Women love epidurals!

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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.

  • EMT2014

    Epidurals are very uncommon in Japan*, where I delivered Thing 1. They’re death on narcotics and their medical system is set up in such a way that anesthesiologists don’t or can’t or won’t do them for L&D. Also there’s a cultural expectation that labor will hurt and you’re just going to have to “gaman” (endure) through it. The rural hospital I stayed at wouldn’t give me ANY pain meds, and I asked for everything I could think of, including good old-fashioned opium (the nurse just laughed at that one). “You can have some Tylenol when it’s all over.” Gee, thanks. I had to be induced. It was a day and a night of hell, all completely unmedicated. But I’m still not sure I could have brought myself to get one, even if they’d offered. I hate needles (although I don’t pass out or throw up or anything) and my mother scared the hell out of me about how epidural needles are huge and if you lie down you’ll get terrible headaches for weeks. I tried to tell her that I was pretty sure advances had been made since my birth almost 35 years ago, since I never heard or read anything about that in the current pregnancy literature, but it took our (award-winning, incredibly accomplished) anesthesiologist friend kind of a while to convince her.

    Thing 2 was born in the US and I tried NO and fentanyl, neither of which had much effect. Luckily she popped out in about 4 hours start to finish and I barely felt like I’d had a baby at all. I did get an epidural for my tubal ligation the next day and it was scary (doctor friend was right, though, the needles are much smaller!) and it didn’t even work! I had to get general because it wouldn’t go up far enough. And I HATED having numb legs all day afterwards. At least I got mini-doses of Oxy, because the incision hurt worse than the baby chute, and for longer!

    *I don’t know what they do on military bases. Administer epidurals, probably. *sigh*

    • MaineJen

      Ugh, I had to be induced with my first too (my water broke and I waited and waited, but labor didn’t start on its own). I tried it with no meds at first…then they gave me something through my IV which made me very sleepy…but when that wore off I found myself at 8-9cm and I was just very very very unhappy. Like, out-of-body-experience unhappy.

      I finally got the epidural in at 10cm, and they let me “rest and descend” for an hour or so, and then I pushed him out in 10 minutes flat. So much easier.

      I wonder what the correlation is between generally misogynist cultures (both country-wide and in individual hospitals/communities) and expecting women to labor without pain relief. I’ll bet it’s a 45 degree angle.

      • EMT2014

        Not sure I’d call Japan “generally misogynistic” any more than the US (just in different ways, maybe), and epidurals are standard here.

        • In a comment yesterday, you said that they’re uncommon. Which is it?

          • EMT2014

            Here = the US. I don’t live in Japan anymore.

        • MaineJen

          Oh I agree…there’s no way I’d call the US progressive in terms of ridding itself of misogyny.

          That’s why I argue that midwives are generally more misogynistic than doctors; they don’t think women need medical pain relief.

  • The Bofa on the Sofa

    This is one of those topics where we should have the FAT – frequently addressed topics. We have a lot of anecdotes to give

    Mine:
    When we did baby classes, I asked the instructor why we didn’t get more of the “hoo hoo hee” and work with those types of natural delivery coping things. Her response? More than 90% will just end up getting epidurals so it’s not worth it

    Yeah, epidurals are popular.

  • fiftyfifty1

    Epidurals are a miracle.

  • MaineJen

    I loved my epidurals. Wouldn’t give birth without them!

    I was talking to a friend who was pregnant around the same time I was…after coming back to work we were discussing our birth experiences, and she said “Well! You can’t tell me contractions don’t hurt.” And I said “…who told you contractions don’t hurt??” She said in the birth classes she took, they call them “surges.” Honestly, I couldn’t possibly roll my eyes any harder. At least be HONEST.

    I know there are some lucky unicorn women who don’t have any or much pain during labor. But they are by far the minority!

    • The Kids Aren’t AltRight

      I was told there would be “pressure” lol.

      • Well, sure, just like there’s “pressure” when you’ve been run over by a Mack truck.