Punishing teen mothers by denying them epidurals

Sad and stressed pregnant woman

NPR reports on a bizarre and unethical practice:

An epidural is a common type of regional anesthesia that eases the pain of labor. As she had done many times before, Sweeney followed hospital protocol and called the anesthesia department. But to her shock, they told her they could not help her young patient.

“They said that without parental consent, … she would not be able to sign for her own epidural,” Sweeney says.

In Ohio, people under 18 who are in labor cannot consent to their own health care. They can receive emergency services, but nothing considered to be elective. For the many Ohio minors who become pregnant, it’s a painful gap in coverage.

Who would deny pain relief to a teenager in excruciating pain?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]An epidural for childbirth is a human right and no one, least of all state officials, should be allowed to pretend otherwise.[/pullquote]

Dr. Michael Cackovic, an obstetrician at The Ohio State University Wexner Medical Center, says every couple of months he sees a teenage mom who, under Ohio law, is unable to receive elective treatment, like an epidural. He says it’s frustrating to see patients in unnecessary pain.

… Cackovic … report[s] that, just as frequently, [he’s] had cases where the mothers intentionally denied their teenage daughters an epidural – as a sort of punishment for getting pregnant.

This is both cruel and bizarre. The same teen who is unable to consent to pain relief for herself, is able to consent to pain relief for the baby after its birth. It ought to be illegal for a very simple reason: pain relief is not considered elective for any other person in pain.

Were the same teen to be brought to the emergency room suffering abdominal injuries and requiring emergency surgery after a car accident, no one would deny her anesthesia claiming is it “elective.” Were a teen male brought to the emergency room with a fracture of his leg, no one would deny him pain relief while setting it.

In the paper Pain Management: A Fundamental Human Right, Brennan et al review the ethics of pain relief:

The importance of pain relief as the core of the medical ethic is clear. The relief of pain is a classic example of the bioethical principle of beneficence. Central to the good actions of doctors is the relief of pain and suffering. As Post et al. state, “the ethical duty of beneficence is sufficient justification for providers to relieve the pain of those in their care …” The principle of nonmaleficence prohibits the infliction of harm. Clearly, failing to reasonably treat a patient in pain causes harm; persistent inadequately treated pain has both physical and psychologic effects on the patient. Failing to act is a form of abandonment…

Childbirth is the only setting in which pain relief is wrongly viewed as elective and the reasons are religious, not medical.

In the case of analgesia for childbirth, there was bitter resistance on religious grounds. Fundamentalists cited the Bible as ordaining that childbirth was a necessarily painful process. Opposing both the church and powerful obstetricians, Queen Victoria requested that James Simpson administer chloroform analgesia for the delivery of her son, thus overcoming powerful negative attitudes that discouraged relief of the pain associated with childbirth…

In other words, many religious leaders believed, and some continue to believe, that women should be punished for having sex, and sex outside of marriage should be punished all the more. Abrogating that “punishment” with pain relief is therefore “elective.”

Lest you think that the idea that women deserve pain in childbirth is merely a relic of stodgy religious views, the belief has been secularized by the natural childbirth movement that deems epidurals in labor an “intervention,” but wouldn’t dream of labeling any other form of pain relief elective. Midwives and doulas are the only providers I am aware of that refuse to consult with anesthesiologists and condemn pain relief for ideological reasons.

What about the fact that epidurals have side effects? ALL methods of pain relief have side effects. Opioids administered into vein, muscle or by mouth have far more side effects — respiratory depression, addiction, death — than epidurals, yet no one claims that opioids for relief of severe pain are elective.

The relief of pain is NEVER elective, it is always emergent and ethically mandated. The only time that pain relief can be ethically withheld is if the patient refuses it.

What about the right of parents to determine appropriate medical care for children? If a parent brought a child to the emergency room with a severe burn from playing with matches, absolutely no one would honor that parent’s request to deny the child pain relief to “teach him a lesson.” They’d ignore the parent altogether and possibly petition the court on the grounds of child abuse. There is nothing elective about treating a painful burn regardless of whether the child brought it on himself.

There is also nothing elective about treating the pain of labor no matter how much or how brutally a parent or society wishes to punish women who have sex out of wedlock.

An epidural for childbirth is a human right and no one, least of all state officials, should be allowed to pretend otherwise.