Denying women epidurals is “midwifery violence”

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Another day, another scandal in UK midwifery care. This time it’s not dead babies and dead mothers, all though there are far too many of those. This time it’s the sadistic behavior of midwives.

According to The Telegraph:

Women in labour are being denied epidurals by NHS hospitals, amid concern that a “cult of natural childbirth” is leaving rising numbers in agony.

Mothers said they were told “It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas.

The problem is so widespread that the rate of epidural use is dropping overall:

Midwifery violence: bullying, pain shaming and denial of epidurals and maternal request C-sections.

Official guidelines … state that women must be able to access pain relief when they request it, including epidurals.

However, this newspaper has identified six NHS trusts where women pleading for pain relief were refused it.

It comes as official figures show the number of women given pain relief during child birth has fallen. The statistics from NHS Digital show the percentage of women in labour given pain medication such as epidurals has fallen from 67 per cent in 2008-09 to 61 per cent in 2018-19.

Rhiannon Evans of Grazia refers to this practice as pain-shaming:

…[U]nlike the arenas of mental health, other pain, or addiction, where it feels like things are starting to change and messages of kindness are starting to filter through to our collective consciousness, birth is a bizarre no-mans-land of medicine and shame.

It’s a place where the old and new collide, but women are still left worse off. It’s a strange area where the old world says, ‘Come on, this is how we’ve done it for centuries, stiff upper lips, please, women!’ and the new world says, ‘No, it’s your body, your choice, you can do this, women are amazing, but did you know breathing is the greatest anaesthetic ever and breast milk is the cure for everything you could ever imagine?!’ The place where those two worlds intersect is the place where women deal with birth and pregnancy every day. And for many of us, it’s a grim place to be. It’s where the so-called ‘cult of natural childbirth’ lives.

Maybe there would be more attention devoted to midwives’ unethical behavior if we gave it a name. I suggest “Midwifery Violence.”

What’s the definition of midwifery violence?

It is an umbrella term that includes coercion, bullying, pain shaming and denial of epidurals and maternal request C-sections.

Forcing women to labor in pain when effective pain relief is available is sadistic.

In Eve’s punishment rebooted: The ideology of natural birth, philosopher C.K. Egbert explains:

There’s something pornographic about the way we depict childbirth. A woman’s agony becomes either the brunt of a joke, or else it is discussed as an awesome spiritual experience… [W]e talk about the pain of childbirth — with few exceptions, the most excruciating, exhausting, and dangerous ordeal within human experience — as valuable in and of itself. Hurting women is sexy.

Midwives justify their sadism as “better” for babies and mothers. Egbert makes it clear that this justification is nonsense:

… We probably wouldn’t give much credit to an argument that we should strap patients to the operating table and refuse them anesthetic during surgery, even though general anesthetic is usually the most dangerous part of surgery. Rather than eliminating palliative care, we seek safer and more effective means of performing surgeries and administering anesthetic.

Natural birth advocates are not concerned with women’s welfare, because they are not advocating for safer and more effective forms of pain management; they argue they should be eliminated, because women’s suffering is itself a good…

None of this is surprising when you consider that the philosophy of natural childbirth was created by old, white men (Grantly Dick-Read, Lamaze, Bradley) and perpetuated by old, white men (Odent, Marsden Wagner) who tried to convince women that the pain of childbirth was in their heads, not their bodies. And the philosophy of natural childbirth has been perpetuated by white women (midwives, doulas and childbirth educators) who enjoy wielding power over other women and glory in humiliating them for failing to mirror their own choices back to them.

The midwives and doulas who chivvy women into refusing pain relief, who “delay” calling the anesthesiologist when a woman requests an epidural, who promote inadequate forms of pain relief (waterbirth) and praise women as warrior mamas (i.e. “good girls”) for enduring labor without pain relief are sadists. They believe that women’s pain and suffering aren’t worthy of their compassion and concern. They believe that women are improved by agonizing pain, and diminished by relief.

And that is midwifery violence.

  • Sarah

    I’m surprised they only found six.

  • demodocus

    I battle my own brain every day. Does that make me a warrior mama? *snort*

    I’m safe, we’re always safe. Just feeling down this afternoon. Also, I’m in the middle of a med change, so the new one hasn’t fully kicked in yet.

    • Sarah

      I battle my own idleness every day. I think that should qualify me as a warrior mama too.

  • Kim Thomas (casual)

    Some of the most upsetting stories we’ve seen at the Birth Trauma Association involve things that have happened after the baby is born, so aren’t even to do with facilitating a “natural” birth, such as obstetricians attempting manual removal of the placenta without any pain relief, or midwives stitching up a tear without anaesthetic. The distress caused by this can affect women for months or years. It’s difficult to imagine this kind of approach being taken in any area of medicine outside maternity.

    • Sarah

      Gynae, maybe…

  • Sarah

    It is abusive to deny women epidural analgesia for any reason other than clinical, but it is inaccurate to describe this purely as a midwifery issue- the first article refers to doctors refusing epidural and indeed if you read further there is at least one (reported, likely many unreported) incident of an anaesthetist refusing to site an epidural.

  • mabelcruet

    This has been an issue for a very long time. 10 years ago, a male midwife, Denis Walsh, claimed that women needed to suffer during childbirth because it marked a rite of passage and it meant they bonded better with the baby. Total and utter dick, and its obvious he’s coming from a position of never having given birth, and not being qualified to actually give epidurals anyway. It’s the typical ‘protect midwives, protect natural birth’ mentality.

    https://www.theguardian.com/lifeandstyle/2009/jul/12/pregnancy-pain-natural-birth-yoga

    • rational thinker

      I was reading the comments on the guardian piece he wrote and this one brought up a good point.= ”
      I cannot tell you how angry this wicked, stupid man has made me. how
      DARE he lecture women in this patronising and misogynistic way?. I
      thought the midwives I suffered from were stupid, lazy and cruel, but he
      really takes the biscuit. Is there a petition anywhere to get this man
      out of a job he is clearly totally unfit for?”

      I wanted to ask if there was anything done about him that you know of, was he ever disciplined for denying women epidurals or was there any petitions that demanded his removal from his workplace?

      • mabelcruet

        I honestly don’t know if anything actually happened to him. I looked him up and there’s a few mentions online of him, he seems to still be working (at Nottingham university) and giving talks at conferences (in 2017 he did one on shoulder dystocia). There’s been no more controversial public statements. However, I did find an interview he gave to a website called the Wowcher blog (wowcher are a company who sell discount vouchers for all sorts of stuff like manicures and toilet paper so it seems a bit random). The question was about applying to become a student midwife, and his answer was to say in your entrance interview that you disagree with overmedicalisation of child birth. Brainwashing before you even start studying basically, the university making sure only the ‘right thinkers’ get into training. Sickening, closed-minded, and not patient centred, so he’s obviously learned nothing.