Unnecessary epidurals? Maybe on Planet Midwifery, but not in the real world.

extrasolar planet on star background

Good, old Hannah Dahlen. I can always count on her to say something idiotic that gives us insight into hijacking of midwifery by biologic essentialists. Those are the women who think a woman’s vagina, uteri and breasts are more important than her intelligence or her comfort.

You remember Dahlen? She’s the spokesperson for the Australian College of Midwives who has given us such gems as:

A common concern with water birth is that the baby could try to breathe underwater and drown. But healthy babies have what’s called a diving reflex (or bradycardic response), which causes the infant to hold his breath when under water. The reflex is stimulated via the the infant’s facial skin receptors, which detect the water and inhibits breathing.

Sorry, Hannah, the diving reflex works only in COLD water. Anyone with a modicum of obstetric knowledge knows that babies are happy to aspirate warm fluid. That’s why they do in utero to expand their lungs and practice breathing before birth.

And, my personal favorite:

While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

Really? On what planet would that be?

Apparently that’s the way it is on Planet Midwifery where Dahlen and her colleagues reside, a through the looking glass world, where the acme of childbirth is not a healthy mother and healthy baby, but, rather, an unmedicated vaginal birth.

What’s Hannah come up with today?

Dahlen is incensed that any woman might value avoiding a lifetime of urinary and fecal incontinence over the ultimate achievement of unmedicated vaginal birth.

Dahlen, in a comment to the Australian newspaper WAToday, is responding to speech by Dr. Peter Dietz who is a urogynecologist. That means that he spends his professional life in large part repairing the damage from vaginal births. Dr. Dietz told a recent meeting the Royal Australian and New Zealand College of Obstetricians and Gynaecologists that women are suffering substantial pelvic floor damage in the quest for natural birth, because vaginal birth carries a risk of 30 per cent to 50 per cent of substantial pelvic floor damage.

Major pelvic floor damage can result in years, if not a lifetime, of misery. It can mean being unable to hold urine and feces, being unable to leave the house because of embarrassment and being unable to have sex.

But apparently on Planet Midwifery, that’s far less important than having a baby transit your vagina.

According to Dahlen:

There is no doubt pelvic floor injuries are a threat to the health of child-bearing women. It is imperative we continue research in this area and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.

Umm, Hannah, you apparently do not realize that we have “done research” in this area and the research shows that vaginal birth is the single biggest risk factor for pelvic floor damage.

But who cares about something as trivial as incontinence, right?

Dr. Dietz also criticized the effort to reduce epidurals, calling it, correctly, “reprehensible and anti-Hippocratic.”

Dahlen responds with this bit of nitwittery:

There is no intent to deny a woman an epidural if she wants one; we need to ensure they are not used unnecessarily.

Wait, what? They’re giving epidurals to people who aren’t in pain?

That can’t be what Dahlen means. After all, epidurals are widely used in other areas of medicine like general surgery, orthopedic surgery and management of chronic pain. Dahlen doesn’t mean those people. I’m sure she thinks it’s just fine to use epidurals ease surgical pain or cancer pain. No, Dahlen thinks it is “unnecessary” to treat childbirth pain.

Why? Because it might lead to something other than the pristine unmedicated vaginal birth so valued on Planet Midwifery.

And then there’s this, infinitely more revealing about contemporary midwifery than it is about anything else:

Dr Dietz’s statement that ”human childbirth is a fundamental biomechanical mismatch, the opening is way too small and the passenger is way too big,” provides a real insight into why the caesarean section rate may be so high in this country.

If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?

Because on Planet Midwifery, the most powerful force isn’t gravity, it’s magical thinking.

Earth to Planet Midwifery: do you hear me?

Listen carefully:

There is NO SUCH THING as an unnecessary epidural. Childbirth epidurals are always and only given to women who have so much pain that they want one.

A midwife has NO BUSINESS deciding whether a woman “deserves” to get an epidural. We have a word for that behavior; it’s paternalism, and it’s reprehensible and un-Hippocratic.

Confidence has no more impact on a woman’s ability to have a vaginal birth than it has on her ability to have a child of a desired gender.

Women need to understand that midwives like Hannah Dahlen do not have their interests at heart. How could they when they don’t care if babies die, when they don’t care if women become incontinent and when they don’t care if women are in agonizing pain? Midwives like Dahlen care about one thing only: themselves and their associated ability to maintain control over patients.

Midwives aren’t as capable of obstetricians at saving babies lives; hence “perinatal mortality is in fact a very limited view of safety.”

Midwives can’t prevent pelvic floor damage by performing C-sections; hence incontinence pales in importance to vaginal delivery.

Midwives can’t perform C-sections to save the lives of babies in distress or deliver babies who are too large to pass through the pelvis; hence they pretend that it is doctors’ and patients’ “lack of confidence” in women’s bodies that keep midwives from ensuring a vaginal birth for every patient.

The questions for women are these:

Do you want to give birth on Planet Midwifery, where your vagina is more important than your brain, where your pain is ignored and where you are blamed if you do not achieve the ideal unmedicated vaginal birth? Or do you want to live in the real world where people care about whether your baby lives or dies, whether you are rendered incontinent, and want to ease your agony, not celebrate it? It’s up to you to decide.

  • Susana

    Thank you so much for this article. I live in Belgium and midwives around here are also very much against epidurals. Luckily, I managed to avoid them and both my deliveries were (almost) pain free, thanks to the epidurals. What I fail to understand is why are midwives so much against this. Is it because they may loose their purpose? These women need to stop imposing their will on women. If I was in charge, epidural should be mandatory.

  • Leara

    OMG FINALLY someone else who sees it. I’m in Australia and have NEVER managed to get an epidural, even when I had twins. The midwives TRICK women out of it by saying we have to wait until 5cm dilation, then NOT phoning the doctor for an hour or more, then saying it is “too late now’. I freaking HATE midwives, they are control freaks who weren’t intelligent enough to be obstetricians. I wish you could deliver my baby. Seriously.

  • Lucy

    I agree with your indignation about home births and a midwifery model that prioritises a philosophy over the health and safety of mother and baby. But I live in Australia. My sister is a midwife and my husband a high ranking health bureaucrat. My sister gave birth in a hospital, as did I. And I can confidently tell you that while there are hostilities between midwives and obstetricians, the vast majority of midwives in Australia practice in hospitals and believe that medical interventions save lives. So I can’t help but wonder if you have attributed a certain ‘shrillness,’ to Dahlen’s comments that I have generally found to be missing in the debate in Australia.

    • guest

      I also live in Australia. Dr Amy’s assessment of Dahlen is spot on. Dahlen is an idiot.

      • Leara

        Yes and I second that. I am thrilled to find this post while googling why the hell I cant ever get an epidural!!

  • Catherine, Melbourne

    “Dr Amy” your unprofessional vitriol really discredits your opinions. Such an unbalanced agenda and crusade does women a disservice and adds nothing to very important conversations. Obstetricians can and do work very well with midwives in a respectful and collaborative manner. You do not speak on behalf of doctors and obstetricians, and to purport to do so is disingenuous.

    • Karen in SC

      Scroll down and read Annie’s story from Oz. Then you might understand where Dr. Amy’s point of view originates.

  • ax grinder

    wow you have an ax to grind. too bad your ax grinding is so loud the points you make can hardly be heard.

    • Amy Tuteur, MD

      Rolland, please stick to one screen name.

  • tweetchirp

    I’m a Canadian living in Australia who gave birth herein Australia 2 years ago. I was scared to death to give birth after seeing midwives throughout my pregnancy. (Midwives are public, OBs are private and expensive). I was terrified I would be denied epidural, which I knew I wanted.

  • SaanichMom

    I didn’t understand the battle in the US between doctors and midwives, and I will admit, I thought it was an ego thing or a money thing, but this article has help me to understand it.

    Where I live, in western Canada, when you find out you are pregnant, you choose whether to use your family doctor, or a midwife, for your prenatal care and birth. They are both covered by the provincial health plan, and I believe they get paid the same amount.They are both skilled and trained in childbirth. The midwives may be more experienced because they only do this one job, whereas the family doctors have a regular practice as well. I have not heard of doctors doing home births, but the midwives do hospital or home births.

    Regardless of which one you choose, if they feel you are at risk for any kind of complications during pregnancy, they refer you to an OB. If you show any signs of complications during labour, they will call in an OB, and if you are not already in the hospital you have to go there. I have never heard of anyone having a problem with a midwife assisted birth. I have not heard of anyone who had complications because a midwife waited too long to call in an OB, but if it happens sometimes, I doubt it would happen any more often than it does with doctors. If either one did that, they would be at risk of losing their licence.

    I am sure we have incompetent, poorly trained idiots, delivering babies in unsafe circumstances here as well, but now that certified midwives are covered by the health plan, I can’t imagine that these other ones are getting much business. My kids were born before the change, I paid $1500, 20 years ago. Who would pay for an certified midwife, when a certified one is free? They would not be allowed to assist in hospital births like the certified midwives can, and they could not order prenatal blood tests or ultrasounds. Our provincial surgeon general has even stated that she thinks home births are a safe alternative to hospital births for some people.

    I realize that our system could not be implemented in the same way in the US, but it works well for us.

    Having had one hospital birth and one home birth, I can say that one big benefit of a hospital birth, is that they don’t ever run out of hot water, so you can stand in the nice warm shower for a really long time.

  • SaanichMom

    I think that making your own informed choice is really the biggest issue. If the people who you are trusting with helping you through this very important and painful and emotional experience have an agenda that is anything other than finding the best way for you to end up with a healthy baby, then they should not be who you choose to have assist you.

    I had my first baby at 36 weeks, in the hospital, with a midwife and a doctor. I had a quick, easy, natural child birth. Baby was 6lb 4oz.

    My second baby was born at 42 weeks at home with the same midwife, and a back up midwife, and an apprentice. Baby was 7lbs 14oz. The midwives were both RNs. My midwife was very clear that she would not do home births with people that she believed would resist transfer to the hospital if she felt it was necessary. She said I had to get to 37 weeks and my iron had to be at a normal level. She brought with her all kinds of medications and tools and a big oxygen tank.

    My labour was very fast, I only had to push once, and he came flying out, they had to stop him to make sure the cord was not around his neck. I had some trouble with the placenta, it took a long time to come out, and just before it finally did, they were getting ready to call an ambulance to transfer me to hospital. I didn’t ever feel like we were in danger, I didn’t ever wish for painkillers. It was the right decision for us. We lived 4 blocks from a hospital, I could have walked there while they got an OR ready if needed. My doctor came to my house the next day to examine the baby, and the midwife came every day for a couple of weeks.

    This was 23 and 19 years ago, and I live in Canada. Our system is quite different than the US. I never saw an OB, no one does unless they are high risk or have an emergency. I had never been to a gynecologist, until a few years ago when my a had a prolapse. I have other health issues that make it much worse but I am sure that the extra pushing for that placenta was what weakened the area.

    I can’t imagine going through the birthing process with someone who I didn’t trust to make decisions based only on what was best for the health of me and my baby. I also can’t imagine having a home birth without the assistance of people who are well trained and experienced.

    That is one of the reasons I hired a midwife for my first birth in the hospital. We had hour long one on one appointments throughout the pregnancies. If I had needed any interventions during the birth, having a nurse who was there only for me, who could explain anything that I didn’t understand or who could help my husband make decisions if I couldn’t gave me an extra level of support. Also, not having to learn any breathing or panting or whatever you learn in those classes was not necessary because she could tell me what to do when I needed it. It was also great for my husband because he didn’t feel like there was a bunch of things he had to remember, he just had to be there with me.

    I would not choose to do it any differently, but I would never judge anyone for their choice to do it differently. I know that I have a high pain tolerance, I hate the way local anesthetic makes me feel, so I have as much dental work as I can stand done without it. I only take narcotic pain killers for pain that is too much to sleep through. I do like the IV sedation that the use during colonoscopy. It makes that unpleasant experience every 5 years bearable.

    I don’t understand why anyone would want to tell me that I need pain management if I say I don’t need it and I don’t understand why anyone would want to make someone feel bad for saying they need it.

  • Annie

    I’m an Australian who endured a birth on Planet Midwifery. Was denied a caesarean and an early epidural. The result, a ruptured uterus, a dead baby and the midwives suggesting it was my fault, I “could have done it” and it had nothing to do with them even though my daughters birth weight and size and my smallness indicated I truly did need a caesar. I obviously had one…an emergency, but by then, too late. I almost died from blood loss and shock. I’m only mildly urine incontinent but I can’t have any more children, my womb and fallopians are a mess of scars and I have terrible periods.

    • Annie

      Also, the nurses wouldn’t call the doctor because apparently I was “hysterical”… Yes, I was, in the, my baby will die kind of hysteria I think is allowed. Not shouting or screaming, but quietly pleading. I knew it was all going wrong and they didn’t listen to me, not when her heart rate dropped, not when there was meconium everywhere, not when they could see I was not progressing, that she was too big to move down let alone pass through the birth canal. No apparently, I had no idea and being hysterical meant all these bad things were happening and I should calm down and the low heat rate, meconium et al would magically go away.

      • KarenJJ

        Only in planet midwifery is it OK to deny a patient’s wishes for a second opinion and more medical care. I’m so sorry to hear this happened to you and your baby. I occasionally hear of this sort of thing happening in hospitals in Australia and I hope that midwifery organisations and hospitals are weeding out this patriachal (matriachal?) style of medical care. It’s not OK.

        Hannah Dahlen’s “Normal Birth” agenda should be chucked in the bin where it belongs. Go back to assessing patient satisfaction and health outcomes of mothers and babies and ditch the ideology.

      • Isramommy

        I am so terribly sorry for your loss and the abuse you and your child suffered at the hands of those midwives. And I am just so angry your behalf. I hope at the least you were able to pursue successful civil and even criminal action against the health care providers who killed your child and caused you such injuries. I hope the midwives who did this will lose their right to practice in Australian hospitals and the ability to inflict such horrors on unsuspecting women.

        Women in labor should never be ignored and disempowered so horrifically. Women in active labor become dependent on their care providers; you can’t get up and seek another hospital’ s services once active labor begins. To have a hospital based provider ignor your requests for medical assistance, ignore your request for a doctor, and then blame you for the outcome… it is just infuriating, criminal and unforgivable. Again, I am just so sorry.

      • Dr Kitty

        Annie, I’m so sorry for your loss.
        I hope you have been able to pursue all legal remedies available.

        Midwifery seems unable to reconcile two opposite beliefs.
        The first is that a labouring woman is in a liminal state called “labourland” and can’t be trusted to know or express her wishes and desires properly, so that whatever she says can be ignored if you disagree with it.
        Which is how you get MWs refusing analgesia to women who are literally screaming at them for it, or refusing to call Drs just because the woman asks for one.

        The second is that a labouring woman has special intuition, and that everything she feels and wants and needs is absolutely the BEST thing for her and the baby. So you can ignore mec and foetal distress if “mama” tells you that she “knows” baby is OK and even the most ridiculous birth plans have to be adhered to, even if the situation changes dramatically.

        Midwifery is slowly evolving from genuinely being “with woman” to a discipline consisting of procrastination (“we’ll just wait until 7cm and see how you manage before we call the anaesthetist”), manipulation (” you know, if we call the Dr you’ll probably lose the lovely natural birth you’ve planned”) and woo (“reflexology can really help in transition”). I am getting tired of it.

        • auntbea

          The beliefs are easy to reconcile when you realize it is the conclusion — no c-section necessary! — that drives the reasoning, rather than the other way around.

          It seems completely impossible that something like this could happen in a developed country in the 21st century.

      • Amazed

        I’m so sorry for your loss and what you have been through. It’s unforgivable. It should never have happened. Not on Planet Midwifery, not in the real world.

      • moto_librarian

        Annie, I am so very sorry for all that you endured. Please tell me that something has been done to these midwives to keep them away from laboring women and their babies.

    • Morgaine

      Oh…my god. Oh. My. Fucking. God. OH MY FUCKING GOD. I hope you let them know that they murdered your child and almost murdered you. It blows my mind that while we’re busy picketing abortion clinics or blogging about womens health or squabbling over when life begins, that clear cut, medieval bullshit like this is still happening. Oh my fucking god.

    • I don’t have a creative name

      “could have done it”? Could have done WHAT? Magically wished your uterus into not rupturing? I can’t believe this woo has gained such a hold in developed countries with access to the finest medical educations, and how many babies are dying needlessly because of it. I am so, so, so, sorry for your terrible loss.

    • Jocelyn

      I am so sorry. That is absolutely, absolutely horrible. I’m so sorry.

  • Lucy

    Anyone here who is suffering from pelvic floor damage should read an awesome book called “Ever Since I Had My Baby” by a urogynecologist name Dr. Roger Goldberg. It’s a great book! I give to women at their baby showers.

    • Lucy

      Sorry, also check out a video called hab-it. It’s a kegel excercise program by a physical therapist who had a severe prolapse after her biths. Most importantly, don’t ignore your symptoms. There are great PTs out there and urogynecologists who will help you!

  • Dr Kitty

    All of the “but I didn’t need an epidural” stories miss the point.
    If YOU didn’t need one, great, but that doesn’t mean that everybody feels the same.

    It’s like someone who has short, light, painless periods telling someone with heavy, painful periods that, really why on earth would she take painkillers for period pain (don’t do that, BTW, ever).

    We know that some women get horrible cramps with their periods and others have no pain at all- for factors more to do with genetics and luck and anything else. Why is it so hard to believe that the same spectrum exists for labour?

    If YOU find labour pains to be mildly annoying “rushes” great- but if the lady in the next room finds them to be excruciatingly painful, well shouldn’t she be able to access appropriate pain relief rather than be told to suck it up?

    • Karen in SC

      Did you mean Don’t take pain medication for horrible cramps, or did you mean don’t ask those women why on earth would they take painkillers?

      I couldn’t get through the day without constantly taking Midol and sipping a cup of wine at lunch. Once I took so much Midol, I passed out (not sure why, did not go to the doctor or anything). Once ibuprofen was available, I popped 2 at the first twinge, going up to 3 if needed.

      Btw, I love menopause.

      • Amazed

        Zumba is my salvation. Alberto Perez is my hero. Since I started zumba workouts, my periods are mostly slightly uncomfortable. Sometimes, I take a pain medication, usually when I haven’t exercised a day or two before my period or I don’t have a workout later this day. But it’s nowhere near the period agony that I’ve been going on once a month (or twice, as it happened when my hormonal disorder threatened to vaporize my progesteron) for a decade and a half. I could have never gotten through the day without medication.

      • Dr Kitty

        Sorry, to clarify, don’t tell people they don’t need painkillers for period pain if they feel they need them. Neither helpful, nor polite.

        I have endometriosis, at times I have had period pain that has been severe enough it has woken me from sleep and made me puke (thankfully laser and Mirena put a stop to that) and that was after taking painkillers ( for me, usually Mefenamic acid, codeine and paracetamol, which just about took the edge off). My CS recovery was less painful than some periods I’ve had.

        It’s very hard to convince me that a pain the occurs while sleeping is “all in the mind”.

  • np

    This is the most ridiculous topic on birth I’ve ever read. Women are being induced with fear about very natural process of birth. I had two children without any epidural, even though I was offered few times and guess what ??? I am alive and healthy, my children are alive and healthy and I don’t have incontinence, what a surprise !!! Some doctors just have to go and reeducate themselves. Or OBs fear that they will loose clients who will be choosing midwives ? Oh, and of course, money, money, money.

    • That’s great, I’m glad you got the births you wanted, didn’t need medicine, and didn’t suffer any complications.

      You know how that makes you different from a lot of women? You have a higher pain threshold and you got lucky. That’s it. So yay you, but don’t you dare suggest or imply that epidurals are unnecessary for all women because you personally didn’t need them.

    • PJ

      You could also have a root canal without any anaesthetic and still be “alive and healthy.” Why do you think women’s pain doesn’t merit pain relief? I’m so tired of this sexist rubbish.

    • Amy Tuteur, MD

      Awesome reasoning skills, NOT! If you drove to the store with your children unblelted and they ended up “alive and healthy,” would you conclude that seatbelts were just fear mongering? Let’s hope not.

      Perhaps this is too complicated for you to understand, but “increased” risk is not the same thing as “100%” risk. I’m not sure why NCB advocates can’t figure that out.

      • Amazed

        I can help you figure it out. Because NCB advocates think that their experience is the only one that matters. Just go to the article you linked to, the one about the birth center. It’s all “I had an awesome birth there,” “One of them was my midwife…” Their own experience is the only thing that matters.

        Of course, that leads to thinking that dead babies are not all that important. Other people’s dead babies, I mean. How many of the pathetic little wives there offered condolescences to the mother who posted that it was not the first death in the center, that her own baby had been another one? No one… because I don’t count the sensible women who feel that after a death there, the center should be investigated.

    • The Bofa on the Sofa

      Women are being induced with fear about very natural process of birth.

      For pete’s sake, 3000 years ago, the pain of childbirth was recognized as being so severe that it was considered to be punishment from God!

      Long before the days of OBs and epidurals, the pain of childbirth was considered “unnatural.”

    • Karen in SC

      So, midwives work for free?

      Educate yourself – the majority of women still choose hospital births. And the OBs make no money from epidurals in any case, that’s the anesthesiologists.

    • Squillo

      Sorry, my reading comprehension must have been affected lack of sleep. Can you point out where the post states that not having an epidural affects the health of mothers and babies?

      And where it says all women suffer pelvic floor damage from vaginal birth?

    • amazonmom

      My OB has a waiting list months long for new clients, the group practice is always recruiting for more OBs to join because there is an OB shortage in the area. There is zero threat to the group’s profits from a few patients going to homebirth “midwives”. They don’t want anyone getting substandard care so they fight against woo filled “midwives” spreading lies. Real midwives with proper education and training are always welcomed as colleagues. My favorite thing about local “midwives” is the thousand dollar fee to be transferred to a hospital on top of the regular global billing fee. If the parents don’t fork over the money before the ambulance arrives the “midwife” doesn’t go on the transport and provides no report to the physician besides what the parents say themselves. Now who is worried about money?

      • Young CC Prof

        Also no doubt your OB’s practice doesn’t want to be cleaning up homebirth messes that they easily could have prevented.

        • amazonmom

          You win the prize! The OB group regularly provides OB hospitalist services for the L&D unit. The stories they could tell are the stuff of nightmares. Dump and runs in the ER with the parents being told to say it was an unattended labor…

          • Bombshellrisa

            They must have read “From Calling to Courtroom”.

      • Bombshellrisa

        Oh yeah, that fee to be the doula. The fee used to be $750 and has climbed to $1000. They also charge an “emergency transfer fee” (this is also separate of the global billing fee) for which is there is no insurance code for those using insurance and ends up being more out of pocket ($450? Could be more now, it’s been awhile since I have been on that end of the woo).

        • realitycheque

          What on earth does a doula require an “emergency transfer fee” for?

    • Mishimoo

      Generalisations are not your friend. Over here, OB/GYNs are mostly on a salary. It makes almost no difference to them how I access care through the public system*. I opted for CNM-based, OB/GYN-backed care and had awesome experiences. I also chose not to have an epidural with my three deliveries, but that’s MY CHOICE. I also (surprisingly) have no pelvic floor issues. I’m just lucky. I’ve seen the stats for how my babies present and I’m shocked that I don’t have problems.

      *There is a new option for healthcare access, which I chose for the latest baby, as it apparently increases the government funding to that department.

    • ngozi

      I’ve had FIVE without an epidural, but that doesn’t mean that other women can’t chose them. I do wish that hospitals would be more supportive of women who chose to labor naturally. At my hospital, if you don’t want an epi they look at you like you are from Mars.

      • The Bofa on the Sofa

        So “looking at you like you are from Mars” constitutes “not being supportive”? Oh, I know, they also do things like keep asking you if you want an epidural, right?

        I am trying to figure out how they aren’t supportive. Do they not try to help you through the pain or something?

        • ngozi

          I didn’t say they weren’t supportive at all, I just said I wish they would be more supportive. I really am not that peeved if they keep asking if I want an epi. I can say no (if I don’t want one) as often as necessary. I did get upset with the nurse that screamed at me because I didn’t want one. That was unnecessary.
          And yes, they do look at you like you are from Mars if you don’t burst through the door screaming for pain meds. When I arrived at the maternity ward of the hospital in my city, nobody took me seriously that I was in labor because I wasn’t screaming for meds. I had a nurse tell me that is why they didn’t take me seriously. By the time anyone bothered to check me my son was crowning.

          • Sullivan ThePoop

            I never had an epidural for labor pain and no one at the hospital acted like anything over it twice (the middle one I could not get one for BP reasons). So, don’t say that they do look at you funny if you are not busting through the door screaming for pain relief because that is not accurate, it happened to you not everyone.

    • MaineJen

      Wow. Good for you. I had 2 children too, both with epidural anesthesia, and guess what?? I’m alive and healthy and so are they. I don’t have pelvic floor damage or incontinence either, what are the odds?? We sure did get lucky, the two of us. It’s almost like…other people’s decisions about pain relief are none of our business! Huh. I guess some people need to reeducate themselves about the fact that their experience might not apply to others.

    • Burgundy

      So my friend did not have epidural and ended up with mild incontinence. What did she do wrong? Did not trust birth enough?

  • rblazo

    “Wait, what? They’re giving epidurals to people who aren’t in pain?” This line made me laugh!!! I endured 24 hours of labor before opting (nay, begging) for an epidural (I dilated only one centimeter in that time). If I’d known how bad it was going to get, I would’ve gotten one much, much sooner. It was the best decision I ever made in my life, as childbirth was followed by a lovely postpartum hemorrhage (1.5L!). I was a totally low-risk patient. My experience has made me feel very strongly about the importance of actual medical care for labor and delivery. My baby was huge (9 lbs 7 oz, born right on time) but I have, luckily, not had any pelvic floor issues!

    • Zoe

      Have you ever considered the fact that the epidural may have contributed to your hemorrhage? Epidurals can have negative side effects for babies. Natural child births advocates don’t think that women deserve to suffer pain, but they want to educate people on the fact that pain relief isn’t without risk. All medications have side effects. If you choose to use it, great! But it’s important that women are fully educated on what those side effects are.

      • LibrarianSarah

        Yes because not having (and not having I meanin being denied) an epidural really helped Annie up thread avoid hemorrhage. Do you have any evidence that epidurals increase the risk of hemorrhage or did you just pull that out of your ass? Reread Annie’s story and tell us again about how NCB activists just want to “educate” people on risk. Your ideology is responsible for that happening.

  • Anothergreatpostbydramy

    I wanted to have one fitted at 37 weeks and then they could just top it up when I came in! In the end, I was induced and so decided on one at 1cm (pre-ARM), knowing that at some point (as a primip), I would end up on syntocinon (US: Pitocin). I watched a movie, fell asleep and woke up fully dilated when told to start pushing. Nil problems whatsoever. That’s what modern obstetrics has taught me.

    My entire birth-plan fit on one line: active third stage management (tick)

    • J

      Wait, you SLEPT through most of your labor? I’m pretty sure you get some special kinda medal for that, epidural or not.

  • Anka

    This kind of thing makes me boil with rage. I for one LOVED my epidural. I’m considering making a t-shirt that says “I <3 MY EPIDURAL" on it, even though it will probably elicit lots of angry commentary from strangers in my neighborhood. I have low milk supply and am supplementing with formula at 11 weeks, but I doubt it had anything to do with the epidural (my breasts didn't change much during pregnancy, and nothing at all came out of them until a couple of days after labor). And even if the epidural HAD been the reason, I would so do it all again. I'm a person, not a freaking VESSEL.

    • Happy Sheep

      I had low supply after my epidural baby, and wait for it – just as low after my 100% natural, no IV birth too! I’m not a nutter, I had a precipitous birth so there wasn’t time for an IV, I thank FSM daily that I didn’t have any complications.

    • Poogles
    • canadoc

      God bless you for having a brain AND using it. I’m now 22 weeks pregnant. I’m a canadian family doc and I’ve delivered about 500 babies. I’ve done extra training in breastfeeding medicine and you know what makes me wild? Militant breastfeeders who use stupid unproven pseudoscience to make mommies feel badly about feeding their babies. I don’t care how you feed your child as long as s/he grows for heavens sake! My dad was fed boiled cows milk and interestingly, he’s fine. Good for you for persisting in giving your baby what she needs in order to grow and be healthy! Apparently its never occurred to the sanctimommy lactivists that there have been wet nurses around for. . oh. . . ever. . .for a number of reasons…maternal mortality, too high class, and, shockingly, NO BREAST MILK!! Makes me nuts. I’m going to do the same as you my friend, whatever it takes to have a healthy mommy and baby at the end of my delivery and feed baby what is needed for health and growth!

  • I think that in our world it may be necessary for things that can actually be created and recognized, it is realistic.

  • thankfulmom

    wait till you hit menopause. I don’t have any incontinence, just a prolapse that is uncomfortable sometimes. I’m getting it taken care of now before I have any major problems.

    Interestingly the crunchy crowd is anti-surgery for pelvic floor disorders. They suggest exercise to fix it. The ureogyn explained that is like expecting a stretched out garter to hold up a stocking that has fallen to your ankle.

    Who knows…maybe the crunchy crowd will change their minds about educated doctors when dem’s can’t help them with pelvic floor disorders. I for one am thankful for smart doctors.

    • yarnbarf

      I’ve heard from friends that pelvic floor problems happen around menopause whether you’ve had a baby or not. This is not encouraging.

      • Kerlyssa

        They aren’t uncommon. They are not inevitable, and there are degrees of severity from ‘better pee regularly because a full bladder is a bad idea in case I laugh or get pressure put on my abdomen’ to ’24/7 Depends’.

        • Anj Fabian

          ..and health insurance doesn’t cover adult diapers.

  • ‘Nother Lawyer

    I think one way of looking at it is to think about whether insurance companies in the United States would cover an epidural under the circumstances. In the US, insurance companies will typically only cover services that are “medically necessary.” So you cannot get a mastectomy just because you feel like it, but you need to have a valid medical reason (breast cancer, high risk for breast cancer, etc.). So looking at whether an insurance company, under the available maternity coverage, would pay for an epidural can be informative as to whether an epidural is necessary.

    Given this, does anyone know of any insurance companies that limit the availability of epidurals based on criteria beyond being a female in labor?

    In other words, do you have to have labored without an epidural for a certain period of time? Do you have to rate your pain above a certain amount to be eligible? Do you have to have certain complications to be eligible? Do you have to try certain other types of pain relief first? Or do you have to just be a female in labor?

    • Young CC Prof

      I’ve certainly never heard of such guidelines. Some insurances don’t cover maternity care at all, but the ones that do, if you are in labor, they’ll cover whatever pain relief is deemed appropriate.

    • Anka

      This is just anecdata, but in my online birth month group, someone noted sadly that she would love to have an epidural and was afraid to labor without it, but that her insurance doesn’t cover it and she can’t afford it, so she wasn’t getting one.

    • J

      In my local hospitals (with a post-communist social healthcare system), women must decide whether or not they want an epidural before they go into labor, and if they do they must book it and pay out of pocket. it isn’t seen as an essential service, so you get to pay.

      You also pay if you want your partner in the room with you during labor and birth.

    • Sullivan ThePoop

      even Medicaid pays for epidurals.

  • Tmom21

    I’ve been thinking about pelvic floor damage a lot since I had a c-section a year ago for a suspected macrosomic baby (oh the horrors). I don’t regret the decision I made, even though my son was only 8 pounds 9 ounces, because I can only imagine what pushing out an almost 9 pound baby would have done to my pelvic floor.

    Anyways, on to my question. Do you think the growing size of newborns is what is leading to a lot of the pelvic floor issues women are having? I wonder if women who have larger babies are more likely to have these complications with their pelvic floor than say, a woman who has a 5 or 6 pounder. I have a few friends who’ve had small babies who barely even tore and claim their vaginal births were blissful and amazing. I, on the other hand, had a vaginal birth with my first who was 7 pounds 14 ounces and my recovery was a long and painful one. I peed myself daily for almost a year.

    • ngozi

      The smallest baby I have had was 5 pounds 9 ounces. The biggest baby I have had was 6 pounds 13 ounces. Maybe this is why I haven’t had the problems other people have spoken of (yet)? But like I have said I have heard of the pelvic floor problems and “peeing” problems happening to women who had c-sections and vaginal births. Perhaps these problems happen because of carrying the baby and not just how they are delivered??

      • Kerlyssa

        If these problems were from carrying the baby and not vaginal birth, you’d see similar rates in c section and vaginal birth women. Your math doesn’t add up. =/

        • ngozi

          Not really my math, just asking a question…My experiences with vaginal birth have been very good. I am not saying that is everyone’s case.

          • Kerlyssa

            But you are asking precisely that question. ‘Perhaps it’s not how they are delivered’. No, it pretty clearly is the biggest factor in resultant incontinence. That you yourself have or have not been part of that 40% is irrelevant. It is still an increased risk for choosing that method of birth. Winning at Russian Roulette does not make the bullet disappear.

          • ngozi

            I’m sorry, but you can’t tell me that 9 months of carrying a child around doesn’t wear out the pelvic floor, no matter how you deliver..

          • Kerlyssa

            It’s a good thing I didn’t tell you that, then. Pregnancy itself affects incontinence rates. Mode of delivery itself affects incontinence rates. One does not cancel out the other. If two women eat a piece of cake, then one eats a carrot, and the second a milkshake, the second woman has received more calories. Saying it’s the first piece of cake that made you fatter than the first woman is silly, just as it is silly to say it is the pregnancy that put you at greater risk of incontinence compared to the _term pregnancy csection women_, not your vaginal births.

        • ngozi

          And where are you getting your “similar rates” from, just wondering?

          • Kerlyssa

            I am unsure of your problem with this. Simplified: If term pregnancy causes, say, 5% incontinence rates, and neither Csec nor vaginal causes incontinence, you’d see 5% rates in all post (single) birth women. If both csec and vaginal caused 5% incontinence as well, you’d see 10% in all post birth women. If vaginal causes 10%, csec 5%, you’d see 15% in vaginal post birth and 10% in csec post birth. Therefore, 5% increase over csec.

            There is not parity in the rates of incontinence in csecs vs vaginal births. Vaginal have greater amounts of incontinence. Pointing to a common factor (pregnancy) makes no sense, it is not what makes vaginal a greater risk.

      • theadequatemother

        oh well, if you look at the studies, many of the that claim the rates are the same in women who delivered vaginally and women that had only c/s looked at POST-menopausal women. The real question is, which birth plan is more likely to make a young woman incontinent just when she should be chasing after her children, jumping on trampolines with them and enjoying sports and an active lifestyle? When you frame the question that way CS win hands down. Also, there is virtually no risk of anal (gas) and fecal incontinence with a c/s birth plan.

        Of course, once menopause hits and you loose the effect of estrogen on female tissue all sort of problems are unmasked.

      • Lucy

        Honestly, I think it’s a little of both. I have friends who have incontinence despite having preplanned c-sections. I also have a friend whose never been pregnant with fecal incontinence. I imagine that it has a lot to do with vaginal births, however. I’ve had a perineocele since I had my 8.11 girl. I had a 3rd degree tear. DD2 was 9.9 with a nuchal hand and I didn’t have anything but a superficial laceration( which hurt a lot for some reason). I attribute my lack of tearing the 2nd time to side lying pushing. My urogynecologist advised me that side lying is best position for avoiding tears. A bonus is that it can be done with an epidural and is a lot less tiring because you can curl up in the fetal position and rest between ctx.

      • Sullivan ThePoop

        My SIL had a C-sections and had twins. They were big, she went to 38 weeks 4 days and one was 6lbs 7oz and the other was 5lbs 9oz. Her doctor was worried about pelvic floor problems just from carrying them. So, I am pretty sure it can happen.

    • yarnbarf

      If you’re right, then obviously we need to encourage smoking among pregnant women to promote low birth weight babies.

      (I’m a child of a smoker and was under 5 pounds at 38 weeks!)

      • Lisa Cybergirl

        My mother’s OB encouraged her to smoke for lower birth weight and an easier delivery for all three of her pregnancies! Yes, this was the early to mid 60s… We all came out fine, but who knows, we might have been even finer without that great advice.

        • Young CC Prof

          Yes, they actually did that back in the day. And said absolutely do not gain more than 20 pounds, again to keep birth weights low.

          Now, c-sections are so routine that oversized babies aren’t such a concern any more. (And, yeah, we know nicotine is a teratogen.)

          • araikwao

            And that low birth weight isn’t desirable after all

      • Sullivan ThePoop

        The funny thing is the one person I know that actually did smoke the entire time during one of her pregnancies had a 9 lb baby with no gestational diabetes, then quit smoking and had two babies in the 7 lb range. I always thought that was weird, my biggest baby by far was 7 lbs 10oz. Though, she is a bigger woman than me.

    • Expat

      I had minimal trouble with 8 lb babies, but my last was almost 9 lbs and I think there has been some permanent damage, hemorrhoids that came out when pushing her out. She almost didn’t fit after 3 hours of pushing and probably should’ve been a c section, but only half of the ultrasounds predicted that she would be big.

      • Expat

        And, yes, I got hemorrhoids from just the pregnancy, but they went away after my first two deliveries. there was no mistaking what happened during my third, almost 9 lb delivery. A lot of what should typically stay inside ended up outside and it still causes discomfort occasionally.

    • SK

      My two daughters were 5 lbs 14 oz (5 1/2 weeks premature owing to pre-eclampsia) and 6 lbs 14 oz (at 37 weeks and 2 days). I didn’t have pelvic floor issues, but I do have diastasis recti, or separation of my abdominal muscles. I didn’t realize it until I lost all the weight I’d gained with pregnancy, but it explained the sudden injuries to my back that I would get from the most trivial of movements, like getting out of bed. I have done exercises to strengthen the transverse and oblique muscles, but the recti are somewhat useless. So even now that my youngest is two, I still look pregnant. Before I always had a very flat belly, so every day I look down at my stomach and dislike it very much – it’s not fat, it’s intestines, and my medical practitioner looked down at it and said, “I can see peristalsis!” Well, I can actually palpate that with my own hands. Unfortunately, the repair to this abdominal hernia is viewed as cosmetic, so it would cost me a lot out of pocket to have it repaired. My friend Juniper, who is an ND and a feminist, is all for having it repaired, because it would help with posture and alignment. I appreciate her view (being told it was just “cosmetic” by the insurance company made me feel like I was being stupid and vain, even though I think it would help me be more athletic again).

      • Guesteleh

        You should try appealing it, that sounds like one of those procedures that gets an automatic denial on the first go-round but if you pursue it with good medical documentation they might give in.

        • SK

          Thanks – I will look into it! Mostly what I have learned from my own experience is that pregnancy and birth take a toll.

          • auntbea

            Wouldn’t prevention of “sudden injuries to the back” be more than cosmetic?

          • SK

            I like that idea! Thanks.

          • Sullivan ThePoop

            Definitely I would write a letter to your insurance company. I got a biopsy recently that was done with a new technique where they only need a little material and automatically do molecular tests on it no matter what it looks like. It is about $200 more expensive than a conventional biopsy if they do not do molecular tests, but is actually cheaper if they do. anyway, my insurance first denied the claim and I wrote them a long letter about the benefits of this kind of biopsy about how at least one of my samples would have needed the molecular tests anyway and it actually saved them money and other things. They agreed after denying it three times.

  • ‘Nother Lawyer

    An unnecessary epidural is one that is provided to the baby’s father.

    • yarnbarf

      Unless he’s having surgery at the same time!

  • Expat

    OT: for a laugh: a real patent to aid the birthing woman. the pictures are quite impressive. https://www.google.com/patents/US3216423

  • Something From Nothing

    Ok I will take a stab at an example of an unnecessary epidural. This will happen when midwives are allowed to order epidurals without consulting an obstetrician. A patient whose labor is obstructed, and has been for hours is offered an epidural by her midwife for ‘therapeutic rest’ to see if that will relieve the obstruction. Now she can comfortably remain obstructed, making her c section, that is inevitably coming, more risky by the hour, when she should have been offered a caesarean under spinal anesthesia. That, to me is the only instance where I might refer to an epidural as unnecessary.

  • ngozi

    I have had 5 vaginal births with no epidural. I did the research for myself and chose it like that, not because I was swayed by some crunchy homebirth advocate. I am happy with my decision. I just never had a labor and delivery that I felt needed more than Stadol (or Demerol, before I became allergic to it).
    With my first birth, I had a nurse to come in and SCREAM at me because I didn’t want an epidural. I finally had to tell her that I was an adult, and if I missed the window of opportunity then I would just have to deal with it.
    I’ll go ahead and tell you that I haven’t experienced any problem with my pelvic floor.
    I’m glad I didn’t have an epidural, but I don’t bash people who do. Why is it that it is okay to accept pain relief for other issues, but not childbirth. I think it should be the woman’s personal choice.

    • Something From Nothing

      Indeed, it should be the woman choice. And, if you aren’t post menopausal by a few years, your pelvic floor is far from out of the woods…

      • ngozi

        But that would be from pregnancy as well, not just how I delivered.

        • Kerlyssa

          Ah. So it didn’t hurt you anyway, and if it did hurt you it’d be from something totally different. Gosh, that reminds me of just about every non compliant person with a medication/lifestyle dependent condition ever.’It wasn’t the decade of daily fasting/junkfood binge that took my sight and legs, it just happens in my family’.

          Chances are, no.

          • ngozi

            Umm, okay, whatever. I’m not sure you are even reading my posts before commenting.

        • Kerlyssa

          Meh. Sorry. That was nastier than it could have been. I really, really dislike when people decide to cherry pick which of their environmental/lifestyle/whatever conditions caused X, especially when one risk is used to diminish the seriousness of another risk.

    • LynnetteHafkenIBCLC

      Me too, only 3 births. The takehome message here is just to provide informed consent (which I never got about the pelvic floor risks from my CNMs, but honestly wouldn’t have listened to anyway), and accept the woman’s decision. I don’t think anyone here would argue with that. The main focus of this blog seems to be the lack of informed consent of some NCB advocates of the real risks of avoiding medical intervention.

      • The Bofa on the Sofa

        It’s not just _lack_ of informed consent, but even the presence of _misinformed_ consent. As in, making decision based on lies.

        • ngozi

          And people following trends instead of really considering what is good for their OWN health. Sure, I’d like to have a nice, hippie, crunchy homebirth, but I have to be real about my age, my gestational diabetes, and my previous pregnancy history. I’d love to be my own witch doctor and do all my medical care myself, but then my kids would probably end up motherless!!

  • My friend is pregnant in Poland. Before, women had to pay (sometimes, let’s put it mildly, “in an inofficial way”) but epidurals were available. Now, the government changed that and said that epirudals were made free to stop the corruption- great? No, because most hospitals, with the possible exception of very few so called obstetric hospitals- but you can also deliver in a “normal” one- instead of offering edpirals for free, they just got rid of them, firing anesthesiologists because now they don’t have the money to pay for them. This is just so ridicluous. My friend is scared and I can see why- she can’t go to an obstetric hospital because it’s too far for her, and now she’s worried whether she’d make it without pain relief- the only thing they can do is to give her gas and air! I am just so angry.

    • AmyP

      There should be some way to fix this, with either a planned induction or moving into a hotel or a rented room across the street from a good hospital. I wouldn’t take “too far” for an answer in a relatively densely populated place like Poland–it’s not Australia or Canada. And if she has a younger child or children, an induction might work fine.

      This is a problem that enough money will fix. (Although it certainly stinks that the situation exists.)

      • Thanks, AmyP. I agree that there are ways to make this work and I’ll talk to her. They don’t have much money but maybe they’ll consider paying for that. They don’t have other children, either, so it could be easier for them…the situation stinks a lot, and just that one time, I am glad that I didn’t give birth in Poland- even though I totally miss other aspects of living there.

        • AmyP

          Good luck!

          (My husband and in-laws are Polish immigrants and I know how good Poles are at worrying, especially about health. The expectation of misery must be very hard on your friend.)

          • You are so right- she’s not only worried about health, but also about the way she’s going to be treated in a Polish hospital. When I was visiting my family there, I was pregnant with my second child and had a bleeding. In the hospital, they kept me there for hours, never talked to me directly, my husband (who is German and doesn’t speak Polish) was not allowed to go in there with me. Of course, nobody bothered with telling my mom and my husband what was going on. And that was in supposedly the best hospital in Warsaw! Oh yes, and we Polish people like to worry, that is true. I hope she’ll be fine.I wish for either an easy labour or that she will figure something out…

          • Toni

            Could she at least get a pudendal nerve block? I don’t think you need an anaesthetist for those.

          • rblazo

            This reminds me of Moscow. We called a highly recommended hospital only to find out my husband would not be allowed in the room for exams, so we decided on a private (and very expensive) clinic. One night I woke up in a pool of blood and we called a hospital asking what they would do, and they would keep me for a mandatory 72 hour observation! The bleeding did not continue, so we decided to stay home (everything was fine). Epidurals are becoming more common in Moscow, but they are still not widely available, and the hospital you give birth at is decided quite randomly (based on an incomprehensible bureaucratic system, and also largely on the whims of disgruntled nurses). Needless to say, I was so relieved we were able to move to the US before my due date. Good luck to your friend! I hope everything works out ok for her.

  • GiddyUpGo123

    I had awful tearing with my first two babies–4th degree with the first and 3rd degree with the second. With my third, I asked my doctor if he could do a c-section, and he was more than happy to. Oh, the horror! And as a result of that c-section and the one I had a couple of years later, I have adhesion pain that occasionally interferes with my daily routine. But I will tell you what (sorry if I’m being redundant because I know I’ve posted the same thing here before), I’ll take adhesion pain or just about any other c-section side effect over not being able to hold my poop in public. I can’t imagine what that would do to your quality of life. How can you enjoy the babies you have if you can’t leave the house without an adult diaper? How would you do birthday parties, school functions, field trips, swim lessons, trips to the county fair, swimming in the summer and all those other things I love about being with my family? Can you imagine as your kids got older and figured out that mom wears a diaper how embarrassed they would be to be seen with you? Is losing out on all those experiences with your child really worth having a vaginal delivery? Really? Because I’ve done it both ways and frankly I don’t think either one was more magical than the other. I can’t imagine me and my little pack of Depends thinking to myself, oh but at least I pushed all my babies out through my vagina!

    No I’ll say it again and again, and sorry if I’m shouting: THANK GOD FOR C-SECTIONS. Or, more accurately, thank medical science.

    • I was lucky enough not to have any problems… here in the Netherlands, they tell you how good natural birth is but then you see lots of easily available adult diapers and I wonder how connected that is…

    • ngozi

      I have heard personal stories of women who have had the exact same problems and had c-sections. Vaginal births aren’t promised complication free, and neither are c-sections.

      • Kerlyssa

        B-b-but babies die in hospitals, too!

        Informed consent has nothing to do with offering perfection. It means offering valid information about risk rates. Not ‘oh, a friend of a friend post on facebook that her csection 5 years ago caused her to pee when she laughs, and therefore it has the same risks as vaginal’.

        • ngozi

          Great, there are valid risks to pregnancy and childbirth whether the child gets here from c-section or vaginal delivery. I have no problem with people being informed about both. In fact, I think that is best.

          • Kerlyssa

            But you don’t like ti when someone says that one mode is riskier than another for a particular complication?

      • Box of Salt

        ngozi, just carrying a pregnancy to term adds its own increase risks (over never being pregnant), regardless of mode of delivery.

        • ngozi

          I have been trying to say that they both play a part!!! Thank you!!!

          • kerlyssa

            Oh great gazoogle!

            “Results of this study demonstrated that women who delivered vaginally had a 2- to 3-times higher risk of stress incontinence compared with nulliparous women, whereas those who delivered by cesarian section had a 50% higher risk. ”

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472678/

          • GiddyUpGo123

            What about fecal incontinence though? I’ve never heard that that is associated with c-sections and frankly, that’s the type that I would *most* want to avoid.

          • Kerlyssa

            Rates look about the same for csec as vaginal, so no obvious benefit one way or the other. Also, mixed csec and vaginal does not appear to have significantly less risk than going all vaginal- the big difference is between women who have only given birth via csec and other mothers.

        • GiddyUpGo123

          Does anyone know the stats for that? Risk of incontinence associated with c-section vs risk for incontinence associated with vaginal delivery? I’m betting the latter is a bigger number but would love to know for sure …

  • Young CC Prof

    For my own upcoming birth, initially I was thinking it wouldn’t be so bad to go natural. I’ve been through a knee fracture with no pain relief at all (long story) and with my hernia repair a couple years ago, the postoperative pain control was made of fail. I have chronic back pain, and I’ve learned to function with, ignore, and even be happy under quite a bit of pain.

    At this point, I think I’ve gotten past the macho. I realize I’ve got four months to go on this pregnancy, and it’s going to hurt plenty before the end. Yes, I could endure an unmedicated childbirth. The women in my family conceive and bear easily, and my husband is actually smaller than me, which means the baby is more likely to fit nicely. I could do it.

    But I don’t have to.

    • sleuther

      I like your attitude, Young CC Prof. I think that it’s important to trust yourself _and_ your medical caregivers and also understand that it’s not a contest. They don’t hand out gold medals for unmedicated childbirth. At the end you get a baby, God willing a healthy one, and the process of birth is just that – a process, that’s over, and now you get to enjoy your wee one. 🙂

    • rblazo

      My own experience made me realize that labor is a huge gamble. The best way to prepare for it is to have no expectations other than a healthy baby and mama at the end. Good luck!

  • DaisyGrrl

    I love this post so much! Pain is pain. It is not “good” or “bad”. It doesn’t have some kind of special purpose in childbirth. It is the body’s reaction to an event that can be extremely damaging or even fatal. That’s why we have pain – to let us know that something is wrong.

    To suggest that epidurals for childbirth pain are unnecessary or harmful is one of those things that just instantly sets me off into an incandescent rage. Midwives touting that their patients have fewer epidurals like it’s something to be proud of angers me beyond reason. Women should be provided with accurate information about the pros and cons of different pain relief methods and then, if medically advisable, chose the one that works the best for them. That’s it.

    This conversation doesn’t happen in other areas of medicine. When I walked into emergency with appendicitis, the questions were “are you in pain?” “how would you rate your pain?” and “would you like pain relief (appropriate for the level of pain you’re experiencing)?”. Not, “that’s just your body working through the infection” or “don’t worry, it’ll stop once the appendix is out”, or “you’ll forget all about it in a few months”. I rated that pain as a 4-5/10 at the time. I’ve been in worse pain before, but there was no question in the minds of the medical staff that pain was to be treated.

    This is how it should be for labour. Are you in pain? How would you rate it? Would you like pain relief? Yes? Let’s have a conversation about the best option for you. No? Okay then, I’ll check in with you later to see how you feel.

    • Antigonos CNM

      There are some recent studies which show that women are routinely UNDER-medicated for pain in general, not just OB. And that the rationale is often “women bear pain better than men” which is absurd.

      • Mishimoo

        And the follow-on comment from that of “Why aren’t you happy that we believe women are ‘tougher’ than men?!” rather irritates me.

        • Antigonos CNM

          Remember, it wasn’t so long ago that even terminally ill patients were given restricted amounts of opiates lest they “become addicted”. I can remember when the hospice movement began, and there was considerable criticism at first.

          There is definitely an ambivalent attitude to the whole question of the “value of suffering” which pervades Western thought. IMO, it is worst in birth situations “since the Bible decrees that women should suffer”, but it affects attitudes toward suffering in general.

          • Mishimoo

            Very true!
            I know of at least one person who is campaigning (and trying to recruit people) for reduction of comfort measures for the terminally ill as she maintains that it hastens death and that it is forcible, legal euthanasia.

            It must be wonderful to be so sheltered.

          • Dr Kitty

            Seriously? REDUCTION OF COMFORT MEASURES FOR ACTIVELY DYING PEOPLE?

            Someone with dementia will eventually get to a point where they will have an unsafe swallow and will refuse food and fluids. Usually we give pain relief and sedatives, make a decision to manage symptoms as they arise and stop active treatments and let them slip away in their own bed, in a nursing home, with people they love beside them. It is a quiet, peaceful, dignified passing for the majority.

            The alternative is drips, PEG tubes and aggressive
            treatment of pneumonia in hospital. It isn’t prolonging life so much as postponing death, while making the life that remains painful and undignified. I wouldn’t want it for myself or for anyone I loved. Even the Catholic Church believes that futile and burdensome treatments should be stopped.

            Part of the dying process involves the bowels and kidneys shutting down- food doesn’t get processed and constipation, nausea, choking and vomiting can result if someone continues to be fed. That is not a kindness.

            I’ve been at enough death beds to know how I want to go, and it involves a syringe drive full of narcotics and sedatives, thanks all the same.

          • Mishimoo

            Unfortunately, I’m completely serious. She believes that NPO is torture, it is killing people, and there is no medical reason for it. She also believes that mental illnesses are created by Big Pharma in order to addict and control the population, and that vaccines are poison. Takes everything that Mercola and Philip Day say as gospel. *rolls eyes*

            My Grandpa died from Pneumonia recently, and I am glad that the doctors agreed with our family that his previous requests to allow him to go peacefully should be honoured. He was barely lucid, miserable and in quite a lot of pain. (He also had 3 types of cancer) I miss him a helluva lot, but I’m grateful that he was spared the nursing home hospital spiral that so many others go through.

          • Dr Kitty

            I’m sorry for your loss and hope you find comfort from your memories of the good time.

            My own grandmother, who is almost 100 and, while physically surprisingly well, is very, very confused, has an “if anything happens call a priest, not an ambulance” understanding with her nursing home. This is a woman who refused to take medications or have tests for angina and atrial fibrillation 15 years ago, BEFORE she had dementia (“I’ll go when the good Lord takes me and I’ll enjoy myself in the meantime”). I can’t see how we would be respecting her wishes by making her endure hospital treatment.

          • Mishimoo

            Thank you 🙂

            I really like your grandma’s take on the subject, it’s both happy and practical.

            We have the same understanding with my husband’s grandma. She doesn’t want heroic measures, she wants to pass peacefully when its her time. That’s why she has organised for my husband to have enduring power of attorney. She knows that he’ll do the right thing.

          • Poogles

            “She also believes that mental illnesses are created by Big Pharma in order to addict and control the population”

            As someone who suffers from dysthymia and has a mother with (untreated) bi-polar, people like that evoke a special kind of rage from me. Believe me, I WISH mental illness wasn’t real, it would’ve meant a lot less suffering over the course of my life.

          • Mishimoo

            I wish mental illness wasn’t real for very similar reasons.

            The worst part? She has a son who needs medication to function and should be accessing therapy, but she encourages him to not take his meds and feeds into his delusions.

          • Lisa Cybergirl

            SAME HERE. Depression, anxiety, and recently discovered ADHD (which was not exactly HELPING the depression and anxiety, because I thought I was an IDIOT). THANK GOD they are treatable, and I can live an enjoyable, productive life.

          • BeatlesFan

            My grandmother had dementia. She essentially starved herself to death. I’ve had people ask me, “why didn’t they give her a feeding tube?” My response is always, “Why would they?”

            I loved my grandmother dearly, and that is why I wish assisted suicide/euthanasia were legal. The last two or three years of her life she spent by wasting away, not speaking, walking where she was led, and not knowing who anyone was. It was a horrible time for my whole family, and I can’t even begin to imagine how it was for her. Those last few years of her life added nothing to it besides suffering.

            When my cat became old and sick, and his quality of life was practically zero, I had him euthanized because it was the humane thing to do. Don’t people deserve to be treated at least as humanely as animals?

          • Eater of Worlds

            She sounds like Mother Teresa!

          • yarnbarf

            the Liverpool Protocol is many things, but at least it isn’t cruel.

          • Eater of Worlds

            This was why Mother Theresa refused to treat any of her patients for pain. She felt that the suffering of the poor was as beautiful as the suffering of “Christ’s Passion”. You’d think she could spend some of her vast millions to at least let these people die in a clean building, you know? She chose to get her palliative care in the US, which is rather telling.

            http://www.nouvelles.umontreal.ca/udem-news/news/20130301-mother-teresa-anything-but-a-saint.html

          • ngozi

            Well while Jesus was on earth he cured many people of their illnesses and did something about their suffering. One of the points about the New Testament story of Lazarus and the Rich Man is that the Rich Man didn’t care a hoot about Lazarus’ suffering. Methinks Mother Theresa was mistaken there.

        • Jenna

          It is part of my religious beliefs that pain and suffering can be used redemptively. But one is never required to endure pain and suffering. I “offer up” pains big and small, but at the same time I take Tylenol for headaches and an epidural for labor.

      • Sullivan ThePoop

        I believe, from anecdotal evidence, that having had bad pain makes you deal with pain better. I used to think it was that women were better with pain because my husband is soooo not good, but my son has kidney stones and handles other pain like a champ. I have a friend who never hurt herself really or had a baby and she is just as bad as my husband.

        • Antigonos CNM

          There is some evidence that women who habitually have severe dysmenorrhea find labor pains easier to deal with. Possibly because of the “been there, done that” factor, while the woman who never has the slightest twinge with her periods has no idea what labor is like.

          • amazonmom

            My aunt is one of those women. She would rather go through labor every month than have one of her horrendous periods.

          • Mishimoo

            I find this believable because my labours were less painful and much shorter than my pre-baby periods. Labour was still long, exhausting and painful; but it was bearable and I could actually walk.

          • rh1985

            I had debilitating cramps and it never got any better to deal with so it didn’t help with me coping with pain in general, I was in bed crying from the pain every month. I finally just went on the pill and was on it most of the 10 years before I got pregnant. I’ll see if my cycles change after I have the baby, but if not, back on the pill it is. I am terrible at dealing with the pain and expect I will want/need an epidural.

          • Mishimoo

            Wishing you all the best with your new addition 🙂
            My cycles were lighter/easier after the first baby but my best friend’s ones have gone back to the pre-pill horror. If my cycles change back after they return, I will be very tempted to beg for a hysterectomy despite the risks and recovery time because I don’t have the option of being in bed for a week every month or so.

  • Leslie

    Wow. Can I just say how much I loved the anesthesiologist who helped with my delivery last year?

    I was being induced at 38 weeks (because of severe GD). I knew from the outset that I’d want an epidural, so my OB (who is also fantastic) actually checked the anesthesiologist schedule before putting me in the L&D schedule. He told me that Dr. Coch was the best, and he was right. That guy put my initial IV in — I’m a hard stick — and then he faithfully showed up every hour or two to see if I wanted my epidural yet. At one point, Dr. Coch even warned me that he was scheduled to be in a C-section at 4:00 pm for an hour, so if I thought I’d want it before 5:00, I should ask for it by 3:00. When I finally said, yeah, now I want it, he dropped whatever paperwork he was doing, and bang! he was there. At my request, he started me out on weaker drugs, and then later, when I needed a bolus of the stronger stuff, he rushed back from the other side of the hospital to do it right then. (The nurse told me later that he’d had the shot ready to go for me down at the nurse’s station.)

    I asked Dr. Coch why he was so “on it,” and he looked very surprised at the question. “Because MY JOB is to make sure you aren’t in pain,” he answered. “It’s MY JOB to stop your pain as soon as I possibly can.”

    Because of him, I had a lovely, pain free delivery, and my daughter’s birth is a happy, joyous memory, untainted by pain or even fear of pain. Thank you, Dr. Coch.

  • Sarah
    • DaisyGrrl

      I liked that they could face steep fines or up to a year in prison, but what I would really like to see is a promise of prosecution in the event of negligent practice leading to a “bad outcome”. If they’re not registered, and the baby dies due to your incompetence/recklessness/negligence, they should face manslaughter charges. If a midwife is not willing to be bound by the rules of professional practice, then she should be bound by the rules of criminal law.

      I remember a case years ago locally where a naturopath was convicted of manslaughter because she treated a diabetic child who went into a coma and died within days of starting “treatment”. If a midwife wants to knit in a corner and hold the space while charging the mother money for the so-called expertise, she should be held criminally responsible when things go wrong. The parents, rightly or not, are trusting that when they pay someone to supervise a birth, the person will know what to do in an emergency (or at least know when things are going wrong and it’s time to call the ambulance).

    • KarenJJ

      “Nursing and Midwifery Federation official Elizabeth Dabars said the current legal gap needed to be plugged.

      “Regulation really is essential to ensure people meet appropriate educational, practice, conduct and ethical standards and we believe regulation is in fact absolutely essential for those reasons,” she said.”

      Awesome. A firm response from a midwifery organisation. It’s about time they started getting pissed off by people like LB too.

  • Renee

    Tell you what Hannah- YOU have your NCB and leave the rest of us alone!

  • Renee

    I think this needs to be posted, as it shows how much pain labor can be, and when moms wants relief:

    http://theadequatemother.wordpress.com/2013/02/04/2-cm-810/

    Go read it! The whole blog is good. In short: moms request an epidural when pain hits 8/10 average, which is at 2 CM, on average!!!!

    I know some MWs are awesome, but the ones like this are doing moms a huge disservice, and should not ever call themselves “with women”. They are sadists, IMO, and not the fun kind.

    • Jennifer2

      When my dad was in the hospital before he died, the nurses and doctors were amazing about pain relief. If his meds weren’t helping, they were usually in his room within 5 minutes with the stronger stuff. He usually rated his pain around a 4-5 or less, which he found manageable. But they kept telling him they didn’t want to let it get worse. They wanted to keep it as controlled as they could. There was no “let’s see how much pain you can tolerate before you cry uncle and beg for pain meds.” They weren’t letting him try out an 8 if they could keep him at a 3.

      Why, why do we wait till an 8 to get an epidural in childbirth? I ask this as a woman who did just that. Then I got the epidural, fell in love with it, and have been singing its praises since. Future births? I will be asking for that epidural nice and early. Maybe not at a 2-3 because my labor with my son was long and I don’t really want to be confined to the bed longer than needed. But 4-5 seems reasonable based on my recollections. And definitely at ROM. That’s when it quickly got bad for me.

  • violinwidow

    How do you quantify whether someone’s epidural is unnecessary? Pain is subjective. If a woman asks for an epidural, it’s necessary.

    • AL

      I guess those of us who opt for it are lazy and not real women. I had an epidural for my first child as I had horrible back labor and was crying in excruciating pain every time a contraction hit and I was only at 3cm. Once they administered it I felt like the heavens opened up and a choir of angels started singing. My second child however was coming out so fast that there was no time for one. That s%*t hurt. Having done both scenarios, I vote for an epidural.

    • The Bofa on the Sofa

      Well, technically, no epidural is “necessary,” in that everyone COULD have a baby without it.

      So the issue is, what makes it necessary? And that is the desire for it. So it comes down to your comment, to the extent that we consider an eipidural necessary, what makes it necessary is the desire to have one. In the end, if she thinks she needs an epidural, that is because she thinks it is necessary, and therefore it is. End of story.

  • AL

    OT: This is a good illustration and a simple explanation of the BS that is Dr. Andrew Wakefield. http://tallguywrites.livejournal.com/148012.html

  • Isramommy

    I have a minor prolapse since the birth of my second child eight months ago. While I don’t (yet) have any urinary or incontinence issues, it is still bothersome, unpleasant and upsetting. This midwife’s callous dismissal of pelvic floor damage and its impact on women is disgusting, and truly illustrates how the crazed natural-at-all costs movement is all about putting ideology above women’s health.

    I am so angry at the way pelvic floor damage is ignored or glossed over. Even in normal medical practice I think women often aren’t sufficiently made aware of the risks of vaginal birth. I only knew about the risks because of this blog, not from anything my ob told me, and though I didn’t have any specific risk factors, I still ended up with damage. I suspect it occurred when my son’s birth suddenly needed to be expedited with fundal pressure and an episiotomy because of very distressing heart tones. I am eternally grateful they got him out quickly and healthy (I think in a homebirth setting he would have been one of those babies that “suddenly” drop out dead or damaged since without cEFM there would have been no way to know that things had gone from normal to dangerous so quickly) but the prolapse I suffered is a very real issue and something I wish I didn’t have to face while still in my twenties. Even more distressing is the fact that I will almost certainly face additional problems in later life.

    Pelvic floor damage isn’t something to be taken lightly. It is absolutely ridiculous that any supposed health care provider would put her own philosophy about birth ahead of individual patients’ autonomy or anatomic integrity. But, I’ve been reading this blog long enough that I’m just really not surprised. Shame on Hannah Dahlen.

    • moto_librarian

      If midwife means “with women,” then they should be disseminating information about pelvic floor problems and screening for it. I started having issues after my second was born, and when I went in for my annual, I told my CNM about it. I left the office with a referral for physiotherapy.

      We need to stop being ashamed of these things and make sure that other women know that with treatment, the problems can usually be fixed or at least made manageable. Some women might opt for c-sections to avoid the problem entirely. That should also be viewed as a valid choice.

  • Squillo

    To translate:
    * Stop worrying so much about dead babies. It’s a real buzz-kill.
    * When I want your opinion about your level of pain, I’ll give it to you.
    * Don’t worry your silly little head about pelvic floor dysfunction. Having a baby come out of your vagina is so much more defining of you as a woman than your continence or your sex life.

  • Captain Obvious

    Just performed an EPCS this week on a primiparous woman with geetational DM and an ultrasound that suggested a 4400 gram baby. All went well. Actual weight was 10# 4 oz with a 38 cm head. The NUCB advocates would say you can’t grow a baby big enough that you can’t deliver and late trimester ultrasounds are up to two pounds off. Well, I was spot on, she’s going home in three days and quite happy about HER option. I reapproxiamated her rectus muscles back to prevent a diastasis and I used Exparel in the parietoperitoneum, fascia, and skin. It is local anesthetic that lasts up to 96 hours. Her bladder has been spared as well. Hahlem could offer her patients that, but she would have to relinquish care (and payment) from her client.

    • Captain Obvious

      Oh yeah, she came in at late night with SROM two before her scheduled CS. Since she just ate, I allowed her time to digest till morning allowing her to contract some which has been shown to help decrease TTN (allow some labor before CS). Baby’s breathing and glucose were fine.

      • R T

        Same thing happened to me! Scheduled csection at 39 weeks because of large size of baby, especially his abdomen! I had gestational diabetes requiring several daily shots of insulin, SEVERE symphysis pubic dysfunction which had me in a wheelchair even after I was released from bed rest. Also, a partial placental abruption caused by SCH and had been on bed rest for four months. My perinatologist guessed by son’s weight down to the ounce! One week before my scheduled csection I went into labor and had my csection in the wee morning hours! My son was nearly 9 pounds at 38 weeks gestation, but had a tiny head. His shoulders and abdomen were huge! My doctor said I made the best choice due to the risk of shoulder dystocia! His small head and large shoulders and abdomen were a recipe for disaster. Afterwards my mother, who had all of us at home unassisted, confessed my youngest brother actually got stuck. He was 9 pounds and presented face first. His shoulders got stuck briefly and my father had to wrench him free. I was surprised because I was under the impression all of her births has gone perfectly! Anyway, it made me feel very, very good about my choice. In hindsight, I guess I’m glad my baby got to experience some labor before he was born! I was upset with my doctor though because I begged for a csection at 38 weeks as I was 5cm dilated and in intense pain, but he said the hospital had recently been subjected to picketing protesters due to their high csection rate and the hospital had cracked down on csection before 39 weeks. Apparently, my son did not read that memo, lol! He’s a rebel!

        • Stacey

          Picketing protesters that don’t like their Cs rate? That makes me rage. Who the fuck are they to make such decisions? The 39 week trend is also an irritant, as stillbirth goes up after 38 weeks, so babies will die because of this.

          • R T

            The most ridiculous part is it was at Mary Birch! They have the largest Perinatal Special Care Unit in the country! They fly women in from as far away as Hawaii to stay there until they deliver. They have the best NICU in the county, one of the best in California and they are attached to Rady Children’s Hospital! They have a high csection rate for a very good reason! A huge section of the women who deliver there, like me, are giving birth to miracle children who shouldn’t even have survived pregnancy! It mad me so mad to think about those women out there protesting the csection rate when I’m inside hoping my son at least makes it to viability! They are lucky I wasn’t allowed out of bed, lol!

    • I don’t have a creative name

      “I reapproxiamated her rectus muscles back to prevent a diastasis and I used Exparel in the parietoperitoneum, fascia, and skin.”

      CPM response: “Oh yeah? Well *I* used Shepherd’s Purse and seaweed, and my intuition tells me that it’s just as good!”

  • Ainsley Nicholson

    OT: Can anyone comment on whether the later stages of labor are more dangerous to the baby than the earlier stages?
    Background: I’m at 38 weeks, and for the last week or so have been having contractions that last a few hours then go away. These are beyond braxton-hicks contractions…they feel very much like early labor. Because of this, I plan to wait until I am very sure I’m in active labor before going in to the hospital. They will send me home if I arrive too soon. At the same time, I know I will be getting continuous EFM once I’m in the hospital, and I wouldn’t have it any other way. I’m experiencing some cognitive dissonance between “it is safe to labor at home until well into active labor” and “it is best to be monitored continuously”, and I’m reconciling those two beliefs by telling myself that the baby will tolerate early labor more easily than later stages of labor …but is that true?

    • What does your OB think about the situation?

    • Rochester mama

      What’s wrong with going in having them watch contractions and then send you home? Do you live far from the hospital? Did your provider give you a rule to follow like x number of contractions in an hour?

      • Ainsley Nicholson

        I did that the first time….but it is happening almost every day, so I can’t go in to the hospital every time. Biophysical profiles of the baby are consistently great. My pattern is to have contractions every 5 minutes regularly when I have them at all, so the normal rules-of-thumb don’t help. I’ve discussed it with my OB and she isn’t worried by the contractions at all.

        • Rochester mama

          For what it is worth that is how my early labor was….for two weeks contraction would start and stop. Then my water broke at 4:30 and labor went into high gear and my boy was born three hours later.

          • Ainsley Nicholson

            I will hope for something similar!

        • batmom

          I had that starting at 35.5. Not painful, but regular. My CNM recommended that I go in when they became too painful to talk through, and to go in for BFP/NSTs if I got nervous.

          I wound up with nearly six weeks of prodromal labor, but on the plus side, I was already 3cm/100% as a primip when labor did start. Good luck!

    • moto_librarian

      I had prodromal labor with my second for 10 days. The first time it happened, I spent a few hours in OB triage with the baby on the monitor to make sure he was tolerating contractions well. I was right at 37 weeks.

    • guest

      I had prodromal labor for literally a month before my baby was born. At night I would have regular contractions, five minutes apart, lasting one minute each. They were stronger than braxton hicks, but still not really what I would call painful, just kind of intense. My doctor never worried about it. Baby came when he was good and ready at 38 weeks! I hope everything goes well for you and your new little one.

    • hurricanewarningdc

      Like the others, I had it, too. Actually for most of my third trimester. Sometimes, it would last for 12 hours or more. I could time them at 10 min apart or 8 min apart etc. (They got closer together and more painful as i got closer to my due date.) After two visits to L&D (where all registered on the monitor – but where the contractions obviously weren’t producing labor), we stopped going. BH are BH… My real labor – a week late and insanely long – followed exactly same pattern as my BH did; they were simply closer together and eventually far more painful.
      If it helps, I knew the difference when it happened for real. I’d worried before about whether I would know. In the end, there was no mistaking what it was. And having a clock (i used an online stopwatch where you just hit the space bar at the start/end of the contraction) was useful. I waited about four hours, timing on and off, to be sure and then woke my husband, took a shower, and we went in.
      I’d talk to your doctor about it. Depending on your history, etc they may want you to come in asap. Or they may say (as I think is normall said) that you wait for at least an hour where they’re timed 3-4 min apart, and then get moving. But get your plan from your own doc, for sure. Good luck! It’s going to be so exciting to meet your little girl/boy!

  • EB151

    My 20 hours of unmedicated labor were the worst day of my life. If someone gets some kind of spiritual high from that experience, GREAT! Good on ya. But don’t impose your religiosity on me. I see absolutely no benefit to that kind of suffering and I am so grateful to all the lovely people who invented and provide epidurals. P.S. Childbirth is one day. Parenting is 18 intensive years followed by a lifetime. Get your priorities in order. Who cares how the kid gets here? Just get it done.

    • I do think we should care how – to the degree that women are provided with informed consent and empowered to make medical decisions for themselves after taking into consideration the advice of qualified health professionals. I also think we really need to care about the period beyond the birth and the 42 days after – there are broader issues that need to be addressed (things like pelvic floor health, birth asphyxia, PDD and PTSD).

  • EllenL

    There’s a website run by the Royal College of Midwives that echoes a lot of what’s being discussed today.

    A common theme of the website is that midwives are the real experts in birth, and OB’s are clueless. Here’s an example:

    http://www.rcmnormalbirth.org.uk/stories/do-as-you-would-be-done-by/

    The article on Coping with Pain really raises my blood pressure.

    http://www.rcmnormalbirth.org.uk/stories/wheres-the-doctor/coping-with-pain/

    Consider this ridiculous statement:

    “Fortunately pain in a normal labour builds up gradually, giving the woman a chance to acclimatise to it.”

    The way labor pain relentlessly worsens over time is the most demoralizing thing about it! No matter how terrible the pain becomes, you know it will only get worse. There is no escape. I have had friends say of their labor “I thought I would die” or “I wished I would die, but I knew I wasn’t going to”.

    On this website, letting patients experience excruciating pain is cheerfully endorsed.

    Perhaps I should be grateful for the website, as it so clearly exposes the ideology and prejudices of this group. I should say “Thanks
    for telling us what you really think” (OB’s are idiots, pain is a good thing,
    etc.).

    • theadequatemother

      “Fortunately pain in a normal labour builds up gradually, giving the woman a chance to acclimatize to it.”

      That is a bold-faced lie! When you enroll a few 10s of thousands of women in clinical trials looking at early vs delayed epidurals, and the median dilation at which pain relief is FIRST requested is 2 cm AND the pain is rated 8/10…well…I’m sorry but early labour HURTS badly for a lot of women.

      My labour was near-precipitous. I started in transition. I guess my labour is not normal and the RCM will fully endorse my informed choice for a prophylactic epidural followed by an ARM at 39 weeks, right?

      • The Computer Ate My Nym

        My labor was obstructed and started out with continuous severe pain. I don’t know what normal labor with breaks between the contractions is even like.

      • I support your choice and applaud you for taking your well being into your own hands. I hope that your bean cooperates with the plan!

      • moto_librarian

        With my first, early labor wasn’t terribly painful, but bear in mind that I was 3 cm. dilated before my water broke. I do know with certainty that transition hit me like a ton of bricks. With my second, I had uncomfortable prodromal labor for 10 days. That was exhausting, and when I went in to be checked on the tenth day and still hadn’t dilated beyond 3 cm., my CNM stripped my membranes. Two hours later, I was admitted to the hospital at 5 cm., got my epidural, and slept through most of labor.

      • Ceridwen

        I am one of those. My contractions became noticeable at ~7pm the day I was due. By 11pm they were still going and getting regular and I was pretty sure it was going to be the real thing. by 5am I’d woken my husband to make him get ready to go to the hospital as they were 1 min long and 4 min apart and had been for a while. By 10am I could not talk through them. I was at 2cm.

        I wound up getting an epidural at 7pm after 24 hours of labor, with more than 12 of it involving strong, regular contractions. I was exhausted. I was also only at 3cm. Who was anyone else to decide for me whether it was time for the epidural unless there was a valid medical reason I could not get one?

        I did end up with augmented labor, but we were headed that direction before the epi anyway and since I already had the epi it actually took the pressure off of making that decision. And despite my long (40 hour) labor the epi meant I did get *some* sleep and was able to make calm, informed decisions about my care and enjoy my daughter after she finally arrived!

    • Zornorph

      Her Majesty should revoke their royal patronage.

    • The Bofa on the Sofa

      I have said it many times. Pain in childbirth was recognized as being so severe 3000 years ago that it was attributed to being a punishment from God. Only a punishment from God could account for such pain, it wasn’t anything natural.

    • moto_librarian

      “Fortunately pain in a normal labour builds up gradually, giving the woman a chance to acclimatise to it.”

      Yeah, I bought into that, right along with the whole “Pushing will feel good,” rhetoric. I will never forget how angry I felt when I started pushing, only to discover that it hurt like hell. The next hour and a half were a blur of agonizing pain. Then when I thought it was finally over, the pph started, and I got to have manual examination of my uterus without pain medication. By the time they got the I.V. run, I was in and out of consciousness. I remember the anesthesiologist saying, “tell me when you start to feel the medicine,” and I remember the bliss of feeling the pain recede as the fentanyl streamed into my body.

      I am completely serious when I say that I would not have had a second child without the availability of epidural anesthesia. I told my CNMs frankly that I had considered asking for an elective CS because I was so haunted by the experience. They were extremely supportive, and made a note on the front page of my chart detailing my prior experience with delivery. As soon as I was checked by the on-call midwife at the hospital, she ordered my epidural. Supporting a woman’s right to pain relief IS being “with women.” If midwives can’t understand this, they have not business being healthcare providers. Too many CNMs have absorbed the “trust birth” mentality, and until this aspect is thoroughly weeded out of the profession, I cannot give blanket approval to the midwifery model of care.

      • Karen in SC

        “Supporting a woman’s right to pain relief IS being “with women.” If
        midwives can’t understand this, they have not business being healthcare
        providers.”

        That, a thousand times!

    • Squillo

      Fortunately pain in a normal labour builds up gradually, giving the woman a chance to acclimatise to it.

      Yah. It does that with cancer, too.

    • MaineJen

      I very vividly remember thinking during transition in my first labor: “GOD. Wouldn’t it be easier if I just died?” I was pressing my forehead into the bed rail. Thankfully, the anesthesia arrived soon after. Pain relief FTW!

  • Dr Kitty

    Labour- a physiological process characterised by painful uterine contractions, and often accompanied by involuntary defecation, vomiting and screaming.
    Sounds fun, no thanks.

    Who is HD to decide if an epidural was unnecessary?
    If the woman concerned and the anaesthetist who placed if both felt that it was appropriate and necessary, then it was appropriate and necessary.
    End of story.

    Strictly speaking, no epidural is “necessary”- you CAN deliver without one, but if you don’t want to, you don’t have to, so it is “necessary” if you want one. Just like a local anaesthetic for a root canal isn’t “necessary”, but no one should argue with you if you choose to have one.

    It does sound like HD is saying that, in her opinion, with her special super MW knowledge, all the bad Drs are talking women into having needles stuck in their backs. When all they really need is some aromatherapy and to buck up, pull themselves together and just get on with it, like women having been doing for millenia- and sod the pelvic floor damage.

    SUPER sympathetic sounding.

    • EllenL

      “we need to ensure they (epidurals) are not used unnecessarily”
      Translation: “You aren’t getting one unless I think you need it – and I don’t.”

  • Therese

    So going off on a bit of a tangent, does the whole thing about infants having a swallow reflex (instead of aspirating) if they get dunked under water continue to only apply to cold water even when they’re not newborns any longer? When people do baby swim training, do they have to do it in cold water?

    • Expat

      I never did the baby swim lessons with my kids, but my mom did them with me a lot and they told her to blow in my face before dunking me under the water. I was the only one of my siblings who got this treatment and I am the only one with terrible allergies. I have wondered if my regular exposure to gulps of chlorine water as an infant had anything to do with it. I read some article that found a correlation between early swimming pool usage and severity of allergies, but I don’t know if it was any good. There was another paper on allergies that I read which pointed to a specific bacteria in cow poop that conferred some protection from hay fever.

      • Hannah

        “There was another paper on allergies that I read which pointed to a specific bacteria in cow poop that conferred some protection from hay fever.”

        Seriously?? I could’ve used that. Spent my toddler/preschool years living on a ranch in the middle of nowhere on land that was also rented out for use by a neighbor who raised free-range beef cattle. I had all kinds of exposure to cow poop… and still get hay fever! Man maybe I should’ve played in poop more.

    • araikwao

      Science-Based Medicine did a blog on that fairly recently, IIRC, AAP only endorses swimming lessons for children aged 4+

    • Amy H

      I don’t get that one – my baby has always (up to his current 14 months) gasped and acted traumatized if I poured water on his head during baths. That is, he gasped afterwards like he’d been out of air for ten minutes … drama! So I don’t get the cold water/warm water thing, but there’s no way I’d trust a reflex like that to keep a baby who’d just been through the birth canal and was starving for air (don’t care what they say about the cord and placenta) from trying to get some.

  • Amy M

    It is true that the population of women that get epidurals end up with more instrumental deliveries (forceps or vacuum)? And if so, it is truly the epidurals causing this, through the woman’s diminished feeling, or is it that women whose babies are in less than ideal positions are likely to be in more pain (or laboring longer, therefore asking for epidurals for relief), or some combination of the two? Or maybe some other factor/s?

    I think a maternal request Csection, for any reason, is valid, but wanting to preserve the integrity of the pelvic floor is MOST CERTAINLY a fabulous reason, and anyone who thinks otherwise needs to get shredded in the perineum, rendered incontinent and then rethink it.

    • theadequatemother

      The literature on epidurals spans several decades during which the technique has become significantly modified. Midwives, NCB advocates and Science and Sensibility like to quote studies from the 1980s when the concentration of local anesthetic was higher, the local anesthetic used was different, there was no such thing as a combined spinal-epidural (CSE), we didn’t use patient controlled epidurals, and potent narcotics were not used for their local anesthetic sparing effect.

      The association between an epidural and instrumental delivery was not seen in modern randomized studies using a concentration of bupivacaine or equivalent less than 0.125%. Most centers now use 0.06-0.08% bupiv or ropivacaine with a small dose of a potent synthetic narcotic.

      The association between epidurals and CS or instrumental delivery is seen in retrospective studies but not prospective randomized studies for exactly the reason you mention – dysfunctional labours and labours with malposition hurt more.

      Two large, prospective randomized controlled trials looked at epidurals on demand or only after 4 cm. Both showed no association with cs or instrumental delivery, and earlier epidurals actually caused a shorter labour (90 minutes on average!). Oh…and women in both groups requested them at a median dilation of 2 cm, reporting 8/10 pain. So early labour does hurt and there is no reason to make a woman wait from an anesthetic point of view. Although most LDRs won’t admit prior to 4 cm so there is a resource issue that delays the provision of an epidural for a lot of women.

      • EllenL

        No matter what the science says, the midwifery community
        will not give up the demonization of epidurals. They continue to ignore the latest studies, exaggerate the side effects, mention the “cascade of intervention” etc.

        The funny thing is, they can’t scare most women out of
        getting an epidural – where epidurals are offered. Pain has its own language and it’s more powerful than their propaganda.

        • theadequatemother

          plus it doesn’t make sense. We ane’s aren’t so myopic that we would continue to offer a modality of labour pain relief that was truly dangerous to mother and/ or baby.

          • The Bofa on the Sofa

            You need to have long mustaches and tie women to railroad tracks.

            Seriously, that almost seems like how they view medical providers.

          • auntbea

            This is something I can’t figure out. We know that most of these people are middle-class and well-educated. How do you get to be middle class and well educated without knowing any doctors (I know at least twenty)? Because I can’t believe you can personally know any doctors and still believe they are all evil.

      • Isramommy

        I just want to say how much I always enjoy reading your technical comments. Really interesting stuff.

      • Amy M

        Thank you for your excellent answer, I love hearing from the experts. 🙂 (Incidentally, my baby A was asynclitic leading to a nice long labor, with an epidural and vacuum extraction for A, but very little pelvic floor damage for me…luckily the babies were little.)

        Anyway, I was thinking some more about this…I imagine, and please correct if I am wrong, that there is a correlation between pelvic floor damage and 1)long labors, 2)large babies and 3)malpositioned babies regardless of epidural use OR forcep/vacuum use? IF this is so, I am guessing that women under those conditions in the hospital are more likely to end up with a C section, possibly saving their pelvic floors BEFORE the damage is done, then women doing homebirth with no access to “unnecessary” epidurals (and therefore, according to Hannah Derpy, no forceps or vacuums needed) are likely to have more and/or worse pelvic floor damage. So Hannah’s own argument about epidurals=pelvic floor damage falls flat.

      • DaisyGrrl

        Thank you so much for your contributions to these threads. They have really made a difference to me. My sister gave birth this past spring with a (Canadian) midwife. She was leery of epidurals because our mother had two terrible experiences when we were born. My sister’s midwife told her that getting an epidural wasn’t a good idea because it would prolong the labour by hours (and cascade of interventions, childbirth pain was different, etc).

        I used your blog to send her some good information on studies that contradicted what the midwife was saying. The information also calmed my mother down about how epidurals are done today so she would know what to expect.

        My sister wasn’t *against* epidurals per se, but she had been fed such a steady diet of bullshit from her midwife that I don’t think she would have gotten the epidural without the extra info. The midwife made my sister labour for three hours after the initial epidural request before she called in the request (grr…). I have to say, between you and Dr. Amy, I’ve become convinced that if I ever give birth it will be with an OB and an epidural should I feel I need one (which will be almost certainly).

        • theadequatemother

          its always best to ask the midwife to page the anesthesiologist from the phone in the labour room. That way you know she’s done it. Some of our canadian midwives can be very anti-epidural. Some of the LDR nurses too. One of my family members didn’t have her request called in until her husband went out to the nursing station and gave the RN involved in her care (who didn’t call, and then lied and said she called but the ane was busy) a public dressing down.

          The fact that women and their real advocates have to go to these lengths to have a perfectly reasonable request honored is disgusting to me. The decision about whether it is “too soon” or not to have an epidural does NOT involve the midwife or nurse. It involves the woman making the request and the anesthesiologist on duty.

    • batmom

      It’s really hard to disentangle the two, I think. I had an epidural and wound up with forceps, but my kiddo had a big head and had kinked it sideways, and I know he did that about three weeks before he was born (he was easy to feel in utero.) I feel sometimes like I caused the long labor and delivery by not being strong enough (epidural placed at about 6cm and shortly after that labor stalled, which led to a long night), but my husband tells me from his perspective the pain relief was a smart choice.

  • It sounds like on planet midwifery, Birth Trauma and post-natal PTSD are probably silent epidemics with a huge toll on women. For a group of care providers who trumpet “empowering women” – they seem to think that taking away choice and denying access is fair when it comes to epidurals and cesareans.
    Unfortunately, planet midwifery has done a fabulous job disseminating propaganda with respect to natural childbirth and is absolutely blind to the harm caused to women and children. Yes, more matters than just surviving the process – but to think that it is the specific process that matters is foolishness.

    • theadequatemother

      can you imagine the difficulty you would face trying to access mental health resources for your post-natal PTSD if you had HD or equivalent as your midwife telling you that your birth was wonderful and essentially telling you how to feel about it?

      • That’s part of the problem. WE do live in that world. Denying you could be traumatized by a normal birth is prevalent…women deny themselves this all the time. It doesn’t mean they weren’t traumatized, it means they can’t or won’t admit it.

  • PrecipMom

    Unnecessary epidural = Your pain lacks sufficient validity to me for me to give my ultra necessary blessing to you having pain relief.

  • ” perinatal mortality is in fact a very limited view of safety”

    This isn’t a ridiculous statement. Injury and disability are concerns as well, and so is maternal mortality. They may not be addressed well by midwives but the statement itself made sense to me.

    • Dr Kitty

      It’s a limited view of safety if perinatal mortality is all you look at, I agree, but that isn’t what she meant.

      What HD MEANS is that HB, although it has a higher perinatal mortality, shouldn’t be seen as “less safe” than hospital birth, just because of that.

      Which is a very, very stupid way of looking at safety.

      A is less fun than B, but B is more likely to kill you.
      B is less safe than A, but what we really want to talk about is how fun A is. So we pretend that safety doesn’t matter, or that safety is less important than fun. Or, as HD tries to do, that “safety” is an equation where deaths are cancelled out by fun.

    • Ainsley Nicholson

      If you look at the original article (http://blogs.crikey.com.au/croakey/2011/11/14/home-births-its-time-to-broaden-the-focus-of-the-debate/), you will see that Dahlen is not so much concerned about injury, disability, etc as she is concerned about the “Cultural, emotional, social, psychological and spiritual safety” that “rarely appear in the mainstream debates about the safety of homebirth”.

    • Amazed

      It is a ridiculous statement because she meant it like “mothers might be traumatised by their c-section!” Maternal mortality is no concern of hers.

      Funny, I’d think that mothers might be traumatised by having a dead or disabled baby. But typically, these mothers are not considered real women by Dahlen and her cohort so there’s no need to think about them.

      Read this. The comments are stunning. Homebirthing bitches in their full glory!

      http://www.charlotteobserver.com/2013/09/11/4305143/state-releases-details-on-babys.html#.UjHrXz__lsT

      THESE are the women Dahlen and the likes of hers are concerned about. These are the women they can mooch off from.

  • Antigonos CNM

    IMO, the resistance to medication in general is because US midwives can’t administer it. When I was in the UK, I could give certain forms of analgesia, according to certain protocols, in the home or hospital. Of course, I couldn’t do an epidural. But there was no reason that a home birth had to be an unmedicated one, and most of the women I delivered at home did receive something for pain at some point.

  • KarenJJ

    “Nitwittery” – great name for it.

    And with the Australian College of Midwives sponsoring a conference where Lisa Barrett was a speaker (along with Gloria Lemay), I think Hannah Dahlen and her colleagues are quite possibly knee deep in nitwittery..

    http://vidm.wikispaces.com/International+Day+of+the+Midwife+2013

    • Karen in SC

      Recently saw Bambi refer to “Midwitchery.” Another good descriptive noun.

      • me

        Don’t diss witches 😉