)

          • guest

            Well, thank goodness I don’t get a baby at the end of every headache. I generally support women having as many babies as they like, but I still have to draw the line at 500+.

          • Empliau

            Amen, sister.

          • Molly B

            When she said accident and stated injuries I assumed it was a car accident and that would mean factoring in other things and other injuries that would lead doctors to recommend certain pain relief measures

          • momofone

            You seem to assume a lot.

          • Charybdis

            Even a “simple” break hurts like hell. Even with children and babies who are more likely to have a “greenstick” fracture, it still hurts. I would rather have the medication on hand and not need it than to realize that you need it at 1:30 in the morning on a weekend.

            Or does pain to a baby not matter?

          • Molly B

            The question raised wad not having whether or not to yo have meds on hand. It wad whether or not they are always necessary. So thanks for your response and statement that you would.want them.on hand just in case, meaning they may not be needed

          • Charybdis

            Let me rephrase then. HELL YES I would want effective opioid pain meds for my infant/child if they had a broken bone. I would give them for the first few days and then see how things were going. I would rather be safe (relieving pain) than sorry (not relieving pain) in a preverbal infant/child. If, after the first couple of doses, the baby/toddler in question doesn’t seem to be painful or uncomfortable, then I would consider skipping a dose or two.

            I have an outrageously high pain tolerance myself; I would not assume that my baby had the same. So yes, take home opioid pain meds after being discharged from the ER, where they would have given adequate pain relief. When that began to wear off, I would give an appropriate dose of the take-home prescription, I wouldn’t wait to see if “they were needed” at that point in time. I *know* they are needed, and as a parent, I would make the appropriate decision and medicate my child because BROKEN THINGS HURT, NO MATTER YOUR AGE.

          • demodocus

            Actually, the accident in question *was* at the playground. I tripped over the slide while carrying him, landed with one hand on his leg, and snapped his femur. There are reasons why I’m on zoloft.

          • Molly B

            Ok a femur being snapped in half is not the same as a hairline fracture or a green stick. That’s what I was saying. Pain relief depends on pain level.

          • MaineJen

            For a broken bone? Hell yes. I don’t want my baby to be in unnecessary pain, thanks.

          • Molly B

            Yes, but that doesn’t mean something as strong as an opiod would be necessary to relieve the pain.

          • demodocus

            For a broken bone? You must have an extraordinarily high pain tolerance. My toddler doesn’t.

          • Charybdis

            What do you think would be adequate to relieve the pain of a freshly broken bone? Because ice, elevation and a couple of Tylenol or Motrin aren’t going to cut it.

            Broken bones HURT (for the record, I’ve broken 2 in my entire life: compression fracture in my left wrist in college and broken coccyx last year). Both required opioid pain meds for several days. Why would you want your baby to suffer?

          • Molly B

            Not all broken bones require narcotics. Severe breaks, yeah probably. I.have never had a severe break so I cant say from personal experience. I have broken multiple bones including my ankle at age 3 and left the hospital in a walking cast and walked to the car with the help of my mother for balance. No narcotics. It was ibuprofen and elevate.
            The question originally raised was about broken bones in general. That is a very broad statement encompassing a wide range of bones and breaks. That being said I stand by my remarks.that NO narcotics are not necessary in every situation.

          • Monkey Professor for a Head

            Paracetamol can cause liver failure. Non steroidal anti inflammatories can cause renal failure. Of course these things are rare when used at appropriate doses for a short period time in patients without underlying contraindications. But still, better be safe and not treat the pain.

          • Charybdis

            NSAIDS can also cause gastric bleeding….

          • Molly B

            Labor can last for days requiring multiple doses of pain relief medication, in the case of this argument, opiods.

          • Nick Sanders

            Actually, by arguing against epidurals, you are effectively arguing for opioids, as IV opioids are the next most effective pain relief, if what I’ve read is correct.

            The primary pain relief from epidurals doesn’t come from opioids, but from anesthetics.
            http://americanpregnancy.org/labor-and-birth/epidural/
            http://www.acog.org/Patients/FAQs/Medications-for-Pain-Relief-During-Labor-and-Delivery

            Morphine:

            In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby’s ability to breathe.

            http://americanpregnancy.org/labor-and-birth/narcotics/

          • Molly B

            Arguing against lack of informed consent and full disclosure in relation to epidurals is not arguing for IV opiods. That like saying arguing against 2% Milk is arguing for all other forms of dairy. You are ridiculous. Also not routinely used doesn’t mean NOT USED.

          • Nick Sanders

            If you think you aren’t de facto arguing for opiates, let me ask you this, what do you expect to happen to all those women who decide not to get an epidural because you have scared them away from them? Because most of them are NOT going to opt for an unmedicated birth, they’re still going to want something to help with the pain.

          • Molly B

            Have you conducted a survey? Are you saying that women have told you they are.scared to get an epidural because of.what I have posted? You have asked me to sight sources for my statements and I have done that. One woman may be scared another woman may decide to go ask her doctors opinion another may choose to do her own research, yet another may feel the benefits to her outweigh the risks. Who are you to say what anyone else thinks?

          • Molly B

            I am not arguing for IV opiates. AGAIN.i am.arguing for full.disclosure being given to women. I have not stated the benefits in my argument simply because this seems to be.well.known. Great pain relief, when they work properly.

          • Charybdis

            All righty then. How about, in the interests of full disclosure and informed consent, that people be told about all the potential negatives of vaginal delivery: pelvic floor damage, 3rd and 4th degree perineal tears, excruciating, unrelenting pain, infections to mother and baby, shoulder dystocia and associated issues (Erb’s Palsy, broken clavicle for baby), cord prolapse, placental abruption, uterine atony, varying degrees of PPH, cervical lacerations, broken coccyx, broken pelvis, nuchal cords, bladder prolapse, rectoceles, retention of the placenta, oxygen deprivation to the baby, tearing “forwards” through your clitoris, amniotic embolism, aneurysm, and death.

            If these potential outcomes were not presented by your doctor and thoroughly discussed so that you understood the things that *could* go wrong during a vaginal delivery, then you, by your standards, could not have given informed consent for a vaginal delivery of your baby. Horrors!

            It is still not clear how you think informed consent is missing in regards to an epidural. It is discussed with you by the nurse/doctor and again by the anesthesiologist when they come to place the epidural. They tell you what is going to happen, how they will proceed, along with any potential risks and side effects and how those will be addressed if they occur. Just because *you* don’t like how it is done, or think it should be done differently doesn’t mean the doctors are coercive or negligent.

          • Nick Sanders

            Did you leave fistulas off that list, or are they there under a name I didn’t recognize?

          • Charybdis

            Probably, although I didn’t mean to. Don’t they result from a 3/4th degree tear that heals improperly (no stitches). I listed those, but not fistulas specifically.

          • Nick Sanders

            I don’t remember off the top of my head what causes them, only that first world medical care almost (but not entirely!!1!) eliminates them.

          • Molly B

            I researched and spoke with my doctor before each birth. My doctor did tell me the risks of vaginal/cesarean/medicated/nonmedicated to what i thought was full disclosure ( i was very young at the time) and yes you are correct i was not given full disclosure about each birthing option and med vs non med.
            This is my point. That women should be full informed by doctors. Most women see a doc for months! There is no reason why Doc cant take some time at each appt to discuss risks and benefit in full over the course of the pregnancy

          • AllieFoyle

            I would love to see more women being fully informed about the various risks in childbirth. The risks involved in epidural anesthesia though are probably among the most discussed and consented. If you were truly concerned with informed consent you would also be concerned about the risks of childbirth that don’t have to do with interventions, as listed by Charybdis above. The fact that you don’t, and are only concerned with epidurals shows that you are biased and have an agenda.

          • Molly B

            Because I made an initial statement about epidurals and that that has taken off and while it is regrettable that I did not plan my opening comments more carefully or understand how it would take off like this I also regret that no matter how many time I keep stating that i am not Pro NCB or against epidural that seems to be what I continue to come up against is people arguing med vs no med with me. I have clearly stated multiple time that I am for whatever a woman chooses I just wish we had better informed consent measures in this country. While some docs and hospital do amazing jobs at ensuring women have full disclosure and informed consent, this is sadly not common.

          • momofone

            There’s also no reason a woman can’t ask any questions she may have if the doctor hasn’t addressed them.

          • Charybdis

            Ahhh…now I see. You must be a NCB at all costs acolyte. If a woman is laboring in a hospital or other medical setting, labor isn’t allowed to go on for days, especially if her water has broken. Why? Because labor is stressful for both the mother and the baby and the longer it goes on, the higher the risks for infection to both mom and baby, exhaustion from pain and lack of sleep for the mother, and death or damage to the fetus.

            AGAIN, no one is denying that opioids can pass the placenta and affect the baby. However, an epidural is regional anesthesia and is placed so that the anesthetic effect is localized to the nerves in the spine that innervate the uterus, etc. The amount of medication is very small, because it is placed exactly where it is needed, and if an opioid is also used along with the anesthetic agent, it is also placed on the nerves involved. The medications do not generally enter the mother’s bloodstream (I say generally, because nothing is guaranteed 100%) and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby. If (again nothing is 100%) some medication DOES get into the mother’s bloodstream, it is an inf

          • Irène Delse

            It’s painfully evident that MollyB is moving the goalpost. “Epidural opioids are dangerous! See that article!” “Wait, that’s about addicts, epidurals use controlled doses.” “But, but, it can cross the placenta!” “Yes, and? We are talking teeny tiny doses, because the opioid is not injected in the blood but the CSF. Any leakage has to be minuscule.” “Aha, but what if the labour lasts for DAYS?!” And so on.

            Of course, the labour is not allowed to go on indefinitely in the hospital. It’s almost as if the hospital staff’s priority was helping their patients to the best of their abilities, with all the tools of evidence-based medicine. Go figure!
            /Snark

          • Molly B

            Since your late to the game I will clarify for you that the article was posted only to show that narcotics cross the placental barrier.
            This has been stated and clarified many times.
            The labor can last for day was because someone stated that a single dose of opiod wouldnt have an impact on the fetus. This may or may not be true but epidurals are topped up and pain meds are given more than once during labor.
            These were the threads

          • Molly B

            #1 Your information about epidural medication not entering the blood stream is innacuratew and I am not the only one on this thread who has said otherwise.
            #2 AGAIN…I am not Pro NCB
            AGAIN…I am Pro Full Disclosure regarding Informed Consent

          • AllieFoyle

            As she said above, the point of the epidural is that it isn’t administered into the bloodstream. She explicitly said it wasn’t 100%.

            You’re arguing against epidurals because OPIOIDS! PLACENTA! FETUS! but you completely miss the point that epidurals are specifically designed to minimize the risks you are worried about.

          • Molly B

            “and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby.”

          • Charybdis

            Please use the entire quote:
            an epidural is regional anesthesia and is placed so that the anesthetic effect is localized to the nerves in the spine that innervate the uterus, etc. The amount of medication is very small, because it is placed exactly where it is needed, and if an opioid is also used along with the anesthetic agent, it is also placed on the nerves involved. The medications do not generally enter the mother’s bloodstream (I say generally, because nothing is guaranteed 100%) and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby. If (again nothing is 100%) some medication DOES get into the mother’s bloodstream, it is a tiny, tiny amount and is diluted by the mother’s blood.

            The important part is the last sentence: if some medication DOES get into the mother’s bloodstream, it is a tiny, tiny amount diluted by the mother’s blood.

          • Charybdis

            Never said it didn’t enter the bloodstream. It mostly, generally, usually, the vast majority of the time it stays where it is placed, in the cerebrospinal fluid surrounding the spine, where it acts locally (means right where you put it) to block pain signals to the brain. There is *always* a chance, miniscule, but there is a chance that a small amount of an already small amount of medication could get into the mother’s bloodstream. IF it does, it can cross the placenta and get to the baby.
            Which is what you were after in the first place, wasn’t it?

          • Linden

            If labour is going on for days, ur doin it rong.
            And how is prolonged labour *not* a risk for mother and baby? Compared to an epidural, say.

          • Molly B

            Laboring for days is not “doing it wrong” Labor can last 6 hours for one woman and 48 for another.

          • Linden

            U R DOIN IT RONG
            Risks of Prolonged Labour
            Fetal Risks:
            Fetal Distress due to decreased oxygen reaching the fetus.
            Intracranial hemorrhage or bleeding inside the fetal head.
            Increased chances of operative delivery like Cesarian sections.
            Longterm risks of the baby developing cerebral palsy.
            Maternal Risks: ◦
            Intrauterine infections
            ◦Trauma and injuries in the maternal birth passage like vulvar hematoma, perineal tears, cervical tears and vaginal wall tears.
            ◦Postpartum hemorrhage.
            ◦Postpartum infection.

          • moto_librarian

            Um, I would be demanding a c-section if my labor had lasted longer than a day.

          • Nick Sanders

            That’s only because they aren’t obtaining properly informed consent before performing c-sections! Why, the surgeon might accidentally remove your liver instead of the baby, or do the surgery with a rusty scalpel that’ll give you a blood infection. But the hospital will never tell you about these risks, and they are underreported! Doctors label them things like “heart attack” and “preeclampsia”, but I know the real truth!

          • Charybdis

            No one is saying it doesn’t. The AMOUNT that crosses, however is miniscule to negligible.

          • Molly B

            Actually more than one person on here has said that NO narcotics get the the fetus at all in a epidural, ever.

          • Heidi_storage

            “The dose makes the poison,” does it not?

          • Molly B

            And what is a safe dose that will not likely result in side effects for a 7.5 lbs fetus?

          • Lucycavendish2002

            You tell us, you’re the one making the claim that epidurals harm babies. Be sure to clarify exactly how much danger and discomfort women should endure to reduce the miniscule risk to the fetus incrementally. Use micromorts as units, if you like. Be specific: “I believe women should have caesarians without pain relief if it reduces the risk of death to the baby by 1/1000000”

          • Molly B

            My claim was that epidurals have risks to mom and fetus that women are not always informed of.

          • AllieFoyle

            Childbirth, natural childbirth in particular, has risks to mom and fetus that women are not always informed of. Epidural anesthesia is the one aspect of childbirth in which women are very likely to receive explicit informed consent.

          • Roadstergal

            What part of birth has the risks and benefits clearly laid out for the mom to sign – epidurals, or vaginal birth? You’re on the wrong campaign.

          • Amy Tuteur, MD

            Typical epidural hysteria promoted by natural childbirth advocates. They’re utterly wrong, as usual. http://www.skepticalob.com/2011/03/epidural-hysteria.html

          • Molly B

            Siting a link to your own article that has no research sites is vain and uninformative. Also, if you have actually the time to read some of my comment you would of seen that I am in fact not NCB. So your references and comments are worthless, Doc.

          • Amy Tuteur, MD

            Oh, I see. I studied biochemistry in college. I went to medical school for four years. I did an internship and residency in obstetrics (4 years), and then spent years in practice. But you think you know more about epidurals, how they are administered, what their risks are and how women are counseled about them than I do.

            Do you have any idea how ridiculous you sound?

          • Molly B

            You have sited nothing to back up your claims.

          • Dr Kitty

            Dose of Fentanyl in an intrapartum epidural is usually 50-100micrograms. It’s lower still for a spinal.

            The dose of IV Fentanyl appropriate to relieve severe pain in a 4kg neonate is 4-16micrograms (1-4mcg/kg).

            The amount of fentanyl which would cross from the epidural/intrathecal space to the maternal bloodstream, and thence to the foetus, is unlikely to be anywhere near as much as that.

            We’re talking about administering a drug to relieve severe pain in a woman.

            The baby is getting much less fentanyl than we would give if IT were the one in pain. Most neonatologists would feel that a baby’s severe pain would be appropriately treated by IV fentanyl, and that the benefit of pain relief outweigh the risks for the baby.

          • Molly B

            ” is unlikely to be anywhere near as much as that.”
            Fetus, not baby.
            So in short…you have NO CLUE

          • Roadstergal

            Splitting non-existent hairs, numbnuts. Epidurals are given for that whole ‘birth’ thing, which is the transition from a fetus to a baby – the kid doesn’t have a growth spurt as it’s exiting the vagina. The amount that it gets before the placenta detatches, even if the whole dizam bolus went straight from the mom’s spine, through the placenta, into the being-born-thing, is orders of magnitude less than what doctors find appropriate to give the just-born thing of the same size if it were in pain.

          • Charybdis

            Dr. Kitty is an actual, real-life medical doctor. I think she knows this stuff better than you do.

          • Molly B

            I would say that the doctor should discuss the risks and benefits of all available options to her including the risks to the fetus and allow her to make her decision based on what it know to be safest meds (or no med if that is her choice)

          • Heidi_storage

            I was prescribed a small number of opiate pills (I forget what they were) by my OBGYN when I broke my feet at 14 weeks of gestation (not a typo). I only wound up taking one of the pills–the pain really wasn’t bad, as long as I didn’t put weight on my feet–but the doctor told me that short-term use was safe, and that I should use the pills if I needed them.

          • Linden

            “Any narcotic provided to a mother at any time in her pregnancy including during labour has direct or indirect risks to the fetus”
            So does any medical procedure she undergoes during pregnancy. If she has a raging UTI, should it remain untreated through the course of her pregnancy? I marginally increased my risk of contracting a communicable illness by visiting the dentist, should I have refrained?
            Should *all* risks to the mother be ignored, in favour of reducing *any* risk to the fetus?

          • Who?

            Well except if you have a raging infection that will kill you, as UTIs can do. To quote The Bird Cage, should the doctors let the baby go down with the ship?

            I love that film.

          • MaineJen

            “Your wife is a very intelligent woman. She makes a lot of sense.”

          • Who?

            😉

          • Molly B

            Point as always has been that women should be informed of all.the risks of any procedure and that this is not systematically done.

          • guest

            How are women NOT informed about epidurals, anyway? You’re not saying anything new here. Your scaremongery boogey man ideas are the standard party line in birth books right now.

          • Amy Tuteur, MD

            How would you know what is or isn’t done? Have you practiced obstetrics?

          • Charybdis

            She researched it and read all about it on teh interwebs.

          • The Bofa on the Sofa

            She had three babies.

          • Linden

            Tell us exactly what they should be told, then. You keep dodging the question of what women should actually be told. What dosage of each drug reaches the fetus in an epidural? What dosages are associated by what risk? Which of the medical events that constitute the risks are reversible and which are not? Use your numbers.

          • The Computer Ate My Nym

            Refusing pain relief also has risks to the fetus. Or do you not think that epinephrine, adrenal steroids, etc cross the placenta?

          • Irène Delse

            Ouch. That’s a good point. Maybe if we talked about “pain toxins”, the answer would be different?

          • Who?

            All natcheral surely?

          • Megan

            Good point. My pain before I was able to get my epidural* was so bad that it caused fetal tachycardia from all of the circulating epinephrine/norepinephrine.
            *Note that I was not able to get my epidural for almost 2 hours after I requested it because my CBC was a day too old and the anesthesiologist would not do the epi until it was updated. Lab took forever to come draw and run the test. In the meantime, I had already waited until I could no longer tolerate the pain (because of the belief that an epidural would slow down my labor). So much for anesthesiologists just doing epi’s willy nilly without full informed consent and mitigation of risk…

          • guest

            Let’s all sing it again: Correlation is not causation! Association is not instigation!

          • Molly B
          • Monkey Professor for a Head

            Your second link is about risks of c sections, not about epidurals.

          • Nick Sanders

            Your first link was included in the meta-review done in my link. Your second takes me to a log-in screen.

          • Molly B

            Click the little.x in corner of the login pop up….

        • rosewater1

          Uh…and you know this how?

          I see epidural consents almost daily in my job. The one I see used is one page…front and back. ALL the risks are laid out. Anesthesia won’t touch a patient w/out it being signed.

          I’ve seen verbal consents done in case of an emergency c/s for general anesthesia. But that’s not what you’re discussing.

          If there is a hospital where they aren’t fully consenting patients, I hope you report them. They are playing with dynamite.

          If a mom has consent fully explained to her and still chooses an epidural…then it ceases being anyone else’s business.

          You clearly have done what you think is careful research. I have no idea how accurate it is but you’ve done it.

          You’ve made your choice. Let other pregnant women make theirs. They can access the same websites you do.

      • Molly B

        Section 8.2 Labor And Delivery

    • The Computer Ate My Nym

      The point of an epidural, as opposed to IV administration of opiates, is that, because the opiates are administered directly into the spinal fluid where the nerves are, the dose of opiates needed to obtain relief is very low. The issues that are mentioned in your reference refer primarily to the use of IV opiates.

      Also, a class C drug is pretty safe for use in pregnancy. There are effectively no class A (proven safe) drugs and only inadequate numbers of class B drugs. I would and, in fact, did take a class C drug during pregnancy because the risks of stopping outweighed the potential benefit of possibly lowering the teratogenic risk, but maybe not because there is no solid evidence that it is actually teratogenic.

      Use of epidural anesthesia has been associated with lower rates of PPD. That should be considered when one is examining the risks and benefits as well.

      • Molly B

        Category C
        Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

        https://www.drugs.com/pregnancy-categories.html

    • AllieFoyle

      Who ever said that epidural anesthesia didn’t have risks? Like all drugs and treatments, women need to weight the risks and benefits and make their own decisions.

      The reason that anesthesia is offered during childbirth is that the pain can be severe and prolonged. For many women, the relief from suffering severe pain outweighs the possible risks of an epidural. And, as others have noted, the epidural has the advantage of providing good pain relief with very little drug entering the bloodstream and therefore only very small amounts being transferred to the baby. IV painkillers, on the other hand, which are often given to women without epidurals when they find the pain unbearable, DO enter the bloodstream and can cause sedation and other adverse effects in the infant.

      If your main concern is the danger of neonatal drug exposure, you’d be much better offer speaking out against Nubain, Stadol, etc. It’s worth noting that a woman with an epidural is likely to have good pain relief with very little risk that her infant will be significantly exposed to sedating medications, while a woman without an epidural is more likely to request or accept IV painkillers when labor pain becomes severe, even though those drugs are more dangerous for the baby and less effective at relieving the pain. Perhaps that is something that ought to be discussed more during the risk:benefit conversations as well.

      • Molly B

        As far as I am concerned opiods benzos it doesn’t matter. You said women opt for epidural or pain relief because they feel it outweighs the risks, but are they really being given full disclosure? The amount.that passes through placental may be small…to.us as 100-200+ lbs adults but the at to.a 5-10 lb fetus….

        • Linden

          Please provide evidence that epidurals harm fetuses. Not just your feeling that the dosage is too high, *actual evidence*. Because your feeling counts for zilch. It’s like saying, “Oh, the poor wee babies! We give them too many vaccines too soon!” Same nonsense, emotionally driven and fact-free.

          • Molly B

            I didnt say they harm fetus I said there were risks to the fetus

          • Linden

            Enumerate the risks. What are they? How many are reversible? How many are life-threatening? How often do they occur? What dosage is associated with what risk?

          • guest

            A risk of what if not harm? A risk of feeling less pain?

        • Dr Kitty

          There are some people, who, no matter what the risk to the foetus might be, would feel that relief of their severe pain is worth it.

          Other people would feel that no risk to the foetus is acceptable and would prefer to endure severe pain themselves.

          However, most people exist somewhere between those two ends of the spectrum.

          Women, even pregnant women, have a right not to be subjected to torture. Not offering pain relief, when pain relief exists, is unethical

          You seem to feel that simply because women are willing to accept risks that you are not, that this makes them objectively “wrong”. It doesn’t.

          • Molly B

            AGAIN>>>I never said women should not receive pain relief. I never said they were somehow wrong or less than if they do. I HAVE HAD AN EPIDURAL BEFORE (AGAIN)
            My only argument is that women should be given full impartial disclosure to make truly informed decisions when providing or withholding consent.

          • momofone

            “Impartial disclosure.” Meaning “not in line with what Molly believes and therefore clearly not adequate.”

          • swbarnes2

            But you DO want to tell women that epidurals cause such significant amounts of medicine to get to the fetus that it might cause addiction or fetal deformities? That is why you brought up that stuff in the context of the dangers of epidurals, right?

          • Molly B

            I never said an epidural.could cause anyone to get addicted. You need to read other posts relating to this issues as it has already been cleared up MORE THAN ONCE

          • Azuran

            So, why are you even still here? Everyone here agrees that discussing risks and benefits of a medical procedure is important and that it should be done whenever possible. And for the most part, Doctors do talk to their patient about the general risks and benefits of any given procedure.
            Did you find out some specific risk about epidurals that your own doctor didn’t specifically tell you about? Probably. But it’s not because your doctor is trying to hurt you or because he willingly hid some facts to influence your decision.

            It’s because by the time your doctor is done giving you the ‘full impartial disclosure’ of every single adverse effect ever reported under the sun, complete with the short/long term potential effect of each of those complication and the risks of each of those complication happening compared to a complete analysis of all the possible benefits, your baby will already have been discharged from the hospital. (And that’s not even taking into account the lack of medical knowledge of those without proper medical training, which makes
            explaining all of this even longer. As illustrated by your own inability to understand that drugs given through an epidural don’t end up in the baby’s blood in significant amount to have any effect)

          • Molly B

            Wrong…wrong…wrong…
            I am.still.on here because others continue to ask me questions and what ifs.
            Discussions about risks and benefits should start at the time.of the first appointment.
            I having sited links on here already to show that epidural meds can have significant impact on baby depending on what is used in epi

          • Azuran

            And I’ve also seen other people post links debunking yours. All you go on and on about is ‘it crosses the placental barrier’ despite many people showing you is wasn’t a real concern. If anything, you should concentrate on the side effect on the mother, since most of the risks of epidural are on the mother.

            But your comment is also not addressing my point. If every doctors had to lists every single possible complication of pregnancy and birth as well as all the possible risks and benefits of each test and procedure that could potentially be done during pregnancy or labour, there would be a worldwide shortage of doctors because it would just take a ridiculous amount of time. There is a difference between what we wish could be achieved and the reality.

          • Roadstergal

            No, you cited links that show diddly squat, as we explained in painstaking detail above.

            All of my remaining sympathy for you evaporated when you told us the real story. You want to take a numerically far more substantial risk to the life of your baby-to-be than the basically zero risk to his/her life that having an epidural in place to make a crash C/S (if needed) faster and safer, would have.

            Just be honest. You don’t want to do certain things, and you’re willing to risk the life and health of your child to labor the way you want to. All of this business about the ‘risk of the epidural to the fetus’ is trying to blow smoke up our collective asses, given that you shrug off the very real risk of a uterine rupture as not worth worrying about.

        • The Computer Ate My Nym

          The amount given is distributed through the fluid into which it is inserted. If it is given IV, it is distributed through the bloodstream at a certain concentration per ml. The dose given is calculated such that it will induce a safe and effective level of drug in the bloodstream of the mother, that is, based on her weight. However, it is also distributed throughout the bloodstream at that concentration. So, even if crosses the placenta with 100% efficiency, the amount in the fetus’ blood will never be more, on a per ml basis, than that in the mother’s bloodstream. So the weight of the fetus is irrelevant except insofar as it increases the mother’s weight.

          Of course, if the drug is injected into the CSF then not only is less needed, but less can leak out into the blood and get to the fetus. This is one reason that the risk of effects on the fetus is lower with an epidural.

          • Who?

            I’ve got money that the answer will be a variation on ‘but, 8.2’.

        • swbarnes2

          This is where you would CITE the relevant mg/kg doses. Those figures are required for “full disclosure” so why are you so absolutely dead set against referring to them?

  • mama455

    monetizing? I would say that by selling a book and getting paid by a hospital/insurance company, you have a lot to gain in opposing the natural childbirth movement. Making people feel guilty? It looks to me that you are making this out to be way more than it is to sell a book.

    • Who?

      Oh yay alexan’s friends are here!! More traffic for Dr T.

      Welcome!

      • mama455

        ??

        • mama455

          I had a CNM with a ton of training and experience in and out of the hospital setting. I agree that it is concerning to have midwives with little experience… but there are a ton of midwife with lots of it. We have had midwives for longer than anything else…

          • The Bofa on the Sofa

            We have had midwives for longer than anything else…

            True. But the problem was that, even with those midwives, childbirth was extremely dangerous for both the mother and the baby.

            And then we “medicalized” birth and it became precipitously safer. As the hospital birth rate grew, the death rate plummeted, mother and child.

            Yeah, there have been midwives forever. But we moved on because they were not cutting it.

            I don’t know why you think that is a redeeming feature.

          • LibrarianSarah
        • Who?

          My bad-sorry! I hadn’t seen your other posts when I put up this one.

      • Amy Tuteur, MD

        No, it’s just alexan’s sock puppet.

        • LibrarianSarah

          So how many socks does he/she have?

          • Idiotsmustdie

            He does have one foot in his mouth.

    • Nick Sanders

      Right, she wrote this article 5 years ago to sell a book that hit the market last month.

  • alexan o’brien

    This is this article and everyone who agrees with it:

  • alexan o’brien

    In trolling this page, I have proven my point that most of the echo chamber of the internet is simply a magnet for others who share their distorted view of reality. Now, back in reality… women still give birth without drugs, or doctors, to healthy babies that come out of their bodies. Good luck to the believers in modern medicine. It has a great track record for sure! And by that, I mean, it doesn’t. At all.

    • Who?

      Would you reject your own child, if its mother needed a cs to save its life or hers? Or would you prefer they were both dead?

      • alexan o’brien

        No. See… you are completely missing my point. This is NOT about believing in c-sections and saving the life of the mother or the baby… this is about people completely turning their backs on the way things have been for millennia and thinking that the “new way” (read: the accepted way) is the best way.

        I would not be trolling if this bitch didn’t write some smug article about how a form a birth developed less than 100 years ago is superior to the way birth has existed for millennia. That’s the point. If you believe that, then you are a fool.

        Evolution has proven one thing — the new way is NOT the best way… the time tested way is the best way. If you can’t give birth without medicine, in a cave… then you shouldn’t give birth. Sorry. Deal with it. We will always disagree.

        • Nick Sanders

          Evolution has proven one thing — the new way is NOT the best way.

          Pffffff… HAHAHAHA! Thanks, I needed that laugh.

        • Who?

          Can you give birth? Thought not. Life’s good in the cheap seats.

          Lovely of you to equate women’s value with their ability to give birth ‘naturally’. And to value babies based on their mother’s ability to expel them out of the birth canal, without assistance.

          If you’re an example of a naturally delivered, breast fed person, you’re not doing the brand any good.

        • LibrarianSarah
    • LibrarianSarah

      Have you ever heard of the naturalistic fallacy? You might want to look it up? While you are at it look up “appeal to tradition” as well. It might clear a lot of things up for you.

  • alexan o’brien

    TEN LIES ABOUT BLAH BLAH BLAH BLAH BLAH… I 100% BELIEVE IN PHARMACEUTICALS AND BLAH BLAH BLAH… I TRUST EVERYONE FOR NO REASON… BLAH BLAH BLAH….

    • Who?

      Well, not everyone.

    • Idiotsmustdie

      FACTS FACTS FACTS…….blah blah blah can’t handle it …..BS BS BS …

      • alexan o’brien

        I especially like your single use name “idiots must die.” Please know that the feeling is more than mutual.

        • Idiotsmustdie

          You have no credibility and even less class.
          Here is my suggestion for you to elevate youself out of the idiot class – take each of the points raised by the author and challenge them one by one with proper evidence based research.
          Talk soon.

          • Who?

            Oh now, asking for a thoughtful explanation of why he disagrees is so unfair! He’ll be holding his breath to prove how wrong we all are if you keep talking to him like that.

  • alexan o’brien

    I love how the internet just proves time and time again that people looking for comfort within their own echo chamber can find anything they want, while people who disagree stumble upon their ranting insanity in utter disgust — disgust met with “ugh, you are so wrong.” Ah, yes. Indeed. Millennia of natural childbirth and now it is somehow wrong. You people would all die in nature with your c-sections and inability to endure the pain of labor. Humans didn’t get to 2016 with pain medication, we got here being delivered in caves. You are all fools. Now, please, enlighten me with your intellect and knowledge of modern drugs. They have done so much good, haven’t they?

    • rosewater1

      I love how the internet just proves time and time again that people looking for comfort within their own echo chamber can find anything they want, while people who disagree stumble upon their ranting insanity in utter disgust — disgust met with “ugh, you are so wrong.”
      Read what you post. Read what I quote. Pot meet kettle?
      You aren’t even an original troll.
      What you are is a representative for the worst of NCB. The blaming and shaming and utter viciousness. It’s not bad enough that you shame C-section mothers. You call them…FAT. Like THAT is the worst thing a person could be!
      What do you hope to accomplish by spewing this bile? Truly?

      • alexan o’brien

        I’m not calling the women fat, you idiot. I hope to accomplish nothing, just like what was achieved by the writing of this “article.” Maybe if you read the articles I posted, you would see that I was not calling mothers fat, but pointing out that research is clearly pointing out that without a vaginal birth, the child is not able to get the massive-dose of its microbiome at birth, and thus has a higher rate of obesity. You would just like to ignore that, though, woudln’t you? It’s easier to just call me a troll. F you.

        • rosewater1

          Gee, that’s original. Wait till I catch you by the monkey bars at recess. I’ll pull your hair and steal your lunch money.
          And you hope to accomplish nothing by posting? Got it. You’ll be happy to know you’re succeeding admirably.
          Oh, and for the record? My sister in law had 3 vaginal births and one C/S. The C/s boy is the tallest and skinniest of all of them. He’s 6’5″ and a beanpole.
          Guess he’s the exception that proves the rule.

        • AnnaPDE

          Oh wow. You sure know a lot of grown up words. Would you like a sticker for that? Though you probably wouldn’t like one from this skinny but carb-eating C-section kid…

        • LibrarianSarah

          The study of the human microbiome is in it’s infancy (no pun intended). We have no idea what the “ideal” microbiome is and the affect that mode of birth has on the microbiome or whether c-sections are good, bad or neutral. So everything you are saying is just conjecture.

    • Nick Sanders

      You people would all die in nature

      That’s exactly the point. Given the choice between dying “naturally” and living “unnaturally”, we’ve decided we’d rather live.

    • LibrarianSarah

      Also intellect, knowledge and modern drugs have done a shit ton of good. We have eradicated smallpox and made significant strides in eradicating many other deadly and debilitating diseases. We have antibiotics that practically cure diseases that would have been deadly 100 years ago. We have drugs that allow people to live for decades with HIV. We can pretty much cure many different types of cancer.

      In fact, the reason so many people are dying of diabetes, cancer, and heart diseased today is because they are NOT dying of smallpox, famine, cholera, dysentery, tuberculosis, polio, and a whole host of “normal” childhood illness. Never mind being killed by predators (and prey.)

      So yeah, odds are a lot of us would not be able to survive in nature but neither would you.

  • alexan o’brien

    Zero references. Zero credibility. No further comment. Good luck having an obese child because you thought a cesarean was ok. Yeah. No mention of that in this article.

    • momofone

      I had a c-section because it beat the hell out of letting my baby die before he was born. Good luck sticking the flounce.

      • alexan o’brien

        Good for you. You would have otherwise died in nature without modern medicine to save you. Good for you. I bet god is on your side.

    • Who?

      Oh my God! Thanks so much for posting! I’m going to change my mind about everything I know about health and medicine based on your trenchant, thoughtful, thorough and learned exposition on the risks of cs.

      Bazinga.

      • alexan o’brien

        I strive to be someone who never says nor writes the word Bazinga, so let’s call it even, ok?

        • Who?

          Shan’t.

    • LibrarianSarah

      Where is your references for having a c-section causes you to have an obese child? Oh wait you don’t have any. Where is your medical credibility? Can’t find any of that in your comment either. All I see is “ewwww fatties!” Which while might be an impressive argument to to your six grade classmates, is not really all that impressive here.

      So yeah sit down and keep your “further comments” to yourself because the adults are talking here.

    • rosewater1

      Her child is alive. I’m pretty sure dead children don’t gain weight. I guess to you that is better?

    • MaineJen

      Oh wow. This one is really special.

  • Akasaka

    I’m a Taiwanese physician(not a OB/GYN practitioner) interested in natural birth vs medicine-intervened childbirth conflict. And some natural birth promoter cited some reference (listed below) to validate the benefits of the natrual way over the “conventional” one. Would Dr.Tuteur please enlight me?

    • Akasaka
      • Nick Sanders

        I don’t know enough about medicine, let alone this sub-field, to directly evaluate the paper, but looking up the journal it was published in, it looks like a bad source:

        Impact Factor: 1.024

        ISI Journal Citation Reports © Ranking: 2014: 47/108 (Nursing (Social Science)); 50/110 (Nursing (Science)); 67/79 (Obstetrics & Gynecology)

        Skimming the article itself I’m seeing a lot of loaded language:
        “Nature’s simple plan for birth has been replaced by a maternity care system that routinely interferes with the normal physiological process”
        “In this article, we go back to basics. We describe the physiology of normal natural birth and the ways in which maternity care practices affect this exquisitely orchestrated process.”
        “Nature’s carefully orchestrated plan”
        Etc.

        From the looks of it, the authors set out to prove a point, then gathered data to support that point, rather than looking at all available information and drawing conclusions based on what it reflected, then took their ideological piece to a low ranked journal that wouldn’t look to closely at it so they use “it’s peer-reviewed” to give it undue weight.

    • The Computer Ate My Nym

      Skimming the article, I found nothing in it that provided evidence that a “natural” birth was in any way “better” than one with interventions. It was mostly about how to deny pain relief to women in labor and get away with it. Nothing about better outcomes unless you count not getting an epidural as a “better” outcome.

    • mojasowa
  • Julie Wimberley

    What a misguided person is Amy. I have read “Childbirth Without Fear,” sure there are some areas that we now view as out of date because it was written in the 1940’s. But its message is clear. Educated women can birth their babies themselves when they are not contaminated by fear, which can be picked up so easily in the hospital system. I delivered myself at home with my fifth child and a homebirth midwife. I was well educated in natural childbirth techniques of which I am sure Amy appears to know nothing.

    • Fallow

      You people sure have a knack for finding years-old posts on this blog, and then masturbating in the comments.

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  • Fawn Hacker

    It is obvious this woman took statements completely out of context to give a jaded rebuttal. It is evident she is pushing a technocratic birth model that most (8-9 out of 10 women) do not fit into.

    Please people don’t read this and let it push you away from a natural childbirth. Sure there are some judgmental, nasty, and ignorant people who submit to the purely natural childbirth claims but there are those extremists in every end of…well everything.

    Read and do your own research. But please let me correct this woman…as a mother, a future midwife, doula and natural childbirth educator in training, and RN………

    1. Childbirth in our society IS inherently safe with good prenatal care, mother health, and an environment to give birth in(which is a majority of us if we are pregnant in America)….yes, actual childbirth has always been inherently safe BUT disease, malnutrition, and poor birth conditions led to a high maternal/fetal mortality rate after delivery.

    2. Fear intensifies any pain that plagues us. There is a mind body connection…fear causes our muscles to tense and a myriad of other physiological symptoms that can intensify pain, and labor is no exception.

    3. Labor pain is inherently painful and anyone that tells you different is lying or one of those rare women who have completely painless labor. But seriously, its painful having been through it but it is absolutely different than a broken bone or a collapsed lung, for example. If you have had the opportunity to have natural childbirth and also a broken bone or other painful medical condition, you will understand. Labor/birth pain feels purposeful, it ebbs and flows(assuming there is no pitocin involved) and gives you relief as it builds and builds. Sure it travels the same pathways but it is pain women have been built to endure. So no…it does not feel the same. But again this is a perception statement.

    4. Epidurals offer a host of complications that are not present with women who do not get an epidural. People would consider crossing the street, driving in a car, riding a bike as dangerous. The word danger and unnecessary are both true. The degree of danger is debatable but as a mother it is your choice and we hope you just weigh the pros and cons before making a decision. Unnecessary, absolutely. But again so are many things we consider “normal and necessary” in everyday life. An epidural is not necessary to give birth, therefore, it would be considered unnecessary, right?…An epidural is not safe, so then it must be on a spectrum of dangerous…right?

    5. Interventions are not always bad or always good. It is very situation specific. However, there is the infamous cascade of interventions in which increase your risk of c-section and poor birth outcome. These include movement restriction, continuous fetal monitoring, induction, and epidural. If you have one of these you are more likely to have another and another and another and ultimately a c-section.

    6. Again the need for induction is much less than is given in our society. Doctors are beginning to induce mothers on mother-chosen birthdays , on actual due dates(regardless of the fact that not all women carry for 40 weeks and hate to say it but not all doctors/midwives are correct in their date estimations and may be off by +/- 2 weeks. Many doctors will not go beyond 1 week of due date and virtually none will go past 2.

    7. C-sections are almost always unnecessary?? What is the specific percentage of the wording “almost always”? The World Health Organizations have a statement that c-section rates should not exceed 10-15 % as higher rates are associated with higher maternal and neonatal complications. So yes, if 1 in 10 NEEDS a c-section I would say that for 9 out of 10 women c-sections are “almost always” unnecessary.

    8. You missed the number 8.

    9. Vaginal birth is superior in maternal and fetal health versus c-section. . Not in a morally superior way like this woman is suggesting but from merely a physiological standpoint. For you 1-1 1/2 in 10, when it is absolutely necessary for fetal/maternal health then honestly who cares about the other lesser complications because of course, delivering a live baby is the priority in that situation. However, we need to rethink as a culture the impact women who are choosing c-sections and scheduling them ahead of time are having on our human processes and health.

    10. If I was in a natural childbirth course and someone uttered, “Women who love their babies choose NCB”….I would get up and walk out because that is ridiculous and extremely judgmental. More so that this woman is throwing all natural childbirthers in the fire because she had a poor one, that is even worse.

    I hope you had a few minutes to read this, I have done intense reading and research on this topic and my goal is to help empower women to have the birth they want. I had to set the record straight with this and I hope you, Amy Tuteur, rethink what you are sending out for women to read, as a doctor nonetheless. Thank you.

    My own disclaimer: The basis of this article is written in inferiority to other “natural childbirthers” and it is a justification to that bias. If anyone makes you feel bad for your choices in your pregnancy, natural childbirth, interventions, or even a c-section that is their problem NOT yours. My belief is that MOST pregnant women can have a natural, non-medicated vaginal childbirth but that doesn’t mean I would ever judge someone for not. As a mother and a currently pregnant woman, I can say do your research and figure out what is best for you and your family. And do not read ignorant peoples sensationalized banter or at least read it and take it with a grain of salt.

    • Amy Tuteur, MD

      Bad news, Fawn. You can’t do research on the internet by reading books, websites and message boards for lay people and you certainly can’t be “educated” by reading the crap written by other laypeople. Thank you for demonstrating that natural childbirth advocates are both profoundly ignorant and clueless of their own ignorance.

      • Binky

        No offense meant by this what-so-ever — you’re a retired professional and clearly still interested and invested in the research — but can I just say that I’m glad, for the sake of the laity, that you don’t practice anymore? If you were my OB, I’d be terrified, no matter how well-researched you are. I understand having not gladly suffering fools or pseudoscience, but you seem to have as much sympathy for pregnant women as a bug collector for anesthetized butterflies. At least, that’s how your rhetorical choices come across. Maybe you get this way because you care so much. It’s just hard to tell. Sincerely, no offense.

        • The Bofa, Being of the Sofa

          Saying “no offense” does not make an insult not offensive.

          Then again, I really don’t know what you are talking about. You think Fawn is pregnant and needs sympathy? Come on, this is the idiot who claimed (below) to have done “graduate research on home birth.” The concept is a joke, and anyone who suggest it is a joke. They don’t deserve to be treated with sympathy, they deserve derision.

      • mojasowa

        Fawn’s points are common knowledge, but not exclusively to laypeople. Many doctors and researchers will validate her points. Interventions do often lead to more interventions. There are some risks to epidurals along with advantages (pain relief). It’s good to get informed and have choices. You see only one way, and seem to be very bothered that women have choices at all.

        • fiftyfifty1

          “Many doctors and researchers will validate her points.”

          If research backs your claims and doctors are in agreement, then providing us some references should be easy, shouldn’t it? So go ahead and give us some proof.

          • mojasowa

            americanpregnancy.org states the pros and cons of epidurals for example. This is not made – up information http://americanpregnancy.org/labor-and-birth/epidural/

          • Who?

            It isn’t made up, but it also isn’t medical advice directed to the needs of an individual.

          • fiftyfifty1

            Your American Pregnancy link about epidurals actually does contain “made-up” information. Epidurals do NOT cause increase in CS or lower breastfeeding rates. The link also fails to put the real risks in context. Women are deliberately not told how very rare their listed “downsides” are.

          • mojasowa

            objective information from webmd : (with links to studies). It’s not a black and white issue. It’s GOOD to have choices. NCB is not for everyone, but it’s not a foolish choice either for healthy women…

            “Some research suggests that midwives lower the risk of infant mortality and reduce the need for C-sections and other interventions. One study showed that births attended by a midwife had a 19% lower infant death rate and a 31% lower risk of delivering a low-birth-weight baby. Another study showed that nurse-midwives had 4.8% fewer C-section rate than obstetricians and used fewer resources, such as forceps and vacuums for delivery. (The reductions in mortality and complications, however, may be because midwives generally handle very few high-risk deliveries.)

            Are There Any Risks to Using a Midwife?

            Some states do not allow midwives to administer pain medications or to provide certain medical interventions such as electronic fetal monitoring.

            And if there is a problem with the newborn, the midwife can only administer basic life support. At a hospital, obstetricians, pediatricians, and neonatologists can step in to handle these issues if they arise.

            Most midwife-assisted births take place in hospitals, but some women prefer to give birth at home. The American College of Obstetricians and Gynecologists does not endorse home births, because complications can occur even in otherwise normal pregnancies, and women who give birth at home don’t have access to doctors or specialized medical equipment.”

          • fiftyfifty1

            So this study says that women who seek out midwives are less likely to use epidurals. No surprise as women who want good access to pain meds are likely to choose an OB, while women who believe pain meds are evil are more likely to choose a provider who can’t easily offer them. Higher risk women are also more likely to choose an OB. But despite all that, the study says that OBs do NOT have a higher rate of CS when corrected for risk. Sounds like your assertion that one intervention leads to another *isn’t* actually true.

          • mojasowa
          • mojasowa

            If you want to read a specific study, this is just one example of many out there.. http://www.ncbi.nlm.nih.gov/pubmed/23963739

          • The Computer Ate My Nym

            Actually, that’s not a study, it’s a Cochran review. Cochran reviews are reviews of studies, so effectively meta-analyses. Meta-analysis as a technique has its pros and cons, but that’s probably more statistics than most people want to get into. On to the results.

            On second thought, one other word of caution with respect to the methods: of the blinded studies included, only a few were judged to be low risk with respect to bias introduced by the blinding method. So clearly, the data available are of uncertain quality at best. Okay, now on to the results.

            Despite the fact that the review appears to have included studies where women were randomized to midwife versus OB care, the women in the midwife group were less sick, probably due to some risking out: they had fewer miscarriages and premature births. These are not indicators of quality of care in this setting, but rather of risk of the pregnancy. Despite this, women in the midwife group did not have lower rates of neonatal mortality. This suggests some increased risk, though not a high risk, probably because the studies in the review are of hospital births led by well trained midwives.

            Women who had midwife led care had longer labor and were less likely to receive analgesia. They were slightly more likely to have spontaneous vaginal birth, but no more or less likely to have a c-section. The difference was all in probability of instrumental delivery. Again, remember that these are lower risk pregnancies. Also note that the relative risk was 1.05. In other words, for every 100 spontaneous vaginal deliveries in the OB group, there were 105 in the midwife group. Hardly an overwhelming difference.

            No differences were observed for initiation of breast feeding. No differences were observed for augmentation of labor, perineal tears, or induction of labor, which supports the idea that the midwife care was for the most part good, but highlights the fact that these are not all “natural” births in any category.

            In short, midwife care led to a small increase in the rate of spontaneous vaginal delivery at the expense of longer labors and more pain. The rate of the favorite “evil” of the NCB movement, c-sections, was unchanged. It highlights the possibility that well trained midwives working in a hospital system can provide very good care, but fails to prove any great advantage to midwife care and demonstrates some significant downsides.

            It certainly does not support Fawn’s claims.

  • Dani

    No matter how you birth there is danger and risk. All of you should just shut up really. There are dangers with natural birth, cesareans, inductions, etc. Just like anything else there are pros and cons and It is up to each person to research and educate themselves. Do what is best for you and your situation.

    • Stacy48918

      So it’s best for me to have my 1 year old unrestrained in the front seat of my car. I drive safe and those car seat straps are so restrictive and such a nuisance to buckle every time. I’ve researched it and I feel pretty safe. To each their own, right?

      You have NO idea about relative risk. It’s risky to walk down my 1 lane country dirt road and it’s riskier to walk down the center of a 6 lane highway. The relative risk of death is quite different.

      Home birth is 2-8x more likely to kill a healthy baby than hospital birth. Sure it’s everyone’s “choice” but some choices are bad.

      • Fawn Hacker

        Again, would love to see where you have gotten this information…. yes I agree some choices are bad but don’t put down home births when you clearly do not have all the facts. I have done plenty of graduate research on home birth and hospital birth and came to find that the risk of home birth is NO riskier than hospital birth for low-risk pregnant women. Please research before you put skewed statistics out there.

        • Amy Tuteur, MD

          Graduate research on homebirth? You have no idea what you are talking about. You are simply repeating nonsense written by other homebirth advocates.

        • anion

          So what do you think of the MANA stats, then, Fawn? What research did you do that showed you the opposite of what MANA’s own statistics showed?

          Where did you do this “graduate research?”

        • The Bofa, Being of the Sofa

          I have done plenty of graduate research on home birth

          You need to tell me more about this. I just want to warn you, I have a) done graduate research myself, and b) advise students who are doing graduate research, so I know what “graduate research” means. I’d like to hear about your version of it.

      • mojasowa

        Where is the source of your 2-8x more dangerous statistic? Just a wild guess?

        • The Computer Ate My Nym

          The CDC wonder site provides information on infant and neonatal mortality. When high risk groups are eliminated, home birth attended by a non-CNM midwife ends up with consistently 3-4 x higher neonatal mortality. Plus various studies which demonstrate higher rates, hence 2-8x.

          • mojasowa

            Can you provide the links to the studies please? It’s hard to take someone’s word for it as there are many “words” circulating the internet. Btw most “natural birth advocates” that the author is stereotyping and villainizing choose a natural birth in the hospital and are 100% open to interventions when NECESSARY (vs. pre-emptive interventions). Midwives carefully monitor and screen women collaboratively with an OB and anyone other than low-risk candidates are directed to conventional birth methods. I am a believer in natural birth whenever possible but I would not choose a home birth. I don’t judge any women as I would get an epidural too if I could not manage the pain on my own. Projecting irrational extremism (competitive, judgemental, would rather die than have a c-section, home birth only) on so many women like myself is absurd. This is what i feel is happening in the article and in the comments. This “them vs. us” attitude and a whole lot of stereotyping, projecting, and jumping to conclusions. I have not met a single woman who fits this stereotype, not to deny that they exist. However if you are curious call a sample of midwives and doulas in your city and ask them if they are strictly against epidurals and other interventions. You may get a better idea of the attitudes out there vs. reading a sensationalist article by an angry retired OB speaking on behalf those that she is against.

    • Young CC Prof

      Actually, driving around with a 1 year old unrestrained in the front of your car is a lot safer than having a home birth. Never putting a seatbelt on your child at all is safer than having a home birth.

      • Fawn Hacker

        Would be very interested to see where you got this information from…

        • The Bofa, Being of the Sofa

          Crash and fatality rates for seatbelt vs non-seatbelt crashes are available from the DOT.

        • Young CC Prof

          Look at the annual auto death fatality rates among children age 10-15 from, say, 1960. No child seats, no seat belts, no airbags, no crumple zones, no tempered glass.

          • Um…

            Um, above you said driving around with a 1 year old but now you stated to look at auto death rates for 10 to 15 yr olds…

    • Who?

      I have a question about pros and cons.

      Why would a home birth mother transferred to hospital due to a problem with the foetus agree to life-saving or health saving treatment for herself if the foetus is already hopelessly damaged or dead? Surely by homebirth logic, the outcome for mum is part of the experience-some new mums aren’t meant to be alive, or continent, or able to have another child-and that’s just birth doing its thing.

      Or am I missing something?

    • KarenJJ

      So it’s OK for people in healthcare roles, such as childbirth educators and midwives, to lie to women?

      • mojasowa

        I am currently pregnant and have never been told any of these things by doctors, midwives, or any of the doulas I interviewed. No one says childbirth isn’t painful. Most women I know who chose to attempt natural birth were open to interventions if necessary. Some needed them. Some had one child naturally and the other medicated, depending on how their labor was going. The author paints this picture of judgmental mothers and it’s just not the norm among women interested in natural birth. She’s spinning information and projecting to villainize a birth choice.

  • Alex

    Natural childbirth is the future. For if childbirth is something which is inherently dangerous and painful (as this MD opines), then it also stands to reason that it is undesireable. Even if the first generation overcomes this fear, the constant indoctrination from the parents will prompt the second and subsequent generations to reconsider the wisdom in giving birth at all. This leads to lower birth rates for the women who believe childbirth is dangerous. On the other hand, women who love birth – yes, there are women who actually enjoy the whole process despite the pains – will have a tendency to not only have more children themselves, but also tell their sons and daughters of the awesome beauty of childbirth, thus leading to a far far higher birth rate for those who believe in the power of love during birth (and the host of synergistically beneficial hormones released thereby – love hormones which are NOT released in the presence of artificial medications).

    Natural, unmediated childbirth is the future by definition. If that we’re not so, we would still be in the “knock ’em out, drag ’em out” barbaric era.

    The who would rob women of their innate power of life creation through ignorance and fear are a dying breed. Good riddance.

    Look up Ina May Gaskins “The Farm” birth center in Tennessee. Over 2,500 births initiated out-of-hospital. Csection rate there is 1.7 percent. Maternal deaths – ZERO.

    Csections do save some women’s lives, and other intervention are necessary at times too. But understand the NATURAL process before turning to the UNNATURAL.

    • Durango

      Holy poor reasoning! Your opening paragraph is hilarious…and, needless to say, entirely made-up.

    • Young CC Prof

      So you claim that “The Farm” delivered 2,500 babies with no maternal deaths. That’s nice. The overall maternal death rate of the USA is 1 in 10,000, and nearly all the women who went to The Farm were unusually healthy. Many had given birth before. Even one or two maternal deaths would have been outrageous compared to hospital outcomes.

      What was the intrapartum and neonatal death rate of babies at The Farm? What is the Apgar distribution and the incidence of permanent disability? And how do you know your numbers are accurate?

      And you know, most people’s decisions on whether or not to have children are motivated by whether they want to raise children, which is a decision that will shape the next few decades of their lives, not on the one-day experience of their births.

    • Trixie

      Lolz forever. Oh, this is so special.
      I would hope that most women make rational decisions about the number of children they should have based on the number they feel they can care and provide for until they reach adulthood. It seems rather selfish to bring a child into the world purely for a few hours of pleasure on the mother’s part.

    • The Bofa on the Sofa

      For if childbirth is something which is inherently dangerous and painful (as this MD opines), then it also stands to reason that it is undesireable.

      My wife had absolutely no interest in going through childbirth, and was more than happy to have a (non-threatening) justification for a c-section, with a breech baby.

      So, according to my wife, childbirth is absolutely undesirable.

      Having kids, on the other hand, was something we did want to do, and therefore we were willing to go through what it takes to do that.

    • Fawn Hacker

      Love Ina and thank you for mentioning her statistics. I hope this is the case that more women are empowered by their natural processes and share the beautiful experiences with their children.

      • anion

        Ina shared a “beautiful experience” with her baby as she let it die. Oh, it was lovely…

    • anion

      That’s…really not how people or emotions work. At all.

  • Sarah

    Damn right. Thank you. It’s just typical competition among women on who is a better mother.

    • Fawn Hacker

      I don’t know why mothers feel like there is this competition. Why do you give them even a second thought or look. It is because women play into this competition that it even exists and then get jaded about not living up to some perfect mom standard.
      No one is a perfect mom…end of story.
      There are enough wonderful women who struggle in being the best mom they can, who are willing to share their insecurities in a healthful manner with other mamas. Find these women and forget the others.

    • mojasowa

      I find the author just as judgmental. She is implying women who choose natural labor are idiots. And hateful, competitive, judgmental people. That’s quite a load of negative stereotypes projected on a HUGE population of mothers. I have never heard any woman say or even imply that women who get epidurals or c-sections don’t love their babies. What a joke.

      • Who?

        She says people who claim that natural birth is safe, easy and a good choice for everyone are dangerous liars who should be called out for it.

        Dr T can speak for herself, but my understanding of her position is that she supports informed consent. That is, understanding the risks and benefits attendant on each decision made.

        Many natural birth advocates do not share the parts of the story that don’t suit them, for instance that birth is not inherently safe; that there is a date past which a woman has been pregnant too long; that how you choose to feed a baby matters not a jot, so long as the child is fed.

        • mojasowa

          Except that what midwife says natural birth is safe, easy and a good choice for EVERYONE?? You may not have experience with midwives but they are VERY clear that natural birth may not work out for everyone. They are aware of the difficulties and their motive is to help you through them with their expertise, and ease your fears with information and more choices. They believe in a woman being able to move around, walk around during labor, change positions, soak in a tub, labor in the shower, whatever works. And they spend more time with you in general. Benefits you don’t get in a conventional setting. They carefully screen you for risk and redirect you to the OB and more conventional methods should any red flags arise during pregnancy or any complications develop during labor. You are moved out of the alternative birthing center down the hall to the standard labor room for any intervention if anything is going wrong or should you opt for an epidural. They have OB’s that they are affiliated with, who step in ONLY when something is going wrong, not by default. This is clear from the beginning, on paper, in orientation meetings, etc.. The difference is that they don’t treat you like “something is wrong, or will go wrong” from the get-go by loading you up with interventions pre-emptively (if that’s what you want you don’t go with midwives– some women don’t want that– in my case it increased my anxiety). Similarly, doulas assist women with natural birth, at home and in the hospital, with and without epidurals, etc… The philosophy is “one size does not fit all” which is great compared to how I was being treated, rushed in and out of the OB’s office like a number. I imagined similarly being rushed in the hospital, my OB rarely present and some fresh-out-of-school nurses attending to me. I’d trust my OB with a c-section if I needed it but I’m much more comfortable with the midwives. Let women have a choice. Don’t fight it so much. If we all have choices it empowers you to have yours as well. One size does not fit all… Natural births are not for everyone. I think we agree there! Being hooked up to stuff while giving birth is not for everyone either.. Sometimes we don’t have a choice, but when we do, it’s good to have..

  • Lee

    I’m looking into this and other issues from an objective standpoint. I only care about statistics, not emotional arguments or personal anecdotes. The most recent study I have found is one from the Netherlands, where about 20% of births are home births. The study was reported in the British Medical Journal, June 2013. It found “the risk of severe complications to be one in 1,000 for home births and 2.3 in 1,000 for hospital births” according to the BBC report on this topic. I continue to look for other reliable statistics. I’m suspicious of listening to anyone who may have a financial stake in this.

    • Box of Salt

      That study is discussed on this blog here:

      http://www.skepticalob.com/2013/06/no-new-dutch-study-does-not-show-that-homebirth-is-safe.html

      and here:

      http://www.skepticalob.com/2013/06/surprise-there-were-homebirth-deaths-in-the-dutch-study-that-claimed-to-show-that-homebirth-has-lower-risks.html

      “I’m suspicious of listening to anyone who may have a financial stake in this. ” You mean like midwives whose income depends on attending home births?

      • Fawn Hacker

        You mean the home birth midwives that make maybe $30,000 per year because they believe in the process and what it can do for us as a society….
        What financial stake? Big business? If you are worried about financial stake maybe take a look at those websites and studies funded by corporations like hospitals. More interventions=more money to hospitals and insurance companies. There is your financial stake.
        Midwives get so much backlash, it is unreal there are still amazing women who have so much passion to continue their careers in natural childbirth.

    • Amy Tuteur, MD

      If you only care about statistics, it should have been a red flag to you that the authors never mentioned DEATHS. There was a reason for that; homebirth doesn’t look nearly so safe when deaths are included, and not merely complications.

      • Fawn Hacker

        You are ignorant.

        • The Bofa, Being of the Sofa

          You have evidence to the contrary?

    • Wren

      You would expect more complications to be reported for hospital births though, wouldn’t you?
      a) Women who know they are likely to have a complication would be in the hospital already. It wasn’t randomised or anything.
      b) Complications are harder to ignore at the hospital due to more people being involved. This isn’t saying anyone deliberately lied, but blood loss could well have been estimated on the lower side (and it’s always estimated).
      c) Greater monitoring is more likely to show potential problems developing sooner, leading to speeding up delivery or C-sections. This could well lead to more complications but fewer deaths.
      Also, wouldn’t practicing midwives have a much higher financial stake in this than a retired OB? In fact, given the numbers who choose home birth versus the number who choose hospital birth, and how large most OB’s case loads are, I find it hard to believe OBs have a greater financial stake than midwives in this. A few women here or there won’t make a huge difference to an OB but could be a home birth midwife’s whole case load.

      • mojasowa

        Midwives would go out of business with lawsuits if natural births were in fact as dangerous (compared with births with medical interventions) as this author tries to convince us of.

        • Who?

          No point suing them, they have no money to start with, and no insurance.

          Their ‘professional’ (ahem) bodies do not criticise them in any way for errors, let alone remove any accreditation they may hold.

        • Wren

          Midwives are rarely sued, for a variety of reasons including both financial and emotional reasons.
          This author has no issue with natural births, if that means a birth with no interventions, as long as there is monitoring showing no reason to intervene and medical intervention is available if needed. Neither of those conditions are met with non-CNM midwives practising outside the hospital environment in the US, or most other countries.

        • sapphiremind

          I so wish that were true. I just recently had a homebirth go wrong come through my unit. Mother, doulas and midwives were so inappropriate at the bedside at times – clearly in denial. The baby came in with a *flat* eeg. We did therapeutic hypothermia. We tried what we could to save the baby’s brain. It wasn’t enough. They ended up discontinuing support because of the severity of the brain injury. We also found on the MRI that there was a severe spinal cord injury, likely due to the midwives trying to extract the baby during the dystocia.

          But mom got her VBAC at home. Yay. Doctors made her nervous and she didn’t like her first birth experience which ended in a c/s (and a living child)

  • b

    I want a natural child birth, but I have nothing against women who chose otherwise, in fact i am glad interventions and csections exist. and most of the things in this post i dont even believe or agree with, so i guess i’m not the average ncb advocate. i’m not saying anything other than natural child birth is wrong, i’m just saying its not for me.

    • Wren

      You may find yourself proven wrong.

      I was certain that a natural child birth was all I would need and what I would have. My son, on the other hand, thought coming feet first was an excellent plan. The risks for the baby are very high for a vaginal footling breech delivery, so c-section it was.

      That was the first lesson my son gave me on the topic of “Parenting is a totally different thing when you are actually a parent”.

    • Fawn Hacker

      You may find yourself proven wrong…you are stronger than you ever thought. Would love to know how your birth went.

    • mojasowa

      Agree. I am like you, and I would not assume the “average ncb advocate” feels the way the author describes. I firmly believe the average ncb “advocate” feels the way you or I do about it. The competitive extremism a stereotype the author of the article is projecting on women like you and me. Anyone I’ve ever known to have a natural birth is super understanding of those who choose not to (or couldn’t). Some had a great first birth and opted for an epidural the 2nd time around because the experience was different (my sister for example). The only judgement here is the author and the commentors out to shame women who choose natural birth.

  • Faredae Audrey Miller

    I see now how my words have been hurtful. When I started commenting on here I did not stop to realize that many of the women on here have lost babies as a result of natural childbirth. You are correct I am ignorant. As I type this with tears in my eyes I am sorry. I am so sorry to have been such an idiot and asshole. Wow, every day we are given lessons, today’s lesson was a tough one to learn.

    I am so sorry.

    • The Bofa on the Sofa

      When I started commenting on here I did not stop to realize that many of the women on here have lost babies as a result of natural childbirth.

      WHY THE FUCK DOES THAT MATTER?????

      Your attitude is what it shameful, not the fact that you said it in public, nor that there were loss mothers here. I have not lost a child, nor am I even a mother, but I find your attitude extremely disgusting. Admittedly, I attribute it to just pure cluelessness, but now that you have been made aware and hopefully understand, it will make a difference. And I don’t just mean “you’ll be careful about who you say it, too.”

      One last thing: you should look up the internet meme known as Pablo’s First Law of Internet Discussion. There are links out there that talk about it. It states, “In any internet discussion, assume that someone participating knows more about the topic than you do.” That includes things like knowing what it is like to lose a baby. You are the poster child for it. Sadly, in this case, it’s not even close. You are way out of your league. Pretty much EVERYONE here knows more about almost every topic you have mentioned (ID? Really? You don’t think we know darn well what ID is, and how it completely fails as science? That is even without referring to the Dover trial, that exposed the creationists trying to pass of creationism as ID, where Dembski wouldn’t even show his face to defend it)

      • Faredae Audrey Miller

        I have lost a baby so I know exactly what it is like!

        • The Bofa on the Sofa

          Yes, I know you had a miscarriage. Again, assume that someone here knows more about it than you. You have read the stories. They go far and beyond a miscarriage.

          • MaineJen

            Whoa. Let’s not assume that her pain about her miscarriage isn’t real, or just as valid as anyone else’s. No one wins at the “my pain is better than your pain” game. Faredae, I’m sorry for your loss…And Jenny, I’m heartbroken over yours.

          • The Bofa on the Sofa

            Nope, a miscarriage is a terrible event. It is not the same as losing a child during childbirth, however.

          • Michele

            I would like to know since when is miscarriage not childbirth. As a labor delivery nurse for well over 20 years, I have attended many “BIRTHS” that were miscarriages. After several hours of labor, (both natural and induced,) I have delivered tiny babies with no signs of life and laid them in their parents hands. I helped parents say hello to their tiny child so they could say goodbye. I have baptized this so called “miscarriage” at the parents request, have dressed this child and taken footprints and pictures.Technically a miscarriage is when a baby dies before the 20th week of pregnancy.Technically, a stillbirth is the death of a baby after the 20th week of pregnancy but before delivery. Whenever parents deal with the death of their child, whether it is early or late in pregnancy, or sometimes after birth, there can be a great sense of disappointment, loss and suffering. Stillbirth and miscarriage are separately defined not because one or the other is an easier or more difficult loss with which to deal, but because they have different causes, need different evaluations and differ medically and in the ways parents and families can best be helped.

          • Young CC Prof

            I believe he’s referring to the difference between a spontaneous stillbirth due to some sort of pregnancy complication vs going into labor at full term with a live healthy baby and losing the child to a birth accident.

            Both are tragic. But many stillbirths are unpreventable, while most losses DURING birth can be prevented with proper care.

          • mojasowa

            funny because the person who seems to know most about pain and loss of a child, enough to chime in and judge, is someone who admitted is not even mother. May not even be a woman?

          • LibrarianSarah

            Why would it matter if Bofa was a woman or not? Do you think fathers don’t feel the loss of their children as deeply as mothers? That’s pretty messed up. I hope your child’s father doesn’t know you think so little of him.

          • mojasowa

            scroll up some.. and read the context. you’re defending a troll. Someone apologized and was really sincere. He responded by barking at her.. “”what the F does that matter?” Your attitude is what it shameful, not the fact that you said it in public, nor that there were loss mothers here. I have not lost a child, nor am I even a mother, but I find your attitude extremely disgusting.” He’s never lost a child, and he’s shaming women for choosing how to birth their own children out of their own bodies. My husband would agree with me, don’t worry.. he’ll be the first to say how lucky he is for not having to go through what a woman has to go through in creating a child. This troll can shut up.. and let women speak for themselves.

          • jenny

            Yes, I believe her pain over her miscarriage is real and valid. I would never tell her to be glad that she “just” had a miscarriage. Or, you know, “Babies die during birth, too. Just because you complete a pregnancy doesn’t mean you will bring home a baby.” Or, “At least you didn’t lose an infant.”

            However, the fact that she has experienced loss does not make her qualified to tell me this

            ” But I hope all of you can recognize there are tragedies in hospitals too. Even with all the medical intervention available.”

            Yes, babies do die in hospitals too. That doesn’t make my daughter’s death any less painful.

          • Burgundy

            My heartache when I read your story.

        • jenny

          Since we are talking about experiences, let me tell you about my daughter. She did not die during childbirth. She had a heartbeat, so she was rushed to the hospital, resuscitated, and treated for her injuries. She lived four days. She was very fat and cute, and because of the long period of oxygen deprivation, her kidneys were destroyed. As the days went by, she got fatter, cuter, and sicker from all the fluid and waste her body could not expel. On her first two days in the hospital, she sometimes tried to cry but because of the breathing tube she could not. I am sure that if she was able to sense anything on those days, she was in great discomfort, despite the careful use of pain relieving medication. As her brain damage worsened, she slept more and more. By the time we made the decision to switch to comfort care, she was no longer able to perceive sensation at all, which was a blessing. Her death was a mercy.

          You might know what it’s like to lose a wanted pregnancy, and I am very sorry for your loss, nor do I want to diminish that pain, but you do not know what it is like to look at the baby you carried for nine months, gave birth to in great pain, and longed for with all your heart…. to look at the little sister of your older child, to look at the much loved child….and then make the decision to remove all life support interventions because to do anything else would be a horror. You do not know what that is like.

    • moto_librarian

      Faeredae, take this as an opportunity to learn. Ignorance can be remedied by taking the time to evaluate your prior beliefs in the light of actual evidence. Look, the people who frequently post here have been approached by many well-meaning NCB advocates. Some really aren’t trying to be condescending assholes; others are. If you really want to help women (and yourself), read what the experts have to say. Rikki Lake, MDC, Baby Center, Lamaze – these are not reputable sources. Many people dislike Dr. Amy’s tone, but she is honest. Here are some questions to ask yourself:

      If birth is safe, why does homebirth have a mortality rate for infants that is 3 times higher than that of the hospital?

      If birth is safe, why does it continue to kill so many women and babies in the developing world? (Hint: it’s not because of malnutrition and sanitation)

      If birth is safe, why does MANA refuse to release the death rates for homebirth?

      If you can come up with answers supported by fact rather than anecdote, you will have come a long way.

      • Faredae Audrey Miller

        Thank you for your kindness. I appreciate it. Sadly I am realizing that so many women assume “natural childbirth” means home birth. Women can have natural birth (meaning no intervention) in a hospital or birthing center. With doctors present. That is what I advocate for. That way IF intervention is needed it can be easily accessed. Thank you again.

        • The Bofa on the Sofa

          Why do you advocate for that? And please try to respond without being insulting to those who do otherwise, for a change.

        • moto_librarian

          I know that not all NCB advocates are promoting homebirth. I am encouraging you to dig a little bit deeper. Many women welcome interventions like pain relief once they discover just how painful birth is. I am against the misinformation that is spread about interventions. For example, a lot of NCB advocates tell you not to get a heplock, because that is an intervention. I am living proof of why a heplock is a very good thing to have even if you are having a “natural” birth. If I had I.V. access established in this way, I could have received fentanyl almost immediately and avoided the agonizing pain of manual examination of my uterus. Instead, I had to suffer through it until they could run an I.V. This took time, as priority was given to trying to diagnose the source of my hemorrhage and administering cytotec and pitocin via injection.

      • mojasowa

        WHO is saying childbirth is safe, painless, or that everyone should do a home birth and no one will need interventions?? This is being projected onto women like myself who are interested in NCB. No midwife or doula says this. Most women I know who opted for a natural birth did so at a hospital where they could get a cesarian if an emergency occurs. This is the average reality or NCB “advocates”. Most aren’t even “advocates”. It’s just their choice for themselves… They don’t project onto others or judge. Sometimes NCB is just something to aim for, and it either works out or it doesn’t.

        • Who?

          Maybe none say all of it all the time. Many say some of it most or some of the time.

          And what is the value of ‘aiming’ for anything other than a healthy mother and baby? No one knows how their body will work during pregnancy and in labour, and beyond being young but not too young, not smoking and maintaining a healthy weight, there’s little you can do to change that. Being young helps, but that isn’t under control.

          • mojasowa

            Right. If a woman is healthy, there are many ways to have a healthy baby. The idea is that women not be treated like an item on an assembly line. Giving birth is such major life event we SHOULD have options. whether it’s an epidural or a natural birth or an OB or a midwife, and not be judged because it’s not how someone else would do it. I personally switched from my OB to midwife b/c I liked the customization and options the midwives offered that my OB did not. (OB rushed through our visits, informed me nothing more than the obvious, etc.). In the alternative birthing center I have a queen size bed my husband can fit on, I can move around freely, change positions, soak in a tub, labor in the shower, try their various birthing tools, and the midwife will spend more time with me than an OB would. I will have a doula to take some pressure of my husband and to be a reassuring, compassionate coach. I have these choices now. Should I need or CHOOSE interventions, i have this option too. I will be moved down the hall to a standard labor room and The OB on staff will step in. The image this author presented of the NB “advocates” is totally skewed and sets us all up for a “them against us” attitude.

          • Can your midwife diagnose a placental abruption in time to save your uterus and your baby’s life? Will she call the OB, stat, if there is a shoulder dystocia that isn’t resolved within 1 minute? Will you have an IV/heplock in already just in case, fetal monitoring, and other things to tell you if your baby is having distress? Will you have access to an epidural if you decide that pain sucks and you’re done with it?

            Hospitals actually let you go in the shower or tub, change positions, etc. You can even have a doula if you want one. Giving birth anywhere but a hospital is much less safe than giving birth in a hospital. It’s not a good or smart decision. You have the right to make stupid choices, of course, but we have the right to tell you they’re stupid choices. You will get no validation here.

          • mojasowa

            “You have the right to make stupid choices, of course, but we have the right to tell you they’re stupid choices. You will get no validation here.”. Yes, i can tell.. I’ll have a really disrespectful person judging me and indulging in calling me stupid. Read the words rather reading between the lines so much. You just validated my point about projecting extremist stereotypes.. You assumed I’m having a home birth EVEN though it was clear I’ll be in a hospital.

          • No, I presumed you’d be in a birthing center unattached to a hospital, which was my mistake. It was clear you weren’t choosing a homebirth.

            You’re not making stupid choices. That is good. I still don’t see why you’re dissing hospital births, then?

          • mojasowa

            “Should I need or CHOOSE interventions, i have this option too. I will be moved down the hall to a standard labor room and The OB on staff will step in.” Catch and pay attention to your confirmation bias? That includes, putting words into mouths. I have not dissed hospital births. I’m dissing the judgement and one-sidedness of stereotyping women who choose natural births and experienced midwives who assist them with it to be clueless, lying, judgmental, extremist idiots. The judgements seem to be coming from somewhere else…

          • mojasowa

            In my city, every midwife group performs births in alternative birthing centers IN A HOSPITAL. I did a lot of research before switching from my OB to a midwife group, and i’m happy with my “stupid” choice, thanks for letting me know it’s “stupid”. That was really valuable to the discussion.

          • mojasowa

            My sister had a natural, unmedicated birth with her experienced OB btw. He was not one bit against it. She was in active labor for 4 hours but felt she was doing well, with no stress on the baby, and wanted to continue. With my OB, she’d be sent for a cesarian after 3 hours, like a statistic (My OB stated that is their “policy”). Her OB however, treated her as an individual and let her influence the outcome b/c there were no complications and her feedback was that the pain was manageable for her. This is what I’m talking about. There are different ways to do things. It’s nice to have choices and be supported (unless you’re being truly irrational– like bleeding out and dying and refusing a cesarean– i imagine– an unusual request). My sister felt her own chemicals were kicking in as she was able to cope with the pain just fine. She had a healthy baby, and wanted to do a natural birth again. Next baby however, she just got over food poisoning, and chose an epidural b/c she did not feel she had the strength. That baby was in the hospital for 6 weeks with sepsis, not saying it had anything to do with the interventions… But you can have a healthy or unhealthy baby in any setting. There are no guarantees. Do what’s right for you… I’m glad I have choices.

          • Molly B

            Because some.people believe that a low intervention, natural child birth is what’s best just like.some.people.disagree.
            That is why some feel there is value it aiming for it.

        • moto_librarian

          Why don’t you pick a recent thread if you want to engage on this topic. Seriously, I’m not wading through comments on a two-year old thread to remember the context of what I said.

          • mojasowa

            then don’t.

  • Faredae Audrey Miller

    I wish you all pure happiness and joy. I can see very clearly that anyone who supports natural childbirth is going to be judged on here. I never intended to offend anyone. I simply wanted to share my opinions. I am sorry to anyone who had a “bad” birthing experience. No woman or baby deserves to be harmed in any way. It saddens me to know there are midwives and doctors out there that push their beliefs on parents. We should all support each other no matter what. I have many friends and family members that live a different life style than me and I do not love them any less. Same goes for parents who choose a birth plan that is not aligned with my belief. I still support them with all the love in my heart.

    ~Many blessings and love to you all.

    • Karen in SC

      Okay, thanks!

      We already know that it’s okay to have a natural birth, if desired. We just don’t want anyone coming here, saying it’s better or any other idealized view like “you can manage the pain” , “you have instincts”. etc.

      Peace.

      • Faredae Audrey Miller

        Again, I was just trying to have conversation because I assumed we were all mature women who could share with one another. You say “we” but maybe there is someone on here who did need/want to hear what I have to say. <3

        • FormerPhysicist

          Once again Preaching =/= conversation. Stop being insulted that this isn’t your choir.

        • anion

          If your first post here was your idea of a respectful, mature conversation starter, I shudder to think what you’re like at parties.

    • The Bofa on the Sofa

      I can see very clearly that anyone who supports natural childbirth is going to be judged on here.

      Is that what you are doing? Go figure.

      Actually, I’m not even sure what that means, to “support natural childbirth.” Because obviously, you can’t support NCB in all circumstances. There are obviously times when NCB is clearly improper, and no one should support it in those circumstances. But in those circumstances where NCB can be done safely, sure, I’ll support it, if that’s what the mother wants. I don’t know anyone here who would say any different.

      However, what I won’t do:
      1) Cajole women into choosing natural birth on the grounds of
      a) Inventing fantasies about how great NCB is, or by
      b) Poisoning the well about how evil interventions are, or
      c) Implying that they are weak or flawed if they don’t have an NCB
      2) Lie about risks and/or benefits
      2) Complain that there are too many women choosing intervention or not

      Actually, no one has called you out on 1c with your whole “we are designed to give birth” and “inner lionness” crap. If women are designed to give birth, does that mean that those who are not successfully able to give birth, such as those that have lost a child in childbirth, as broken? How else would you characterize something that does not do what it was designed to do? My car was designed to start up with the ignition. If it fails to do so, then it is because it is broken.

      So you talk about “we should support each other,” but your whole message is a complete insult to those who, for whatever reason, are unable to give birth successfully. Maybe they can’t conceive. Maybe they have anatomical issues that prevent carrying to term or delivering. Like the car with the bad ignition, they have something broken. That is the message you are giving.

      It’s not support at all. It’s total judgement. To that I say, thanks for nothing, asshole.

      • Faredae Audrey Miller

        You are obviously very bored, and need drama in your life. I have not insulted anyone intentionally, and I apologized if I did offend someone. Yet you call me asshole. I will no longer waste my time with you.

        • Dr Kitty

          You know the self righteous flounce only works if you actually stop posting, right?

          • The Bofa on the Sofa

            Well, she had to return from her flounce to accuse me of needing drama in my life.

        • The Bofa on the Sofa

          As I tell my kids, the apology is only the first part. The second part, and the most important part, is to make sure you don’t do it again.

          I’ve seen no indication of such. Your apology don’t mean shit if you just continue doing what you did to offend in the first place.

          • kumquatwriter

            “Saying ‘I’m so-rry’ is the first step! Then, ‘how can I help!'”

            Wisdom from Daniel Tiger’s Neighborhood. Which my not-quite-three year old grasps just fine…

          • The Bofa on the Sofa

            For some reason, the lessons from Daniel Tiger’s Neighborhood stick with my kids very well. They are singing those Daniel Tiger songs for days after just hearing it once.

          • kumquatwriter

            Its Mister Rogers. That man’s gentle and accepting soul and gift for communicating with children carried on beautifully with the new show. We use a lot of their little songs! My other two favorites are “STOP! And listen to stay safe!” and “when you FEEL so mad that you WANNA roar, take a deep breath (breathe) and count to four! 1…2…3…4”

            Granted, my boy replies, “I meed to count to TWENTY!” And then does it!

          • kumquatwriter

            Also – just look at ALL THE DRAMAS you clearly need, what with the little tiger songs and all.

          • Jocelyn

            I can hear that song playing in my head now. 🙂

    • jenny

      I didn’t have bad birthing experience. My baby died. Namaste!

      • The Bofa on the Sofa

        Yeah, jenny, what do you think about her claim that you are “designed to give birth”? I’m sure that makes you feel a lot better, right? Because hey, we should all support each other no matter what.

        • jenny

          Well, Bofa, I did have a successful vaginal birth, after all, so it’s not like my BODY failed. If only I had spent more time visualizing her cord moving away from her head, perhaps I could have done something to prevent the accident. I feel so supported.

          • Dr Kitty

            Jenny, how you deal with these idiots I don’t know.
            Much respect for your grace and patience.

          • jenny

            I don’t feel particularly graceful, but thank you, Dr. Kitty. Sometimes I want to leap through the screen and pour kale smoothies over the next person that says, “As long as you follow your instinct everything will be fine!” But I’ll settle for a resentfully flung namaste. Faredae has no idea what she is talking about, and if she’s lucky she will remain in ignorance. At this point, I don’t respond to people like this because I think I’m going to change their minds…. but like all of us I think we’re hoping that someone who is searching for information will come along and see this stuff doesn’t go unchallenged.

          • Faredae Audrey Miller

            I lost a baby too. And I am very sorry for your loss. Mine was not during childbirth, I had a miscarriage. Today is pregnancy and infant loss remembrance day and yet here we are “arguing”. I am so sad with all of this talk. People calling me names simply because I have a particular belief. And Jenny, I agree, we will never change each others minds. Like politics and religion. Some things should not be discussed. I guess I asked for all this when I commented on this article. I guess I just assumed it was more of a discussion where women could share their experiences either way. But it is not. It is for women who have had bad experiences with natural childbirth. My heart goes out to all of you. You can call me an asshole, ignorant, idiot, whatever you feel you need to. I am just a woman who loves pregnancy and childbirth. And I will not remain “ignorant” I know there will be times of tragedy in my line of work. But I hope all of you can recognize there are tragedies in hospitals too. Even with all the medical intervention available. ~Blessings~

          • Still Fed up

            (just go! And stay gone this time! No more blessings, please!) (Oh and your miscarriage does not give you any insight into loss during childbirth—they are different on many levels)

          • Dr Kitty

            You just DO NOT GET IT Faradae.
            You have said rude, hurtful, offensive things which you have neither acknowledged nor apologised for.

            And then you try the “today of all days, don’t be hating” card.

            Depending on circumstances a miscarriage can be a tragedy, or the best solution to a difficult situation, or a total non event with no feelings either way.

            The same cannot be said about losing a wanted child shortly before, during or after birth.

            You believe that if you believe everything will be fine and do everything right then nothing bad will happen at a birth. Or, worst case if it all goes tits up, then it was somehow meant to happen and couldn’t have been avoided.

            I’m sure it is a comforting, pleasant belief to have. I’m sure it’ll help you deal with the “inevitable tragedies” you’ll face as whatever kind of lay birth worker you are.
            That doesn’t make it a true, or kind or helpful belief system.

    • Guest

      And I hope that you will take this parachuting event as a learning experience and really reflect on the perspectives here.

      I did feel very sad and guilty after my daughter’s birth. Do you know why? Because I was surrounded with too many people like you, people who push an agenda that women are “designed” to give birth, and that if you just trust your instincts and prepare in the right ways you will have a beautiful and empowering natural experience. And I bought it. And because I couldn’t have that experience, despite “doing everything right,” I felt broken, betrayed by my body, denied an empowering and meaningful experience that I was convinced I was supposed to have. There I was, with a beautiful, healthy child in my life, ruminating endlessly about something in the past and beyond my control.

      Then I started talking to mothers who were not attached to natural child birth, who did not attach so much intrinsic value to a particular birth experience, and who did not have expectations about their experience going in. And guess what? If they hit bumps in the road, they were not as effected by it. THEY WERE HAPPIER.

      Please reflect on how many women you are hurting through your well-intentioned but deeply insulting philosophy.

      • Faredae Audrey Miller

        I will reflect on how every woman has different experiences. I will however not believe I am hurting women, because I know I am not. I am sorry you are not happy with your experience but I had nothing to do with it. You do not know me or how I work with parents. I teach my parents NOT to try to plan out their birth. Have an idea of what they want to happen but be prepared for it to all go out the window! Even if they are on their 3rd child. EVERY birth is different. And I stay open to ANYTHING happening, including interventions. So please, don’t try to pretend you know me because of your experience with whomever you worked with. I am not them.

        • Fed up with Faredae

          (god, don’t you just hate it when people say they’re going—and then they keep coming around? Particularly when they keep wishing us love and blessing. Just go and stay gone! This is NOT a conversation, this is you preaching and relating your supposed awesomeness)

          • moto_librarian

            I just wish that people could stick the flounce…

        • Burgundy

          My beef with you was “yes, you have all the good intentions of sharing your believes. It is not easy to do especially in a site that hold ideas so opposite from yours. However, instead addressing the questions or concerns that we had/asked, you simply repeated your believe over and over again”. I got it, you believed that labor pain should be manageable and pain med was not necessary. NCB should be the mainstream way of giving birth. However, this blog is addressing the safety issues that associated with NCB. Quiet honestly, if you look at the stat, it is not good. I would love to see you come back and address each so called “lies” with citations and actual studies and not based on your believes.
          BTW, sorry to use the word Beef, but it is lunch time here and I am hungry.

        • Guest

          It seems you are not understanding my point. I think it might be difficult if you are very absorbed in your own ideology.

          I did not say that you personally made me feel bad. I said the philosophy you promote, which you have openly shared here, hurts women. You have said women are “designed” to give birth. You have said we have it within us to do it instinctively, we just need the proper support. We are lionesses, after all, we don’t need medicine to do it for us! So what of those of us who were not able to have a natural birth? What of those who needed help? Were we designed wrong? Do we have bad instincts? Did we have crappy support? Are we not lionesses?

          It does not matter if you pay lip service to the idea that anything can happen. Your whole attitude is setting women up to fail. It took me a while to see that, so I can understand that you probably won’t get it right away. I hope it does sink in, though.

        • An Actual Attorney

          Faredae: Something hurtful
          Other women: That hurt me.
          Faredae: I don’t believe I hurt you.

          Got it.

  • Faredae Audrey Miller

    Wow, is really all I can say right now! I can’t get past the first statement, about childbirth being safe, “Outright lie” What?? Our bodies are designed to give birth. Otherwise we would not be here. It is safe if it is properly prepared for and supported. I keep seeing the word LIE over and over. Ask any woman who did birth naturally if any intervention was necessary. Her answer will be no. Which means drugs and interventions are not usually needed. Ask women who have used intervention with complication (I personally know many of them) if she is satisfied with her birth and you will most likely hear her say no. I hear many women say they never want to give birth again. Then once they are educated about how it could and should be, they are open to trying it the way nature intended. Childbirth is NOT a medical mystery! It is a natural process. We just have to unlearn what the medical field has been taught. Go back to the basics. Let our instincts guide us. A lion does not require a doctor to give her drugs and tell her how and when to push. We have it within us to do it instinctually, we just need the proper support. Why would we be any different from any other species on this planet! People wonder why I have such a deep anger towards our medical establishment! But I equally have a desire to educate women about their choices. And let them decide what they feel is right for them. <3

    • Karen in SC

      A lion doesn’t require a doctor???? Instinct???? Plenty of animals die in the wild, that is why litters are so large. Ask a sheep or cattle rancher about how they care for their females giving birth. What instinct tells you about uterine rupture, nuchal cords, macrosomic or IUGR babies?

      How ignorant you are. I had complications and my instincts told me NOTHING. Thankfully I was in a hospital and my baby was taken care of.

      PS. I had NO interventions, still I had complications….

      • Faredae Audrey Miller

        I said this in another reply but I will say it again to you. It is really sad that we cannot talk as woman to woman on here without lashing out at each other. I never judged you nor called you ignorant. I am simply stating my opinion on here based on my knowledge. You say your instincts told you nothing. That is the whole point to what I mean by women need to be supported and educated for months prior to labor. I am sorry you had complications. And I am grateful that you got the help you needed. But that again is my point. There are times when it is needed, but there are many times it is not needed. You say you had no interventions, I do not know your story, but did you have an i.v.? Were you allowed to walk around? Were you hooked up to electronic monitoring? These are interventions. Again, I am just asking, I do not know the answers. One of the worst things we can do to a mom in labor is keep her immobile. Labor goes more smoothly if mom can move around. Anyhow, I do seriously just want to support women. NO MATTER what their experience. It breaks my heart how many women seem to have anger or guilt around their birth. Those are the last emotions a mother should ever feel.

        • anion

          If women have anger or guilt around the births of their children, it’s likely because people like you insist they were “uneducated” and that if they’d just studied more they could have had magical pain-free natural births.

          Also, you say that labor “goes more smoothly if mom can move around.” Citation please?

        • jenny

          I had a baby die as a result of a cord prolapse during a precipitous second stage. It happened in my house, before I could get to the hospital. No “interference,” no monitors, and no immobility caused that. It just happened. Because bad shit just happens sometimes. And before you go googling how to fix a prolapse in your kitchen, all the BS people circulate on the internet about what to do in case of a cord prolapse only works if you have access to skilled, experienced personnel with appropriate equipment. A monitor could have given early warning and a c-section could have saved her life, but INSTINCT isn’t going to do shit.

          • Faredae Audrey Miller

            First off, I am sorry for your loss. Truly. Secondly I am even more sorry for offending you. I never intended to.

          • jenny

            Thank you. I believe you did not intend to say something hurtful, but you have. Do you understand why someone could be hurt by statements like

            “Our bodies are designed to give birth. Otherwise we would not be here. It is safe if it is properly prepared for and supported. I keep seeing the word LIE over and over. Ask any woman who did birth naturally if any intervention was necessary. Her answer will be no. Which means drugs and interventions are not usually needed.”

            And on and on. Not only is this hurtful, it’s not true that birth is safe if you are properly prepared and supported. Just because there are things we can do to mitigate birth emergencies does not mean that birth is safe.

        • Karen in SC

          I stand by my comment. Being ignorant is not a failing, you can always learn more.

          When I said I had no interventions, I mean NONE. I walked, I ate, I drank, I showered, no iv. Typical NCB birth just in a hospital. Again, I had NO INSTINCT that anything was wrong.

          Good news my doctor realized it and my son was born safely and resuscitated by a well trained team.

          Please read today’s post. You can learn a lot about your body and being pregnant, but you (and I ) will never be fully educated about OB/GYN.

        • EllenL

          If you want women not to feel anger or guilt, stop telling them there’s one right way to give birth – your way.

        • Dr Kitty

          Sorry, Faredae, YOU’RE the judgemental one here.
          You say “I’ve never heard of any natural mamas ever needing interventions or having bad outcomes”.

          Karen tells you how her natural birth nearly ended in her son’s death.

          Moto Librarian tells you how her natural birth ended up with a cervical tear and almost in HER death.

          Jenny tells you how her precipitous unintentional UC ended in her daughter’s DEATH.

          And your response is “Ah yes, but are you SURE it was REALLY natural? Did you move around enough? Well, you weren’t educated or supported enough to trust your instincts, if you had been it all would have been fine!”

          That is some judgemental, offensive rubbish.
          Lady, all the <3 and "blessings" doesn't make it less mean any horrible.

          • Burgundy

            I don’t think she gets it. I asked her about how she thinks about moms who lost babies due to nature birth, she gave me more BS (the good old hospital lost babies too bingo) but never address my question.

          • moto_librarian

            Well, to be fair Dr. Kitty, just being in a hospital probably qualifies as an “intervention” in her mind.

          • An Actual Attorney

            Or living in a house, with electricity.

          • Faredae Audrey Miller

            Where did I say I have NEVER heard of natural mamas ever needing interventions or having bad outcomes? That is the opposite of what I said! (unless I typed it wrong) Because I KNOW there are times when women need intervention. You are totally twisting my words! I was ASKING questions when I asked if she was able to move around. Your whole last paragraph has quotation marks yet I NEVER said any of it! I am trying to ask questions to learn about your experiences. Yet no one actually tells me anything! You all just say you were lied to “by people like you” YOU DO NOT KNOW ME or how I teach. You assume I tell women they are dumb if they choose drugs, or they are broken if they lose a baby, or whatever insane assumptions you are coming up with. I have tried to have conversation with you all but I can see it is completely pointless.

          • anion

            We’re not assuming anything. We’re taking your statements at face value and telling you how they read/sound to us. That’s not an assumption. Every statement you’ve made here can be logically interpreted the way we have done.

            If those things are not what you meant, then you ought to be more careful with your choices of words.

          • Dr Kitty

            Ok, you want a direct quote of your actual words, rather than my interpretation.
            No problem.

            “Ask any woman who did birth naturally if interventions were necessary. Her answer will be no”.

            Karen, Jenny, Moto (and Margarita, Liz P, Dhanya, Sara, Marlo, Nicole and all the other Hurt by Homebirth mothers) beg to disagree.

            Faredae, that statement pretty much pushed all of my buttons, implying as it does that interventions are never necessary if you do everything “naturally”, which is blatantly false.

            Anyway, I’m embarrassing myself with my condescending assholery, so I’m going to take a time out.

          • The Bofa on the Sofa

            Actually, the statement to me was basically tautology. Anyone who has a birth without interventions will tell you that interventions weren’t necessary. Duh.

            Ask those who HAD interventions if their interventions were necessary. That’s a different question.

          • An Actual Attorney

            Faredae — Very slowly here. You said “Ask any woman who did birth naturally if interventions were necessary. Her answer will be no”

            There are many women (here and elsewhere) who desperately, with every fiber of their being, wish they could go back and have an intervention that was not given. They wish that because their baby is dead. Dead for lack of intervention. They had a natural birth, and their baby is therefore dead.

          • Burgundy

            “Ask any woman who did birth naturally if interventions were necessary. Her answer will be no”
            This is a rhetorical statement. I wonder if she ever ask that question to any woman who did birth “unnaturally”.

      • Burgundy

        So I guess a vet assisted birth for the dogs just a big fat lie made up by vets to make $$. As Faredae stated, an animal should have the instinct to give birth without fail ;P

    • Jocelyn

      Our bodies are designed to swallow food. People still choke. Our bodies are designed to pump blood with our hearts. People – even very healthy people – still have heart attacks. It doesn’t really matter what our bodies are “designed” to do – things can still go wrong, and people can be seriously injured or die.

      Hey, and guess what? I had complications during my first labor, and they used interventions because of them, and I am COMPLETELY satisfied with how that birth went. You know why? Because my daughter is healthy and safe.

      Go ahead and “unlearn what the medical field has been taught.” Personally, I’ll stick to science.

      • Faredae Audrey Miller

        Yes, there are times when our bodies do not function properly. But it is a small percentage. And in those times, yes, medicine is needed. It is my opinion that medicine is used too often and before it is even figured out whether it is necessary. I have a friend who opted for pain meds before the pain even began. They did not work and the doctors kept giving her more. 27 hours of painful labor, groggy and unable to function properly. When her baby was finally born she was unable to hold him because of the drugs. (this is her story as she told it to me) She said she never wants to have another baby again because it was so horrible. Luckily since then we have had many conversations and she as decided she will have more babies but do things very differently. I also personally witnessed an unassisted birth. Meaning no midwife, doctor etc. Just me, mom, dad and a friend. Baby was born in about 5.5 hours with no complications. Yes there was some pain but mom knew how to allow it to pass. My point in this story is NOT that women should birth unassisted. It is simply that every birth is different and women should not make decisions based on another woman’s birth story.

        • anion

          Right. And so you should not lecture others on how they ought to give birth based on a couple of friends of yours.

          • Faredae Audrey Miller

            I am not lecturing anyone on how they should give birth. I am simply sharing my opinions. Unfortunately it does not seem to be welcomed on here since it is different than the author’s. Again, sad that women cannot just have conversation and share info. Which is why so many women do not know all their options. <3

          • The Bofa on the Sofa

            I believe educating women on how strong they are, we are all lionesses at heart. If we are supported and taught how to manage the pain then we learn to move through it.

            If you are not lecturing anyone on how to give birth, why are you “educating” them on how they don’t have to have pain medications?

            I won’t dig up a quote, but have you complained that the c-section rate is too high? If so, you are suggesting that there are those who are getting c-sections who should not. IOW, lecturing about HOW they should give birth.

          • Karen in SC

            You are shared your beliefs only. Not any factual information.

            Women should make decisions based on factual information presented by a OB (in the case of pregnancy). If still decided on natural childbirth, as I did, fine. If deciding on homebirth, at least doing so knowing all the risks. Not some idealized belief system.

          • Dr Kitty

            Faredae, I educated myself.
            I discovered that it is unsafe for 5foot 45kg woman with spina bifida and an abnormal pelvis and spine whose baby has an estimated weight of 7lbs and where the head is still very high (no engagement, totally free) at 38 to attempt a vaginal birth.
            To me the risk of a long, painful obstructed labour, cord prolapse and pelvic floor damage meant that a planned, pre labour CS was a no brainer.

            I’m very happy with my choice and have no interest in attempting a VBAC.

            Your friend lucked out and had an easy UC. Happy for her. But it simply isn’t a safe, advisable option for most women.
            How do you not get that?

        • moto_librarian

          Have you even had a baby? If not, you really don’t have any right to be lecturing anyone here about your “opinion.”

        • Really? A small percentage of women’s bodies are broken? Any woman’s body is broken? How do you think that sounds to one of those “broken” women?

          Before modern medicine, every pregnancy carried a 1% chance of killing the woman. 1%. 1/100. That doesn’t count the neonatal deaths (9%) or birth injuries to both mother and baby. Even today, it’s not safe. I personally know (in real life) a woman who nearly hemorrhaged to death, a woman who nearly died of a massive infection, and a woman whose stalled back labor only started progressing again after an epidural. I’m an introvert, so I do not have a large circle of friends, and I know three women who are alive and healthy today because of hospital interventions. If things go wrong, I want to be someplace where someone can fix it.

          So I’m glad the UC you went to went well. I really am. I am shocked and appalled your friends thought rolling the dice and hoping for the best was a good idea with something so important, though. It’s a choice they have a right to make, but it is, frankly, a stupid choice.

          • mojasowa

            She’s not against interventions when necessary…

          • And who decides when it’s necessary, and will you be in a location that has those necessary interventions available?

            You’re setting yourself up for failure if you put yourself out of reach of modern medicine and just hope for the best.

    • Young CC Prof

      Back in the day, people had 8 kids. If one or two died at birth, the family went on. In fact, throughout all of human history up until just a few generations ago, childbirth was the leading cause of death among younger women, except during times of great disaster.

      Animals die at birth all the time, including animals that usually bear much more easily than humans. Ask a dog breeder how many litters include at least one stillborn puppy.

      Dr. Amy is educating women about their choices. Unlike you, she’s also educating them about the consequences of those choices, including an increased risk of death to babies born without medical supervision.

    • The Computer Ate My Nym

      Our bodies were not designed at all. They have evolved to give birth often enough and well enough for the species to continue. Women throughout history (and prehistory) have died giving birth. More will die if they “trust their instincts” and don’t receive proper medical care.

    • Burgundy

      Why don’t you tell that to all the moms who lost kids because they bought into your “believe”? They trusted their lay MF and trusted body/birth/whatever you parroting over and over. So what did they do wrong? Didn’t they do their homework and research? They all interviewed and build a relationship with their MF. They all believed that what ever OB said was a big LIE, they all thought what they choice was the best for their babies. Their children pay the ultimate price and yet you are still here yapping. Really, when are you (yes, the NCBers/MF/CPM) are going to admin the wrongs and take responsibilities like a true human being.

      • Faredae Audrey Miller

        Do you say this to the many doctors who have had moms and babies die? You can find many stories about death in hospitals too. Yes, babies die, yes mothers die. And my heart breaks for all of them. I will never tell anyone their OB is lying, unless I know they are. A good OB will support natural childbirth unless intervention is necessary. Thankfully there are many OBs out there like this. Unfortunately there are many that go straight for drugs, cutting and c-sec if baby does not come in the time they think it should. With all that said, it truly saddens me to say there are many midwives who are so against medical intervention that they risk a mom and baby based on their belief that it is never needed. So it goes both ways. Thankfully we now have more and more birthing centers that have NCBers and doctors working together to make sure babies and moms are safe. I sense your anger, and I am sorry for whatever it is that you are hurting from. ~In love and light~

        • Amy Tuteur, MD

          Are you familiar with the concept of rate? Most people learn it in the 4th grade.

          http://www.skepticalob.com/2012/02/basic-arithmetic-lesson-for-homebirth.html

        • Burgundy

          At least with a hospital, someone is hold ACCOUNTABLE. That’s why the hospital carry insurance and have review board. What do you get if a homebirth go wrong? NOTHING. Most of the time a MW just hide behind her “chain of sisterhood” and keep on killing babies.

        • moto_librarian

          Yeah, just what we need, more substandard care for women. Has it occurred to you that many of us prefer giving birth with the aid of pain medication? I’ve done it both with and without drugs, and let me tell you, my second birth with the epidural was absolutely blissful compared to my first “natural” delivery.

        • Burgundy

          so Faredae, you still have not addressed my question yet. What are you going to tell the mom who “fail” the birth and lost her baby in HB? Is their body broken? Or some babies just don’t meant to be lived?

    • moto_librarian

      “Ask any woman who did birth naturally if any intervention was necessary. Her answer will be no.”

      You must not have talked to very many women. You certainly haven’t talked to me. I had a “textbook” natural delivery – pushed in every position imaginable, no heplock/I.V., drank during labor, no pitocin, etc. Despite all of that, my son was apparently malpositioned and tore my cervix on his way out. I started hemorrhaging, and got to experience manual examination of my uterus and removal of clots without any pain medication. They were able to run an I.V. and take me back to surgery within about 15 minutes, but I still narrowly avoided a blood transfusion. My recovery was long and painful. I would not be alive had it not been for interventions provided by a well-trained CNM, L&D nurses, and the attending OB. Get a clue, sweetheart.

    • Dr Kitty

      A tiger recently gave birth at London Zoo.
      The labour was six minutes long and the newborn cub was the size of her paw.
      I’d TOTALLY be up for NCB if I could have a six minute labour and deliver a baby smaller than my hand.

  • Aunatural

    We are a different type of mom! Throw all the bullshit you want in air, but NATURAL is the best way to go in all aspect of life. If you feel bad for your choices, I empathize, but don’t for a second bash the way birthing is to be done!!

    • The Bofa on the Sofa

      Throw all the bullshit you want in air, but NATURAL is the best way to go in all aspect of life

      I trust you typed this using smoke signals? And go to work on a sled or a log or wheel-shaped rock?

      Or does the “Natural is the best way to go” not apply to communication or transportation?

      • Faredae Audrey Miller

        really? you are going to compare having a baby to transportation? Giving birth is a natural process that I will agree at times does require medical intervention. However, medicine is used when it is not needed and that is really sad to me. And back to your transportation…..if you CAN walk then you SHOULD walk. Obviously there are times when it is better to not walk. So, I guess you can compare the 2. 😉

        • The Computer Ate My Nym

          you are going to compare having a baby to transportation?

          So you’re saying I should take less care with my kid’s birth than I would with deciding what mode of transportation I wish to use?

          • Faredae Audrey Miller

            No, you should take MORE care! People do more research on which car to buy than they do where and how to give birth. That is my whole point. Do LOTS of research. And the most important research to do is talk to other women. Find mom groups and ask them where they gave birth, what dr or midwife they used, what their experience was. That’s what we do when buying a car! So why not for giving birth!

          • I don’t have a creative name

            What you have described above is not research.

          • FormerPhysicist

            And one can get away with that type of “research” for a car because the government sets minimum safety standards for automobiles. Which many states do NOT do for ‘midwives’.

          • The Bofa on the Sofa

            Besides, I don’t accept the claim that people do more “research” into what car to buy.

          • Kerlysa

            What. I didn’t go around asking my neighbors what car I should buy. I bloody well went online and found third party, reputable sources as to the efficacy of the features I was interested in, and read the fine print on various loan options. Perhaps your next advice would be to find a car salesman who I enjoyed chatting with- clearly, he would have the highest quality cars for the best possible price.

        • anion

          What medicine, exactly, is used when it’s not needed? And who is the arbiter of whether or not it’s needed?

          • Faredae Audrey Miller

            I have a friend who just gave birth 3 months ago. The doctor gave her pain meds before the pain even began. But they did not work. She was still in pain, they continued to give her more pain meds. 27 hours of painful groggy labor. She could not even hold her baby once he was born, she was too drugged. SHE is the arbiter that drugs should not have been used. She has a lot of anger and guilt about her labor. Right after he was born she said she would never have another baby again. Thankfully after learning it can be different she has said she will have more babies, but only if I am by her side. this time.

          • anion

            You stated above that your friend OPTED for pain meds before the pain even began. Now you’re implying she was given them against her will? Why did she continue with narcotics when she could have had an epidural?

            Yes, your friend is the arbiter of whether or not she receives medication, and she CHOSE pain meds. That she didn’t enjoy those meds (as in them not working) isn’t someone’s fault and it doesn’t mean no other mothers should have pain meds. I did, and they worked wonderfully.

            I frankly have a hard time believing she was kept on a narcotic drip for 27 hours, and I suspect that being awake and in labor for that long contributed greatly to her grogginess, but I’ll take you at your word there (I’ll also take you at your word that she was offered pain meds when she denied pain, though it sounds strange to me.)

          • LibrarianSarah

            That’s the funny thing about anecdotes. They can be completely made up and if true only tell one side of the story.

          • Dr Kitty

            Or, perhaps she needs to use a DIFFERENT type of pain medication that would work better?

            If she had IV remifentanyl last time maybe she ould try pethidine this time.

            If she had Entonox last time, maybe she should have an epidural this time.

            If she had an epidural last time, maybe they could switch up the mix from last time.

            The choice isn’t meds bad/no meds good. She should probably see an anaesthetist to discuss WHY the meds she got weren’t effective, and what would be better options for her next time.

            Just a thought.
            Speaking as someone who has idiosyncratic drug reactions, but has now worked out what works really well.

          • Faredae Audrey Miller

            It is totally up to her. They used several different drugs. Epi first then I.V.Nothing worked for her. She just felt drugged and tired. She has chosen to opt for natural next time around. If she changes her mind, that is her choice. I will be by her side no matter what!

        • GuestB

          People who have no education in obstetrics telling other women how they can and should give birth? Now THAT is really sad to me.
          ps – forgive me if you do have medical training. But I’m guessing you don’t.

    • castyourshadow

      You said it ..”the way birthing is to be done”. Implying there is only one acceptable way. Can’t you understand how immature this statement is and how it demeans/judges other women who don’t choose an all-natural birth? Congratulations! You just exemplified exactly one of Dr. Amy’s fundamental issues with NCB’ers. That it sets a standard to which all women should try to adhere regardless of how meaningless or risky that standard is. One problem I have with this movement is how this self-aggrandizing agenda reflects on women who can’t have babies or who choose to adopt. If they adopt a child are they not ever going to experience love and bonding like the birth mother would (since the birth mother in a lot of cases bonded so well with her baby that she decided to give it up for adoption)? I think women who choose to adopt a child should be held in equal or even higher esteem than women who chose to have their own babies for two reasons….1- They are selflessly choosing to care for, love, and raise a child who otherwise would not have a home or family. 2- NCB /breastfeeding plays zero role in their lives as a devoted and loving mother and clearly shows it is NOT a prerequisite to being a good mother or parent to a healthy and well cared for child as the movement advocates would have us all believe.

      • Lizzie Dee

        I can’t see that having a child whether in the usual way or by adoption is in any way selfless – quite the opposite. However I do think the love for that child can become selfless. But what is it that we love? The image of ourselves as mothers, a reflection through family genes, or the child as an individual? The idea of that love being less than or defective because some bonding ritual wasn’t perfect seems to me either a delusion caused by anxiety or a very sad reflection on the capacity to love.

    • MamaNaturesWrath

      Tell that to my friend who died giving birth, naturally. Or to my intelligent, athletic, healthy younger brother who is only alive because of an emergency C-section when, after 36 hours of labor and countless hours of pushing, they realized his head was literally too big to fit through my Mom’s birth canal, and he was a couple of minutes away from irreparable brain damage or death. Or to my friend with whom I spent the whole day today (and her BEAUTIFUL little baby girl who is alive and healthy), who, in spite of wanting to go natural and had a midwife on hand the whole time, also ended up needing an emergency C-section because her little girl was breach and had the cord wrapped around her neck 3 times. As Dr. Tuteur notes, childbirth is not inherently safe. Historically (and currently, in less medically developed parts of the world), it has claimed countless lives of mothers and babies alike. I’m all for trying to go natural, if that is your choice, but it is naive to outright deny the advancements in medicine, and women should always keep the option of interventions open, for the safety of both mothers and babies!

      • Faredae Audrey Miller

        you are so right, it is HORRIBLE to DENY medicine if it is needed. And yes, there are times when it is needed. But in some cases what was really needed was proper education PRIOR to labor. Educate women on what to REALLY expect. How to handle situations that may arise and when to let medicine step in if needed. It is truly sad that women and babies suffer because natural childbirth and medicine cannot seem to work TOGETHER. Most women can birth naturally if educated and supported properly. But there are times when medicine is a must. It amazes me how we educate ourselves on buying cars and houses and work, yet when it comes to having a baby we go to the nearest hospital and use whatever dr there is. Parents need to understand they do have choices. I am very sorry to you for your loss of your friend. ~Blessings

        • Karen in SC

          wow, you would deny pain relief? Educate all you want, labor hurts most women in HORRIBLY.

          • Faredae Audrey Miller

            I never said I would DENY any woman of anything SHE chooses. I believe it is a woman’s decision on her own. I simply believe women are taught too often that it is painful beyond what they are capable of handling. I do not believe that to be true. Our bodies are designed to give birth to babies. Period. I believe educating women on how strong they are, we are all lionesses at heart. If we are supported and taught how to manage the pain then we learn to move through it. I do personally feel that many women who are so strongly against natural childbirth are speaking out from a place of guilt or anger. I am not the type of natural childbirth educator that I tell women they were wrong or bad for doing it any other way. I believe as long as a baby is born into this world with the intent of love, then it is exactly as it was meant to be. I only hope to inspire women to know all of their options, all of the possible side effects of interventions, and prepare them for months prior to labor. It is really sad to read all of these comments and how many of them are angry or judgmental. Can’t we all just share experience and opinion without lashing out at each other. ~In love and light~

          • The Computer Ate My Nym

            It is really sad to read all of these comments and how many of them are angry or judgmental.

            I’d say that it is entirely right and appropriate to be angry with people who give out life threatening advice. Go read “Hurt by homebirth” before you spout off about how “natural” and “safe” birth is again. Or even better read some of the posts here on women who didn’t make it through childbirth because they had a homebirth. The experiences of these women and their loved ones is not one I’d like anyone to share.

          • Faredae Audrey Miller

            Nor would I. You can read stories about women who have had horrible experiences in hospitals too. And my heart goes out to all of them. This is my point! No matter how or where you give birth there can be horrible outcomes. Which is why we all need to quit fighting against each other and learn to work together to provide supported, safe, calm birth for all moms.

          • But supporting safe, calm birth for all mothers involves helping them have correct information about the risks and benefits of different choices, and that’s what it sounds like you’re against. You write as though you want only the happy nonsense promoted that says mothers choices can cause them to suffer interventions but that deaths and bad results are inevitable and would happen no matter what.

          • Amy Tuteur, MD

            Do you realize that you are parrotting the racist, sexist fabrications of Grantly Dick-Read? He wanted to convince women that childbirth pain was all in their heads, so he insisted that they were socialized to believe childbirth was agonizing and excruciating.

            But childbirth pain is not in women’s heads, and the whole theory is inane. Who teaches anyone that childbirth pain is beyond what they are capable of? You’d have to be an idiot to believe that women are unaware that most of the mothers who have ever lived have given birth without pain relief and most of the women around the world who give birth everyday do so without pain relief. The issue is not whether women CAN do it. Anyone can do it. The issue is whether women want to do it and most women don’t want to experience excruciating pain if they can avoid it.

            The irony is that you are the one who has been taught to believe something that is not true. You are the one who gulllibly believe that crap fabricated by natural childbirth and you don’t even have a clue. Why should anyone be inspired by someone like you who has been utterly duped?

          • Faredae Audrey Miller

            Once again I am being called names. Really, aren’t we adult women here. Can we have a true discussion. I am not an idiot. And I do not believe the pain is in a woman’s head. I do not know where you think you read that I said that. I have and will continue to inspire women. Just because you would choose not to handle the pain does not mean other women should be denied the right. I allow WOMEN to decide what they want. I do not tell them they can’t or should not be able to handle the pain. But I also do not tell them they are not allowed to have something for it. Obviously homebirth is different because it is not available. But it is still the choice of the parents to decide if they are going to birth at home or not. No one has the right to make that decision for them. Call me an idiot or duped, your words do not effect me in the woman I am. I know who I am and what my Spiritual path is. One thing you cannot call me is closed minded. I am open to at least hear info on all options, then make decisions based on what my research has found. ~Blessings~

          • DaisyGrrl

            “But it is still the choice of the parents to decide if they are going to birth at home or not.”

            I agree. If they are given proper information prior to deciding on homebirth. If someone is informed of the increased risks and the nature of those risks and still wants a homebirth, go ahead. For me, a 3-8x increase in the child’s risk of death is too much of a risk, even if the absolute number of deaths is still small. I suspect that most women who chose homebirth are not properly informed of ALL the additional risks they take on when they opt out of the hospital. And that makes me sad and angry.

          • anion

            No one is advocating forcing women to have pain meds when/if they don’t want them. No one. I don’t know where you’re getting that impression. Nor are we insisting that women who don’t choose pain meds do so because they are “uneducated.”

            You, on the other hand, have said repeatedly that you think women get pain meds because they’re uneducated and don’t know what to expect, and that if they *were* educated they’d have no problems delivering safely without meds. That is, as I said in my first reply to you, rude, insulting, and derogatory. It implies–and I believe you pretty much outright said–that women show up at the hospital in labor with no idea what’s happening to their bodies, as if pregnant women and/or women trying to conceive don’t bother reading a word about pregnancy and birth through the entire time, as if they’re just silly little lambs allowing their OBs to pat them on the head and send them along without even speaking to them about anything pregnancy- or birth-related.

            Equating choosing medication with ignorance is insulting. You keep insisting you haven’t insulted anyone and never would, but you have done and continue to do so every time you tell us that choosing medication = uneducated.

          • Faredae Audrey Miller

            Maybe me using the word educated was a bad decision. I don’t mean women don’t know what is going on. What I mean when I use that word, is truly knowing what all the side effects are of each intervention, what percentage of c-sec that hospital has, what choices they have as far as what is done to the baby at birth, etc. These are questions that many women do not know to ask. (based on my experience) When I say women need to be educated I don’t mean they are dumb. I mean they need to be given all the information so they can make a decision based on ALL the information. This goes both for OBs and midwives. A good midwife or OB will provide this information. Unfortunately, many do not. I do not think women are dumb for choosing meds for pain. (or weak) It’s their choice. But in my experience I have found some doctors encourage the drugs. And I do not believe they should. Anymore than a midwife should discourage if a women wants them. That is all I meant by my term “educate”. All that word means is to give instruction or information. It does not mean I assume women are dumb. I just assume most are not experts in childbirth. So they need to be “educated” on what happens during labor. I hope you see what I mean by this and understand now that I did not mean to offend with that term.

          • I have read the risk factors for all the common interventions. Unlike you, I’ve also read the risk factors for not having those common interventions.

            If I was truly interested in the safest possible experience with the least possible side-effects, I’d go for a maternal request C-section every time. Vaginal birth is full of hideous complications. I like my pelvic floor.

            EDIT: Note, I’m not pregnant nor have I been. I intend to in future times, though.

          • Male doctors used to tell women that menstrual cramps were all in their heads too, because obviously something natural couldn’t possibly hurt. There’s a long history there of undervaluing women’s pain :/

          • The Bofa on the Sofa

            The pain of childbirth was recognized as being so severe 3000 years ago that it was attributed to a punishment from God – whoops, I mean, “The Intelligent Designer.”

          • Faredae Audrey Miller

            Sorry, but that is a Christian belief. NOT my Spiritual belief.

          • The Bofa on the Sofa

            But it shows that the pain of childbirth is not some fabrication and due to lack of “management.”

          • Karen in SC

            You are entitled to your beliefs. They are not the same as FACTS.

          • The Bofa on the Sofa

            I only hope to inspire women to know all of their options,

            Who says they don’t? Poor, foolish, ignorant women, right? Too stupid to know what they are doing. Good thing you are there to save them.

          • Faredae Audrey Miller

            Wow, I give up on this conversation. I am only trying to be a good woman, helping and supporting other women. I NEVER call people stupid, ignorant, idiot, foolish etc. MANY women do not know all their options. This does not make anyone ignorant. None of us knows everything. I don’t know much about cars, so if I need something done with my car I go to a specialist to get educated on what my options are and I find someone I BELIEVE will provide the best service. So why should we not do the same when we are having a baby. Admit we do not know everything and do research to find what fits our needs. I don’t know what your deal is that you feel the need to twist what I say so you can prove the I am a bad person because I advocate for natural childbirth. Enjoy your day.

          • The Bofa on the Sofa

            If you don’t think women are ignorant, why do you need to educate them?

          • Faredae Audrey Miller

            We all need to be educated! You are going to tell me you know everything about everything?? When you make a big purchase don’t you educate yourself on your best options? I am not talking about going to school to get a degree, I am talking about learning about childbirth. We don’t learn about it (I mean ALL about it) in school. So when you get pregnant, you go to a Childbirth Education class. THAT IS EDUCATING!

          • moto_librarian

            In retrospect, my childbirth education class was a joke. It was filled with the typical NCB misinformation. I would have been far better off to simply stick to reading my copy of What To Expect When You’re Expecting.

          • Burgundy

            totally agreed!

          • Faredae Audrey Miller

            That makes me crazy too! I want to give parents all the information, (even the stuff I would not personally do) so they can make their decision with all the info. It’s not fair to parents to make choices when they only have half the info. That is why I really want to work with birthing centers. And I highly recommend them to expectant parents. They provide the best of both worlds. ~Gratitude~

          • Burgundy

            Faredae, you do realize that we have parents here lost babies (preventable causes) due to NCB in a birthing center right? A birthing center did not provide the best of both worlds because if shit hit the fan, there is no NICU available down the hall.

          • Jocelyn

            I thought that birthing centers sounded like a nice middle ground between hospitals and home birth, too, until I started reading this site and the site “Hurt by Homebirth.” My eyes were opened. Birthing centers, to quote “Hurt by Homebirth,” are not a middle ground. They’re simply like giving birth in someone else’s home. And statistics from the last couple years back that up – birthing centers have higher rates of death than hospitals.

          • The Bofa on the Sofa

            So wait, you are now a childbirth educator?

            I went to childbirth education. It was taught at the hospital by an L&D nurse.

            Afterward, I commented that I was surprised that we didn’t learn more about breathing etc. She said, 90% of the women just get an epidural anyway, so she doesn’t dwell on it. She never told us to get an epidural, nor to not. We actually saw videos showing each, and she told us what happened if you get an epidural or if you undergo c-section.

            For some reason, my childbirth class was NOTHING like the pretentious shit that you spew out.

          • Burgundy

            i wished that I had your childbirth class. Mine was a total joke.

          • Faredae Audrey Miller

            Because not all women know everything about childbirth. Do you know EVERYTHING about childbirth? Most likely no. So your DOCTOR will REQUIRE you to go to a childbirth education class. Ask anyone on here! So ALL pregnant women go to a class to get educated! That’s what I do! Are you seriously this bored with your life?

          • The Bofa on the Sofa

            So the answer is, yes, you think they are ignorant, and you to the rescue because you know so much more than they do, right?

          • Faredae Audrey Miller

            I’m done with you. Peace!

          • The Bofa on the Sofa

            Promise? I mean, I think you’ve said that 4 times to me now. I mean, you keep saying you are going to leave. Others keep telling you to leave. Yet, you keep responding.

            And you accused me of needing drama (you think this is drama? It’s mild)

          • MaineJen

            Funny enough, I DID go to an expert when I was having my kids. Her title was “OB/GYN” and I believe she spent a number of years in medical school ‘getting educated’ on pregnancy and childbirth. She didn’t sway me one way or the other on my delivery options, she simply told me my options and asked me what my preferences were, where possible. And didn’t offer any value judgements on better/worse. And didn’t try to talk me out of pain management. And made sure I and my baby were healthy. I wonder why this model of care is so popular??

          • moto_librarian

            I learned all of those “coping” techniques for labor. They didn’t work AT ALL once I was in transition. You keep saying that women are lionesses. I guess I did feel like an animal while pushing without pain relief – a cornered animal, forced to whelp. And yes, I am speaking from a place of anger. I was LIED TO by the NCB movement, and I will not stand idly by and let you continue to lie to women. Safe, effective pain relief is available now, and I see no reason to actively discourage women from availing themselves of it.

          • The Bofa on the Sofa

            Yep, women all have their inner lionness. And if you succomb to the pain, you have failed to let your inner lionness take over, and are just a weakling.

            It’s the old passive-aggressive nonsense. “I’m not criticizing anyone, I’m just saying that we all have the ability to overcome the pain, and if you don’t, it’s because you’re a failure and/or broken. Hugs all around, sisters!”

          • Faredae Audrey Miller

            You put words in my mouth. I have never said women who use meds to manage pain are weak. Any woman who carries and births a baby (no matter how she births) is a strong beautiful lioness! And I honor every single one of them. I don’t judge people based on their decisions and beliefs.

          • The Bofa on the Sofa

            I have never said women who use meds to manage pain are weak.

            No, you just said that woman should be strong, use her inner lionness and not use meds.

            So if a woman decides that the pain is too much, it must mean that she is not strong nor using her inner lionness. I mean, why would anyone interpret that as meaning she is weak? Aside from the implication that she is not strong, I mean.

            This is what we are telling you. You don’t even realize what you are saying, but your message is clear. Strong women don’t need medication. Thus, if you get pain meds, you are not strong.

            Women are designed to give birth. You even insist on intelligent design. Thus, if they are not able to give birth, it must be because they are broken (it’s not the design’s fault; just like when my car doesn’t start, it’s not the design fault, it’s that the ignition switch is broken)

            Your language is completely loaded. You don’t have to come out and say it without your message being sent perfectly clear. And it is received, make no doubt.

          • Faredae Audrey Miller

            Some women choose to use meds and some choose not to. Does not make one better than the other. I don’t know what lies you were told, and I am truly sorry you were lied to. But not all NCB advocates are the same. Just like not all OBs are the same.

          • moto_librarian

            Are you really that dense? You are part of the problem, spouting off all of you bullshit about how “moving through labor” is effective pain management. Did you read my initial comment? I nearly died from a relatively rare complication after a “textbook” natural birth!

        • anion

          I find your assumption that women only choose pain relief because they don’t know any better insulting and rude.

          Here’s something you may not have thought of: Those of us who chose hospital births and pain medications did so *because* we are educated; because we know what can go wrong, and because we don’t feel the need to endure pain needlessly. Would you deny pain relief to someone with a broken, for instance, because their bodies are MADE to heal themselves? Or is it just women in labor whom you think should endure pain?

          I took the natural birthing class at the hospital where my first was born, which was offered free to all women planning to deliver there (whether they wanted interventions or not, and if they didn’t the hospital certainly wouldn’t force it on them). You know what they taught me? That none of that silliness was going to do me one bit of good, and that I wanted an epidural STAT. I knew “what to REALLY expect,” (I do silly things like read books and ask questions, because I’m not a fool) and frankly wanted no part of it. I wanted a baby, not a “birth experience.”

          I had two c-sections, the first unplanned. I have zero complaints about any of it. I don’t appreciate your assumption that I’m so dumb I chose hospitals, interventions, epidurals, and c-sections because I didn’t know any better, or that I must be unhappy because I didn’t push a baby out of my vagina, as if that is somehow superior to all else.

          Women don’t choose epidurals because they’re uneducated. They choose them because they want them, because labor and childbirth hurt.

          • Faredae Audrey Miller

            And you have the Divine right to all those choices. I have never said DENY anyone of anything. I have different opinions on this than you. That is my Divine right. I am so happy you are satisfied with your experiences. Many women are. Just like many women who opt for natural birth are satisfied. You can find happy and unhappy with either birthing options. I personally choose to have a birthing experience. That is my choice. But some women do not choose that. I do not tell them they are wrong, or call them names (as I have been called on here) I support their decision. I am truly sorry if I offended you, it was not my intent. I thought this was a discussion but I am quickly learning it is not. ~Blessings~

          • MaineJen

            “I personally choose to have a birthing experience…But some women do not choose that.” Wow. Passive aggressive much? I had 2 birthing experiences too, and they were lovely. I progressed into transition during each of them unmedicated, and then both times, I had a lovely epidural and experienced the delivery pain-free. That was the experience I wanted, and it’s no more/less valid than your experience. And if you’ll notice, none of your comments are being deleted, and your statements are being responded to. In my book, that’s a ‘discussion.’ In a discussion, not everyone has to agree with you.

  • Aunatural

    Not every mom can be strong willed as us natural mamas. Keep bashing, your guilt is showing..

    • Amy Tuteur, MD

      My guilt? Why would I feel guilty?

      • LibrarianSarah

        Because you didn’t do things her way silly!

    • Amazed

      Get off the comp, you unnatural creature. Write us a letter and had couriers carry it around.

      • LibrarianSarah

        A letter are you mad? With paper and ink made out of CHEMICALS and OMG TOXINS!!!!1

        What she needs to do is assemble a pile of twigs, wait for lightning to strike the pile and make smoke signals with the resulting fire.

        • Amazed

          Oh my god, oh my god, oh my god. I didn’t think of that. It never occurred to me. I am a danger to the natural world. I am clearly certifiable. Someone calls the psychos (although word has it that they are crazier than their patients).

    • Lizzie Dee

      Are you for real? Do you actually formulate a thought in your head that tells you that people feel guilty because they are not as strong willed/wonderful as you? Without any guilt of your own or self awareness? Amazing!

  • Guesteleh

    Also, where are all of these parachuting posters coming from? Who linked to Amy?

  • Guesteleh

    If “Anna” is a real PhD or a criminal psych, I will eat my placenta.

    • KarenJJ

      She could certainly cite her references for starters.

  • Anna

    Understand that I do not consider myself superior having gone through two natural labors. I do not think any less of women who has opted to go with an epidural, and especially not those who have had no choice but to have a C-section. I am only having a hard time understanding the adamant nature of this article. That is all.

    • Bombshellrisa

      “Understand that I do not consider myself superior having gone through two natural labors” Good, you and Dr Amy both.

    • Box of Salt

      Sorry, Anna: “Understand that I do not consider myself superior having gone through two natural labors.”

      You had already posted “We can’t all be that awesome…”

      Now you are trying to back peddle. It’s not working.

    • Wren

      You don’t think any less of them but you believe they ” will never have that bond with their children”.
      Hahahahaha
      At least *try* to keep your story straight from one post to the next please.

    • KarenJJ

      ” I am only having a hard time understanding the adamant nature of this article. That is all.”

      Try reading the Hurt by Homebirth blog and some more of this blog and then think about what women are being told by some Childbirth Educators. Try doing this with an open mind to alternative viewpoints to your own and with empathy for the parents who felt misled and duped by convincing sounding “professionals”.

      Then you might be able to come to some understanding. Many people here have had natural childbirths and people here are of different sexual orientation. Try considering your insults and stick to the arguments and not the people.’

      And have fun. This is a great site if you like to discuss and debate. We can be a bit blunt but we do like a good argument if you’ve got one.

  • Anna

    You sound like a bitter person who couldn’t handle natural childbirth. It’s ok. We can’t all be that awesome…

    • Amy Tuteur, MD

      Wrong.

      And you sound like a person who has so few accomplishments that you’d like to pretend that unmedicated vaginal birth is some sort of achievement. Sorry, but it isn’t.

      • Anna

        I have many accomplishments in life. I have my PhD in Psychology and actually use it in a lucrative aspect of the field. While I do not condone studies on animals, I understand they must be done, and one particular study that caught my interest was one done on mice and labor. It was shown that the mice that had given birth through a C-section, or with the assistance of an epidural, did not bond with their young as the ones who gave birth naturally did. I feel sorry for the women who will never have that bond with their children.

        Telling women that natural labor is not the route to go is like telling our youth that they should just text their friends on their iPhones instead of picking up the phone and calling them. Modern technology is ruining us, and you’re a fool for falling for it.

        I have read so many articles of various arguments people make that I have found to be a waste of time, but never have I seen somebody concluding that natural childbirth is not “good for you”. It’s absurd. I declare you bored and bitter.

        P.S. I still have two years until I reach 30, and I feel this gives me a reason to still act like somewhat of a child. That being said, have you ever even given birth, let alone have had a penis inside of you? Methinks you don’t swing that way…

        • Amazed

          I knew I had a reason to think that psychologists face far more psychological problems that those they supposedly counsel.

          My brother still has 3 years until he reaches 30 and believe me, he is a man. I would guess that a 28 year old would want to be a woman. Well, to each her own.

          • Anna

            I’m not a Psychologist. Not the type that you’re thinking, anyway. I don’t see patients. I’m in Criminal Psychology.

          • Amazed

            Good. I was already fearing for anyone being counseled by a grown-up woman who likes to be a child and lacks in reading and comprehension skills. Or do you suffer from selective blindness? Maybe that was the reason you were unable to read the little black lines in the left?

          • realityycheque

            I’m a similar age to the commenter (younger, in fact) and I have absolutely no desire to act like “somewhat of a child” and certainly wouldn’t try to use my age as an excuse to do so.

            I’m an adult. I’m a parent. My childhood and teenage years are over, period. I let my hair down from time to time just like everyone else, but there comes a point in time when you need to get your shit together and take responsibility for your actions.

          • Box of Salt

            “take responsibility for your actions”
            And your words.

        • Amy Tuteur, MD

          “one particular study that caught my interest was one done on mice and labor. It was shown that the mice that had given birth through a C-section, or with the assistance of an epidural, did not bond with their young as the ones who gave birth naturally did.”

          Really? What study would that be?

        • Box of Salt

          Anna, I feel sorry for someone who can’t tell the difference between a human woman and a mouse, and who thinks it’s clever to use sexuality as an insult.

          • Anna

            Mice are intelligent creatures. Hence why most studies to reflect human nature is done on them.

          • Squillo

            Why would one not conduct a retrospective study on humans to look at bonding?

          • Box of Salt

            Squillo, you mean like this one?
            http://link.springer.com/article/10.1007/s00737-010-0169-z
            Title: “The experience of labor, maternal perception of the infant, and the mother’s postpartum mood in a low-risk community cohort”

            And, no, I didn’t buy the article, so I am guilty of posting an abstract of something I haven’t read.

            I’d be interested in how many of the ceseareans were elective vs emergency, and how that affects the issue – especially as the assisted vaginal deliveries also reported higher depression rates than the vaginals (but not interested enough to spend $40).

          • Squillo

            Bingo. And I’ll bet it’s not the only human study. The abstract is a bit of a disaster, though, isn’t it?

          • Box of Salt

            Like the laundry list of confounders?

            I wish I still had easy access to a good library.

          • realityycheque

            Wow… you have a PhD and you actually believe “intelligence” is the reason why mice are so frequently used in studies. How embarrassing for you.

          • AmyM

            Yeah, I work with mice every day. They have yet to show me shining examples of their intellect. For example, they have failed to invent anything, like art, and they have several materials available in their cages with which to do so. And plenty of time, as they are fed, and do not need to expend energy on looking for food.

          • auntbea

            I had a pet rat who used to run all over the house picking up stray bits of things and collect them in a pile. I suppose it could have been a nest, but it might also have been sculpture!

        • Wren

          A teeny tiny bit of research would answer your question in the PS. Methinks you cannot be bothered to support a single opinion you hold.

          If you actually care about this topic, plenty of women, myself included, have had children in different ways and managed to bond with them all. Shocking as this may be to you, I am just as bonded to my C-section delivered first child as I am to my epidural-free VBAC delivered second child.
          Of course, I like texting and enjoy modern technology, like the internet, rather than believing it is ruining us.

        • Squillo

          Strawmen, ad homs, and irrelevancies, oh my!

          • realityycheque

            Don’t forget Appeal to Authority! This is Logical Fallacy Bingo! Wondering if it’s too early to do shots…

        • Ann

          This comment is so offensive that methinks you are a troll. What a horrible ad hominem attack implying that it is somehow shamefull to be childless or a lesbian. Your PhD clearly hasn’t taught you to refrain from homophobia or bigotry. And FYI: Dr Amy is a married heterosexual mother of 4. Not that it should have any bearing on the validity of her opinions. A womans worth is determined by her character, not by what goes in or out of her vagina, as you seem to believe.
          About that study you are citing: please do provide us with a reference and additional evidence to support your theory that it can be extrapolated to humans.

  • Emlemur

    These statements are lies. However, my natural childbirth instructor never said these things, so I feel this argument is a straw man. Here is what she said instead: 1) childbirth is natural, but sometimes things go wrong. This is where modern medicine shines. 2) You will probably experience both fear and pain in childbirth. Here are some techniques to help you cope. 3) see #2. 4) All forms of medical pain relief disturb the natural hormones of childbirth and all of them can have side effects. Here is information on common side effects. Here are situations where you might want/need to use them. 5) It’s best if labor can start on its own, but sometimes there is a situation that prompts an induction. Because of side effects, an induction solely for convenience’s sake should be avoided. 6) C-sections are needed in some situations. Interventions increase the likelihood that a c-section will be needed where it might not have been before. If you need a c-section, get one. Be aware that c-section increases the number of potential complications in future pregnancies and gives you a longer recovery period. 7) Vaginal birth is safer when everything is going well. Here are some exercises and meal plans that can make your pregnancy lower-risk so you have a better chance of everything going well. 8) Women who love their babies take care of themselves during pregnancy and gather all the information and help they can regarding both birth and child care.

    I’m doing a drug-free childbirth in a hospital with a family physician and a doula attending (as well as all the wonderful l&d nurses). If everything goes according to nature’s plan, I truly feel that I will have minimized my risks for unwanted side effects. If something goes wrong (because there is real danger in childbirth), I have medical professionals and an OR just yards away. I have no illusions that this will be painless. Nor do I think that any intervention might hurt my child. I am just doing all I can to minimize risks.

    • Amy Tuteur, MD

      “All forms of medical pain relief disturb the natural hormones of childbirth”

      But that’s a lie, too.

      ” Vaginal birth is safer when everything is going well.”

      That’s not true. C-section is almost always safer for the baby.

      “Women who love their babies take care of themselves during pregnancy and gather all the information and help they can regarding both birth and child care.”

      That’s BS. Gathering information has nothing to do with anything. And there are plenty of women who love their babies but can’t or don’t know how to take care of themselves.

      • Emlemur

        Is it not true that medications interfere with birth hormones/processes? All the studies I have read have said that they do to some extent.

        It is true that I have read that c-section is safer for the first baby than vaginal birth (provided it is performed when the baby is fully mature). However, it increases the risks for complications with subsequent pregnancies. I have also read that c-section increases the risk of maternal death over vaginal birth.

        Yes, women who don’t know how to take care of themselves love their babies. It would be best to say ‘women who love their babies do the best they can/know how to.’ But that’s not what my instructor said.