Women love epidurals!


Midwives are desperate for market share.

As I wrote in my book Push Back: Guilt in the Age of Natural Parenting:

No matter what obstetricians offered, midwives would insist that it was unnecessary, disempowering, harmful, and contradicted by the scientific evidence. Midwives would wrest childbirth back from paternalistic doctors and give it to those to whom they believed it rightly belonged—the midwives themselves. And the entire project would be promoted as being in the best interests of women and babies.

Obstetricians offer epidurals, a remarkably safe and effective form of pain relief. Therefore midwives demonize them. But women continue to love them!

Why is there such a disconnect between what women are told to choose and what they actually choose?

That’s the take home message from a new paper, The “good” epidural: Women’s use of epidurals in relation to dominant discourses on “natural” birth.

Sadly, in addition to negotiating childbirth itself, women in Western societies are forced to negotiate pressure to avoid effective pain relief. The authors wanted to understand how women handle the pressure and how they construct their birth experiences in retrospect.

Making the decision to have an epidural is, therefore, not merely a straightforward matter of weighing the advantages and disadvantages of the procedure, as women’s decisions to undergo an epidural for pain management during birth actually influences what “kind” of childbirth they are thought to have had, both by themselves and by others.

In the end, the majority choose epidurals and the majority love them. Why is there such a disconnect between what women are told to choose and what they actually choose? In large part it’s because during labor women discover that midwives and other natural childbirth advocates have lied to them.

Unrealistic expectations of pain led to disappointing birthing experiences. During the post-birth interviews, the participants described feeling overwhelmed by the pain they experienced during birth… Some participants felt that the pain they experienced during birth went far beyond what they had expected and prepared for.

For example:

For instance, Bergdıs commented: “Yeah, I knew that it would be painful, but I never expected this . . . you can’t explain just how painful it is you know”. Similarly, Katrın felt that the amount of pain associated with childbirth is sometimes glossed over. Although she still felt happy with her decision to give birth without an epidural, she did question the validity of some of the information she had been given during her pregnancy, and she felt that, despite the end justifying the means, childbirth had been romanticized and misrepresented…

Sigrıður had a similar experience. She felt that her positive outlook with regard to the birth and the pain involved had not been based on reality…

Pain management turned out to be integral to having a good birth experience:

The women who experienced prolonged labour mostly asked for and received an epidural. Those participants who had an epidural described their experience of giving birth as being very positive. They did not feel let down by their need for an epidural, and the side effects of the epidural were not experienced as excessive or having a negative effect on the birthing experience…

Some participants described the epidural as a “massive relief” after having been in labour and in considerable pain for hours. They described the effects of the epidural as “wonderful”, “cosy” and “comfortable”. With the help of the epidural, they felt like they could finally have some rest and relax.

How did the women make sense of the difference between what they had been led to expect and what they actually experienced?

The findings presented in this paper indicate that … “natural” childbirth is constructed as the optimal goal for birthing women. It should, therefore, be considered the dominant institutionalized discourse concerning childbirth… The continued association of women with nature and the demands made on the maternal body to act in ways that are deemed “natural” reveal how biology is still seen as a prescriptive, determining factor for women.

Ultimately most women rejected the pressure placed on them by midwives and other natural childbirth advocates:

…[D]espite only two women initially wanting to have an epidural, the majority ended up having epidurals, and they constructed the experience as wonderful and immensely helpful. Interestingly, those who ended up having “natural” childbirth did not tend to describe the experience as empowering, while those who had a “medicalized” birth did not, in the end, perceive the experience as a failure or a disappointment…

The authors note that natural childbirth advocates might deride these women’s conclusions as the result of false consciousness. They reject that assessment:

We would argue that it would be unhelpful to take women’s positive views on epidural analgesia as an indication of the increased medicalization of birth, or in the words of Beckett, to “treat some women’s use and appreciation of technology as indicative of a kind of false consciousness, a violation of their true (essential) nature”. The participants in our research made the decision to have an epidural based on the progression of childbirth and their self-knowledge… [T]he birthing women recognized “natural” childbirth as a dominant narrative that was supposed to be better for both them and their babies, although they were still able to reject it as a normative rule because it was not suitable or achievable for everyone.

They conclude:

The agency and self-determination of the birthing woman were originally a major focus of the “natural” childbirth movement. Thus, the agency of women who freely choose, and feel empowered by, an epidural should be deemed equally important.

That means providing women with an accurate description of labor pain and honest assessment of the epidural. That’s what respecting women’s agency requires and that’s what leads to better birth experiences.