Epidurals may reduce the risk of postpartum depression


The mainstream media has been reporting on a new study that shows that epidurals may decrease the risk of postpartum depression.

According to CBS News:

New research published in the journal Anesthesia & Analgesia found that women with acute pain during birth had a 2.5-fold increased risk for chronic pain as a new mother and a 3 times greater risk for postpartum depression…

Research suggests managing a woman’s pain during childbirth is critical to helping her gain footing as a new mother. Less pain during childbirth is associated with shorter post-labor recovery time, which enables a mother to bond, care for and nurse her baby much more effectively.

The study, Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study, appears in the August issue of Anesthesia and Analgesia. The study has some significant limitations including small sample size and different cultural expectations of the participants. Moreover, as we know, correlation does not prove causation.

Nonetheless, this is not the first study that has raised the possibility that epidurals decrease the risk of postpartum depression and/or PTSD. It’s not difficult to imagine a method of action.

First, there is a known connection between pain and depression.

Second, trauma can lead to depression.

Third, as Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia notes in her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain:

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged. This is due, in part, to our inability to understand and talk about pain.

As she explains:

… [W]hen we are in pain, we are not selves who can approximate rationality and control; we are other and untidy and fragmented. When women give birth, they are physically distant from the sense of control over the body that Western discourses of selfhood make central …

So epidurals, as the most effective form of pain relief, give women control over their own bodies and control over the way in which they behave. This allows women to represent themselves to others in the ways in which they wish to be seen, instead of pushing them into a “non-rational” space.

In other words, the excruciating pain of labor is traumatic, not simply because of the agony, but because being in agony makes it almost impossible to advocate for oneself, to make important decisions, and to exert control over your care.

Imagine if labor were painless, or nearly so. Would it be as traumatic? Would it render women unable to advocate for themselves or exert control over their care? Of course not. A woman who is not in excruciating pain can have reasoned discussions with her providers about her preferences, which is particularly important if an unanticipated complication arises.

Natural childbirth advocates are not entirely wrong in pointing out that a lack of supportive care and a lack of feeling in control contribute to birth trauma and PTSD, but they are looking at downstream effects of the real problem, pain. The support is needed to cope with the pain; the feeling of not being in control is because of the pain.

Natural childbirth advocates may actually be promoting psychological complications of childbirth. By insisting that relieving labor pain is a moral weakness and a danger to the baby (both of which are completely untrue), they encourage women to forgo relief of the excruciating pain and increase the risk that women may develop long term psychological sequelae like postpartum depression and PTSD.

How ironic! I can’t wait to see how natural childbirth advocates are going to spin this one.

124 Responses to “Epidurals may reduce the risk of postpartum depression”

  1. Peez
    July 28, 2014 at 7:24 am #

    Note that the limitations of this study are identified and explored in the above essay. This is what pseudoscientists don’t do.

  2. July 26, 2014 at 9:38 pm #

    I think the issue of PTSD in childbirth needs to gain more awareness, and strategies to address and prevent it need to be implemented. I think there are a lot of lessons to be learned and applied – for example, there might be value in deploying tetris on Maternity wards.

  3. Anna T
    July 26, 2014 at 5:21 pm #

    A couple of years ago, I came across a study done in Israel (I just tried to look for the link but it seems I no longer have it) that concluded there was a greater incidence of PTSD symptoms among women who did not receive epidurals at birth.

    Imprecise as such a study must be, it does make sense that significant pain, with the feelings of helplessness and out-of-control it causes, may contribute to PTSD and PPD.

    I think medical pain relief during labor must be given swiftly, safely and efficiently to women *who need it* (and the need is determined by the woman). Women need not feel like failures for wanting/needing medical pain relief, nor should they feel compelled to refuse an epidural despite being in agony, out of false beliefs or baseless fears.

    Having said that, one must remember that we all experience labor pain very differently, ranging from women for whom even early labor is excruciating, to women who are close to transition and have no idea they are in labor. Many describe the pushing stage as very painful; for me personally, any painful sensations ended with full dilation, and from then on and until the baby was out all I felt was very, very intense pressure.

    Therefore, if a woman wants an unmedicated birth, and non-medical methods of pain relief (such as water and change of positions) work well for her, I don’t think she is putting herself at increased risk of PPD by refusing an epidural. But if a woman ends up with significant unrelieved pain during labor and birth, I won’t be surprised if the experience is traumatic for her.

    By the way, going without effective pain relief does not only happen when an epidural is refused. There are many women who plan to get one and don’t, for various reasons, or it isn’t effective. I’ve heard more than one mother complain of a “patchy” epidural that only provided partial relief.

    Also, a friend recently told me an absolutely outrageous story about how her waters broke, she had no contractions yet, and was given pitocin to get labor to start. Naturally she asked for an epidural right away, but the staff told her “you aren’t supposed to get one yet, we want to wait and see how things are developing”. Turned out, things developed so quickly that she ended up giving birth with no pain relief at all – and with contractions that were, because of the pitocin, a lot more painful than her natural contractions are (this was her 4-th, so she was able to compare). I couldn’t believe that a woman was given pitocin (which is known to make contractions more painful), but was denied pain relief to cope with the very intense labor. I think this is criminal.

  4. Staceyjw
    July 26, 2014 at 3:25 pm #

    It makes sense that no pain relief can cause psychological issues. This is not disputed in other fields, which is why pain is (supposed to be) properly treated now. This is one more example of womens pain (that men can never experience) being considered unimportant, lesser than.

    I had brutal pain after a motorcycle accident, and never want to experience that again. I distinctly recall thinking “OMG, if this doesn’t stop, I will lose my mind. Now I understand why people in non stop pain want to, and do, kill themselves.” It really is that horrible.

    This kind of pain can also trigger chronic pain, IIRC. Several friends with fibro were told their unmedicated labors could have kicked this off. I don’t know if this is something thats been studied, but I have heard it’s suspected.

    • Guesteleh
      July 26, 2014 at 3:50 pm #

      Complex Pain Syndrome can triggered by a broken bone or a car accident. It’s like the pain switch in your brain gets stuck on. I had it and it’s a horrible thing to experience. It’s been more than ten years and I still cringe thinking about it.

  5. Starling
    July 26, 2014 at 11:33 am #

    What a great way to say what frightened me about labor–that “birth will somehow undo us as subjects”. What I wanted out of my birth experience was to be able to get through it without swearing at my husband (or anyone else) or hitting or otherwise losing it. There isn’t much dignity in any part of pregnancy or birth for me, but I wanted at least to keep a sense of myself. And I did! Yay epidural!

  6. Votre
    July 26, 2014 at 7:55 am #

    Spin it? That’s easy:

    1) Misquote the study
    2) Claim it’s all a conspiracy
    3) Say it’s “unscientific.” Find a midwife/chicken farmer in Iowa who runs a homebirth hobby website to post an article with a lot of mumbo-jumbo and pseudo-medical terminology. Then announce “There is serious disagreement in the medical community regarding a recent study which claims…”
    4) Censor all forum discussion contradicting the above
    5) Ban anybody that tries as a “troublemaker” “troll” or “industry shill”
    6) Grab yet another glass of wine, and e-mail all your cronies to gloat over how you *pwned* The Man again,

  7. AutonomyOB
    July 25, 2014 at 9:49 pm #

    I am an ob that has a large percentage of patients that seek natural birth and I have one major problem with this article. It presents this association as cause and effect, especially in the main stream media. Based on my experience, I would offer another explanation. I have noticed that a large percentage of my patients seeking a natural birth have previously diagnosed anxiety disorders or display symptoms suggestive of anxiety disorders. I see a large association between maternal anxiety and the desire to have as much control over the birth process as possible and most of my patients see an epidural as giving them less control not more. The link between preexisting anxiety and pp depression is well known. I am sure the investigators in this study excluded patients with a preexisting psych condition (or certainly they should have) but I doubt psych evals were part of the inclusion criteria. I think THAT would be interesting though no doubt unpopular to characterize birth choices by psychiatric tendencies! But needless to say, I think this study may have been tainted by more than a fair share of selection bias.

    • Trixie
      July 25, 2014 at 10:51 pm #

      You could really be on to something with that.

    • Young CC Prof
      July 25, 2014 at 11:51 pm #

      It is nearly impossible to do an epidural study that isn’t horribly tainted with selection bias. Not sure I’ve ever seen one.

      • fiftyfifty1
        July 27, 2014 at 10:33 am #

        There was that small study done in Mexico where women were randomized to epidural vs. not. But it looked at physical outcomes such as need for c-section (and found no differences) not psychological outcomes. But you are right, randomized studies on epidurals are otherwise basically non-existent. We don’t do randomized studies here in the US or in other developed countries because women want their autonomy respected re: pain relief choices and so a permit for a randomized study would never be allowed due to ethical concerns.

    • EllenL
      July 26, 2014 at 12:55 am #

      The new study from China is not a one-off. Similar results
      were found in a 2004 Scandinavian study.


      I’m in favor of more study, but for the time being we have
      to go with the information we have, though imperfect.

    • expat
      July 26, 2014 at 8:31 am #

      But, this study was done in China where they don’t have the rhetoric surrounding epidurals. Therefore, it is possible that in China women with anxiety disorder would be MORE likely to choose an epidural and not less, as you suggested. I would worry that the selection bias would be economic and that the women who didn’t get epidurals were poorer nd therefore more prone to ppd since life was generally harder for tem.

      • AutonomyOB
        July 26, 2014 at 3:08 pm #

        That is a very interesting point. Has anyone actually seen the actual study to know if they addressed that?

        • Amy M
          July 27, 2014 at 9:22 am #

          The authors said they didn’t screen for depression/anxiety before the women were entered into the study, which was a factor/confounder not really accounted for, but one of the tests they used took the last 7 days into account, and they ran the test 3 days pp, so it took a few days antepartum into account.

    • Guesteleh
      July 26, 2014 at 12:51 pm #

      I have noticed that a large percentage of my patients seeking a natural
      birth have previously diagnosed anxiety disorders or display symptoms
      suggestive of anxiety disorders.

      I’m also convinced that a large percentage of women into NCB woo are sexual abuse survivors.

      • Medwife
        July 26, 2014 at 4:15 pm #

        I make a point of encouraging women who I know, or strongly suspect, to be sexual abuse survivors, to get epidurals. I have seen some really horrible reactions to transition and pushing. Those and c-sections are the times I am most grateful for epidural pain relief.

    • Staceyjw
      July 26, 2014 at 3:39 pm #

      Maybe some education on how an epidural works, and what it does, plus what pain can do, would help these moms consider it an option for retaining control.

  8. Ashley Wilson
    July 25, 2014 at 4:41 pm #

    Okay, so a little off topic but I’m in a bit of a dilemma and figured that you all are rational people and could probably help.

    I have this former friend who is into home birth. We had a strained falling out a few years ago, politely nod when were at the same even but secretly can’t stand each other, had our kids, went to “our sides” of the birth debate and that’s where we are today. She has a reputation among our mutual friends as being anti-vax which drives them all insane. I made a post on my facebook about a vaccine article saying that those who wish to refute her, they could use the link. In the comments, I will be the first to admit, it got rather nasty against her. I might have said my new puppy was smarter than her :/ To top it off, turns out I accidentally had the post public. (Oops) I NEVER post publicly with very very few exceptions. But I posted it from my phone and Facebook screwed up my privacy settings. I’m a horrible person but I’m not so horrible I would have left that around where she could read it.

    Turns out, she actually isn’t THAT anti vac (she has some objection but their religion/pro-life based, so I’m not touching that argument). Where much of this impression comes from is that her CPM has a facebook/IRL group where a bunch of her clients talk about various things. One of the Queen Bees is MILITANTLY against vaccines. My former friend posts all of these articles, not to challenge us pro-vaccines, but to get sciences based rebuttals that she can take back to her other group of friends. But since she post them without any context other than her tagging the scientists and pro vax of our group and leaving a message of “CDC covering up vaccine deaths! What do you think of that?” it’s easy to see why we all were under the wrong impression.

    When she found my post, words were had. He husband parachuted into the thread to defend her and the topic of their homebirth came up. It made me realize how *deeply* uneducated they are about exactly what goes on with the NCB scene. They had no idea who MANA was even though they said their CPM was licensed (but clearly with no idea by whom). Quoting the typical wrong stats. Basically every home birther trope.

    Our little SNAFU quieted down. Husband went on his way, I went on mine. But I feel really unsettled about leaving the homebirth issue alone. Her arguments for vaccines, why she believes in them, and why she fights FOR them and asks for the knowledge of those who have degrees in virology, were really well thought out and beautifully argued. I’m concerned they chose a home birth because they have been misled and lied to like we hear so many stories of. I know they chose a home birth due to the cost, but they do feel that it is safer as well. They had a transfer with their first son that wasn’t a real big deal so they feel almost more justified with their decision since “Here was an emergency and the system worked!” Add to the fact that since they don’t have insurance the hospital was 30 times more expensive…

    I posted a link to here at the end of our dialogue hoping they would take the bait, but the more I think about it, the more I am genuinely concerned. I may not like her but I wouldn’t wish any harm to her. She’s very devoutly Catholic and doesn’t believe in birth control and wants a big family, so I doubt that her two kids will be the end of it for her, otherwise I would probably just drop it.

    I want her to know that there are resources for her to see the other side of the debate (here, navelgazing midwife, Doula Dani, etc…) and hope that she sees that maybe she doesn’t know as much as she thinks she does. But equally I don’t want to relaunch a whole nother argument when the other one settled down. She just had her second child about a month ago, and from what I’ve heard from friends who have her on facebook she is not handling the postpartum well and will not seek treatment, despite them expressing their concerns. I remember seeing her about 6 months after her first was born, 2 month after mine. My kid was a dream baby (a monster toddler though lol) but I can remember how envious she looked at my kid being completely chill, letting everyone hold her, not fussing at all. She was already feeling overwhelmed then and from what I have heard, it has gotten worse with the second one.

    Should I reach out? I doubt I’ll be well received. Should I just drop it and hope that she doesn’t ever have to face the dark side of her choices. That feels wrong, but then so does potentially starting a fight with a woman who’s having such a hard go of it (regardless if that was my intention). Ideas? Thought?

    • Karen in SC
      July 25, 2014 at 5:32 pm #

      You could occasionally link to Doula Dani or other blogs when the topic is about new data being published or evidenced based information- for example the Grunebaum article, the explanation of real neonatal resuscitation, or Dr. Orosz’s analysis of MANA data.

    • anion
      July 25, 2014 at 6:55 pm #

      Sorry, but I’m a little confused. Are you looking for information on how to talk about homebirth with her, or how to get her to speak to someone, or…what result are you looking for? What is your actual problem in this situation?

      My suggestion, having read everything here and being not-quite-sure, is to forget all of the anti-vac/homebirth/I want to prove her wrong stuff and focus on the fact that you know and still care about a woman in pain who is having a difficult time. Instead of looking for facts to prove something to her, why not pick up a phone or send her an email or PM saying, “Look, I know we’ve had our differences, but I genuinely do care about you even though we’re no longer close and I don’t want to see you hurting. Is there some way I can help you? Would you like to bring your kids to my place one afternoon for an hour or two? Or how about if I bake an extra lasagna one night and bring the second one to you, so you don’t have to cook, would that help you?”

      Later you can talk about homebirth etc.–if she just had a baby she’s probably not about to give birth again in the next few weeks (unless she’s pregnant with some of those thousands and thousands of twins whose birthdays “average” eighty days apart or whatever nonsense we saw here in that one homebirth horror story) so homebirth isn’t really a topic that needs to be addressed this minute, right? But right now it seems you truly want to help her, so…just help her, man.

      • Desert Willow
        July 25, 2014 at 9:03 pm #

        I feel like she’s been misinformed about the actual risks and since she still plans on having more kids, I worry about all of the problems that could arise. Before all of this, I didn’t care, but since hearing her real stance on vaccines, it seems like she’s into it because she’s been fed false information, not because she thinks that it’s worth the risk. She just doesn’t really understand the risks. I feel like I shouldn’t say anything because it would fall on deaf ears, but if something really horrible were to happen and she starts going “Why DIDN’T I know about all of these other facts?!” and I could have spoken up but didn’t, I’d feel some what responsible (even though I know it’s not my responsibility, still…).

        I think what I’ve decided to do, based on some of the advice I got from the facebook group is to go to a few of our mutual friends and basically arm them with some of the resources I mentioned. They are the more science minded of our group (one is actively pursuing her Ph.D in virology) and they are who she turns to when she has questions about any science or medical questions when they come up in her woo group. That way if she ever expresses any doubts or she starts looking for answers if a tragedy does happen, they have resources to point her along the way. I feel like that way I know there is at least someone near her who can help her along instead of her being stuck in her echo chamber. But equally, it’s not invasive or confrontational. I won’t actively seek her out or tell anyone else to, just that if she wants the other side of the coin she has other people beyond the woo to reach out to.

        • anion
          July 26, 2014 at 10:03 am #

          So, your desire is to find a way to inform a woman struggling with PPD and two young children that next time she gets pregnant, which may be a year from now or may even never happen, she ought to give birth differently? Because if she has any doubts later you assume she won’t be able to find that information for herself despite having educated friends she’s turned to already for help in refuting anti-vac fallacies and arguments? You’ve already publicly called this woman stupid and upset her, so now you want someone else to do the work of insulting her for you. And the fact that you know she’s struggling really isn’t as important as you making sure she knows she might maybe make another mistake possibly in the future and that’s what she ought to be focusing on right now, is her method of birth for the pregnancies she may or may not have, rather than help with her current difficulties.

          Yeah, I can’t help you with that. Good luck, though.

          • Desert Willow
            July 26, 2014 at 11:03 am #

            Yes and these educated friends are also my friends. And since they don’t have children, home birth hasn’t really come up on their radar. They’re not in favor of it but beyond that *shrug* Much like many of us before we had children and this stuff comes up on our radar. I’m not going to seek her out or have others seek her out but if she goes to them, they don’t dismiss her from the fact that it’s not their thing.

            Listen, I know it’s a shitty situation and that I fucked up. There aren’t a lot of good solutions here, especially if in retrospect something happens and I look back at this moment of wondering “should I have said something” and I had let it go without getting other opinions. Before this I was perfectly willing to leave her to her choices. Her and I have never made a secret of our shared dislike of each other. But I’ve been reading Dr. Amy for a few years now and a common theme you hear from those on the other side who have come to our side is that, unless if you really go out and look for information (like this page), any dissent against home birth gets locked down and squelched. Doula Dani even talks about how she had no clue and when she wanted answers, no one could answer her and she swore she’d never give Skeptical OB the traffic. She eventually did and it left her with more questions that no one around her could help her answer.

            I’m not in the saving someone from themselves business. Normally I don’t give a shit other than shaking my head and a disapproving glare from a distance. And if she does express doubt, searches for info, and thinks it’s worth the risk, then fine. I don’t care. That’s what I thought was the case in the first place and was content to leave it for what it was. But when I realized she was probably being lied to, that didn’t sit right with me. I came here and the facebook group for help. I got a bunch of leave it alone, the few of the be her friend, which while I get the sentiment, her and I stopped being friends before we had kids and for a bunch of reasons. It felt disingenuous on my side. Just because I don’t wish harm on her, doesn’t mean I want to be around her (though I will say I do like the idea of making a second dinner and giving it as a peace offering. Because I really do feel bad about it getting back to her. Knowing someone dislikes you that you dislike in return isn’t the same as having to read it.) I also had some suggestions of going to mutual friends and having them express concern. I kind of mashed the ideas all together. It feels very much a damned if you do, damned if you don’t situation.

            But I have to ask, if I did just drop in on her and say “Hey, this practice is dumb! Here are links to prove me right!”, how would that have been any different than when Dr. Amy does the same (other than that whole “Dr.” part. I do get that that is a big thing). I doubted that I would have ever taken that approach since I don’t agree when I ever see that happen on either side of this debate. But beyond this being a somewhat personal connection (in truth, before this whole mess I hadn’t had any contact with her in about 8 months and then another year before that), how would that approach been different?

          • Staceyjw
            July 26, 2014 at 2:57 pm #

            We all do messed up stuff, and come on, someone you don’t like, posting anti vaxx stuff? of course you would say what you did. It wasn’t intentionally meant to hurt her. FB faux pas happen.

            However, I think that it was a “happy” accident. It gives you an opportunity to mend fences, and show her you care (if you do, and I assume you do, or this post would not be here).

            Send her a message congratulating her on her baby, and let her know you will be there if she needs something, longstanding disagreements totally set aside. IF you havent apologized for you gaffe, please do, keep it short and humble. Then, Leave it at that. She has her hands full right now, anything else will be overwhelming, even hurtful.

            IMO, She seems to be smart enough to find out about HB, if she decided she wanted one. I would not worry about this. Most people really don’t bother to think further than what they hear, until it effects them. If her arguments were as well conceived as you say, she will be fine without any help. Really, do not make assumptions- I have some crunchy friends with bad ideas, and do mega crunchy stuff, but would never have a HB.

            If she was in a better place, I would say to post or send some links to Doula Dani. I would add a note that her arguments on anti vax were so impressive, you want her opinion on these things too, from her POV. Realize that you are sharing info with an equal. You can do this in the spirit of sharing good info.

            Lastly- PRO TIP- NEVER share anything online that you don’t want everyone you know to read. Period. There is no such thing as private online.

    • Trixie
      July 25, 2014 at 7:31 pm #

      Also, your Disqus profile has your real name and picture, apparently, so you might want to think about that.

      • Desert Willow
        July 25, 2014 at 8:27 pm #

        Thanks! Fixed (been forever since I signed in with disqus)

    • ihateslugs
      July 26, 2014 at 4:31 am #

      I think that anion’s reply is really spot on. If you truly care about her, her family, and any future children she might have, you need to salvage the relationship first. When we are hurting and overwhelmed, taking advice from someone with whom we have disagreed is really unlikely. Offering a helping hand or a shoulder to cry on, IN REAL LIFE, might help build a bridge. Then, hopefully, down the road, you can have a discussion about this, but the fact that you genuinely care will be well established. At that point, it will be much clearer to her that this is about more than just being right or winning an argument.

    • AgentOrange5
      July 30, 2014 at 10:14 pm #

      Regardless of your intentions, the timing is not right. Have you forgotten what having “new mommy” brain is like? The hormonal flunctuations in the post-partum period? And from what you say, it sounds like she is struggling even more than normal. If you care about her, you will completely drop this subject. For 1 complete year. If this is still weighing as heavy on your mind next year at this time (which I think will be unlikely), then you can think about appropriate ways to broach the subject. For now, just drop it completely. Don’t harass her, don’t try to get mutual friends to harass her–regardless of any misinformation you have, the timing is wrong, she won’t be receptive to it, and the only thing that will possibly be accomplished is making her feel worse about herself.

  9. Dr. W
    July 25, 2014 at 4:07 pm #

    The epidural was my wife’s favorite part of the whole shebang. It was certainly the turning point, from my perspective. I went from seeing that my wife wanted to kill me, to her not wanting to kill me.

  10. Dinolindor
    July 25, 2014 at 4:02 pm #

    OT: I just had my 38 week appointment and my OB suggested that next week he could strip my membranes if I wished (I’m about 2 cm, 50% effaced so far, and he commented that the baby’s head was really pushed up against my cervix). He said that it can help bring on labor in about 1 out of 5 women, but it sounds like a kind of awful experience. On the other hand, my son was already 1 week old at this point and I am anxious to just get this baby here already. I’m curious to hear what others here feel about the procedure.

    • anh
      July 25, 2014 at 4:09 pm #

      meh, I had it done and I was only dilated 1/2 centimeter (I think what makes it painful is thefact you have to force the cervix open a little bit) and it truly wasn’t that bad at all AND I went into labor soon after.

      what hurt like the devil was having my midwife stretch through my cervical scar tissue during a contraction

    • moto_librarian
      July 25, 2014 at 4:18 pm #

      I had membrane stripping done after 10 days of prodromal labor. I was 3.5 cm. dilated, 75% effaced. I was miserable. I asked the midwife if it would hurt. Her reply: “Well, it won’t feel like the day of conception.”

      It hurt, but not that much more than a cervical check. I was in active labor within two hours, gave birth to my son at 4:29 the next morning. I was 38 + 5. Good luck!

    • Aki Hinata
      July 25, 2014 at 4:19 pm #

      I’ve had my membranes stripped a couple of times. I found it uncomfortable, but not really too bad. YMMV.

    • guest
      July 25, 2014 at 5:40 pm #

      It’s not that bad. It’s kinda uncomfortable and you might be a little sore after, but it isn’t what I would call painful. Just don’t get your hopes up too high: with my first baby, I didn’t go into labor until six days after my doc stripped my membranes (and I was 37.5 weeks and 3 cm), and my sister-in-law had her membranes stripped two or three times before she ever went into labor. But, it might be enough to push you into labor-land. Good luck whatever you decide to do!

    • anion
      July 25, 2014 at 7:11 pm #

      It hurt like hell in my case (also at my 39 week appt., also at about 2cm, don’t remember how far effaced but it was at least 50%) and didn’t induce my labor, but my baby was still pretty high up, so that may very well have been part of the reason.

      I wouldn’t say don’t do it, though. It didn’t hurt all day or anything, just intensely while he was actually doing it and for a few minutes after. And it was painful but not agony. I actually think at least part of the reason it hurt so much was that I wasn’t expecting it to hurt at all, if you know what I mean; it wasn’t just pain it was shock. And while it hurts it’s not dangerous. And really, you’re going to be experiencing *some* pain in the next couple of weeks, so you might as well get started. 🙂

      Best wishes for the safe delivery of your beautiful healthy baby!

      • Dinolindor
        July 25, 2014 at 7:22 pm #

        I guess that’s what I’m trying to figure out. If cervical checks are kind of painful, then how much worse is stripping the membranes? And if it only has a 20% success rate, then is it worth the pain (during and after)? It’s good to hear that it wasn’t too bad for a long time after even though it didn’t work.

        • Trixie
          July 25, 2014 at 7:32 pm #

          It hurt me a lot, but it’s over fast.

        • anion
          July 25, 2014 at 7:38 pm #

          I wish I remembered better; it was thirteen years ago almost exactly (my eldest was born at 40w 1d on 8/8) so I honestly only remember being shocked at how bad it hurt, and glad when he was done and when the pain lessened and then stopped. I don’t remember my cervical checks being particularly painful, though, so either if yours hurt it probably won’t hurt much more to have him strip the membranes, or your cervix is really sensitive so it’ll be very painful.

          Maybe this will help? I had a Mirena coil put in eight years ago (it’s since been removed). That was definitely worse than the membrane strip, because it was slow dilation without anesthetic, and every time I said ouch the doctor paused and asked if I wanted him to stop, thus delaying the process. (He was trying to be nice and helpful, I know, but I just wanted him to get it over with. This was in England, so not with my old OB, who would have known I wanted him to just hurry up and do it.)

          So, worse than a cervical check or a pap smear or even a cervical biopsy (I had dysplasia eighteen years ago), but not as bad as a slow systematic cervical dilation and implanation/insertion of a Mirena coil.

          • Dinolindor
            July 26, 2014 at 8:28 am #

            Thanks. I’m definitely in the get it over quick camp too, so good comparison. My husband and mom both are saying it sounds awful and not to bother if it’s not that effective. I’m leaning towards giving it a try since they’re not the ones who have to carry this baby around. And I’m not sure what’s up with the cervical checks. The amount of pain/discomfort has been pretty inconsistent from check to check.

    • Jessica
      July 29, 2014 at 1:02 pm #

      My OB stripped my membranes, I think in an effort to avoid the induction we were scheduling a few days later. I found it incredibly painful, and I had cramping and spotting for several hours afterward. I was 2cm, 75% effaced at the time, and it did not start labor. I plan to decline it in future pregnancies – not worth it, IME.

  11. anh
    July 25, 2014 at 3:02 pm #

    when I look back at my labor and recovery the only part I remember with joy and happiness is the period from when I got my epidural (after 20 hours of labor, 4 of those with pitocin) until my baby was about 24 hours old.
    The parts I remember with pain and regret are they hours I spent in pain because I was so committed to the woo (no pain relief, feeding on demand, denying formula to my obviously starving child, not sleeping because she nursed–painfully with an undiagnosed tongue tie– constantly)
    I still think birth control pills and epidurals are two of the greatest invention that haave ever come along for women

  12. Laura
    July 25, 2014 at 2:15 pm #

    I can see how this would be. My SIL has been very vocal about natural childbirth and had all four of her children unmedicated (three of them out of the hospital), and has had PPD with most of them, even though she will only admit to having it with the first one (conveniently, that’s the one who was born in the hospital). But, she insists that the epidural crosses the placenta (nope, it doesn’t) and that’s why she won’t ever get one.

    • David
      July 25, 2014 at 4:52 pm #

      Everything in mom’s blood passes through to baby, that is a fact. Please don’t quote things like “nope, it doesn’t” with no evidence. Please share a link from an anesthesiologist that quotes differently.


      • Stacy48918
        July 25, 2014 at 5:19 pm #

        Epidurals are administered into the *epidural space*, and not into the mother’s veins. A minute amount may be absorbed into her blood supply, but not enough to affect the baby. The mother certainly doesn’t feel the effects of the opioid. Why would the baby? Stop fearmongering.

        • theadequatemother
          July 26, 2014 at 1:46 pm #

          Everything Stacey said is true. Modern epidurals are very dilute, about 0.08% bupivacaine or 0.8 mg/ml. Generally we put in about 8-10 mL to activate the epi and it runs at 6-8 ml/hr. Some is absorbed into the maternal blood stream where it is further diluted in the maternal blood pool of approx 6 L. Then, transfer thru the placenta to the infant isn’t 1:1 it’s less than that. The drug is then further diluted by the fetal plamsa/ blood volume. It’s a very small amount that the fetus is exposed to and newborns have been assessed for any effects and we haven’t been able to find them. There are quite a few surgical procedures we do on infants where the preferred method is local or caudal or spinal all of who’ve expose them to more bupivacaine than a labour epidural. Examples would include hernia repairs, local for pyloroplasty, even circ under penile block….it’s really not something anyone needs I worry about.

          • Sue
            July 27, 2014 at 7:14 am #

            This is the reserved space for David to come back and say something like ”Oops, sorry. I didn’t mean there was actually much in the mother’s blood, so only a tiny bit could possibly reach the baby”.

      • anion
        July 25, 2014 at 7:16 pm #

        What anesthesiologist wrote that? No author is credited and it is not an anesthesiologist’s website.

        • auntbea
          July 26, 2014 at 8:19 am #

          His penis is all the citation he needs.

          • anion
            July 26, 2014 at 7:30 pm #

            I have no words for how perfectly you summed that up.

      • Bombshellrisa
        July 25, 2014 at 7:38 pm #

        I didn’t see anything mentioned about that in the article. Could you post the link to the anesthesiologist’s website you consulted that told you that epidural anesthesia passes through the mother’s blood stream and adversely affects the baby?

      • araikwao
        July 25, 2014 at 8:11 pm #

        The Adequate Mother is an anesthesiologist and a regular commenter here. Perhaps you could try her blog.

      • different guest
        July 26, 2014 at 11:04 pm #

        But, David, it is not in the mother’s blood.

  13. Captain Obvious
    July 25, 2014 at 2:06 pm #

    “because being in agony makes it almost impossible to advocate for oneself, to make important decisions, and to exert control over your care.” Crunchy translation, “if I am in pain, and ask for pain medicine or an epidural. Don’t listen to me, because it is just the pain talking and I am not able to make important decisions, and what I really want is no pain relief.”

    • Young CC Prof
      July 26, 2014 at 12:20 am #

      You know, I’ve actually had the opposite experience, that pain overwhelmed me to the point that I couldn’t figure out how to ask for medicine.

      After a surgery (not my c-section) I woke up in extreme pain. The nurses were extremely low-key about pain management there. No one actually asked me if I needed anything, and when I asked, nothing much happened. Eventually was given a small and inadequate dose.

      I wish I’d been more insistent. I remember someone saying, “It doesn’t hurt too much now, right?” and I agreed, not because it was true but because it seemed like the expected answer. When the surgeon came by to check on me, I didn’t complain. I was devoting all my energy to enduring, without enough left over to realize that I shouldn’t have to.

      Did it kill me? No. Did it inflict lasting psychological damage? No. Was it an unnecessarily awful night? Definitely.

      • MLE
        July 26, 2014 at 12:51 am #

        Similar thing happened to my dad at a really good hospital immediately after bypass surgery, but he did keep asking. He asked repeatedly for more pain medication and they told him he had enough or it wasn’t time to up the dose. The nurse said it’s bad to have too much for reasons I can’t remember. Turns out his IV bag was empty and had been for some time. Listening is important!

  14. Alcharisi
    July 25, 2014 at 2:01 pm #

    Not to be *that* commenter, but in the third to last paragraph “which is particularly if an unanticipated complication arises” should be “which is particularly IMPORTANT if an unanticipated complication arises.”

  15. Amy
    July 25, 2014 at 1:35 pm #

    This is totally anecdotal and non-scientific but I’ve found it interesting…I have 3 friends who gave birth around the same time as I did. I was deep in woo, hell bent on NCB. My other 3 friends were indifferent, and just kind of waited to see what was going to happen but ended up having drug free births. I ended up with an epidural.

    During my hypnobirthing class we were advised that after a natural childbirth you would feel a huge rush of oxytocin and it would be the most ecstatic moment of your life. I was sad after my baby was born I didn’t get the rush. I asked all three of my friends about the natural high that they felt immediately after birth. None of them had any clue what I was talking about. 2 of them said they never wanted to have kids again. For my third friend, it was her second child but she said she wouldn’t even hold her baby afterwards because she was so angry about how much pain she was in. All 3 had PP depression.

    None of these women expected the natural high because they hadn’t been told to expect it. It’s just more NCB lies.

    Happily, several hours after my baby was born my husband was asleep and I was holding my baby. I was smelling her head and stroking her hair and I felt an overwhelming explosion of joy, the likes of which I have never felt before and will never feel again.

    • Dr Kitty
      July 25, 2014 at 1:52 pm #

      I DID get that amazing rush of joy and love when I held my daughter for the first time.
      Of course, that was during the CS.

      • The Bofa, Being of the Sofa
        July 25, 2014 at 4:33 pm #

        I had it with both our kids. The feeling of joy was completely indescribable.

    • theadequatemother
      July 25, 2014 at 2:57 pm #

      I’m not sure the high is actually due to oxytocin. I think it might be due to endorphins…the release of which is a response to pain. I had a great high with my first birth when the epidural was placed. For a few minutes my endorphins were still sky high but there was no pain to interfere with my buzz.

      My second precipitous unmedicated birth just ended in relief and a bit of shock. I still feel uncomfortable when I remember how helpless I felt and how much it hurt. And how flat my son was at birth.

      • Daleth
        July 25, 2014 at 5:21 pm #

        Dude, if I want to trigger some endorphins, I’ll get acupuncture. (It pretty reliably blisses me out.) I would much rather pay for my bliss with a $75 acupuncture appointment than with a third-degree tear.

        • theadequatemother
          July 25, 2014 at 11:08 pm #

          Or running or sex or…:D

    • Jen
      July 31, 2014 at 7:08 am #

      I had that rush immediately after #1’s birth. It was incredible. His birth was an induction with a shot of pethidine, plus local anaesthetic injected into the vaginal wall – I think! – to help the muscles relax.

      I was expecting the same rush with #2. Nothing. His birth was spontaneous and unmedicated. During second stage the pain was incredible but obviously by then it was too late for any pain relief. I have wondered if that was why I didn’t get the rush.

      I do have PND – I don’t know if the birth contributed as it wasn’t traumatic.

  16. Jenny_from_da_Bloc
    July 25, 2014 at 1:20 pm #

    Many of the natural child birth videos on YouTube show the women in miserable pain, screaming, panting and yelling for the midwife to pull the baby out now. I never understood how that was empowering being in such awful pain. My friend missed out on the epidural the second time around and she was not happy. Also, as someone who has lived in chronic pain for many years until recently I can’t see the appeal in denying yourself pain relief during the most painful process some women will ever experience. Sorry, but I will take the drugs and spinal every time

    • Trixie
      July 25, 2014 at 1:38 pm #

      For me, although it was awful pain, I don’t look back on it with any regret that I didn’t choose pain relief nor do I feel traumatized by it. If I were having more children, I’d probably do it again in the right circumstances.
      Obviously, everyone’s experience will vary, and no one should ever be denied pain relief or shamed for getting it, but it’s not automatically traumatic for everyone to have an unmedicated labor.

      • Sara
        July 25, 2014 at 1:58 pm #

        Yep. I had two without pain relief. It wasn’t really the pain that was traumatic so much as the process itself. At my last birth the midwife offered me a mirror during the pushing phase– something that I scoffed at earlier, when it was asked during the intake questions. In the trials of 2nd stage labor, I accepted the mirror, and the fact that everything looked as bad as it felt was what was really traumatic.

        I did get to see my baby’s angry face sticking out of my bum… so that was neat.

        In the future I will make it very clear in my birth plan, “NO MIRROR IS TO BE OFFERED.”

        • Trixie
          July 25, 2014 at 2:40 pm #

          Oh, yeah, WTF is up with that mirror. No. I’m paying you people good money to look at it for me.

          • Daleth
            July 25, 2014 at 5:23 pm #

            Hahahahaha! Oh god, seriously.

          • anion
            July 25, 2014 at 7:44 pm #

            Hahaha! Yes.

        • Medwife
          July 25, 2014 at 4:16 pm #

          HA! I usually offer women the chance to touch their babies’ heads when they have crowned enough. Not many take me up on it. Sometimes they do and it’s the only thing that convinced her in not bullshitting her that she IS making progress!

        • Stacy48918
          July 25, 2014 at 5:24 pm #

          I liked the mirror with my first baby – I’d been in labor seemingly forever and I was EXHAUSTED…so seeing the baby gave me hope that there really was going to be an end to all this! My second came too fast for the mirror to be of any use at all. They held it up, I looked and thought “Whoa! There’s her head already!” and one more push and she was out.

          • Sara
            July 26, 2014 at 12:26 pm #

            It is nice to see the baby’s head advancing. They positioned my mirror so that I could see the reflection, and just beside it is where my 18yo sister-in-law happened to be standing and watching childbirth for the first time.

            I saw kind of split-screen– birth gore + inexperienced third-party reaction, for the whole pushing phase. Good thing it only lasted 10 minutes (I concede, the mirror did help with progress.)

        • anion
          July 25, 2014 at 7:44 pm #

          Lol, that was actually in mine! I did not want to see any of that. (Luckily I didn’t have to, because I had a section. Although I’m still mad that my OB showed my husband my uterus etc. and my husband didn’t get a picture. I would love to have pictures of that.)

        • Bombshellrisa
          July 25, 2014 at 7:45 pm #

          The hospital I have birth at had a mirror in every room (and a birthing ball in every room too). I didn’t want to look in the mirror, but I know a lot of my friends have requested the mirror and felt like they made progress that way.

          • Sara
            July 26, 2014 at 12:22 pm #

            Yeah, it actually did help the birth progress. It’s just the recall of the image afterwards that disturbs me, as I’m still dealing with some physical trauma (4 weeks pp) and I SAW IT so I know what happened down there.

        • Anna T
          July 26, 2014 at 5:28 pm #

          Oh my goodness, a mirror?!! I’ve never even heard of such a thing.The midwife offered me to *feel* the baby’s head but I was too freaked out to do even that.

      • Elaine
        July 25, 2014 at 8:59 pm #


      • Jenny_from_da_Bloc
        July 26, 2014 at 5:55 pm #

        To each their own, if it’s works for some women that’s great. I just know it is not for me and I never said it was traumatic for everyone just that most of those video aren’t as peaceful or empowering as they are claimed to be in the description. I just don’t see the point of being in agony and having the choice not to be.

        • Trixie
          July 27, 2014 at 6:41 am #

          I never said it was peaceful. I’m sure I looked awful. I just preferred it to the epidural.

    • onandoff
      July 25, 2014 at 2:47 pm #

      I know! I read natural birth stories and watch natural birth videos that are supposed to be so peaceful and wonderful and, without fail, they all sound and look horrific. Like, not a single appealing thing about them. Not empowering, not peaceful, not remotely desirable. Totally incomprehensible to me how someone can watch those and think that’s what I want!

      • Sara
        July 25, 2014 at 2:59 pm #

        I watched the “breech birth against all odds” video recently and it was so horrible. The birth looked horrible and painful. The poor baby came out limp and white and didn’t move for at least a minute. The only positive thing I can say is that if I ever had a breech baby I would happily choose a c-section without question, thanks to that video. Of course, at the end the mom was talking about how awesome and empowering this rule-breaking experience was for her.

        It was discussed here: http://www.skepticalob.com/2012/04/why-are-you-bragging-about-your-breech.html

      • Daleth
        July 25, 2014 at 5:22 pm #

        I was just in the hospital last week and heard a woman moaning and wailing in what sounded like absolute misery. I asked the nurse, “Is that woman in labor?”
        “Sounds like it.”
        “Omigod. If that’s labor, get me a c-section.”

    • Staceyjw
      July 26, 2014 at 3:02 pm #

      It’s a matter of redefining things afterwards. If they accept how horrible it is- even when there is video proof in front of them- then it was all for nothing, and their beliefs would be in question.

  17. Lori
    July 25, 2014 at 12:56 pm #

    Just catching up here and saw this post! I had my second baby last Friday and, some of you here may recall, I was really concerned about not getting access to pain relief which is what happened with my first. Anyway, I got to see how the other half lives this time and was able to get an epidural at 5cm. Totally different experience than last time! I was mentally way more present for pushing due to not being in excruciating pain and exhausted and was actually able to “catch” my son (I know that’s not for everyone but I thought it was super cool). We’re both healthy and doing great now 7 days out and I’m grateful to have a “boring” birth story this time around. =)

    • FrequentFlyer
      July 25, 2014 at 1:11 pm #


    • Cobalt
      July 25, 2014 at 1:39 pm #

      Boring birth stories are the best kind! Congratulations on your baby and I hope things stay both amazing and ‘uneventful’.

    • anion
      July 25, 2014 at 7:45 pm #

      Congratulations!! So happy for you!

    • Bombshellrisa
      July 25, 2014 at 7:50 pm #

      That is wonderful news! “Boring” birth stories are the best-congrats to you and your little one!

    • Mishimoo
      July 25, 2014 at 9:40 pm #

      Yay! Congratulations on the safe arrival of your little one. So glad you had a boring delivery and got your epidural.

    • Box of Salt
      July 25, 2014 at 9:50 pm #

      Congratulations to your whole family!

    • Amazed
      July 26, 2014 at 12:00 pm #

      Congratulations on your boring delivery and new baby!

    • Sue
      July 27, 2014 at 7:17 am #

      Yay for Lori and mini-Lori!

  18. Amy M
    July 25, 2014 at 12:32 pm #

    The anti-epidural crowd just insists that epidurals cause C sections, that’s how they try to ‘refute” this. They have certainly convinced a lot of people that that is true, and in this case, repeating a falsehood loudly and often, though not making it true, has had the desired effect of making it SEEM true. So, they create a false competition: epidural might = less PPD, but it also = more C sections (in their minds), and evidently, the risk of a Csection is worse than the risk of PPD.

    Also, since there are enough anecdotes of women who had epidurals and ended up with PPD anyway, or vice versa (no epi/no PPD), that will convince the crowd who doesn’t understand correlation vs. causation that these researchers don’t know what they are talking about. Moreover, it wouldn’t shock me if some anti-epidural decides to take an anecdote of a woman who got an epidural and PPD and claim that the epidural CAUSED the PPD. That’s the the downside of this sort of article going mainstream, all the crazies come out to play.

    I would love to see the actual article and see what confounders they accounted for and all that. I agree with the general premise: reducing pain if a woman so desires should be standard, and probably reduces risk of PPD for some women. Overall, I think there is a population of women at risk for PPD that no amount of pain killers during labor is going to help, and other measures should be in place to make sure these women do not fall through the cracks. (Of course they should get epidurals if they want them.)

    • Ash
      July 25, 2014 at 1:15 pm #

      Link to the actual article (Free) is in the post.

      • Amy M
        July 26, 2014 at 9:42 am #

        Thank you, I didn’t see it in the news version I read a few days ago, I thought it said it wouldn’t be available until August. I will go read.

  19. SarahSD
    July 25, 2014 at 12:15 pm #

    I have already seen it reposted in one of my parenting groups with an exasperated-sounding caption “they just don’t get it!”. The argument seems totally logical to me – birth is extremely painful; extreme pain can have lasting psychological effects. But I’d be interested, with a larger sample size, finding out how women who prepare ahead of time for an unmedicated birth fare in terms of PPD, that is, whether the “natural” pain relief/management/reframing techniques are effective in preventing pain-related “loss of subjectivity” and resulting psychological trauma. Between hypnobirthing and the epidural, I can guess which works more predictably in providing pain relief, but in terms of a sense of control, epidurals have the effects of being immobilizing, which can also be extremely disturbing for some women.

    Based on the number of people who report being traumatized by their medicalized births (including to a much lesser degree, myself), I’d guess that the framework within which you experience the pain and intensity of labor really influences your interpretation of the event and your psychological outcome.

    • Karen in SC
      July 25, 2014 at 12:24 pm #

      I prepared for an unmedicated birth, and was very committed to stay the course. With my first birth, I was totally incapacitated by the intensity of the contraction pain that I was unable to speak verbally. If I wanted to change my mind, I probably couldn’t have communicated that. Sure I was able to move, but it didn’t help the pain at all. When it was time to push I was so exhausted, but finally able to speak so I begged for the vacuum. Guess it really didn’t work that way 🙂 I was somewhat traumatized at the time but happy it was over.

      Second birth was manageable and I could speak and even laugh along with moving around. I guess my point was that pain can also be immobilizing and that each birth is a different experience.

      • Cobalt
        July 25, 2014 at 1:34 pm #

        You never know how birth will go, even for the same woman at different times. I’m glad your second experience didn’t include being trapped by pain, that sounds truly awful.

      • SarahSD
        July 26, 2014 at 6:27 pm #

        Oh, for sure – pain can be immobilizing. But I mean some women aren’t able to predict that they will be disturbed by the kind of immobilization you experience with epidural/spinal anasthesia. I can imagine that for some, numbness decreases their sense of control rather than increases it. In my case, the epidural was strange, but not scary, and mostly a great relief.

    • fiftyfifty1
      July 25, 2014 at 12:51 pm #

      ” but in terms of a sense of control, epidurals have the effects of being immobilizing, which can also be extremely disturbing for some women.”
      I read this claim a lot, but I really wonder about it. How come it’s only when discussing birth that we hear fears of immobilization being raised? People get spinal blocks or regional blocks all the time for surgery and I never hear anyone express concerns that the immobility/paralysis will be a problem at all for them, much less “extremely disturbing”. This is true not just with limb surgeries but also with procedures on the pelvis.

      • Trixie
        July 25, 2014 at 1:16 pm #

        I personally found the immobilization from the epidural to be disturbing. After 16 hours of nonproductive back labor, it was still the right call, and it was a good epidural, but I really felt claustrophobic in my own body. Dealing with the pain the second time was preferable to me to that feeling of being immobilized, although my labor also progressed faster, so it wasn’t as hard to cope.
        I’ve never had any other regional blocks to compare it to; I’d venture that most women haven’t.

      • Cobalt
        July 25, 2014 at 1:31 pm #

        Immobilization is my greatest fear when I think of getting a cesarean. The thought of having a newborn and not being able to move is something I am instinctively terrified of, and I have no pretense of being rational about it.

        I manage this fear by telling my doctor about it, and adding anti-anxiety measures into my chart should I need a cesarean (assuming there is time to give a damn about how I feel, if baby needs out NOW! all bets are off and I’ll get over it, live baby wins every time). I have a plan for support and meds if needed.

        • anion
          July 25, 2014 at 7:52 pm #

          I’m totally not discounting your perfectly legitimate fear, just hoping maybe it will help when I say that with my first section I was so focused on waiting to hear that first cry that I wasn’t even thinking about it, and with my second–which was scheduled–I LOVED the spinal block. I felt like I was floating on a warm cloud, seriously. I had no desire to move because I was more comfortable physically than I think I’ve ever been in my life.

          LIke I said, I completely get why it’s scary and I’m not saying you’re being silly or anything, just hoping maybe it will help to think of it as something that will be awesome, a new and different experience. It also helped that my husband was right there saying very mushy things, so I could focus on him.

          • Cobalt
            July 25, 2014 at 9:34 pm #

            That’s actually really helpful. ‘Positive’ cesarean stories tend to leave out the mother’s physical experience, whereas stories that do describe the mechanical experience tend end with ‘and I never delivered with an actual medical professional again’. It’s nice to have a realistic account.

        • Staceyjw
          July 26, 2014 at 3:14 pm #

          I had a full on panic attack, which I have never had before, when I got the spinal. The inability to feel anything from the chest down was suffocating and scary. (Keep in mind this was on top of 36 hours of labor with a heavy epidural, fentanyl, and 4 hours of pushing.)

          I was terrified of having this again, so next time I told the anesthesiologist this, and they added something that made it just fine, totally comfortable.

          Many problems can be solved with talking to the doc about it, preferably before it happens. You can’t do this if in screaming pain.

      • Dr Kitty
        July 25, 2014 at 2:02 pm #

        I have a fairly legitimate fear of paralysis. Having spina bifida and having had multiple spinal surgeries which have “risk of paralysis” on the consent form will do that to a person.

        While I didn’t LIKE the loss of sensation and movement with the spinal, and was trying to wiggle my toes and move my legs from about 3hrs post-op to see if I COULD, it wasn’t a freaking out situation, and anyway, I had a cute new baby to feed and cuddle and marvel at, so I was fairly distracted.

        Post-Op CS I was going to be in bed regardless, so whether or not I could move or feel my legs was irrelevant, it didn’t change what I was doing.

        So not my favourite thing, but not extremely disturbing.

      • onandoff
        July 25, 2014 at 2:56 pm #

        Also, I had significant mobility with both my epidurals. For my first, I squatted with a squat bar while pushing. For my second, I had no trouble lifting my legs or moving them wherever I chose. By the time I felt like standing up to use the bathroom, I was able to. I know it’s not that way for everyone, but it’s also not a guarantee that one will be “tied to the bed”.

      • Staceyjw
        July 26, 2014 at 3:09 pm #

        Two reasons- one is the belief that moving around, and walking helps labor, so being immobile will make everything slower/ worse. The other is that most moms haven’t had other experiences in the hospital. This is the first, and this fear is totally reasonable for those that have nothing to compare it too.

        Also, the idea of being mobile for a knee surgery is just not the same, though I cannot explain why that would be.

        I think the PCA (epidural on a pump you control)is the best option for an epidural. I made myself totally numb, on purpose, with the first baby, but could have left it light and been plenty mobile.

      • SarahSD
        July 26, 2014 at 6:35 pm #

        When you have anasthesia for knee surgery or most other surgeries, you don’t have to then do the procedure on yourself or otherwise be physically involved, so you don’t have to experience commandeering your big, weird, heavy, alien, numb body in the same way as someone who is trying to birth a baby. Throw in exhaustion, just having been in a lot of pain, and high stakes situations where people may be telling you forcefully what to do (“you have to push this baby out NOW”), and easy to see how immobilization in childbirth is experienced differently than immobilization for some other surgeries.

        • gifferent guest
          July 26, 2014 at 7:05 pm #

          There are currently pain relief options available that allow you to fully mobilize in labour.
          I wonder if it is more of an issue of “‘intervention” not “immobilization”.

    • moto_librarian
      July 25, 2014 at 2:46 pm #

      I prepared for and had an unmedicated birth with my first child. I can honestly say that I was managing relatively well until transition, but I knew that would be over soon and that “pushing would feel good.” Imagine my shock upon discovering that pushing was absolutely excruciating. I knew it was too late for pain meds, and I distinctly remember telling myself that this was my brilliant idea, and I had better just g it over with. I was not mentally present at all. I cannot replicate the screams that came from my mouth, nor would I want to do so, I vaguely understood that the birth was imminent when I saw the midwife putting on her gown. They handed him to me, and I felt nothing but relief that it was over. And then the pph started, etc., etc.

      I stand by my assertion that the only reason that I did not succumb to PPD was because I stayed on my antidepressant during pregnancy, and adhered to my treatment plan to up the dose immediately after delivery. Even so, I replayed the birth and complications in my mind obsessively for weeks. I was wracked with anxiety that made it impossible for me to sleep. I was trying to breast feed despite the fact that my milk never came in, and it was only the intervention of my mother that kept me from going completely off the rails. I felt that I had been lied to, betrayed even, by the NCB movement.

      I had an epidural as soon as I was admitted with our second child, it was a completely different experience. I had absolutely no pain, even when he was crowning. I was mentally present, and was even able to watch him being born in the mirror. When he went into sudden distress at the end, I was able to push in the absence of a contraction and deliver him (the nurse was asking if she needed to page the OB emergency team just as his shoulders delivered; there had been mec in the fluid so the NICU team was there already as a precaution). Once he had a bit of O2 and deep suction, our son was stable and in my arms. I had no recurrence of the cervical laceration or pph. I was on a high that lasted for days. I had been utterly terrified about giving birth again, and thanks to modern obstetrics, we both came through it safely and with very little pain.

      Give me a medicalized birth any day.

      • SarahSD
        July 26, 2014 at 6:18 pm #

        I also had a wonderful experience with my epidural. I was immediately calm and present again once the pain stopped. In fact, I was able to comfort my husband who had a little breakdown, being quite overwhelmed by the past painful 16 hours and especially the intensity leading up to and getting the epidural administered. I was able to rest after many hours of labor, and when I was ready to push, I had no pain, but was able to feel pressure which was helpful for pushing. I also enjoyed being able to watch my progress with pushing her out in the mirror, and I’m glad to have avoided the pain of feeling her come out.

  20. The Computer Ate My Nym
    July 25, 2014 at 12:15 pm #

    I’m not surprised. I certainly felt a lot more in control and able to participate in the birth after the epidural. (Obligatory disclaimer that not everyone needs an epidural and there’s no shame in not getting one if you don’t need/want it.)

  21. Ash
    July 25, 2014 at 12:02 pm #

    Well all know how NCB advocates will discuss this. They will all say that all the enrolled subjects delivered in a hospital, and if they had delivered at home, they would have less pain and greater satisfaction with their delivery because of fewer interventions.

    One telling thing about NCB advocates claiming that epidurals are bad–I hardly see them protesting about regional nerve blocks in other fields of medicine. Patients opt to do regional nerve blocks all the time–and yes, the nerve blocks have risks, but patients decide that it’s a good option for pain relief for them.

  22. TsuDhoNimh
    July 25, 2014 at 11:58 am #

    being in agony makes it almost impossible to advocate for oneself, to
    make important decisions, and to exert control over your care.

    DUH!!! Been there with non-ladybit issues … So much of your brain is going to coping with the pain that you have nothing left to think with. And all you can do when it’s gone is be afraid it’s going to come back. It’s trapped animal mode, but you have no paws to chew off.

    I get to see other people in agony occasionally – ski injuries can do that – and although it may be counterintuitive because opiates supposedly remove your ability to be rational, those patients make a lot more sense with several mg of morphine in them. You can see them relax and become aware of their surroundings … they get coherent, not “high”.

    • PeggySue
      July 26, 2014 at 8:27 pm #

      I see this as a hospice chaplain; on the acute care unit our docs deal with patients in pain crises at times, and sometimes patients and families are scared of using opiates and there are some woo beliefs in end of life care that advocate for using stuff like reiki, massage, aromatherapy, etc. instead of “drugs.” It is amazing how much appropriate pain relief helps–it’s wonderful to see someone come in feeling miserable and see them go home with family the next day on a good pain control regimen, hopefully to make some sweet memories.

      • PeggySue
        July 26, 2014 at 8:32 pm #

        The caveat of course being, not everyone at end of life has the choice of “feeling great and still being fully alert,” so patient and family sometimes have to struggle with unrealistic expectations… As for me, my big fear is that at end of life I’ll be stuck in some hospice that “values alternative methods” and I’ll be surrounded by middle-aged white American women who think they are shamans, while I’m begging for a fentanyl infusion.

  23. Elizabeth A
    July 25, 2014 at 11:29 am #

    This study definitely tallies with my experience of labor with my son. While the epidural was working well, it enabled me to be a much more active participant in discussions about care and courses of action than would otherwise have been possible. When epidural began to fail in second stage labor, I went right over the deep end.

    It’s always been ironic that the standard NCB portrayal of labor is that the woman without the epidural is in control, and the one with it is a passive patient with limited agency. I can get a lot more done for myself by talking coherently than I can when I’m in overwhelming pain.

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