Natural childbirth renders women’s needs invisible

NoBody Series - woman on the side

The philosophy of natural mothering (natural childbirth, lactivism, attachment parenting) rests on fundamental assumptions that are often unrecognized and therefore unexamined. In the past I’ve written about the social construction of risk within our culture and the social imperative that everyone (mothers and doctors) do everything possible to minimize risks to babies without ever considering the trade-offs that reducing specific risks imply. But risk is not the only thing that is socially constructed within the philosophy of “natural” mothering. Women’s needs are also socially constructed. Specifically, in the philosophy of natural mothering, women’s needs are rendered invisible. Natural childbirth advocacy and its approach to the issue of pain in labor is perhaps the paradigmatic example of the way in which natural mothering erases the needs of women.

Natural childbirth advocacy uses several different strategies to render women’s needs invisible. To understand how these strategies work it makes sense to start with the empirical facts that most of us agree upon:

1. Childbirth is excruciatingly painful. Indeed the pain of childbirth is so impressive that ancient cultures imagined that the only possible explanation was divine punishment of women for their transgressions.

2. Severe pain should be treated. No one would ever suggests that cancer pain be ignored or that pain from a broken bone should go untreated.

3. Medical professionals have an obligation to treat pain. Every human being is entitled to the medical treatment of pain if that’s what he or she desires.

Natural childbirth advocates employ a variety of strategies to render invisible women’s need for pain relief. The first strategy is to insist that a mother’s need for pain relief is insignificant when compared to the “risks” of epidurals. This strategy is all the more remarkable when one considers that the “risks” of epidurals are not empirical, but purely speculative. Presumably, the baby has a need and a right, to avoid any potentially harmful effects from epidurals that might be discovered as some unspecified future time. And that need (even though theoretical) trumps the mother’s need for pain relief, despite the fact pain of this magnitude would always be treated if it were from any other source.

The intellectual sophistry of such a claim is all too apparent. The natural childbirth project involves invoking risks that may not even exist and inflating both the severity and the likelihood of such risks. And it rests on the assumption that no matter how theoretical or how small these risks may be, they automatically trump a woman’s need for pain relief. A woman’s need for pain relief is therefore of no consequence and not even worthy of consideration.

Even when natural childbirth advocates concede that women might feel a need for pain relief, they employ a variety of strategies to diminish the importance of that need. These strategies involve

Blaming the woman for her own pain – if she did it “right,” childbirth would not be painful.
Blaming the woman for not using “natural” methods of pain relief – regardless of their questionable value in providing adequate relief.
Blaming the woman for not embracing the pain as an “empowering” aspect of her biological destiny.

Simply put, according to natural childbirth dogma, a woman’s pain in labor is irrelevant of no importance compared to the baby’s need to avoid theoretical risks, and, in any case, is her own fault.

It is important to note that in natural childbirth philosophy, it makes no difference how small the risk to the baby might be, and it makes no difference how large the mother’s need for pain relief might be. To put that in perspective, it helps to consider another, far more trivial, example of balancing risk and need that all mothers must address.

Consider the issue of driving with a baby in the car. There is no doubt that riding in a car exposes a baby to a real risk of injury and death in a car crash, a risk whose magnitude is far greater than the theoretical risk of an epidural. And consider that the mother’s “need” to go to the grocery store is trivial, and can easily be met at another time without putting the baby in danger of injury or death in a car accident. So why aren’t natural childbirth advocates berating women for driving with infants in their cars? They consider that larger risk socially acceptable. In that case, convenience trumps whatever needs the baby might have.

The reality is that every choice has risks and benefits, and those risks and benefits must weighed against each other. But when a woman’s need for pain relief is rendered invisible, natural childbirth advocates can act as if there is no benefit to pain relief in labor and can pretend that no weighing of risks and benefits is necessary.

It is difficult to imagine any other situation in which ignoring a woman’s severe pain would be socially and ethically acceptable. But for natural childbirth advocates, a woman’s needs are invisible, and therefore merit no consideration.


This piece first appeared in January 2011.

114 Responses to “Natural childbirth renders women’s needs invisible”

  1. 38 weeks
    August 25, 2014 at 6:22 pm #

    As one who is neither a strict NCBer nor a bring-it-all-on interventionist, but who is going in for her first birth planning to labor without medication if possible, it seems to me that the middle ground is sorely missing from a lot of the debates, blogposts, and such that I’ve seen, including this one. You talk about how NCB philosophy sacrifices the mother for the baby, and I think, ironically, the NCB community probably thinks the same of the other camp. My point is that I don’t feel like women are truly being heard by anyone, especially not extremists. It’s very alienating and disempowering. At least, that’s the way I’ve felt. My reason for attempting labor without medication is because I know that if I ask for medication I’ll have to have cervical checks (rightly so), but because I have a condition that makes such examinations incredibly painful (physically and emotionally), I will do my best to avoid them. If it’s my right to labor without pain, is it also my right to deny cervical checks because of the pain they give me? But try explaining that to most people — generally only the NCB community is supportive; others tend to resort to shaming women like me because I can’t handle this type of pain (how ironic – some pain is acceptable, some isn’t), or dispute my right to even have a child in the first place. Granted, the NCBers mainly support the position because they deem cervical checks “interventions,” not because they understand the disorder, but at least they tend to affirm my right to my body. So what do you do? Go to the hospital and hope that the nurse understands something that even your OB couldn’t help you with, or face something less scary (medication-free labor) and risk people labeling you a stubborn natural birth junkie — someone who has to have control or a proper “experience”? The language is sexist, shaming, and hypocritical no matter what, especially for those of us who dare to want a child despite suffering from psycho-sexual disorders.

    • Stacy48918
      August 25, 2014 at 6:48 pm #

      What makes you think that cervical checks are dispensable/unimportant/superfluous as long as one labors without medication? You are exactly right – you have a right to decline cervical checks. For whatever reason. But you have to realize that you will be limiting the information available to your doctors on progression, presentation, etc. Limited information limits care too.

      You also realize that with an epidural in place you won’t feel the cervical checks, right?

      Have you discussed a C-section with your doctor? A pre-labor C-section to avoid whatever psycho-sexual disorder is at hand would avoid all of these concerns too.

    • jenny
      August 25, 2014 at 7:31 pm #

      I’m guessing you suffer from one of the pelvic floor pain conditions and some history of trauma. You absolutely do have a right to decline cervical checks, although they can provide very useful, and in some cases, life-saving, information. Your psychosexual disorder and needs should be in your chart. If excessive checking causes you pain or other distress, this needs to be noted! Many hospitals will do a special care sheet for patients with unique needs. Then you don’t have to hope the nurse understands.

      I have similar issues with both pain and trauma, as well as a bad experience with one OB, which made the NCB perspective very appealing to me when I was pregnant with my oldest. However, when I was pregnant with my second and third children, I was able to discuss these issues thoroughly with my hospital midwife. I found it helpful to be continually reminded that I could decline any checks I wanted (although I ended up choosing to have two) and also to have my midwife very carefully describe to me what she was doing as she did it, and constantly affirm my autonomy. For me one of the most important things was feeling like I could decline without repercussions – then I was able to freely choose what I knew was best for me and my baby. Sometimes an anti-anxiety medication can be prescribed in order to reduce the distress you feel.

      If you don’t feel your OB understands or takes your condition seriously and isn’t willing to do some problem solving with you, I would really encourage you to find another provider if there is any possibility of doing so. You may also want to talk to a social worker at your hospital – they can be an excellent resource for problem solving.

    • jenny
      August 25, 2014 at 7:41 pm #

      And I’m really sorry you are dealing with this issue. It must be very frustrating and scary for you.

    • fiftyfifty1
      August 25, 2014 at 7:53 pm #

      Birth can be really triggering for those with psycho-sexual disorders. One option that some women choose is to find a doctor or hospital-based CNM with experience in this area, and together create a personalized game plan ahead of time. Some examples form my own experience:
      1. A woman with severe vaginismus and a history of childhood sexual abuse. Vaginismus was so severe that she and her husband had never had intercourse, and the baby had been conceived by having him ejaculate near the vaginal opening. She chose a planned epidural at the beginning of labor. All checks were done through a single female provider. She labored and delivered in a very private delivery room with a sign on the door so nobody not involved in the case would enter by mistake.
      2. One woman chose a planned c-section.

      3. Another option I have heard of but not personally witnessed is rectal-route cervical assessments. My grandmother-in-law, now in her late 90s, used to be a L&D nurse in the 1930s and says they were taught how to check the cervix through this route (cervical opening can be felt through the rectal wall which is really thin when you get above the anal canal) as well as the “regular route”. Whether this would be a helpful substitution or not, of course depends on the person, and I can imagine that not everybody has training in this. Any OBs that can add info?

  2. Jane Smith
    August 21, 2014 at 10:11 pm #

    My first birth was a standard, healthy hospital birth with epidural, 10lb baby. Totally textbook other than 4th degree brutal tearing. My epi had worn off by the time he was born, and I do not respond well to local injections – suturing took 50 minutes. The doctor was a stranger to me, and gave me no pain relief. It was very painfull, and should have been handled better. I was young and not a good advocate for myself.

    My 2nd birth, I drank the natural koolaid. She was born 10 lbs 6oz, 42 1/2 weeks, born with hand at her face. I am so grateful we were ok as I made such a dumb decision to have her at a FSBC. Midwife had us transport for suturing, in our own car, and assured me I would have PAIN RELIEF at the hospital for repair, most likely to be done in the OR. The midwife went home to sleep (ugh) and I had no advocate again. The OB let the student suture me and I was not numb at all. I was released home immediatly with no pain meds and as many sutures as a csection patient. The next 4 weeks were so painfull. I resolved the next would be a planned c section Got thru birth with no meds, but the post birth pain was hell.

    Why was my pain minimized by both midwives and doctors? I felt so cheated out of enjoying those first few weeks because of pain. As I know C section moms get pain relief, this is the only route I can think to go. Maybe that is my only solution. Due to a collagen disorder, I have poor skin integrity, and lidocaines do not work on me.

    Any ideas on help for immediate postpartum pain relief? I would never again have an out of hospital birth, as further education has shown me the danger. My actual labors were textbook and I did well there. Hate to have major surgery for this reason, but dont see much choice….

    • Young CC Prof
      August 21, 2014 at 10:24 pm #

      Honestly, a routine c-section is usually less invasive and quicker to heal than a 4th degree tear. But for pain relief, really the key thing is to have that conversation with the doctor as early in the pregnancy as possible, possibly have a pre-conception session with the doctor who treats your collagen disorder, or get the OB and your regular doctor to talk to each other.

      • Jane Smith
        August 23, 2014 at 1:07 am #

        Thank you. I intend to have a choosen OB next time. Hoping to have these issues taken more seriously then. I heal poorly as well, so the choice between csection vs vag will be tough. I think a wound on my belly is better than my past wounds though, or so I imagine it.

    • Lily
      August 25, 2014 at 8:59 am #

      My first was natural with induction. I asked for epidural but they
      were busy with other women need C-section. When my voice once raised because of the pain the midwife came and said “you are the one I heard!? there is no pain!” I felt like I want to punch her on the face. After 4 hours I had the epidural that was like heavens. Once they finished the procedure the midwife found I’m 10 cm dilated. I wished I had it earlier. No one helped me pushing I was the one looking for the monitor trying to know when to push. They were all busy talking. So they decided to use the vacuum. They said if I just pushed one more push. She came out immediately with the placenta. They did an episiotomy and had a tear too. So sutures both sides. While suturing I feel them stitching but not severe pain. She asked if I feel when I said yes she said that’s impossible on epidural! Then why was she asking. That also was when I discovered she’s stitching both sides because I feel. She took like 45 minutes. Later on there was still bleeding from episiotomy so they added sutures and the OB didn’t like the other side stitching and ask another midwife to repeat it. After 4 weeks the Ob didn’t like the result! “what!!!” and asked me to redo it by her this time. That was horrible why didn’t she take the effort to do it from the start!. plus I had UTI I told her when she came after delivery that I have to pee so frequently and said that normal!! plus these huge painful bleeding hemorrhoids that she didn’t notice and I can’t sleep and can’t set and can’t try to breast feed I was so in pain bleeding from every where and I had depression and had difficulty to enjoy my baby and bond to her.
      On my 2nd pregnancy I was scared again to have an epidural and that I can’t be able to push and no one helps me. My OB promised me they will help and the sutures would by by professionals only. So I decided that epidural will help relax and save energy and push better. But my daughter decided to be breech (oh, I luv her. That was my with to have a C-section). And I had that beautiful C-section. Yes, painful in the first few days but pain medications are available. I was so relaxed and happy during delivery and after even though wasn’t so planned and was an emergency for low water level around my baby. And I recovered much faster this time. And thank god no UTI again and the best of all no that awful huge hemorrhoids that never heal. I could try breastfeeding my daughter every time without problems in setting. And we bonded much better than my first experience. After 7-10 days I forget sometimes that I have just had my baby.

      I doesn’t matter how natural. All what matter the end result. Healthy happy Mama and baby.

  3. Samantha
    August 21, 2014 at 5:51 pm #

    I’ve had two “natural” births, with midwives in a freestanding birth center. I will spare you the details that led me away from the natural birth movement, but I am 37 weeks with my third, and as much as I was an advocate for natural birth with the first two, I am an advocate against it now. I’m happily planning an induction plus my very first epidural with this baby. I’m not telling very many of my friends about the induction or the epidural – finally realizing that it is NO ONE’s business how I choose to give birth. It’s all very refreshing to view my new wonderful doctor as a trusted care provider instead of an enemy I need hire an advocate to fight against (aka doula). Anyway, thank you for what you are doing.. your blog is helping me to feel very strong and confident in my decision. It’s great to see something like this online among all the natural birth propaganda.

    • guest
      August 21, 2014 at 6:39 pm #

      So happy for you! Please start spreading the word, if you are comfortable doing so! I’ve been an L&D nurse for over 10 years, and there are very few doulas I can honestly say I have any respect for.. most of the ones I’ve seen are disruptive, undermining and totally disrespectful.. you are totally right, your birth choice is no one’s business! I think you will enjoy your epidural and I wish you all the best!

  4. Cody
    August 14, 2014 at 9:06 pm #

    “Presumably, the baby has a need and a right, to avoid any potentially
    harmful effects from epidurals that might be discovered as some
    unspecified future time. And that need (even though theoretical) trumps
    the mother’s need for pain relief, despite the fact pain of this
    magnitude would always be treated if it were from any other source.”

    I disagree with this. I think the mother trumps the baby on this one, provided the pain relief is reasonably safe. We’re talking about an epidural, not smoking crack/opium or something equally unreliable and unsafe. If it is discovered that there is some small risk, I still think Mom comes first because if it were at all significant, it would have been found by now. The pain of childbirth is universally understood to be at the far end of the spectrum as far as the human experience goes.

    I believe the mother comes first until the baby is out, and then generally speaking, they should be considered of equal importance.

    • Young CC Prof
      August 14, 2014 at 10:50 pm #

      And the author deconstructs that claim herself in the next paragraph. A hypothetical remote risk to the baby does not outweigh the mother’s right to relief from extreme pain.

    • Cobalt
      August 15, 2014 at 4:53 am #

      After decades of women having epidurals, there is just too much data pointing to them being safe.

      This is especially in contrast to some alternative approaches to pain relief, like giving birth underwater, drinking alcohol in labor, or any homemade herbal preparation.

  5. lawyer jane
    August 14, 2014 at 11:35 am #

    Off topic: Marni Kotak, an “artist” who gave birth to her child in an art gallery as performance art in 2011, is now doing another performance art piece where she goes off her post-partum psychosis drugs in the gallery.

    • Cobalt
      August 14, 2014 at 11:57 am #

      Maybe a dose adjustment would be more appropriate.

    • jenny
      August 14, 2014 at 7:13 pm #

      I can’t think of anything to say about this that doesn’t sound dismissive.

  6. Cobalt
    August 14, 2014 at 10:40 am #

    OT, but I’m having a pregnant woman fear and need some data about cord prolapse. What is the likelihood and recommended course of action in a cord prolapse after spontaneous membrane rupture (fetus still not engaged, I know once the head gets down there the cord typically can’t) before you get to L&D? How do you recognize the prolapse (or know there isn’t one)?

    I’m afraid I will be too nervous to sit upright in the car on the way to the hospital if my water breaks before we leave. I’ve never had my water break at home before, but I can’t get the idea out of my head.

    • jenny
      August 14, 2014 at 6:46 pm #

      Your OB is the best person to ask about this and should be able to give you specific instructions about what to do if your water breaks before the fetal head has engaged. Don’t be afraid to tell the triage nurse or whoever you speak to, “My water has broken and at my last appointment the head was not engaged. I’m worried about my baby.” Then they can advise you. Unless you have a specific reason not to, you should sit up and wear your seat belt when you go to the hospital. 😉

      Cord prolapse is fairly rare and occurs most frequently with preterm or malpositioned (breech or transverse) fetuses.

      A frank prolapse is easiest to detect – loop of umbilical cord is in the vagina. It may be pulsing. In that case you would lay down and elevate your hips and call 911. Avoid touching the cord as much as possible. A complete prolapse may be detected during a VE, as it comes above the presenting part but not into the vagina. An occult prolapse is really only detectable with fetal heart rate monitoring. Generally the pressure of the presenting part on the cord is what hinders the blood flow and causes fetal hypoxia. Excessive handling of the cord could also cause it to spasm.

      I had a complete prolapse with my second baby. I was very concerned about having a cord prolapse again with my third child, even though I knew the chances of reoccurance were not any higher. My OB office told me if my water broke at home, it was fine for me to check myself since it would alleviate my anxiety. However, a self-VE after ROM introduces risk of infection and, well, it’s not always really clear what you are feeling so it could introduce false comfort or false anxiety. Fortunately, my water didn’t break until I was in the delivery room.

      • The Bofa, Being of the Sofa
        August 15, 2014 at 7:55 am #

        My wife’s college roommate had it happen to her twice! Both times, at about 28 weeks. For the first one, she was sitting in the ob’s office waiting for her appt.

        • jenny
          August 15, 2014 at 9:47 am #

          Talk about bad luck! Were the babies ok being born that early?

          Actually, they did tell me if I’d had several preemies or babies who failed to descend, there could be structural abnormalities in my pelvis that could predispose us to a greater risk of cord prolapse, but absent those factors, I had essentially the same odds with every pregnancy.

          • The Bofa, Being of the Sofa
            August 15, 2014 at 10:13 am #

            Both of her kids turned out just fine, thankfully (I know her older girl needed glasses as a baby, but I think that’s common for such early premies).

            I have no direct information, but, in her case, I generally figure there was an anatomy issue. Could very well be that her cervix just can’t handle it when it gets to be that size.

            Or it could be random, but either way, they haven’t had any more kids, so it’s really hard to test the hypothesis more.

        • Cobalt
          August 15, 2014 at 10:42 am #

          Wow. The odds on 2 in a row so early have to be low enough to raise suspicion of some sort of specific problem. Glad the babies were healthy, that had to be very hard for the parents. Preemies are heartwrenching.

    • jenny
      August 14, 2014 at 6:57 pm #

      Also, the frequency of cord prolapse is 1 in 305 births, but as I mentioned in my other comment, the vast majority of these occur with preterm or malpresenting fetuses. It is exceedingly rare. One of my midwives has been involved in something like 4,000 births over the course of her hospital career and said that she had never encountered a cord prolapse after term SROM until it happened to us.

      • Cobalt
        August 15, 2014 at 5:16 am #

        Thank you for sharing your experience. I just had to change OBs at 35 weeks (very frustrating, I loved my old OB) and I haven’t had a chance to ask the new doctor “rare and random what if” questions. Pregnancy brain is a real pain, and some risk numbers are hard to find.

        • jenny
          August 15, 2014 at 10:02 am #

          Ooh, that stinks! Do they have a nurse line? Around here everyone has a nurse line where you can leave a question and they will call you back, and if necessary they will talk to the dr first. They may tell you to pay attention to your baby’s movement. If your baby continues to move in a familiar pattern, that can be very reassuring. Pregnancy is kind of terrifying because so much is out of our control.

          • Cobalt
            August 15, 2014 at 10:36 am #

            I hadn’t thought of the nurse line, my insurance has one I’ll need to check out. Laboring at home always makes me nervous, because I have no idea what is going on in there. At the hospital, I feel a lot better knowing I’m monitored by people who see this all the time.

            I figure the average L&D nurse or OB sees more births in 2 shifts than I’ll see in my life, I trust them to keep a look out for trouble.

  7. Beth S
    August 14, 2014 at 7:19 am #

    There are times when I feel like the World’s Most Unqualified Anesthesiologist because of the number of times I’ve had to explain the blood brain barrier and epidurals. I refuse to let the nonsense that’s infiltrated the mothering community to stand.
    You don’t have to be the most natural parent in the world to be a good mother, hell I’m probably the worlds most unnatural parent considering I formula feed, had a C-section, didn’t do immediate skin to skin (because you know it might have interfered with bonding) I do CIO after a certain age, and my stroller is my favorite thing ever. But you know what I’ve got a six year old who was raised the same way and she’s doing damned well.
    And that’s despite the fact that I used off brand generic formula instead of the expensive organic stuff that might have the evil GMOs in it and despite the fact that every once and a while I buy her a Happy Meal.

  8. WordSpinner
    August 13, 2014 at 8:54 pm #

    Well, I have to think neither the woman’s needs nor the baby’s needs are considered–it is all about the midwives needs. Think about the promotion of VBAC at all costs and HBAC–in that case, there is a known increased risk to the baby (and frankly 1/200 or whatever it is… that honestly is too damn common for me to feel comfortable, but then again, I’ve suffered complications from giving blood that were in the 1/1000 range, so the idea that I could be the one is pretty firm in my mind).

    So in NCB: nonexistent or hugely exaggerated risks of epidurals mean your a bad mother if you get one, but the known and fairly common risks of VBAC don’t prevent HBACs from being lauded. Because one of those choices involves hiring midwives, you see.

    On the blood donations: The study is here:

    I fainted, my blood pressure dropped more than 20 points (it was 90/50 forty minutes later, when they finally took it, so I assume it was even lower when I passed out) and I wasn’t able to go back to work for two hours. I learned important information about my reaction to fast blood loss.

    • Young CC Prof
      August 13, 2014 at 9:34 pm #

      You know what one part of the difference is? A hospital midwife or OB delivers thousands of babies, potentially hundreds or thousands of VBACs. They WILL see the 1 in 1000 complication, and have to live with the results if they botch it.

      A homebirth midwife might only do a few dozen babies a year, and only a handful of VBACs (if she accepts them.) Which means she probably won’t see the rare complications, and can therefore afford to be blase about them.

      • Anj Fabian
        August 14, 2014 at 7:40 am #

        If she does see them, it’s one of those things that happens – not one of those things that can be prevented or the effects greatly mitigated with close monitoring and immediate intervention.

        What else are you going to tell the family after the fact? “Yes, I should have but I didn’t?”. Hardly.

        • Amazed
          August 14, 2014 at 10:01 am #

          Err, Anj? Christy Collins said (wrote) just that in her vile letter. Besides blaming it all on mom, of course.

      • D/
        August 14, 2014 at 10:21 pm #

        A infant resuscitation debate that I stepped into recently finally drove home to me how completely much of professional home birth community eliminates any responsibility for themselves. They know mothers and babies die (in fact, such possibilities are frequently acknowledged), but every discussion comes back to this “fact” … It is the parents who are responsible for and who have to live (or die) with their choices.

        I left the NICU long ago when I could no longer function adequately in that capacity because of my deteriorating hearing. At the time I still had every necessary competency. I would have *never* been alone resuscitating a baby, in fact, I would have been unlikely to ever be in a resuscitation team of less than four individuals.

        Even now I maintain certification in high-risk neonatal care, teach NRP at least every other month and strongly suspect that I could still run resuscitation circles around the majority of home birth professionals. Despite all that, I would be an unsafe piece in the birth plan for saving a baby’s life when that rare (but inevitable) disaster finally happens, and that can never be an acceptable choice for me to live with.

        “Trusting birth” is all well and good until it all starts going to shit, and parents should be able to trust that those present are proficiently skilled in dealing with that too. More than that they should be able to expect that any *paid* birth attendant *choosing* to be inadequately skilled will be held criminally responsible since it seems that some folks will figure out ways to live with it otherwise.

    • EmbraceYourInnerCrone
      August 15, 2014 at 10:53 am #

      Weird, same thing happened to me both times I tried to donate blood. First time I passed out twice after giving blood. Second time i passed out during the donation, in the middle of a conversation with the person in the next chair , as soon as my bag was half full.

  9. Junebug
    August 13, 2014 at 8:20 pm #

    OT I’m going to talk to my doctor, but can anyone give me an idea of the most effective non epidural pain relief in labor? I have mild scoliosis and have had 3 epidurals that did a great job of numbing my leg into a rock for 8 hours, but did absolutely nothing for labor pain.

    So for baby 4 I’m hoping to skip the being stuck in bed in excruciating pain deal for maybe being able to move around in slightly less pain.

    • FormerPhysicist
      August 13, 2014 at 8:49 pm #

      I think someone here mentioned ages ago that you can ask for a consult with the anesthesiologist ahead of time. I never would have thought of that.

      • theadequatemother
        August 13, 2014 at 9:43 pm #

        That might have been me. I’ve since been informed that CMS in the US has delisted anesthesia consults (ie won’t pay). If you are in the US you’ll need to see what your insurance will cover. And the insurance gap may make them more difficult to access compared to the situation here in Canada.

        The one numb leg is likely due the catheter turning down instead of up or going down a nerve root. That may be more common bc of your anatomy and the fact that it happened three times suggests it wasn’t just a fluke. One option for you may be a combined spinal epidural. The spinal part will prob work and tends to last a couple of hours which may be all the analgesia time you need for a fourth baby. Another option might be to go to a bigger center where the group has the skills to use ultrasound to assist with catheter placement. Another option may be a narcotic only epidural although that may not be very effective. Narcotic diffuses farther in the space and does provide some analgesia without any motor weakness. It’s probably equivalent to systemic narcotic in terms of effectiveness tho with adverse events that are more serious.

        Non needle pharmacological stuff includes IV narcotic (some centres particularly tertiary teaching centres will have PCA as an option for labour either fentanyl or remifentanil). Nitrous (not in US) which is only mildly analgesic and very difficult to use at all in second stage. Talk to your obstetrical care provider and find out what’s available and what they think the best options for you are.

        • Junebug
          August 13, 2014 at 11:06 pm #

          I don’t know what the deal was last time around. I was in a major hospital and I explained at great length the problems I’d had. The first two times. They placed the epidural and the guy was just super put out that I said it wasn’t working after giving it a long while to start, and refused to re place it and instead just jacked up the medicine crazy high. So my leg was dead to the world but I still felt every second of every contraction.

          Since my baby went to the NICU after being born I didn’t get to see her for 12 hours because they had some asinine rule that I had to get up out of bed and walk to a wheel chair to go see her. If I have to be in a wheel chair anyway, why can’t the nurses just help me into it?!

          I really don’t want a repeat of that if I can help it. In the last year my insurance has gone to complete shit and now the

          • Junebug
            August 13, 2014 at 11:08 pm #

            Only hospitals I’m allowed to deliver at are smaller, and don’t even have level III NICUs. Really frustrated about that considering I was fine to deliver at any of 4 hospitals with lvl 3s only 13 months ago.

          • Elizabeth A
            August 14, 2014 at 12:07 pm #

            Junebug, I don’t know how much you feel up to, but I would want to poke at that hospital exclusion. Can you be referred from the smaller hospitals to the ones with NICUs? Is the health insurance company in some kind of asinine dispute with the hospitals?

            (My godfather was an OB, and used to growl, occasionally, that the best way to transport a preemie was in utero. If you think you might need the stuff, birth where they have the stuff! I wound up in ambulances three times during my last pregnancy. Twice, the ambulance personnel told me that I needed to be at a hospital with a Level III NICU and they were not permitted to drop me at a hospital that didn’t have one. The other time, I got myself to a smaller hospital without a level III NICU, and the CNMs packed me into an ambulance and sent me to a partner hospital that had one. With this experience, I feel VERY STRONGLY that women should be able to start out at the high level hospital if their needs or preferences tend that way, and insurance should cough up what it costs.)

        • AmyP
          August 14, 2014 at 2:37 pm #

          I think that under the circumstances, it would be totally worth it to do a consult with an anesthesiologist on a cash basis (asking in advance what the fee is, of course).

          Best wishes!

        • krazydoc
          August 17, 2014 at 12:53 pm #

          i don’t know how things go in the us but in canada we offer fentanyl and/or morphine dependent on where you are in your labor. For a g4 like yourself with 3 previous svd’s i would probably opt for fentanyl because you could go fairly quickly. . .

    • lawyer jane
      August 14, 2014 at 11:30 am #

      Some hospitals are starting to offer nitrous – it doesn’t numb you, but apparently makes the pain more mentally bearable. Other than that, maybe get a doula and plan on most likely going unmedicated? Because that sounds like the worst of both worlds – no pain relief, but being stuck in bed. Before I got my epidural, moving around definitely helped, and a *good* doula can also help get through the pain by basically having you focus on not freaking out about the pain (to the extent that is possible).

    • Somewhereinthemiddle
      August 14, 2014 at 11:34 am #

      They aren’t done much anymore, but I has something called a paracervical block.

  10. JoannaDW
    August 13, 2014 at 7:16 pm #

    I was nine when I learned about natural childbirth for the first time…reading the Genesis story in a children’s Bible.

    “When you have babies, it will be painful for you now, and your husband shall be your master.” Let’s see, we have the idea that women are meant to experience pain in labor, that avoiding it is avoiding your destiny as a woman, then we have male masters in the form of husband-coaches, doctors like Dick-Read. Sexist drivel clothed in feminist language, how original. How is it that so many of these people-feminists, non-religious, anti-authority, wouldn’t pick up the Bible over a comic book-got suckered into such old religious bigotries? Needless to say, that was what came to mind every time I heard about a woman having a baby. Scary, eh?

    I was 12 when I was first exposed to the concept of natural childbirth in a more realistic context…reading a book from the “Dear America” series, a series of historical fiction novels written in diary format. The story I was reading was a “diary” called A Coal Miner’s Bride. Context? A woman was giving birth in excruciating pain, but of course suffered no emotional or physical complications afterwards. Reason. I quote: “Labor pains awaken mother love.” I recognized it even then, at 12, as being both absurdly naïve, unbelievably sexist, and hideously cruel. I started, at 12, to research the reality of birth and ever since then, I had no problem arguing with grown women who bought into this BS and telling them what for. Now that I am a grown woman, I’m less bearable and more dangerous.

    So…if a middle-schooler can get that, why can’t so many grown women see that they’ve been had.

  11. Michelle
    August 13, 2014 at 7:05 pm #

    Bit off topic, but I this to me is relevant to the discussion especially when talking about the social constructions of risk, how pregnant women are expected to handle this and how they are blamed for this (in this context for not being able to cope with severe pain) leaving aside the myriad of other factors that can apply or any realistic assessment of the situation and it’s risks and benefits:

    “From folk medicine to popular culture, there is an abiding fascination
    with how the experiences of pregnant women imprint on their descendants.
    The latest wave in this discussion flows from studies of epigenetics —
    analyses of heritable changes to DNA that affect gene activity but not
    nucleotide sequence. Such DNA modification has been implicated in a
    child’s future risk of obesity, diseases such as diabetes, and poor
    response to stress….Questions about the long shadow of the uterine environment are part of a burgeoning field known as developmental origins of health and disease (DOHaD)…”

    “DOHaD would ideally guide policies that support parents and children,
    but exaggerations and over-simplifications are making scapegoats of
    mothers, and could even increase surveillance and regulation of pregnant
    women. As academics working in DOHaD and cultural studies of science,
    we are concerned. We urge researchers, press officers and journalists to
    consider the ramifications of irresponsible discussion.”…

    “Although it does not yet go to the same extremes, public reaction to
    DOHaD research today resembles that of the past in disturbing ways. A
    mother’s individual influence over a vulnerable fetus is emphasized; the
    role of societal factors is not.”

    • Smoochagator
      August 14, 2014 at 7:56 am #

      My mother has long said that the tendency in popular psychology is to always blame the mother. And now they’ve even got “science” on their side. Except not quite.

  12. Jocelyn
    August 13, 2014 at 2:29 pm #

    OT: Really wordy home birth story, with some gems.

    “Everyone joked about how it was a party. And really, it kind of was. There were 13 adults and 1 child in my bedroom for the birth.”

    “There was a snack table in the loft (they request snacks, just in case the labor is long; they don’t want to have to leave me to go seek out food).”

    “They then helped me into the very attractive adult diaper and told me to walk around while rubbing my belly clockwise. To help making the rubbing easier, I diluted some clary sage oil (which is supposed to help induce contractions) into some olive oil (for a carrier oil) and rubbed that onto my belly.”

    “It turned out the cord was shorter than normal, because it was wrapped around him, so he progressed slower. And I was pushing slower. So the entire crowning process took longer than normal.”

    “Heather had heard a slight dip in Peter’s heart rate during one of my later contractions, so she listened to it the entirety of one of these last contractions to make sure everything was ok. (It was.) She didn’t explain why at the time, but I knew she felt it was necessary. I hated her for doing it anyway. It wasn’t comfortable. I think I even told her, ‘I hate you right now, but I know I’ll love you again later.'”

    “The next part is somewhat of a blur. I remember him coming out. I remember either seeing or hearing someone say that he had the cord wrapped around him. I felt the urgency of the birth team to get it unwrapped. I instinctively flipped from a kneeling position to a sitting position to make unwrapping easier. (Heather later told me that had made it so much easier and was grateful I acted on my instincts.) I remember as I was flipping the birth team was panicking to keep Peter under the water as I moved. As soon as I was sitting, Karla reached over and quickly unwrapped the cord.”

    “Often people talk about how the cord was wrapped around the baby’s neck and how scary it was and how the baby could have died! But the majority of the time, it’s not a problem. Because as long as the cord is still attached to the placenta, the baby is still receiving oxygen through the cord and doesn’t need to breathe. It actually happens quite often. What makes it scary is when the cord pulls tight around the neck and cuts off the artery to the brain. The oxygen is getting to the baby, but not to the baby’s brain. That had been the urgency to get the cord off. They knew that he would be fine, especially as his heart rate was strong, but they knew they had to act quickly.”

    “From my perspective, everything was much the same as Abby’s birth. Sure, they had to unwrap the cord and that was different, but he looked and acted peaceful and much the same as Abby had. I could feel the urgency in my birth team, and I worked with them. But I didn’t feel their urgency. I knew, without doubt, that he was ok. I trusted my birth team and did exactly what they said to do. It was nice to have such trust that I could know there was urgency and act upon it, but not have to feel it myself. I could fully bask in the joy.

    When Abby was born, she didn’t cry. She was calm and peaceful. She took almost a full minute to take her first breath. Some of the student midwives voiced concern over it, but Heather calmly explained that so long as her heart rate was strong, she was fine with Abby taking her time. Peter looked and acted the same to me. So I was a little surprised when Heather calmly instructed me to give Peter a puff of air on his mouth. But I didn’t question her, I just did it. She had me repeat it two or three times. She also had us fold him in half. Again, I didn’t question, I just helped the mass of hands following instructions.”

    “Kessa got to watch the birth. My mom said she went around the tub, peeking in between people, then moving on to the next gap. Apparently she wanted to see it from every angle. The only time I saw her, she was in someone’s arms and had a semi-panicked look on her face, but was quiet. I was a bit preoccupied, so I couldn’t do anything about it, but I knew she was in good hands. I just hoped it would be a good experience, and not traumatize her.”

    “I remember debate over whether he was 8 lbs 13 oz or 8.13 lbs. Heather settled that one by declaring it was the first and then I heard one student mumble, “Oops. We got the one this morning wrong, then. We’ll need to fix that.” Haha.”

    • The Bofa, Being of the Sofa
      August 13, 2014 at 2:42 pm #

      They then helped me into the very attractive adult diaper and told me to walk around while rubbing my belly clockwise.

      According to the Half-Blood Prince, adding a counter-clockwise rub after every 7 clockwise rub makes it progress much faster.

      • ngozi
        August 13, 2014 at 3:22 pm #

        I know this is completely off the subject, but is there any such thing as an attractive adult diaper? And I really don’t mean any offense to anyone who has to wear them for medical reasons.

        • MLE
          August 13, 2014 at 4:05 pm #

          And why would this be needed at a home birth??? Half the stories I read feature the woman laboring on the toilet anyway.

          • Smoochagator
            August 13, 2014 at 4:24 pm #

            Probably because her water had broken and she was walking around leaking amniotic fluid.

          • moto_librarian
            August 13, 2014 at 5:05 pm #

            A regular pad worked just fine for me while laboring after my water broke…

          • araikwao
            August 16, 2014 at 7:01 am #

            For me,a regular pad would have been swept away in the series of amniotic fluid tsunamis!

          • MLE
            August 14, 2014 at 2:37 am #

            Yeah I thought for a second that it had broken or they wanted to be sure they noticed when it did based on volume collected, but then I thought….nah.

        • Beth S
          August 14, 2014 at 7:22 am #

          I’ve never found any attractive adult diapers. Or baby diapers for that matter.

          • Cobalt
            August 14, 2014 at 12:00 pm #

            Some cloth diapers are really cute, at least when new.

          • AmyP
            August 14, 2014 at 11:29 pm #

            There are some cute pull-ups.

        • Siri
          August 14, 2014 at 9:14 am #

          I think the word attractive was used ironically. As in, look at me in my gorgeous surgical stockings/stylish hospital gown/sexy disposable panties.

        • Cobalt
          August 14, 2014 at 10:20 am #

          They make attractive adult diapers, depending, of course, on your personal definition of attractive. There is a niche, and a fetish, for everything.

          Google at your own risk.

          • The Bofa, Being of the Sofa
            August 14, 2014 at 10:57 am #

            I can’t imagine we can find the Cars version like my kids wore, can we?

          • Cobalt
            August 14, 2014 at 11:02 am #

            Probably not licensed characters, but who knows.

      • MS
        August 14, 2014 at 2:10 am #

        This is the best comment. Maybe the best non-medical comment ever.

    • Young CC Prof
      August 13, 2014 at 3:04 pm #

      The baby in need of resuscitation who gets something only vaguely like it is a classic, as is the bit about how cords around the neck are no big deal.

      The process of unwrapping a nuchal cord underwater was presumably quite a bit dicier than the mother admitted, and yes, if you click the link you can see the obligatory white water-birth baby.

      Of course, we have a little girl watching everything, including the near-catastrophe at the end. At least she wasn’t helping.

      I think my favorite, however, is the bit about not knowing how to weigh babies. Just that bit of icing after all the rest of the fun. Because why would a midwife need to know the difference between a decimal and an ounce? That’s MATH, not mother-wisdom! Besides, if you under-measure newborn weight by most of a pound, the baby is FAR less likely to be diagnosed with potential breastfeeding problems.

      • Petanque
        August 14, 2014 at 7:12 am #

        All just part of the midwives’ “other ways of knowing”, isn’t it?

      • Beth S
        August 14, 2014 at 7:20 am #

        How do you not know how to weigh a baby? And then to be told you’re wrong not by an adult but by the two year old in the room? I’d give up being a birth hobbiest and hide my head in shame.

    • laywer jane
      August 13, 2014 at 3:59 pm #

      Jesus, I can’t understand two things about this birth story: 1) What mother thinks it is a good idea to make a 2 year old watch her give birth?? I just cannot enter the mindset that makes that a reasonable parenting choice.

      2) Why do water births always show the baby wrapped in a wet towel? That seems like a terrible way to help a NB regulated temperatures.

    • Smoochagator
      August 13, 2014 at 4:30 pm #


      “Sometimes I wonder if my labor experiences are unique. I know that I’m fairly unique among my personal acquaintance. This story proves that. Most stories I hear/read include the mother feeling early labor contractions. I just… don’t. But historically, before the push for drama-riddled birth… was my experience more common? Or did I just do something very right in the pre-mortal life to earn such an awesome blessing? Because apparently someone with her water broken shouldn’t be bored while pacing for more than a half an hour. But let me tell you—it was boring.”
      NCB bingo – before we started expecting labor to hurt, maybe it DIDN’T HURT. Which is really insulting considering that she admits that most of her acquaintances definitely felt their early labor pains.
      I don’t deny that some women have painless labors and don’t even realize they are in labor – I’ve personally met two – but it is most definitely outside of the norm.

      • Roadstergal
        August 13, 2014 at 5:03 pm #

        Drama-riddled? As opposed to 13+ people in your home, trying to unwrap a cord underwater, delivering a non-breathing baby, and a panicked toddler, all of which is totally drama-free, I guess.

        • Smoochagator
          August 14, 2014 at 7:57 am #

          Yeah, this is totes the way that birth was meant to be in nature!

      • Cobalt
        August 14, 2014 at 7:41 am #

        So, even after seeing and knowing that others have vastly different experiences, she magically thinks her experience is the only true and valid one?

        • Anj Fabian
          August 14, 2014 at 7:44 am #

          Of course! She’s breaking ground on an entirely new way of approaching birth! No one has ever done this or experienced this before! She is going to help other women realize their birth fantasies.

          (Typing that out makes my head hurt and my stomach churn. I’d make a lousy evangelist.)

          • Cobalt
            August 14, 2014 at 10:14 am #

            I keep thinking that if I could just shake off all these damn ethics I could be making so much money. If only I didn’t value truth and respect so much.

          • The Bofa, Being of the Sofa
            August 14, 2014 at 10:56 am #

            Hey, that’s my line!

    • Anj Fabian
      August 13, 2014 at 6:41 pm #

      I just looked up the normal respiration rate for a newborn:
      30-60 per minute.

      Wait a minute? Oh sure. Deprive your child of thirty breaths? Why not. If someone had told her to put her hand across her baby’s face, she probably would have freaked out – but that’s what they were doing.

    • Susan
      August 13, 2014 at 7:17 pm #

      Horrified but the sarcastic part of me is thrilled for the L and D nurses who didn’t have to care for this self absorbed loon.

      • guest
        August 14, 2014 at 12:06 am #

        I’ll second that one!

      • Anj Fabian
        August 14, 2014 at 7:37 am #

        Do you think she’d be talking about how calm she was if this took place in a hospital?

        Nope. She’d be talking about how freaked out that people were rushing around, doing things and not saying anything to her. She’d be beside herself with the immediate cord cutting and the quick removal of the baby to be suctioned and given NNR. She’d insist that there was nothing wrong with the baby and that it took forever for them to give the baby back to her.

        She’d wrap it up by saying it was a horrible experience and she never wants to birth in a hospital again.

    • Sue
      August 13, 2014 at 7:21 pm #

      ” as the cord is still attached to the placenta, the baby is still receiving oxygen through the cord and doesn’t need to breathe. It actually happens quite often. What makes it scary is when the cord pulls tight around the neck and cuts off the artery to the brain. The oxygen is getting to the baby, but not to the baby’s brain.”

      Just another example of how little these people understand pathophysiology – they think the baby dies of strangulation of their neck, and forget that the magical cord is being squeezed off. Sigh. Don’t know what they don’t know.

    • emkay
      August 14, 2014 at 10:26 am #

      13 people!!! so peaceful and PRIVATE! Nothing like those nasty hospital births with all manner of jerks tramping in and out?!?!

      • The Bofa, Being of the Sofa
        August 14, 2014 at 10:55 am #

        But they were all friends, and not strangers staring at her hoo-ha.

        Although, I have to say, if there ARE 13 people staring at my junk, I would much rather they are dispassionate medical professionals who I will never see again than my close friends and family, who I will be seeing all the time.

        • Empliau
          August 14, 2014 at 11:39 am #

          Exactly. I am a reasonably shy person (somehow have a lot of body shame) and I always say before a pelvic ‘It’s their job, they’ve seen thousands, there’s nothing special or horrible about yours.’ And it’s always been true. I’m very glad that there are ob/gyns and CNMs who have made me feel comfortable and kept me healthy!

    • MaineJen
      August 15, 2014 at 11:40 am #

      Holy mental gymnastics, Batman. How often can one lady contradict herself?
      “The oxygen is getting to the baby, but not to the baby’s brain. That had been the urgency to get the cord off. They knew that he would be fine, especially as his heart rate was strong, but they knew they had to act quickly.” Did they know he’d be fine, or did they know they’d have to act quickly?
      “I could feel the urgency in my birth team, and I worked with them. But I didn’t feel their urgency.” Did you feel it, or didn’t you?
      “Some of the student midwives voiced concern over it, but Heather calmly explained that so long as her heart rate was strong, she was fine with Abby taking her time. Peter looked and acted the same to me. So I was a little surprised when Heather calmly instructed me to give Peter a puff of air on his mouth. But I didn’t question her, I just did it. She had me repeat it two or three times. She also had us fold him in half.” No words for this one. Just…no words.
      “The only time I saw her, she was in someone’s arms and had a semi-panicked look on her face, but was quiet. …I just hoped it would be a good experience, and not traumatize her.” Well, you’re the one who has to pay for the therapy, I guess.

      • araikwao
        August 16, 2014 at 7:05 am #

        Fold him in half???

        • D/
          August 16, 2014 at 7:29 pm #

          Neonatal Resuscitation Origami!
          It’s new … I had to Google it.

  13. Zornorph
    August 13, 2014 at 12:36 pm #

    Obviously I’ve never experience the pain of childbirth and never will – I really don’t have any basis for comparison. I certainly don’t enjoy pain and I would not put myself though such a thing willingly even though I’ve got a high pain threshold. I really don’t care if anybody else does, just don’t expect me to be impressed by it.

  14. AuberryShortcake
    August 13, 2014 at 11:51 am #

    Off topic, but, I do personally know people who have suggested cancer pain not be treated. As my grandmother was dying of cancer, her sisters fought with my father, myself, and the hospice nurse over the level of pain relief being provided because the morphine made her “loopy” and if we would just wean her off the drugs she would be able to function properly. Apparently being incoherent from pain was preferable to being incoherent because of pain medication.

    • Smoochagator
      August 13, 2014 at 1:14 pm #

      Anyone who has not actually spent a night with a terminal cancer patient who has inadequate pain relief is not qualified to enter into that sort of argument. It’s not pretty and it’s not something I’d wish on anyone.

      • Beth S
        August 14, 2014 at 7:24 am #

        I’d rather give birth without an epidural than ever have to sit with my stepdad without pain relief again.

    • Anonymous
      August 13, 2014 at 1:47 pm #

      We’ve had a few nurses put this forward to doctors dealing with terminal cancer patients. Normally after getting it from the doctor they come around but we recently terminated one nurse who was “morally opposed” to giving a patient the amount of morphine that the physician was requesting. This was a female patient in end stage stomach cancer in probably the worst pain possible. When the patient’s physician came into the ward she started berating him in front of some of the other doctors. She was fired the next day. Denying someone dying of cancer that pain relief is tantamount to torture in my opinion.

      • moto_librarian
        August 13, 2014 at 5:07 pm #

        I am so glad that she was fired immediately!

    • Beth S
      August 14, 2014 at 7:23 am #

      My stepdad is a terminal cancer patient, and I’ve heard people say time and time again he’s on too much medication. I just look at them and ask if they’d rather he suffer every day for the rest of his life, or would they rather he have some sort of quality of life.

      • Dr Kitty
        August 14, 2014 at 8:29 am #

        I am quite clear with my palliative patients that sometimes we balance analgesia with side effects of sedation.
        It is up to THEM to tell me where they want that balance set, if they want their pain 100% controlled and are happy to accept whatever level of sedation comes with that, that is what we’ll do. If they prefer to have their pain 80% controlled so that they can have some final conversations with loved ones, then that is what we’ll do.

        But I tell them I’m always happier to see people comfortable and dignified and IME pain relief helps more than it hinders.
        I tell the families that it is not their decision where to set the balance, because they aren’t the one living with the pain, that individual doses vary from person to person, there is no such thing as an arbitrary “too much” unless there is evidence of actual toxicity…which we monitor for, and can decrease the dose if it occurs.

        • Siri
          August 14, 2014 at 9:06 am #

          I love you, Dr Kitty! If I get terminal cancer, can I move to your practice?

        • The Bofa, Being of the Sofa
          August 14, 2014 at 10:59 am #

          IYE, do you find that most of these patients also prefer the side of pain relief/sedation?

  15. Young CC Prof
    August 13, 2014 at 11:03 am #

    Let me point out one thing about the potential risks of epidural to baby: It’s not just that no risk has ever been documented, but that researchers have looked for it pretty thoroughly and not found anything.

    This is a common concern I’ve heard from people slightly affected by chemphobia or naturalist fallacy: “But what if there’s a risk no one has found yet? After all, Thalidomide.” And the counter is to explain that people have done lots and lots of studies on epidural babies, and various problems have been specifically checked for and ruled out, for example, we know that unlike systemic painkillers administered to the mother shortly before birth, epidural anesthesia doesn’t result in sleepy babies or lower Apgar.

    It’s possible that we could find a risk in the future, but it would have to be either something that shows up only much later, which isn’t terribly plausible biologically, or a very very weak correlation with some neonatal outcome, smaller than quite a lot of other modifiable factors.

    • Karen in SC
      August 13, 2014 at 11:23 am #

      I believed that and endured a horribly painful birth with my first. The second went much better as usually happens, and I never got a chance to have my “healing epidural birth.”

      I tell everyone now to get all the pain relief they want.

    • Mariana Baca
      August 13, 2014 at 1:16 pm #

      “But what if there’s a risk no one has found yet? After all, Thalidomide.”

      Right, and we found out the risk of thalidomide fairly quickly. It was first licensed in October 1957 in West Germany (in 1958 in other countries) and by 1961 it was withdrawn almost everywhere, Canada was the last place to withdraw it in 1962. It was never approved for general use in the US at all — it was only used as part of clinical testing. These issues were found as part of testing or due to insufficient testing relatively quickly, not decades in the future or something. It isn’t the case of a hidden risk nobody had found.

      • Young CC Prof
        August 13, 2014 at 1:31 pm #

        Exactly. There just aren’t too many examples out there of a serious risk that remained hidden for a long time AFTER researchers went out and deliberately looked for it.

        • The Bofa, Being of the Sofa
          August 13, 2014 at 1:49 pm #

          Consider, for example, the famous case of the flu vaccine causing GBS (I can never remember the spelling, so it’s easier this way). That was a case of something that became apparent after testing, but not long after testing. That was pulled after a few million doses, when the problem became apparent.

          You know how many cases of GBS were caused by those few million doses? if you do the math and correct for the background, it’s somewhere in the 18 – 30 range. Not 18 – 30 thousand, but 18 – 30 cases of GBS, total, that were caused by the millions of doses of flu vaccine. Yet, it was still enough to be noticed, and to cause the vaccine to be pulled. Because it caused GBS in two dozen people.

          • Sue
            August 13, 2014 at 7:27 pm #

            Oh – and what is the most common cause of Guillain-Barre’ Syndrome? Influenza infection.

      • Sullivan ThePoop
        August 13, 2014 at 4:39 pm #

        Not to mention our knowledge at the time made it very difficult to understand. The US did approve thalidomide in 1995, but now it only contains the correct enantiomer.

        • Young CC Prof
          August 13, 2014 at 4:51 pm #

          Also, as a cancer drug, not intended for use in pregnant women.

          • KarenJJ
            August 13, 2014 at 7:28 pm #

            I know it is sometimes used in Behcet’s disease too.

          • Empliau
            August 13, 2014 at 9:23 pm #

            And Hansen’s disease, right? I’ve heard it does a good job with patients who don’t respond to other medications.

          • Deborah
            August 14, 2014 at 11:10 am #

            I had a patient with Hansen’s disease about 10 years ago and she told me that as a woman, in order to get thalidomide, she would have to be an inpatient in that Hansen’s place in Louisiana. They were too scared to give it to women of childbearing age without basically confining them.

    • Sullivan ThePoop
      August 13, 2014 at 4:36 pm #

      Thalidomide a subject people where the people bringing it up never understand it.

      • The Bofa, Being of the Sofa
        August 13, 2014 at 5:32 pm #

        Shoot, it wasn’t even thalidomide that was the problem. It was the enantiomer. The problem was that it was too expensive to make it pure, so they left it as a racemic mixture.

        As a result of thalidomide, the FDA no longer allows drugs to be sold as racemic mixtures, and you need the pure enantiome that you actually tested.

        There is no sign that the correct enantiomer of thalidomide is dangerous. There has even been discussion of approving thalidomide again for various uses.

        ETA: See StP’s comment below

        • Sue
          August 13, 2014 at 7:23 pm #

          There was actually nothing much wrong with thalidomide as a general purpose medication in the non-pregnant population. It was teratogenic in pregnant women. In those days, a lot less was known about teratogenicity.

          And who uncovered the link and led to the end of its use? A homeopath? Nope. A midwife? Nope. It was an OB.

          • The Bofa, Being of the Sofa
            August 13, 2014 at 8:35 pm #

            But even the teratogenicity was due to the enantiomer, right?

        • August 13, 2014 at 11:50 pm #

          The problem was that it was too expensive to make it pure, so they left it as a racemic mixture.

          According to wiki it can racemize in vivo.

        • Empliau
          August 14, 2014 at 12:02 pm #

          Have you read Sayers’ ‘Documents in the Case’, wherein a murder is discovered because the poison used was a racemic version of Amanita muscaria? (Or the non-racemic version. Anyway, a murder mystery about racemic substances.)

Leave a Reply

You must be logged in to post a comment.