Dear New York Times, since when is treating women’s pain an “intervention”?

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Proving yet again that newspapers should not opine on medical issues, The New York Times tackles the safety of midwifery in Are Midwives Safer than Doctors?

Let’s leave aside for the moment the fact that the Editors don’t really understand the new UK recommendations and their back story, and let’s focus the misogyny directly regurgitated from the propaganda of the natural childbirth movement.

Doctors are much more likely than midwives to use interventions like forceps deliveries, spinal anesthesia and cesarean section.

Oops! Spinal anesthetics are used for planned surgeries; the Editors are apparently referring to epidurals.

An epidural, the single most effective method for relieving the agonizing pain of childbirth, is an interventions?

Since when, dear Editors, is treating pain an intervention? Oh, right, when it’s women’s pain. No one ever thinks treating men’s pain is an intervention, do they?

The truth is, however, that adequately treating women’s pain, in childbirth or from any other cause, is a feminist issue.

Let’s look at some empirical facts about labor pain:

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.

But all too many midwives, prisoners of the philosophy of natural childbirth, view birth as a piece of performance art, wherein a woman demonstrates her intrinsic worth by attempting to recapitulate childbirth as they imagine it occurred “in nature” (minus all that death, disability, subsequent incontinence, etc., of course); that means no relief for excruciating pain.

In other words a woman’s need for pain relief is rendered invisible.

How do natural childbirth advocates do it?

  • 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.
  • Blaming the woman for not understanding that childbirth is “good” pain, even though it is biologically identical to all other forms of severe pain.
  • Treating women’s need for pain relief as an “intervention,” although, to my knowledge not a single form of pain relief for men is ever considered an intervention.

Simply put, according to natural childbirth dogma, a woman’s pain in labor is irrelevant.

There is a long and disreputable history of ignoring women’s pain.

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, Journal of Law, Medicine & Ethics, 29 (2001): 13–27, provides a disturbing description of the ways in which the pain of women is systematically devalued, disbelieved and undertreated.

Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated…

The study by McCaffery and Ferrell of 362 nurses and their views about patients’ experiences of pain found that while most of the nurses (63 percent) agreed that men and women have the same perception of pain, 27 percent thought that men felt greater pain than women. Only 10 percent thought that women experienced greater pain than men in response to comparable stimuli. This result has no justification in the literature … The same study also found that almost half of the respondents (47 percent) thought that women were able to tolerate more pain than men as compared to 15 percent who felt that men were able to tolerate more pain than women…

These erroneous attitudes are particularly prevalent in regard to childbirth:

Bendelow found that “the perceived superiority of capacities of endurance is double-edged for women — the assumption that they may be able to ‘cope’ better may lead to the expectation that they can put up with more pain, that their pain does not need to be taken so seriously.” Crook and Tunks point to the influence of the psychoprophylaxis movement in the United States with its implicit assumption that it is good to experience childbirth without the aid of analgesia. As a result, some women who have “gone through psychoprophylaxis classes, feel guilty if they relent at the last minute and ask for an epidural”; according to the authors, “these attitudes imply that we have a value system endorsed by some parts of our population that suggest women should be encouraged to keep a stiff upper lip.”

Most natural childbirth advocates appear to be unaware of the deeply sexist and racist history of the philosophy of natural childbirth. Grantly Dick-Read, the found of the philosophy, was a eugenecist who was preoccupied with visions of “race suicide” with primitive people overwhelming white people of the “better” classes. He thought that upper class women could be diverted from their insistence on greater political and economic rights back into the home where they belonged if only they didn’t fear the pain of childbirth. Therefore, he told women that the pain of childbirth was all in their heads; he lied in claiming that primitive women (i.e. black women) experienced painless childbirth because they were unafraid of it. In other words, the pain of childbirth is all in women’s heads. Never mind that is was a spectacular lie with a sexist, racist purpose. Contemporary natural childbirth advocates are still spouting the same misogynistic clap trap, counseling women that childbirth pain is a result of fear.

The end result is that, women’s pain is discounted and ignored, and treating women’s pain is derogated as an “intervention.”

But, dear Editors, women’s pain is should NOT be discounted and ignored. The treatment of women’s pain is never an intervention; it is feminism at its most basic.

Claiming that treating childbirth pain is an intervention is both brutally misogynistic and hideously cruel.

Please correct your mistake as soon as you possibly can.

  • Allison

    I love this! I’m a criminal defense attorney and I love doctors like you who are so along to treat females’ “pain.” Keep writing those opioid prescriptions. How do you work this? Can people just pay a fee and you’ll write the prescription and mail it out? I can refer several clients to you if you will do the same for me. Women between the ages of 22-40 are the fastest growing population of addicts thanks to doctors like you telling them they shouldn’t have to even feel the pain of a big poop! Thanks for the business!

    • fiftyfifty1

      You believe that “Women between the ages of 22-40 are the fastest growing population of addicts” as a consequence of labor epidurals? You think that the pain of childbirth is akin to “the pain of a big poop”? You believe that docs who treat women’s pain are somehow going to help your business as a “criminal defense attorney?” How is that exactly? Because there are a number of lawyers who post here on a regular basis, and none of them seem to have indicated that treatment of a woman’s labor pain is a criminal offense.

    • anotheramy

      Ummm, I used to work in an inpt psych unit and saw lots of pain med addicts. None of them were getting their pain meds from OBGYNs. I believe the post is referring to epidurals during childbirth, which is typically a fairly rare event in one’s life. No one is becoming an addict or increasing your business b/c of epidurals during childbirth and OBGYNs do not typically prescribe on-going opioids for pts.

    • Floid and DeWitt

      Stawman much?

      What are you, 12?

    • MLE

      No it’s better than mail order. All you have to do is show up to the hospital in labor and they will hook you right up. Of course you then have to stay and actually deliver a baby, so it’s somewhat difficult to fake your way into getting the sweet sweet meds.

    • Medwife

      “females”? Lol.

    • Stacy48918

      Wow. Presumably, you went to school for a very long time and spent a lot of money to be so…stupid.

      • Box of Salt

        Stacy “you went to school for a very long time”

        Eh. Not likely, and even if it were true, poster Allison would have been disbarred by now.

    • sdsures

      You really don’t know anything about epidurals, do you?

  • sara stout

    My sweet husband will tell you that I have one of the highest pain tolerances he has ever seen. Within a couple of weeks of one another we both went through kidney stones mine being about twice the size of his. While he felt that it was the most unbearable pain and spent three days in bed. I continued to work for a good majority of the pain and never stopped caring for my children. I can tell you that the pain of child birth was by far the worst pain I have ever felt. http://www.triadobgyn.net

  • Floid and DeWitt

    It really upsets me how pro life men dismiss the risks of pregnancy and the pain of childbirth as a “minor inconvenience”.

    Yes. Childbirth is compared to a stubbed toe, and things like obstetric fistulas are laughed off as rare and, yes, minor.

    Any woman who doesn’t consent to harming herself, temporarily or permanently, for a fetus, is considered to be a selfish b*tch.

    It is very upsetting.

    • Young CC Prof

      Ug. Don’t get me started on men who no nothing about pregnancy and claim, “No one needs abortions! We have adoption!”

      • Floid and DeWitt

        I have even met the occasional guy who has told me that his wife nearly bled to death from birth, that her insides were all torn up, but that the precious life of an embryo overrides *any* female suffering.

  • Maggie Howell

    My anecdote: The madly popular OB/GYN (so cool that she didn’t take insurance) I used for my first pregnancy was an idiot; she went to a conference and didn’t bother to order pain meds for me, nor an epidural. Forty hours later (40!), a wonderful OB/GYN who happened to be walking by my labor room (and happened to have gone to school with my husband) ran in and saved the day (and our lives). He called another buddy to give me a spinal and I had a lovely baby girl via Cesarean section an hour or so later. My husband got to assist. My baby developed meconium aspiration pneumonia and we were both in ICU for days; it took a couple of weeks before all of the broken capillaries in my eyes healed and I didn’t look like a vampire. Second pregnancy a few months later; went to Wonderful OB/GYN and we planned a perfect Cesarean. Baby girl #2 was healthy, mama, daddy, and OB were thrilled. Labor pain = overrated; why on earth should anyone suffer like that? I marched for the right to choose in the 1970’s; I had no idea I should have demanded the right not to have to suffer. If anyone wants to call me uneducated, look up my Ph. D.–Kris, there is no pain/labor management technique (sic) if one’s baby is stuck in one’s pelvis.

    • Maggie Howell

      BTW, the awful, crunchy OB (who never bothered to tell me that she doesn’t “believe” in Demerol/other pain meds) still doesn’t take insurance and has left other mums stranded whilst she went on cruises, etc.–her popularity has gone down the tubes over the past 25 years, primarily because of her lack of attending to mums’ pain issues. The Wonder OB/GYN is still my doctor.

      • Medwife

        That is legally patient abandonment if she left town with full term patients and didn’t arrange a backup. But in that situation another OB with privileges at that hospital would necessarily be called in, be asked for orders, and at any hospital I’ve ever heard of, pain medication is a standing order for laboring patients. I’m not sure what happened with you but I think there was a misunderstanding somewhere along the line.

    • kris

      Yes, there are bad doctors out there as well as bad midwives. It’s up to the parents to ask the right questions during prenatal visits so we can each get the best outcome possible. And we don’t even know what the right questions are until we’ve had a bad birth experience. It sounds as though your first OB/GYN was not there actively monitoring labor, is that correct? That’s abandonment. Some doctors are wonderful and will stay around and check on you. Some don’t. If you go into it knowing you probably want pain meds, I don’t hold that against you or anyone. The statistics I read before my VBAC showed that the longer I was in the hospital laboring, the higher my chances were for repeat cesarean. I wanted to be able to take care of my baby afterward if at all possible, which I was not able to do with my first because of the recovery. I felt the cesarean recovery was worse than the labor pains I had experienced. Obviously, you are describing a very different experience – and it seems you reclaimed some piece of yourself with the control you had over the second experience which is very similar to my experience. We can debate without being against each other. It is my hope that when a woman researches about labor that she can find good stories of uncomplicated births among the bad stories. Fear is a powerful emotion.

      • fiftyfifty1

        ” I wanted to be able to take care of my baby afterward if at all possible, which I was not able to do with my first because of the recovery.”

        Why not? I had absolutely no difficulty taking care of my baby after my CS. The discomfort was nothing more than a nuisance of the “hey stop making me laugh, my stomach muscles are sore” variety. I dressed up in a party dress and danced in the living room with my toddler son at his request on POD #3. It’s about doing your research, knowing what to expect, and being in control. There are a lot of scare stories out there about how painful CSs are that women fall for if they are not educated about all the myths that get spread. It sounds like that happened to you and I’m sorry for you. I hope that if you ever have a CS again, you will remember my story and be inspired by my example of what is possible when you don’t fall prey to misinformation and fear.

        (completely true story about my total lack of pain, dancing in the living room, no problem caring for my baby independently. But the part about me thinking that I’m totally awesome and that I somehow did something to merit my painless recovery is satire. The only people actually narcissistic enough to think that way are natural childbirth [aka purebirth] cultists)

        • FormerPhysicist

          I had 3 c/s, two after labor, one pre-labor. I don’t think the easier recovery from the pre-labor c/s was random chance.

          • fiftyfifty1

            That seems to be general consensus, that planned CS have an easier recovery, although I have a friend who had a long labor followed by CS with baby #1 and a pre-labor CS for baby #2 and said the recovery after #1 was smooth sailing and was actually jogging at 1 week (she is an ultramarathoner). In contrast she found recovery from #2 to be extremely painful, especially in the first week, and could not run until 6 weeks postpartum. I myself can’t comment because I have nothing to compare. My own CS was not pre-labor, but I had been laboring only an hour.

        • Elizabeth A

          I also experienced very little pain after my pre-labor c/s (I was managing with mostly tylenol by the time I checked out of the hospital), but I wonder if this, too, is a roll of the genetic dice. Some people find surgical recoveries very difficult, others do not.

          There are many stories (many on this thread, even) of women being denied pain medication after c-section, even in direct contradiction to doctor’s orders. As long as the people directly providing care fail to take pain seriously, patients will have difficulty accessing appropriate pain management.

        • Liz Leyden

          I wasn’t able to care for either of my babies immediately after my C-section because I was snowed. My memory is very fuzzy, but I met my babies 12 hours later. I fed and held my son soon after (daughter was in the ICU).

          I was walking around slowly the next day, climbed a set of stairs a week later (bad, bad idea), and drove (automatic transmission) to a job interview 10 days later. It was a few weeks before I could walk normally, and about a month before I attempted the stairs again.

      • yentavegan

        A pregnant women should not have to know the right questions to ask her Ob/Gyn. The Ob/Gyn asks the questions. Pregnancy/labor/birth is not an event to herald in a woman’s self worth nor is it a time for her to create a narrative of personal achievement. Pain during labor is due to the roll of the genetic dice. Like brown eyes. Either you experience pain during labor or you don’t. Nothing a mother does alters that.

  • kris

    Many women are not trained and have not sought out pain/labor management techniques. I went to hospital lamaze class and of the 3 classes one entire class was all about cesarean section. Fitting, since roughly 1/3 of first time moms end up with a section – I was one of them. Pain meds and hoapital labor management techniques can slow the natural birthing/labor progress and eventually lead to cesarean. The answer ia not simple. If a woman is in distress, give her pain meds. But, could we please try to prepare women for the labor beforehand?
    After 12 weeks of Bradley Method classes, I actively gave birth to my second child with a midwife in a small hospital that would still allow midwives to attend vbacs. I had a 3rd child via purebirth as well – no medications & not even an IV – in a hospital. Let’s keep doctors for medical emergencies and let midwives attend the uncomplicated births. If an MD just wanta to deliver babies that’s fine, but they should be ashamed if their cesarean rate is anywhere near 20% let alone 30%.

    • kris

      Just to clarify, I understand an MD who specializes in very complicated pregnancies will have an abnormally high c-section rate. This is not who I am referring to. If I had a complicated pregnancy I would be thankful for their treatment. And aeeing some of the others comments, I understand you think I’m in a cult or something. If a woman chooses not to pursue as natural a birth as possible, that is certainly her choice. I speak out because I had hoped I had more information with my first pregnancy.

      • birthbuddy

        Check your facts on the C-section rates.

      • Guesteleh

        If a woman chooses not to pursue as natural a birth as possible, that is certainly her choice.

        You have no idea how condescending you sound.

      • Samantha06

        How about this:

        “If a woman chooses not to pursue as pain-free birth a birth as possible with an epidural, that is certainly her choice.”

        Has a bit of a superior ring to it don’t you think?

      • Sarah

        If you think enduring great pain when you don’t have to is natural, despite the fact that humans usually do what they can to minimise their own suffering, that suggests maybe even more information would be helpful to you. If you prefer to continue with pain that could be alleviated, that’s certainly your choice, but don’t call it natural.

      • Poogles

        “I speak out because I had hoped I had more information with my first pregnancy.”

        Which was the frank breech baby, yes? If so, what other information do you wish you had had? Do you think it would’ve made any difference in the outcome?

    • Zornorph

      ‘Purebirth’? Even the name is offensive – as if a different type of birth wouldn’t be ‘pure’.

      • kris

        This was not meant as condesending or offensive. I had heard calling it “natural” birth was offensive, so not sure what the current politically correct title would be.
        I interpret purebirth to simply mean no medications, no interventions. A boring, uneventful birth, other than the miracle of life thing.

        • Box of Salt

          How about something along the lines of “I gave birth 3d child with without any interventions, not even an IV, in a hospital” ?

          That way you are not flaunting your own superiority for achieving something “pure,” and your comment would not come across as offensive.

          • kris

            It’s not superior, it’s just possible. A lot of women have lost confidence in their bodies and that labor is possible and a natural process – when everything is working correctly. It was empowering to be able to do that for my baby and myself.

          • Amy Tuteur, MD

            Who has lost confidence in their bodies? What does confidence have to do with the function of bodies? If you have “confidence” in your pregnancy will that prevent a miscarriage? If you have confidence in your ovaries will that prevent infertility?

            Having a unmedicated vaginal birth is only “empowering” for privileged white women who set up faux “achievements” for themselves. The majority of laboring women in the world have unmedicated vaginal birth every day (or die trying), and they don’t consider it empowering.

            An unmedicated vaginal birth is as empowering as a designer handbag. If that floats your boat, you’re welcome to it, but don’t expect anyone else to be impressed.

          • Mishimoo

            Exactly!

            I had confidence in my pregnancy. I felt connected to the tiny little ball of cells. I embraced the start of the food cravings, soldiered through the morning sickness and then it was all gone. Faith in my body did not stop a miscarriage from sweeping all of that budding love and hope away. Likewise, faith in one’s body would not prevent needing a caesarean nor would it prevent the damage from a vaginal birth that shouldn’t have happened.

          • Box of Salt

            kris, you imply superiority when you coin the term “purebirth.”

            Most people value purity. That’s how they used to advertise Ivory Soap.

            It was a poor choice of wording if it were not your intent to suggest that mode of birth is superior.

          • DaisyGrrl

            My body has quit working in life-threatening ways on more than one occasion. Why should I have any confidence in it? Besides, even if I *can* have an intervention-free birth doesn’t mean there is any thing wrong with me for wanting all the interventions available.

          • MLE

            Except you didn’t “do” anything. It was working correctly (you admit this), so you didn’t need help. That had nothing to do with you as a person, or empowerment. You were a passenger on a ride that didn’t crash.

          • Kq

            And THAT is why it’s offensive. As if trusting your body is a magical solution to all birth problems.

          • Poogles

            “A lot of women have lost confidence in their bodies and that labor is possible and a natural process – when everything is working correctly.”

            This doesn’t even make sense – yes, when everything is “working correctly” then of course labor is more than possible (it’s inevitable) and it is a “natural process” (because everything is “working correctly” thus no need for treatment/intervention for complications). Confidence doesn’t make a difference one way or the other.

        • Zornorph

          Well, why does that make it ‘pure’. My son was born with the benefit of an epidural and the mum’s water being broken – does that mean his birth was ‘impure’.
          I should say I’m really just teasing you a bit – I’m not in the least bit offended as I don’t suffer from ‘daddy guilt’ – but that ‘purebirth’ thing really did make me roll my eyes.

        • Kq

          I’m offended. That you’d insinuate my son’s birth is less “pure” because it was surgical. Really? Or that he’s not “natural”?

        • disqus_ok9xndxFPu

          Pure is a value judgement. You had a vaginal birth without medication or surgery. Call it what it was.

      • Who?

        I read ‘purebirth’ and thought ‘sad case’. If that’s how kris feels good about herself, fine. It’s positive that she acknowledges doctors have a use, and she seems to acknowledge that a live baby is a good thing, so let’s call that a win.

    • EmbraceYourInnerCrone

      Your numbers are off. (21% is not 1/3rd)
      From the CDC: http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_01.pdf
      The primary cesarean delivery rate for the 2012 revised reporting area (38 states, District of Columbia, and New York City) was 21.5%. That is, more than one out of five births to women without a previous cesarean delivery were delivered by cesarean. Primary cesarean delivery rates varied by state, ranging from 12.5% in Utah to 26.9% in Florida and Louisiana (Table B and Figure 3). Summary Overall, primary cesarean delivery rates for the 19 states that implemented the revised birth certificate by 2006 increased from 2006 to 2009 and then declined from 2009 to 2012. Rates also declined during 2009–2012 for the total 2009 revised reporting area (28 states and New York City). Rates for 16 of 29 reporting areas were lower in 2012 than in 2009, but were unchanged for the remaining 13 areas. By gestational age, state-specific primary cesarean delivery rates at 38 weeks declined for 18 of 29 reporting areas.
      Also why should we be happy about not having an IV? I was very happy that I had mine when I started vomiting when I hit transition. I probably would have become dehydrated without it. I have pain meds for other types of severe pain, why would I have wanted no meds for the precipitous birth of a quite large baby (8lbs 15oz) ? Also if your delivery suddenly goes south, trying to FIND a vein to put in an IV in a crashing patient is NO fun and, makes it take longer to push plasma/blood/whatever.
      Doctors do C-Sections so that situations don’t become emergencies. I’m really glad my mom had one or she’d be dead.

      • moto_librarian

        After enduring manual examination of my uterus during a pph with no pain medication, there is absolutely no way that I would ever give birth again without a heplock in place. That her midwife did not require one makes me question her clinical judgment,

        • kris

          The baby came fast. There was no time and I didn’t want one. I came into hospital in full control and pushing. I don’t think my post was worded in an offensive way so I’m not sure why people are so upset by this.

          • Who?

            Is anyone upset? You made assertions and quoted facts, people are challenging both. No one seems upset, they just want to either update or disagree with you.

          • Mer

            I had a precipitous labor and was GBS positive and needed IV antibiotics. It required calling in anesthesia to do my IV after 4 failed attempts by the L&D nurses but they got one in just in time to get me at least one round before delivery. I showed up at 7 cm (not on purpose, as we left home within 20 minutes of labor starting) and moved along quickly. I was not able to get an epidural because of the delay with the IV, and I desperately needed that epidural as I ended up with a 10 lb baby with a pretty severe shoulder dystocia and quite a bit of pain in getting him out.
            I’ve also done the hemorrhaging thing and had 3 large gauge IV’s placed. When you say that you labored without even an IV, you are happy that you avoided that little intervention. That little intervention does not interfere with labor and can give enough time to save two lives, yours and baby’s. Anyone that complains about getting one because it’s annoying does not understand the incredible value for cost a simple IV provides for a mother in labor. It hurts a little bit, and might be a little annoying when trying to move around but if you end up needing that IV and it isn’t there it hurts a whole lot more. Anecdotally, every time I’ve gotten an emergency IV it hurts, way more than any of the ones even my fellow students have inserted on me during practice.
            I understand that a lot of natural childbirth educators say avoid interventions, but if you understand the reason for this one and how helpful it can be in an emergency I hope that will help you understand why people like us are outraged at some of the claims made by proponents of natural birth. IV’s are simple and can provide some serious support in emergencies. That there are lay people, or worse some medical providers, that say to avoid them can cause some pretty devastating cascades of problems.

          • Cobalt

            The only concern I’ve ever had with an IV in labor was requesting it be somewhere other than in my hand so it didn’t interfere with my ability to use my hand. For all but my first baby the nurses were totally ok with sticking me higher up the arm.

          • fiftyfifty1

            Oh the fuss that NCB makes about a simple heplock! These are the same people who insist that visualization can erase the pain of labor: “Imagine you are surfing waves at the ocean”, but seem completely undone by a little needle poke. Seriously? Can’t you make up some sort of visualization to make it all better? An itsy bitsy unicorn poking its horn into your hand to give you a magical birth blessing or something?

          • Dr Kitty

            I have veins like hoses and no fear of needles.
            I used to let the med students practice blood draws and IVs on me before I let them loose on the patients.
            When my daughter was born I let my anaesthetist friend put the second biggest venflon they make into my wrist because he needed to get his numbers up.

            Do. Not. Get. It.

            I assume none of the NCB ladies who fear heplocks are blood donors.

            The best place to get an IV is the vein on the thumb side of your wrist “the Housemans’s vein”. If it is sited on your forearm, just above the wrist joint it doesn’t hurt as much as your hand, and won’t get in the way like one at the elbow or hand will. I speak from experience.

          • fiftyfifty1

            I have veins like tiny threads and something of a needle phobia after years of miserable fruitless pincushion experiences. The Red Cross has told me not to attempt to give blood any longer because my veins are difficult enough that they can’t get the nice rapid flow they need for a good collection.

            I also Do. Not. Get. It.

            Like I want them desperately fumbling around when I am bleeding out? No thanks! Give me the heplock and give it to me now!

            What’s in a name? that which we call the Houseman’s Vein by any other name would be as big. (it is called the Intern’s Vein here)

          • sdsures

            Because you don’t know what you’re talking about with regard to epidurals.

      • kris

        Thank you for your reply. You have clearly done your homework. I believe the rate was higher 7 years ago when I did my research while pregnant. I absolutely believe that my OB/GYN made the right decision at the time I presented in active labor with a frank breech baby just shy of 37 weeks. My frustration came during a subsequent completely healthy pregnancy where I had a difficult time finding a vbac supportive provider.
        I am glad to hear the rate Is lower and I am glad that you and your mother had a good outcome. My son was also 8 lbs 15 oz. That was a funny coincidence.

        • moto_librarian

          So in other words, you didn’t have any “interventions” – you had a frank breech baby as a primip! That is DEFINITELY cause for a c-section. I don’t understand why you felt the need to blame epidurals and hospitals for c-sections.

    • Karen in SC

      You should be ashamed for thinking you know more than OBs. No way can you judge whether or not a c-section or even an epidural is necessary.

      • kris

        If you read my entire post I’m not sure how you could conclude that I feel I’m “smarter” than an OB. I simply know my body and had all the recommended prenatal care an OB/GYN would have provided but chose to hire someone who 1) does not carry a scalpel and 2) was trained enough to recognize complications that would require an intervention.
        I will never be ashamed of that. I would like a healthy debate without people likening doctors to Gods. Look at birthing practices in other developed countries who have good outcomes. I have.

        • Who?

          I’m not sure how that helps though. What you are really saying I think is that you don’t want to pay someone who might wield a scalpel to advise you when wielding a scalpel is needed.

          This line of thinking has a certain naive allure until you think about it. You trust someone to cut open your body, but not to tell you, honestly, that it is needed?

          • kris

            No, the doctors I went to would have put me on a monitor and checked in once in a while and not really shown up until the baby was crowning. If I went a day overdue they would induce me – which statistics show can increase risk of uterine rupture in a VBAC (and I believe ACOG has since adopted a policy of NOT inducing VBAC moms). I wanted someone to help manage my labor – to help me through. And the midwives that I went to worked under the supervision of the area’s best OB/GYN who let the midwives do what they do best. He trusted them & they trusted him. If they saw something abnormal & brought the doctor in and he determined that I needed a cesarean, then yes, I would trust him then. He was always there, always a phone call away if there was a sign of complication. It’s the many preventative steps, the emotional support, and the time that a CNM puts into the process that makes such a difference.

          • Who?

            I’m not sure you’re being as compelling as you think you are. You trust the midwives, who are as I read it employees of, or at least under the supervision of, the doctor. His or her professional indemnity insurance, his or her rules. You wanted your full on first world medical care wrapped in a blanket of ‘preventative care, emotional support and time’ and you got that.

            It’s great everyone is well and happy. Let’s not fetishise good medical management as some kind of statement that natural is best, and always achievable.

          • birthbuddy

            You have no idea what you are talking about and your true colours are showing.
            You are simply repeating NCB trash that OB’s are surgeons so they need to cut every thing that moves. (So they can get to golf).

          • sdsures

            You want someone to hold your hand. Doctors don’t do that.

    • moto_librarian

      Evidence demonstrates that epidural anesthesia does not increase your risk of a c-section, nor does it lengthen labor appreciably. So when you state that these things are causing birth to go awry, you are wrong. There is no evidence-based reason to decline pain medication during childbirth. If you don’t want pain medication because you can tolerate the pain with other coping mechanisms, that’s fine, but we need to quit pretending that this is the “right” way to give birth.

      • kris
        • Karen in SC

          While that citation discusses a study that shows a lengthening of labor of around 2 hrs, when previously it was thought about 1 hr, it said nothing about any correlation to more c-sections.

          • fiftyfifty1

            No, it doesn’t show even that actually. This is talking about the 95th%ile (already the outliers). Even more importantly, this is a retrospective study. A woman who is experiencing a straightforward, rapid labor is much less likely to request an epidural than a woman with a complicated labor with, for example, a poorly positioned baby. Complicated labors are likely to be both more painful and longer. Studies that *randomize* women to epidural vs. not, do not show increases in labor length.

          • MaineJen

            So just to clarify: the study was comparing women who were *already* having longer labors than average. It is not normal for pushing (2nd stage) to take 2 hours or more, right? So this was the pushing stage of labor for women who were already having an unbelievably difficult time. The ones with epidurals on board took longer to push…maybe the fact that they had epidurals indicates that their labor was very very painful and their babies were not in the ideal position.

          • theadequatemother

            And the study doesn’t look at women who request epidurals jut women that got them so all of the fast labours where epidurals couldn’t be placed in time are part of the non-epidural group which is a further source of confounding. I really think just looking at epidural requests would be better that way wed have a group of women who believe in NCB tying to do everything “correctly” and a group that will take pain meds if they need it and we would definitively see no difference in length of labour, instrumental delivery and cs. Heck we might even see worse outcomes in the “refuse all interventions bc the OBs are out to get me” group.

          • fiftyfifty1

            Because that’s the million dollar question isn’t it?:

            If I wish I could have pain relief but I refuse it, does that benefit me in some way?

            That’s what women need to know. And randomized epidural studies say no–using an epidural does not slow labor, increase instrumented births or CS.

            Women do not need more poorly designed observational studies that come to the conclusion that hard labors are harder than easy ones.

    • sdsures

      “Pain meds and hospital labor management techniques can slow the natural birthing/labor progress and eventually lead to cesarean.”

      Citation, please.

      • kris
        • Guesteleh

          Compared with women without epidural use, the 95th percentile length of second stage for nulliparous women was 197 minutes without epidural and 336 minutes with epidural (P<.001), a difference of 2 hours and 19 minutes. For multiparous women, the 95th percentile length of second stage was 81 minutes without epidural and 255 minutes with epidural (P<.001), a difference of 2 hours and 54 minutes.

          No mention of cesarean here. And most women would trade a longer labor in order to get pain relief.

          • KG

            Yes, but many OBs are still using Friedman’s curve, therefore holding medicated (yes epidurals are interventions) women to the same standard as unmedicated. While not clearly evidenced, the difference in progress of both first and second stage does lead to C birth.

          • Young CC Prof

            When hospitals expand access to epidurals, the epidural rate tends to increase very rapidly. A corresponding change in the cesarean rate is generally NOT seen.

          • Guesteleh

            The studies I’ve seen show no increase in CS with epidural. Where are you getting your information?

          • theadequatemother

            Oh we know where she is getting her info…NCB websites and books, hence goer, Ina may, tfb, science and sensibility/ Lamaze etc.

          • birthbuddy

            Remember, these are the same people who believe that vaginal examinations cause C-sections. I find it very difficult to take them seriously.

          • fiftyfifty1

            But the studies show there is no increased rate of CS.

          • Poogles

            “Yes, but many OBs are still using Friedman’s curve, therefore holding medicated (yes epidurals are interventions) women to the same standard as unmedicated.”

            The Friedman Curve has never been a hard and fast rule against which all women are held equally regardless of the particulars of each indivudual labor anyway, so your point is moot. See this post for more info: http://www.skepticalob.com/2014/02/which-obstetrician-was-the-first-to-oppose-arbitrary-limits-on-the-length-of-labor.html

          • Dr Kitty

            I trained in the Coombe in Dublin.

            The *home* of actively managed labour.
            This is where AROM on admission and pit to ensure minimum dilation of 1cm/HR were SOP.

            Women with epidurals got an hour to labour down at 10cm before anyone asked them to push. Anyone who asked for an epidural could have one as soon as an anaesthetist was available, provided she was in established labour.

            The Coombe has a historically low CS rates for a tertiary referral centre with a high level NICU, and very high VBAC rates.

            So…I call shenanigans.

          • Samantha06

            I call total BS on her too. She (or he) is an obvious NCB supporter with no medical background, at least none that she will admit to. (I’ve asked with no response).

            I heard about the Coombe back in the 90’s. Wasn’t the Coombe the leader in high-dose oxytocin?

        • fiftyfifty1

          Correlation =/= causation.

          Yes, epidurals are correlated with longer labors because complicated labors (with for example a poorly positioned baby) are much more painful and tend to be much longer than easy straightforward births.

          It’s like saying that arthritis pills make you walk slower. No dummy, people with arthritis walk slower AND they are more likely to take arthritis pills.

          The studies that have *randomized* women to epidural vs. not have shown no increase in either labor length or CS rate.

          • Sarah

            Exactly. The correct comparison would be with those of us who were already experiencing risk factors for instrumental delivery, such as lengthy labour and poor positioning, but were denied an epidural. Nobody seems too concerned about us, though.

        • birthbuddy

          13 minutes prolongation on average. Big deal.

        • sdsures

          Funny – my pain medication doesn’t seem to make my migraine last longer. It stops it.

        • theadequatemother

          That study is looking at the 95th percentile for the second stage. So the time afte whih 95% of women in both groups have delivered? Why? Bc if the length of the second stage is normally distributed in the population those more than two standard deviations above that are considered “abnormal” and intervention might be needed. And that corresponds roughly to the 95th percentile. That abstract doesn’t tell you what the mean for each group is or if there is a difference between them. They could be equivalent with the epidural group having a much larger standard deviation.

          And with all retrospective studies it will suffer from biases such as selection bias (difficult labours and dysfunctional labours hurt more and take longer). They only controlled for parity. They didn’t control for maternal age, BMI, fetal position or anything else that could affect the duration of labor. When all the studies of epidural effect on labour duration are meta analysed, the effect, if any, is very small. Like 60-90 min for the first stage and 15 for the second. And in the randomized controlled trials of early vs late epidurals early epidurals shortened the duration of labour by 90 min on average.

          So don’t trot out a single study and act like you know the answer when you don’t have a competent grasp of all the literature in the area.

    • sdsures

      “If an MD just wants to deliver babies that’s fine, but they should be ashamed if their cesarean rate is anywhere near 20% let alone 30%.”

      You know what’s much better than a cesarean rate of 20-30%?

      A “alive and thriving mom and baby” rate of 100%.

      • kris

        Unfortunately, there is no doctor who can guarantee a healthy mom and baby 100% of the time. Some babies are stillborn. I would not hold any doctor to that standard. they are human as well.

        • fiftyfifty1

          “Some babies are stillborn.”

          Especially babies born at home.
          Especially babies from poorly monitored VBACs
          Especially babies not induced in a timely manner.

        • moto_librarian

          Do you know that it is so rare for a baby to die in utero in a hospital once labor is started that it is difficult to collect statistics on it? Yes, stillbirths happen, but rarely during the course of a monitored hospital labor.

          • Cobalt

            I wonder if that has anything to do with those belts they use to tie women to the beds and all those guys walking around with scalpels.

          • Susan

            Damn… The visual in my head that goes with that sentence wants me to a abandon Xmas prep for cartoonist career! Belts and scalpels oh my!

    • Sarah

      Or alternatively, you and those who are interested in the same type of birth you’re interested in can do all the Bradley and Lamaze classes you want. I’ll steer well clear, as I’ve no interest in unmedicated labour (got plenty of that against my will last time, thanks) and rather than keeping the doctor for the medical emergency, they can come and do my epidural. If you want to pass on the pain relief, that’s your business, but when you say keep doctors away from uncomplicated births you’re saying all low risk women have to do it like you- because to have an epidural or opiates, you need a doctor. Not a chance.

    • Allie P

      That is not true. Hospital “labor management techniques” can sometimes help PREVENT c-sections by engaging more minor interventions. The joke in my OB office is that if a patient comes in with a Bradley birth plan, you might as well get the operating room ready, because they will refuse all minor interventions that will help labor progress until there is no choice but CS.

      • yentavegan

        Mothers. who due to NCB propaganda refuse early low tech interventions, describe their c/sec ‘s as traumatic because indeed by the time the c/sec is done she has labored in pain for hours, pushed without delivery for hours…

    • moto_librarian

      So just to clarify, in a reply downthread, kris tells us that her first c-section was due to a frank breech baby. So hospital “interventions” had absolutely nothing to do with her getting a c-section.

    • Bombshellrisa

      “If an MD just wants to deliver babies that’s fine, but they should be ashamed if their cesarean rate is….” As discussed before, a cesarean rate means nothing unless you look at the reasons for the rate. High risk OBs are going to have what might be seen as a “high” c–section rate. Doctors at teaching hospitals where there are easily 9,000 births a year will have “high” c–section rates. You are very fortunate that you had great outcomes with your births, but you are looking at it from the perspective of a low risk woman whose main concern was that she might get too much care. It’s not a situation many women worldwide are faced with.

    • Trixie

      “Purebirth” was a new one on me, and as I pride myself on being up to date on the latest in ridiculous natural childbirth lingo, I googled it. Wow, what a pile of road apples. http://purebirth.wordpress.com

      • Box of Salt

        Well thanks Trixie (/sarcasm)
        It raises my hackles any time anyone suggests to me that a good way for women to handle life is to “surrender.”

  • Valerie

    Few things anger me more than the notion that anybody besides the patient can decide if he or she is experiencing an intolerable level of pain. It’s arrogant and patronizing for someone to assume that they know better, and it’s literally torture when they are wrong. There is no way to tell for sure what another person is feeling- it could be excruciating, or they could be exaggerating or making it up entirely. I’ve never experienced severe pain myself, but I’m aware of some of the more extreme treatments chronic sufferers will elect to try, such as removing parts of the brain, so it’s got to be absolutely debilitating beyond my imagination. I’d rather treat a thousand imaginary or fake pains than let one person’s pain persist unmanaged.

  • alison

    I’m totally on board with what you’re saying here, but, regarding your own headline of this post–why isn’t pain treatment an intervention? I mean, there is a problem (undesired pain) and the provider has an intervention (epidural, iv meds, whatever) to treat it. Isn’t that what the definition of an intervention is?

  • Votre

    A lot of this “good pain” mindset used to confuse me until the day it suddenly clicked that “natural” childbirth has become a cult, not a health movement. All the facts in the world will never sway that crowd. There’s no arguing with crazy. But it can be fun to piss them off.

  • The Computer Ate My Nym

    So doctors are more likely to use epidurals, forceps, and c-sections than midwives? Why is that a bad thing? All 3 of these can save lives. A well educated childbirth attendant should be prepared to offer whatever is needed to help the woman who is in labor deliver safely and with as little pain as possible.

    • Cobalt

      I would hope CPMs aren’t doing epidurals, using forceps, or doing cesareans. Their mortality rate is high enough without putting tools in their uneducated hands.

    • Ash

      Also, what is the original publication evaluating in hospital CNMs vs physicians for safety outcomes ? The NYTimes said singleton pregnancy, vertex, so I’m assuming that’s what the research they are citing uses as a population. I would like to read the original publication.

  • lola

    The idea of pain being discounted fascinates me. I had a bad fall when I was around 19 on some ice. I couldn’t walk for weeks, and was told I had strained some tendons. The pain was excruciating, and would go on and off for years. It never followed a normal tissue injury pattern. I couldn’t walk down stairs without holding a handrail, and my knee would “lock” at least once a month for a few hours. I was offered accupuncture. I asked several doctors over the space of 10 years if I could please get an xray (public health system), and I was told that it probably wouldn’t show anything. So I just gritted my teeth and dealt with it. Then about 6 months after my son was born, my knee locked – and never unlocked. After months of seeing a kinesiologist and physio, I finally convinced a doctor to refer me for xrays. I took those down to the States and had them looked at by a rheum and had some CT scans done and those were all reviewed by an orthopedic surgeon. Turns out what happened 10+ years earlier was that pieces of bone had shattered off my patella and were “rattling around” inside my knee. Had a scope done, and he pulled out one large (almost a cm in diameter, worn smooth) and several smaller pieces and cleaned up what he could. I will need a knee replacement eventually. Yet for 10 years, I couldn’t convince any doctors to refer me for an xray and I was told it was in my head, even though I wasn’t asking for any pain medication. I wonder if I would have been more successful as a male?

    • Mishimoo

      Probably not – one of my friends kept being told in Accident and Emergency that he was having panic attacks when he was telling them that his heart felt funny. He was told to go home and stop being a bother several times, until he was fed up and refused to leave without having his heart checked properly. It was then discovered that despite being calm, he was alternating between bradycardic and tachycardic. He’s had the 24 hour halter test now, and gets the results soon.

      • sdsures

        I’ve found that “being fed up and refusing to leave” is actually the best way to get things done in A&E under those sorts of circumstances. 😀

        • Mishimoo

          It certainly seems so! I just wish it didn’t have to come to that. Also, if only I could copy and share my local A&E staff, as well as most of the doctors and nurses at my doctor’s office. Simply because they’re great people and really good at what they do.

    • Isramommy

      I’m sorry you had such an awful experience. But just to say, a public health system doesn’t necessarily have to mean a negligent one. Personally, I recently had a very heavy piece of furniture fall on my foot. I went straight to the emergency room for an x-ray and was in and out of the hospital in just over an hour, including films and a consult with the on-call orthopedist. And of course I didn’t pay anything for the visit or treatment. My point is, a public health should be able to handle basic needs like an x-ray and competent evaluation of an injury. Sorry to hijack your point, but I wanted to get a word in on behalf of national health systems.

    • no longer drinking the koolaid

      I spent about 4-5 months trying to solve the issue of pain with my hip. PT x 2 rounds, acupuncture, multiple doctor visits. Finally got tired of the whole thing and referred myself to an orthopedic surgeon. X-ray showed a partial femur fracture on the compression side. Turns out it was a stress fracture related to the amount of running I was doing and the shoes (supposedly well fit) that I was running in.
      I had been telling health care providers for months about my running and it appears they all dismissed my accounts of the mileage because I was female, older, and overweight. But I perfectly fit the pattern for the type of running injury that occurred.
      (Now I run more, but run barefoot or in minimalist shoes, and participate in triathlons at 60 y/o)

      Moral of the story is that it isn’t just female pain that is minimized, it is also our athleticism. I would imagine that men are treated the same when they mention a lump in breast tissue.

    • Maggie Howell

      Probably if you were a male, you would have been seen and treated appropriately immediately.

    • Ella Warnock

      My back went completely out when we were on vacation in San Diego. I literally couldn’t walk and was stuck in the hotel bed with my husband practically carrying/dragging me to the bathroom. I’ve had back trouble for years, on and off, but never this severe and no doctor has EVER taken it seriously. So my husband went to the nearest walk-in clinic and said he had pretty seriously pulled a muscle in his back. No one blinked an eye and he was given 30 Norco and 30 Flexeril, both with one REFILL. No matter what shape I showed up in at the same place, I know it would have been a miracle if I had gotten half as much of either with NO refills. A day and a half later I was back on my feet and well enough to ride the train back home.

      That was a year and a half ago, and I’ve just been lucky that nothing else has happened. I’m not really sure what to do when it eventually gets pissed off again. We would seriously consider just sending him off to the doctor again, since they seem to take HIS pain so much more seriously than they take mine.

  • Spamamander

    That kind of explains why for a year doctors threw Vicodin at me and told me to lay down when I had severe sciatic pain down both legs that incapacitated me. Finally after a doctor change I got an MRI and an immediate consult with a neurosurgeon- I didn’t simply have a slipped disc, it had ruptured to the point of having pieces floating around in the spinal canal. A small surgery later and I was functional again.

    • sdsures

      Ouch! Vicodin isn’t the right sort of painkiller for that. Has too short a half-life.

  • yentavegan

    OT somewhat…. my friend of 31 years who had been complaining of pain while swallowing/indigestion/reflux for 3 straight years..and who had been growing increasingly despondent just died of esophageal cancer. HEr doctors poo-poohed her symptoms and never referred her for an endoscopy…which could have saved her life 3 years prior… overweight menopausal clients are routinely disrespected and not taken seriously…a man would have gotten referrals for more tests instead of antidepressants and tums…

    • Guesteleh

      OMG I’m so sorry. That is unconscionable. With all of the recent research linking acid reflux to esphageal cancer, there’s no excuse for this shit.

    • Dr Kitty

      I’m sorry for your loss

    • So sorry to hear of your loss. Your friend deserved better.

    • fatphobia kills

      Sadly, all overweight patients, regardless of age or sex, are given substandard treatment. An overweight patient, no matter what symptoms he or she has, is told that losing weight will cure the problem. There’s no reason for doctors to even speak to fat patients anymore. Just have “lose weight” printed up on some cards and have your nurse hand the card over after collecting the co-pay.

      Doctors should do something about the prejudice in their profession. It’s killing people.

      • Yes, as a diabetic I am constantly told I should lose weight, and indeed, I am obese. But here’s the problem: I am well-controlled with medication and my current diet. Should I ingest substantially less calories, my meds would [and have done] put me into severe hypoglycemia multiple times a day. Oral meds have a much longer duration of action than rapid-acting insulin. But no dietician deals with diabetic meds, and no doctor deals with diets. I can’t get a satisfactory answer to “how” to lose weight, just to lose it.

        • Cobalt

          Reminds of most of the pregnancy advice regarding gestational diabetes- prevention is “don’t be fat” and management is “don’t eat too much sugar, but make sure you do eat enough carbs”.

          Because those are really clear and easy to follow.

        • Bombshellrisa

          My mom is currently experiencing something much like this, except she is not well controlled and needs to be on insulin and refuses. Losing weight would help, but she doesn’t understand how to do that best for her situation. There is a nurse practitioner I went to who cares for diabetic pregnant women and also teaches the diabetic classes at the hospital where I had my son, I found her incredibly helpful because she understands both meds and nutrition. There are not a lot of nurse practitioners like her available and none at either place my mom goes to for her care.

          • Mishimoo

            My dad has recently been diagnosed with Type II, has been told that he needs to start on insulin, but has decided to ‘cure’ it by trying to rapidly drop his weight and dismissed it as fearmongering when I pointed out that hey, eyesight is important. So are toes, kidneys, etc. He’s insistent that juicing will fix it, and has also “fixed my gut issues as long as I use this herbal extract which you should also take!!”

        • fiftyfifty1

          If cutting a moderate number of calories daily (e.g. 300) throws you into hypoglycemia, then you are overmedicated with your secretagogue (glyburide, glipizide etc), and your A1c should be reflecting that. The other possibility is that you are not overmedicated with your secretagogue but that your hypoglycemia experiences reflected cutting your calories too substantially.

          • Cutting only 300 calories a day wouldn’t cause me to lose a gram. I need to eat 900-1000 calories a day to lose weight substantially, because I can’t exercise due to arthritis and back problems, and because, being post-menopausal, my metabolism is fairly slow. Right now my A1C is between 6.5-7.

          • fiftyfifty1

            Cutting 300 calories a day, every day, will cause *everyone* to lose weight. This is basic dietician knowledge, well established experimentally. 900-1000 calories per day is a starvation diet. Literally every adult who is placed on such a diet will eventually starve to death, also well established “experimentally” I am afraid. Now sticking to a diet, any diet, is another matter. Very difficult due to multifactorial cues and drives to eat.

    • Mishimoo

      Oh no, I’m so sorry for your loss. That’s awful!

    • Bugsy

      Hugs, yentavegan. I’m sorry for your loss.

    • Samantha06

      How awful!

    • Spamamander

      I’m so sorry. Nothing more can be said.

    • Brix

      I’m so sorry. That is absolutely unconscionable. Your friend deserved so much better.

  • Emily

    Of course doctors do more Caesarian sections that midwives. For fucks sake.

    That’s like saying “baristas make more coffee than electricians or mechanical engineers do”

    • FormerPhysicist

      Heck, worse than that. Electricians and Mech E’s can and do make coffee.

      • MegaMechaMeg

        I am an aerospace engineer and I make so much coffee. Coffee forever. As far as the eye can see.

        But a barista could probably also do my job some days so there is that.

        • RKD314

          I am a physicist, and I know exactly what you mean.

        • sdsures

          My husband is in systems engineering (working in website security due to health reasons), so I have a ton of respect for engineers. <3

    • Liz Leyden

      I’ve been a barista. I can still sling a mean double cappucino. That doesn’t qualify me to re-wire a house.

      • Mishimoo

        I could quite possibly do a decent job of rewiring a house or rebuilding a car, because I spend a fair chunk of my childhood pulling wires and in a workshop…I just wouldn’t because I know how much I don’t know and that when things like that go wrong, they can go really wrong really quickly.

  • no longer drinking the koolaid

    The UK/NICE guidelines will be the topic of the Dianne Rehms show on Tuesday. http://thedianerehmshow.org/shows/2014-12-16/new_research_on_the_safety_of_using_midwives_for_low_risk_deliveries

  • Mel

    “Doctors are much more likely than midwives to use interventions like forceps deliveries, spinal anesthesia and cesarean section.”

    Well, duh…

    I hope midwives aren’t doing forceps deliveries, spinal anesthesia or CS since they aren’t trained in any of those.

    In related news, chickens are much more likely to produce hard-shelled eggs than cows. Likewise, botanists are much more likely to study plants than trout!

    • suee

      obstetricians don’t administer anesthesia either, the anesthesiologist does that. the idea is that the ob/ or midwife is in charge of the patients overall care and clinical decisions, not whether she performes the procedure herself

      • sdsures

        I have loved every anesthesiologist i have ever needed (major and minor neurosurgeries).

  • Samantha06

    Yes!! This! I had a labor patient recently who was in excruciating pain and at that point, was declining an epidural. Her husband kept saying, “you can do it!” He thought he was being helpful.. sigh…..

    • RKD314

      My husband knew that he had one job: make sure that I get my epidural. He took it very seriously. I love him.

      • Samantha06

        Awww! What a great guy!! Did you have a good experience with your labor and birth?

        • RKD314

          It was great! I would have liked to have felt a whole lot less, the epidural certainly didn’t leave me numb (I needed local anesthetic prior to receiving a few stitches afterwards). But in the end, healthy me, healthy baby = we are all happy. I didn’t go into it with any goals other than healthy and minimal pain if possible.

          • Samantha06

            Sorry your epidural didn’t work well. I’m glad that overall your experience was positive and you and your baby are healthy!

          • RKD314

            Yeah, I’m glad I had it though. My whole labor from water break (the way it started) to baby was only 4 hours, so the contractions were really intense. The epidural helped me through that pain considerably.

          • Samantha06

            That’s good! I have seen that with a fast, intense labor. I’m glad you got some relief though!

    • suee

      they might have discussed this in advance, she might have requested this from him in advance without realizing how she would feel in the moment. if so, can’t really blame him. what happened in the end?

      • Samantha06

        Totally. I think that is definitely the case. I think they had both bought heavily into the woo, and he was trying to stick with the plan and help her in that way. I don’t think either of them realized how it was going to be. She had an obstructed labor and ended up with a C/Section.

    • inandout
      • Samantha06

        You know what is so pathetic about that? Patients that have totally bought into the NCB cult many times see their doula as some supreme being so will do whatever they can to gain their approval, even if that means foregoing pain relief when they are screaming and writhing. For a woman to suffer through pitocin without pain relief just to please her doula is horrible. But for the doula to keep encouraging her to do so, just because the woman planned that prior to actually experiencing labor, especially with pitocin, is unconscionable. Plans change and any doula without a self-serving agenda and an ounce of compassion would have already discussed this with her client and come up with a “plan B.” She truly is a piece of work.

        • Kelly

          It makes me want to be a doula or a lactation consultant so that I can offset the crazies.

  • I want to applaud this post, and face-palm at how we got to a place where safe care is defined as the avoidance of intervention, rather than the avoidance of death and disability.

  • DaisyGrrl

    One tactic that I know certain NCB proponents use where I live is to overstate the risks associated with epidurals. Prior to labour, some of my friends have been told by their midwives that epidurals lengthen labour by hours, carry risks of harm to the infant, increase the chance of c-sections or instrumental delivery, carry serious risks to the health of the mother, etc. No benefits were ascribed to epidurals, and labour pain was described as natural and manageable with nitrous. In other words, they lied to my friends.

    These midwives were university educated and practicing in hospitals. And, of the people I have spoken to about this issue, I’m the only one who views these “informed consent” discussions as violating the patient’s right to proper informed consent. It’s disheartening to say the least.

    • theadequatemother

      this is the crux of the issue. Myths about the effect of epidural analgesia on labour progression and outcome continue to be perpetuated even in the face of solid contemporary evidence that there is no clinically meaningful effect. Because of that, epidural analgesia continues to be considered an “intervention” by certain groups.

      • DaisyGrrl

        Given the research showing benefits to maternal mental health outcomes, I think it’s even more unconscionable that some women encounter barriers to effective pain relief. Not only do you get to be in agonizing pain, you can have a side of PTSD to go with it!

        • Liz Leyden

          Motherhood is suffering; might as well start early.

          • fiftyfifty1

            Or rather: Motherhood is suffering, better start early because suffering is needed to purge women of selfishness.

          • suee

            i’ve heard too many women describing their homebirths ecstatically to beleive thats the philosophy behind it.

          • realitycheque

            My MW claimed that the pain of childbirth prepares a woman for her new role; that it’s a physical exercise in “taking the back seat” that helps initiate the transition you need to take to be able to meet the demands of motherhood.

            So, basically, “Your needs are nil now, better kick start your transition into sub-humanness”.

          • Who?

            Does one also have to supply one’s own polished martyr’s badge? That is just wrong, wrong, wrong.

          • Vg2010

            Perfect way to tie-in with Attachment Parenting: “You MUST suffer, so you can be prepared to be a helicopter parent that just hovers above your child, puts away all personal needs and concentrates on giving 100% to the new ruler of your life” – except they probably would hide it with pretty words about how good it will be for your child’s self-esteem and how secure and safe he will feel.

            PS: read a sample of Dr. Sears book, and I can’t remember last time I read anyone with such a condescending tone…

        • Samantha06

          That’s exactly the dirty little secret the NCB and home birth crowd don’t want women to know…

    • Liz Leyden

      They also overstress damage to the breastfeeding relationship. When I was in school, the lactation consultant on my OB rotation acted like lack of immediate skin-to-skin contact right after a drug-free birth would ruin any chance of breastfeeding. My crunchy childbirth class was very matter-of-fact about pharmaceutical pain relief, but it still linked epidurals with breastfeeding problems.

    • junebug

      They also claim hospital c section rates are massively higher than they really are. Like 50% but when I did some digging it was 14% for women with no prior sections, 32% overall.

      • The Bofa on the Sofa

        And for women who have had a previous successful vaginal delivery, it’s something like 3%, basically the same as that for a properly screened home birth patient.

  • Amy M

    Do they ever apply the fear=pain in any other setting? What about phobias? Someone can have an extreme fear of heights or spiders, but not feel pain upon being up high or seeing a spider. They’ll feel fear, and that certainly feels unpleasant, but its not actually painful.

    And in general, I’d say most people are afraid of pain. Everyone has experienced pain on some level, and no one (with the possible exception of S/M folks) likes it. Even the S/M folks aren’t going to undergo surgery wo/anesthesia. I think its very difficult to NOT fear pain, when you know its coming. And when the anticipation is over, and the pain is happening, even if you know why, it can be scary to be unable to control yourself, if the pain is very bad. I don’t think its possible to separate fear from pain and/or anticipation of pain, at least past a certain level of pain.

    The assignment of moral value to withstanding pain is so frustrating, because its stupid. We have so many safe ways to deal with pain now, no one should have to suffer if they don’t want to. Sure, pain in and of itself won’t kill you, but denying pain medication, or denying that someone is IN pain, that’s just cruel. I know its wrong, but it makes me hope that someday, these NCB proponents are dying of a painful disease and they are denied pain relief on the grounds of “its all in your head” and “you shouldn’t fear death, its just another part of life, after all.”

    • Roadstergal

      LOL, I’m a masochist with the right person, and I don’t like pain unless it’s _very_ planned and in a _very_ specific context.

      I had a surgery recently, and I did not fear the pain – because we had a plan beforehand to manage it. I spoke with the anesthesiologist, they did a wonderful nerve block, I had very light general because of it, and I had a pain management plan with medications afterwards, which I was able to taper off of as the pain decreased. Pain doesn’t have to be something to be afraid of unless you are given no options to control it!

      • Amy M

        Ok, maybe I should amend to “fear uncontrolled/uncontrollable pain.” Because you talked with your doctors ahead of time, you knew you would experience as little pain as possible, but in the case of a woman giving birth at home, or even in a hospital in the UK (as we have heard so many horror stories), she’ll know that pain relief is likely not available.

        I wasn’t so scared of childbirth pain, because I knew I could get an epidural. I WAS scared of ending up with a Csection because I was afraid of the post-op pain, which I had heard could be quite unpleasant. I knew that women who have Csections get pain meds, but there are drawbacks to those and of course, I had to care for my new babies too.

        • Roadstergal

          Oh, I was agreeing with you! Pain and fear definitely historically go hand-in-hand – but they don’t _have_ to. And the fact that they still do, in situations where we have generally effective and safe means to plan for and control pain, is a situation that needs to be remedied, in NCB/midwifery circles – as per all of the comments here…

          • Amy M

            Yeah. They have it backwards: pain causes fear, not the other way around.

    • I was told, in no uncertain terms, that, after the first 48 hours, my hip replacement pain “should” be manageable with the equivalent of Tylenol Extra-Strength. “Women bear pain much better than men” one [female] nurse [who was a third of my age and did not have chronic back pain from a ruptured intravertebral disc like me] said to me “and you don’t want to become dependent on pain meds”, at which point I demanded to see the nursing supervisor. The [male] surgeon had written orders for Vicodin which the nurse didn’t want to give me.

      It’s not just about childbirth, unfortunately. If you have a chronic condition which causes pain such as arthritis or lower back pain, you are liable to be told that you are “addicted” to pain medication if you can’t “keep a stiff upper lip”, or “learn to live with it”. One doctor actually told me that since I’d been in chronic pain since 1985, “I ought to be accustomed to it by now”.

      • toni

        Ugh, this makes me so cross. It’s one thing sucking it up yourself and going without pain relief if you want to avoid drugs for whatever reason but being so unmoved by other people’s pain especially when your job is to alleviate suffering..gah! What are the drawbacks of long term use of opiates anyway? All I’ve found is liver damage from the acetaminophen.. but you can have hydrocodone without that. Other than that I’ve read about the dangers of snorting vicodin (uh, don’t snort it then) and that it can cause depression, anxiety etc. but so does untreated, chronic pain. And of course dependence but I see nothing wrong with being dependent on something that gives you a normal life.

        • fiftyfifty1

          Chronic opiate use is a risk factor for more than just dependence, it’s a risk factor for addiction, and addiction really is awful. It used to be thought that people couldn’t get addicted to opiates prescribed for pain if they had no prior addiction history and took them as prescribed. Now we know that is not the case, and addiction can start in people with no risk factors with something as simple as a post-op script for Vicodin.

          (that said, cutting a hospitalized post-op patient off narcotics on day 2 after a joint replacement is going way too far with caution).

        • Guesteleh

          The bigger issues is doctors who aren’t aware of all the chronic pain treatment options out the. Antidepressants, anti-seizure meds, beta blockers and other stuff classes all help and you don’t have the addiction problem. It’s not just about opiates.

          • Samantha06

            I absolutely agree with you about beta-blockers! I take both and I know for sure they have helped me.I started menopause in my mid-forty’s with horrible panic attacks and generalized pain and aching. When I started on beta blockers for mild hypertension, the panic attacks stopped and the pain is much better.

          • Amy M

            I was given a calcium channel blocker for migraines at one point. It worked well, but unfortunately, the side effects were intolerable (brought my bp TOO low) and I had to stop taking it. 🙁

          • Samantha06

            Oh, I’m sorry to hear that. Is there another migraine medicine available that might work for you? I have found that the beta blocker does make me feel fatigued at times, but the benefits outweigh the side effects, for me anyway.

          • fiftyfifty1

            I don’t think that it lack of awareness, but rather that these options are typically extremely unpopular with patients. None of them work immediately, they take up to 2 months to work. They don’t provide the same “all’s right with the world” and subtle “high” experience that narcotics do, which can go a long way towards making the experience of pain more tolerable. They can have significant side effects which overshadow the typically modest improvement that these meds bring. They are very idiosyncratic– what works for one person will not work for another (but you won’t be able to know for sure for at least a month). Then there is the stigma of being put on a “crazy med” or an “epilepsy med” or a “heart med” when the patients have none of these problems. Patients frequently hate these meds and a doc has to spend *a lot* of precious time educating, dispelling myths and managing expectations before starting one of them. Even with all that, it takes a very mature and patient patient to tolerate the uncertainty. They can be great meds in the end, but it is no wonder to me that patients want narcotics instead and that many docs give in.

        • araikwao

          Tolerance is the problem. Also no good evidence for the effectiveness of opioids in treating chronic pain.
          (Autocorrect changed opioids to iPods – lol. Don’t know if there’s any evidence for them either)

      • Wren

        I had a similar issue with a midwife, who decided 24 hours after my c-section I just needed paracetamol to deal with the pain. I was written up for stronger meds, but she somehow couldn’t get to the doctor to check that until I’d been in serious pain for her entire shift. Evil witch. I did formally complain and was actually offered better pain meds after my VBAC 20 months later.

        • Roadstergal

          My UK friend was treated the same, only given paracetamol for post-C-section pain. But she’s mega skin-to-skin-immediate-brestfeeding-formula-so-evil, so she probably would have declined anyway… she swallowed everything the woo-ish midwives there have given her (which hasn’t included adequate pain medication).

        • Dr Kitty

          Having this issue currently with a local hospital.
          The midwife I spoke to on the ward was *shocked* that anyone recovering from a CS, caring for a toddler and breastfeeding a newborn might be in moderate to severe pain “because they all seem perfectly comfortable with IV paracetamol on the ward”.

          IV paracetamol is not the same as oral paracetamol.
          Lying in a hospital bed is not the same as trying to go about your daily life at home.

          Pain is what the patient reports it is.
          That is why we have pain scales and titrate doses to effect.

      • JS

        You practice in Israel. Is it true that in Israel women are not provided with narcotic pain medications after a c/section?

        • No, it’s not true. Pain medication is not withheld after a C/S — I’m not only in Israel, but all three of my children were born here, by C/S, btw. Not infrequently, the epidural catheter is left in for up to 24 hours, and topped up as needed. Generally, afterwards, there isn’t too much pain, which can be managed with PO meds.

          • JS

            sure, the question is what type of PO meds?

          • Dilaudid, Percocet [oxycodone], Etopan, optalgin [dipyrone], ibuprofen, acetoaminophen — depending on the severity of pain and whether a woman is breastfeeding or not.

            Generally, most women do not seem to need anything very strong after the first 24-48 hours. Operative technology has advanced a great deal in the past couple of decades.

    • realitycheque

      If anything, wouldn’t the opposite be true? I was under the impression that the fear/anxiety fight-or-flight response triggers adrenaline release, which tends to dull pain.

      • Amy M

        I don’t know, perhaps it depends on the situation. (long personal story to follow)

        I can tell you that while I probably wouldn’t classify as completely “dentist-phobic,” I am extremely uncomfortable there, and if the dentist has to mess with my bridge, I have a panic attack. The reason for this is because when the bridge was put on, there was a short period of time, between the removal of the temporary cover and the cementing of the permanent one, where my teeth, w/no enamel (they remove it or part of it for the bridge to fit) were exposed to air.

        This was one of the worst pains I have ever experienced in my life, up there with migraines, and I have an irrational fear that the dentist will pull off the bridge (by accident or on purpose) and I will experience this pain again. At the time of the pain, which was pretty scary and unexpected, there was no dulling of sensation. If I’d been in any state of mind other than panic and sobbing in excruciating pain, I might have fled, or fought the dentist if he tried to remove my hand from my mouth…I don’t remember, I might have done the latter.

  • jhr

    Dr. Amy- I hope that you are sending your comment directly to the NY TIMES.

  • mythsayer

    Men’s pain can’t be an “intervention” because only women can have “interventions” because only they can give birth. It’s only birth that continues to be painful. No one ever suggests that having general anesthesia during surgery is associated with worse surgical outcomes. Never mind the fact that some people DO have adverse reactions to anesthesia.

    • But birth is NORMAL, not pathologic!!! You shouldn’t need analgesia for something which is “normal”. A pathologic condition, of course, is an entirely different matter. [sarcasm]

      • Amy M

        Every person who suggests that childbirth pain is normal, and therefore women should be denied pain relief, should be denied medical pain relief when they feel the effects of aging. Arthritis is normal, after all, if you live long enough and there are exercises one can do to alleviate the pain.

    • theadequatemother

      There are very specific cases where neuraxial or regional anesthesia or even local with sedation has better outcomes than general anesthesia. And we talk about it quite a bit at our scientific meetings and in our journals. Of course, its a discussion about evidence, not morality.

      Just like we talk about the adverse effects of untreated pain.

      • Mishimoo

        Brain surgery is usually safer as local with sedation, isn’t it? Which makes sense, you need to know which bits are being affected by what the surgeons are working on.

    • MaineJen

      I’ve used this anecdote before but it bears repeating. My husband had two abdominal surgeries within a year (awesome year…), and he had epidural anesthesia placed both during the surgery and during his recovery. (He of course had general during surgery as well; the epi was for controlling post-op pain.) During both surgeries, he had complications involving the epidural; it made his blood pressure drop to dangerous levels. This was, of course, corrected by the surgical team and everyone moved on. At NO TIME did anyone suggest that, because the anesthesia caused unforeseen complications, that it was “an unnecessary intervention” and that he should just tough it out post-operatively. Because that would be cruel, right?

      Even my own mother, who had 4 unmedicated births, told me before I had my first that “You know, I think you should probably get that back thing.” That clinched it for me. 🙂 And guess what…Mom was right again.

  • Young CC Prof

    Hit the nail on the head. There were a number of mistakes in that article, but that line is the kicker.

    When safe, medically appropriate pain relief is available for women in labor, denying it is a human rights violation.

  • Ash

    Can you imagine if it was
    “Internists are much more likely than gastroenterologists to use interventions like pain relief for colonoscopies.”

    I have real doubts that the response would be “I’m so happy that my doc doesn’t recommend sedation for my screening colonoscopy!”

    Colonoscopies can be done without pain relief but it’s almost always given as an option in the US, and most patients are glad to use it.

  • AlexisRT

    I winced when I saw the editorial this morning. It was a mess based on a recommendation they did not understand. It was not about the use of midwives–which are routine in the NHS and fine, can and probably will be used more here due to shortages–but about birth SETTING.