The new Lamaze poster on epidurals raises some existential questions for me and perhaps my readers could help me out.
Which of the many ethical violations that Lamaze has committed within the poster are the worst?
Is it the lying about facts?
Is it the lying about judgment?
Or is it the way they treat their followers with utter contempt, imagining that they are stupid enough to swallow anything that the liars at Lamaze dish out?
Here’s my annotated version of the top of the poster to help you out:
Personally, I’m leaning toward the bald faced lies as the worst ethical violation.
It doesn’t matter to the folks at Lamaze what the scientific evidence shows. They are entirely evidence resistant. They are a business that depends on demonizing epidurals and they apparently see no problem with lying if that’s what promotes profits. Consider the plethora of lies above. In direct contrast to what Lamaze claims:
1. The fact that epidurals restrict movement has no impact on labor.
2. The “prolongation” of labor is measured in minutes and has no impact on anything.
3. There is NO DISRUPTION of hormones needed for labor. That is pure invention on the part of the liars at Lamaze.
4. There are no “dangerous” changes in blood pressure. Temporary drops in blood pressure are easily reversed and have no harmful effects.
5. There is NO EVIDENCE that epidurals cause trauma to the perineum.
6. There is NO EVIDENCE that epidurals cause difficulty breastfeeding.
The liars at Lamaze are batting 1000. Six claims and all six are lies. Way to go, Lamaze liars!
You know what the biggest risk of epidurals is? Epidurals decrease Lamaze profits!
That’s right. Lamaze is a business and it makes it money in two ways: it licenses infant toys (I kid you not) and it charges certification fees for Lamaze educators. Because Lamaze has chosen to indoctrinate its educators with bald faced lies about epidurals, epidurals themselves pose a tremendous economic threat. Who needs an educators to lie to women about epidurals if they find out that epidurals are SAFE, HIGHLY EFFECTIVE, have MINIMAL SIDE EFFECTS, TRIVIAL IMPACT ON LABOR, and NO EFFECT ON BREASTFEEDING? Apparently no one, hence the need for lying at Lamaze.
I must say that the Sanctimommy lie about no judgment is a nice touch. They are so not judging you even if you are benighted enough to believe that epidurals are the only way to relieve pain in labor (they are, of course, the only EFFECTIVE way to relieve pain in labor), even if you think epidurals relieve pain, and even if you are weak and lazy enough to pick the con side of the scale. Got to love that subliminal sanctimony of portraying the choice as the balancing scale, and weighing down the con side with lies.
Even so, I think you could make a good argument for the fact that the greatest ethical malfeasance of the liars at Lamaze is the absolute contempt with which they treat their followers. They figure that their followers are stupid enough to get their information about epidurals from people who only make money by demonizing epidurals. It’s like getting your information on renewable energy from oil companies. They believe their followers are gullible enough that they can lie with abandon and no one will either know or care. Not to mention that the liars at Lamaze apparently think any amount of women suffering any amount of agonizing pain is fine when balanced against the profits of the Lamaze itself.
Keeping that in mind, I’ve helpfully amended the Lamaze balance scale:
In conclusion, let me reassure the liars at Lamaze that I wrote this post about their lies with no judgment, exactly the same way that they designed their poster!
Tangentially – at work today, a pregnant co-worker was telling some of us that she was skipping the Lamaze class because her doc told her it would just be boring and frustrating, and if she wanted to learn breathing techniques, she could buy a DVD and zip to the useful bits. Another co-worker: “Women have been giving birth for hundreds of thousands of years without DVDs. Yes, not all of them made it, but for the ones who didn’t, it wasn’t because they didn’t have the right breathing techniques!”
Her biggest worry about the epidural was not being able to feel her legs – she’s a control freak (and do I ever understand). She’s going to talk to the doc about the possibility of getting one that doesn’t have that effect.
Talk about bold faced lies…. Get your medical facts straight lady! Old school info is no longer good. Time to reeducate yourself.
Which medical facts presented do you consider to be wrong or out of date?
What a deeply well thought out post. Thanks for your wisdom.
I really enjoyed my epidural. When the pain reached a point whereI wanted one, the anesthesiologist was busy, so the put some Stadol (I believe that’s how it’s spelled) in my IV until he could get there. Seriously, I would rather have a needle put in my back any day of the week! My husband still makes fun of the way I was talking after they put that in my IV. My brain knew what to say, but my mouth just couldn’t seem to form the words correctly. It was not my finest moment. I had a c section in the end, but I remember that the epidural , at least for me, was easy and helped me relax. I wasn’t completely numb like I was with the spinal, just more comfortable, and there is certainly nothing wrong with that!
An epidural does restrict movement. The graphic doesn’t specifically say that restricting movement has an impact on labor.
I personally was very glad to be able to move around during labor (and relatively quickly afterwards), and that was the reason why I went without an epidural. I hadn’t been concerned that restricted movement would slow down my labor.
But the advantage of being able to move around is that it helps you cope with the pain. Since you don’t have that pain with an epidural, you don’t need to be moving around to cope with it.
Yes! I never understood that whole “moving around” thing. Yes, I writhed in pain before my epidural kicked in, afterwards, I was very happy to sit and dilate at my leisure.
Me too! Especially since I was finally able to sleep for a couple hours, after missing my night’s sleep due to contractions.
Guy perspective here I realize, but that’s what I would think. One of the great advantages of an epidural is that it lets you lie around and get some rest before the baby’s born. The idea of being awake for 30 hours of labor, after which point you have a baby to take care of always sounded pretty hardcore to me.
Funny, I remember our lecture on obstetric anaesthesia this year, and I almost laughed out loud when the doc said that they tried really hard to do walking epidurals until they realised women didn’t actually want them!
If that worked for you, great, sounds like a sensible decision. It may not work for every woman though and that should be recognized. Also, there are a lot of different levels of “restricted movement”. After I got an epidural, I couldn’t get out of bed without help. Period. I could feel my legs and move in bed with no problems. It didn’t really seem like that big a deal. To me, at least. That might have bothered another woman more than the pain and for her foregoing an epidural would be the right thing to do.
That’s how mine was too. I could feel my legs and could move them around in bed and change position on my own, but did not have full strength in them, so could not have walked around. In terms of my contractions, I could feel them but they did not hurt any longer. After the epidural I really could honestly describe them as “surges”. How ironic.
Yes, I didn’t walk. But I could move my legs however I chose and turn in bed. When I began pushing, I squatted with a squat bar. I felt every contraction, but they didn’t hurt. Afterwards, I got out of bed as soon as I wanted. But there was definitely no walking.
Since there was no pain, I was happy to take some time to rest and think about meeting my baby. And with my second labor, I marveled at the lack of all the pregnancy background pain I had been living with for months.
But had I felt walking was important or had I wanted to stay in the tub, then epidural was out.
The point with my comment above was not that women should forego epidurals so that they can move around (whether or not that is a priority depends on the woman’s personal preference), my point was that it was not actually a lie, as Dr Amy states above. I’ve seen plenty of long labors that seem to have been sped up a bit by an effective epidural, so that mom can get some rest while her body does the work.
Our anesthesiologists will do a mobile epidural. We test leg strength to make sure it’s safe for them to get up. I’ve gotten patients up to the bathroom with no difficulty. Most just want to sleep though, as usually they’re exhausted from a long prodromal labor.
My epidural added about an hour to my labor. I went from 3 cm to 10 cm in the time it took to get the epidural going, and as soon as I had some pain relief, my doctor suggested I take a little while to recover before we started the hard work of pushing. So, yes, there was an additional hour I wouldn’t have been in labor, but it was my choice to spend that hour recovering from the previous two hours of very rapid progression. Maternal choice for the win! And pushing was no problem–I could feel what I needed to feel, and the baby came right out.
I had an epidural with child #1, it worked well, but I ended up with back pain at the insertion point for about a month (during which time I was worried the pain would be chronic). I opted to forego the epidural with child #2, figuring that I would rather deal with a few hours of intense contractions than a month of chronic ache. As it turned out, my incompetent family practice doctor had misdiagnosed epigastric pain as heartburn and my full-blown HELLP syndrome was missed until I was in labor. My platelets were too crummy for an epidural anyways, so I was grateful for practicing other coping mechanisms (mainly using techniques from The Pink Kit, which I really liked). I do think it’s important to be prepared with additional coping techniques, even if you’re planning an early epidural.
I was somewhat into woo with both pregnancies/births, opting for a hospital-based CNM for #1 and a family practice doctor for #2 because I was determined to avoid the evil OB. Both pregnancies had serious complications (meconium aspiration by baby #1 who was born at 41w+13 days) and HELLP syndrome for me with baby #2. I wonder now if both would have been avoided if I had been with an OB.
I’m curious if Dr. Amy has ever looked into outcomes for family practice doctors versus OB. I honestly feel lucky to have survived birth #2 with no complications, given how bad the HELLP syndrome was. (Why would you prescribe heartburn medicine over the phone to a patient at 39 weeks in severe, debilitating pain without having her come in for another exam? My blood pressure wasn’t elevated above screening levels at 39 weeks, but a urine test and blood test would have caught the kidney and liver malfunction).
I have seen the aftermath of one serious adverse event from an epidural: a woman who had a catastrophic fall in her BP after getting an epidural who ended up in a persistent vegetative state. It’s an extremely rare event and that was in the dark days of the 1990s before we really knew how to use epidurals, but it can happen and women should be informed of the risks when considering anesthesia. They should, of course, also be informed of the benefits and the risks of other forms of anesthesia, including getting none (i.e. pain, suffering, risk of PTSD, risk of general anesthesia if c-section is needed, etc.)
There was one monumental stuff up with an epidural at a hospital near me shortly before I gave birth. I get wanting to see how things go without an epidural, just in case you are that one-in-a-million. The procedure they were using was outdated and risky (the wrong liquid was drawn up into the needle and injected) and they’ve changed it, but it made a lot of us nervous at the time.
True, Karen, the catastrophic error was due to drawing up and injecting the wrong substance, not due to the epidural technique itself. The same error can (and has) occur with intravenous medications, which has led to modified procedures to minimise the risk (changing the appearance of the container, moving similar-looking containers to different areas etc).
Medicine moves forward to minimise error and adverse events. Lay midwifery ignores them.
I wanted to avoid the epidural if the pain was bearable because I have migraines. Spinal headache is rare, but the prospect terrified me. I’ve had five day migraines that are incapacitating, and with respect to childbirth I was one of the lucky ones – quick and bearable labor. Pushing was quite painful, but it was very finite compared to migraine.
I’m only 10 weeks and this post is making me excited to get an epidural again! The last time I was induced and I got one before I even had any pain. It ended up being a short, easy labor. Thank you for going out of your way to spread the truth, Dr Amy.
I would add a ton of lead to the “provides effective pain relief” side of the balance, so it would hit the ground.
So 67% of women opt for an epidural to ease the pain of childbirth; is that a bad thing?
Huh. I always thought it was more.
The number who wanted one probably is significantly higher, the need is not ideally met.
There are, of course, precipitous labors that proceed so quickly that the mother cannot get an epidural, but I really doubt that accounts for 30% of labors.
There are also many hospitals that aren’t fully staffed at night, or the patients:anesthesiologist ratio is overwhelming, or stalling tactics make it too late. Not every hospital goes by the “if you’re not crowning it’s not too late” rule. It can get rough in the boonies.
Not every woman wants an epidural (I didn’t, they honestly scare the crap out of me on a level I freely admit is non-rational), but I think the number is closer to 80% than 67%.
Yeah, we (Aus) were quoted 70-80% in our lecture, I believe. (ActuallyI just checked my notes, and I think that stat was actually for IM opioids. All those MWs in the public hospitals are clearly being very effective in their self-appointed mission to enforce NCB)
The more I hear of these stalling tactics the more horrified I am.
Q: Why do 67% of women opt for an epidural?
A: Because they can.
I’m surprised it’s not higher. Outside of crunchy circles, it seems to me that they are considered the default.
Around here, in the non-crunchy crowd, the default seems to be “I’ll see how it goes”. Mostly this does end in an epidural because most labors are really painful. Seems like a good approach for most women.
I was a “see how it goes” and had a great epidural that was an enormous relief.
“I’ll see how it goes” makes for an excellent birth plan…nothing set in stone, nothing pre-determined.
that’s a significant reduction in market share if you are a doula or homebirth midwife or birth center midwife.
that’s a significant amount of resources for organizations that are misogynist and think women’s pain is not worth treating or that women in labour deserve pain…cough cough my provincial govt I’m looking at you here…
I hear you! Are you in Ontario? I’m in BC and one of our midwives was telling me that at some hospitals in Ontario, if a patient gets an epidural, it’s a complete transfer of care to the OB, so the midwife doesn’t get paid for the delivery. Lots of incentive for them to discourage epidurals!
Wow. That is *not* cool! I wonder if women are informed of this before labour because it’s seriously uncool to force a woman to choose between her care provider and pain relief. The whole not getting paid part sucks for the midwife, too.
I agree, and I think it’s unethical too..
Wow, that’s really good (and frightening) to know…as a recent transplant to BC, I wonder a lot about how L&D differs here from my stateside L&D two years ago. It seems that a lot of the moms I meet opt for midwives, but I’ve also heard of laughing gas as a hospital option? That’s new to me.
I’m a recent transplant too from the US.. but I was out of L&D for a while before I came here. I hadn’t worked with Entenox before either, but apparently it’s making a comeback in the US. They’ve been using it in Canada for years, and I find it does help women cope more effectively especially when waiting for an epidural. Few side effects too, but I have had an occasional patient de-sat and have mild hypotension.
Used in UK & Aus, too. But not all that effective. I think our NCB MWs like it because it doesn’t give too much pain relief, they can tell the women that they already *have* pain relief (so you don’t need that epidural), and they don’t need a doctor to give it.
Wow, that sounds so sadistic.. I’ve worked with some MW’s here who are like that, but most are supportive of epidurals if the patient requests it.
I made the mistake of looking at their site…their “birth plan” is a joke – there is only one plan you are allowed to make apparently: no drugs, rooming in and breastfeeding.
spot on.
More epidural pros beyond 1) safe and effective pain relief:
2) allows you a higher ability to concentrate on new information and make decisions regarding your health and labour (pain is distracting)
3) early epidurals (prior to 4 cm) decrease labours by an average of 90 min
4) allows smooth transition to anesthesia for cs if needed
5) provides faster safe pain management in the advent of an emergency (e.g. manual evacuation of the uterus in pph, emergent forcep or vacuum delivery)
6) may decrease your overall risk of morbidity and mortality associated with obstetrical anesthesia (for women with difficult airways and morbid obesity)
7) allows a route of administration for epidural morphine or duramorph for management of pain associated with higher degree (3+) tears or cs
8) may decrease your risk of perineal tears through controlled pushing
9) emerging and consistent evidence that an epidural can decrease your risk of PTSD, PPD and post-partum anxiety
10) may allow rest/ napping during labour which can increase reserve for effective pushing and decrease sleep debt for new parents (see Dr. Amy’s excellent post on SUPC).
11) assists in the management of blood pressure for women with hypertension or pre-e.
Have I missed anything? 😉
Cons:
1) ineffective 5% of the time with first catheter placement. May need to repeat procedure to get 98% success rate
2) may not provide adequate perineal coverage for second stage/ crowning pain
3) dural puncture headache 0.5-1%
4) small risks of serious adverse events…I was going to quote numbers but the ones we have are from survey studies in the 1990s and all the equipment has changed since then, including the type of sterile prep we use on the back.
Would be nice if some new scholarly research was published about the incidence of SAEs–I know the providers have a good idea of the risks but the Internet has led to a lot of disseminated misinformation.
Funny, no groups are railing against, y’know, the entire subspecialty of regional pain management. But just epidurals for labor pain is unacceptable. Right.
there will be. The anesthesia quality institute NACOR project, for example, should give us good contemporary rates pretty soon.
I had a dural puncture (CS though…I don’t know if it’s the same as an epi). Oh my god… that headache…. no one who hasn’t had a dural puncture can’t understand. When you sit up, you have an urge to grab the closest thing and stab yourself repeatedly. It goes away when you lie down. But when you sit up…. EXCRUCIATING. I live in a lot of pain because of lupus, but nothing beats that headache…
Now this ^^^^ is what informed consent looks like as far as the risks go. Along with 1.) I’ve seen them only work one one half of the body. Ugh. I felt bad for that mom. That must have been such a strange and painful feeling.
Seriously. This is the kind of information I want. Plain, straightforward “these are the risks, these are the likely benefits, make your own choice.” Almost like the patient is a rational adult, or something!
Definitely OT, and probably a stupid question, but I’m sure someone here can answer. 😉 Re #2–if mom has an episiotomy or tears, then how are repairs done if the epidural doesn’t provide total numbness down there? I mean, surely a care provider isn’t (*twitches*) stitching up the area in question while mom can feel everything?
Usually local anesthesia is provided by the person doing the repair. Higher dgree tears are often done in the or under ga or spinal
If you’re one of the 2% for whom the epidural does not work at all, despite repeat placement(s), it can be quite devastating. I wish our anesthesiologist had a Plan B.
I had the odd experience of only having the epidural numb the left side of my body…I still felt everything on the right. The catheter was moved and my right side got a little numb, but I never fully lost sensation on that side.
For my second baby-epidural, both sides were covered nicely, but I felt more in the perineal area.
Sheesh.
Both of my epidurals had to be placed twice because only my right side had relief. The first labor, a second placement fixed it. The second labor, the second placement still took a long time to numb the left side and left a lingering “pocket” of pain. Still 10,000,000x better than nothing.
Pro: For mothers who experience debilitating menstrual cramps, an epidural allows you to disassociate your child’s birth from the inescapable oppressive pain you experience monthly.
This was the reason why I ultimately went ahead with my epidural. I have cramps akin to over 7 cm of dilation each month without an effective means for escape. Having the epidural turned the misery of all-too-familiar pain into a peaceful and positive experience for both myself and my son.
That is horrid. I am suppressing the urge to offer well-meaning advice, as I’m sure you’ve already accessed expert help, but that must be awful, having to experience that amount of pain on such a regular basis
Thanks, guys. My saving grace – until my husband and I decided to start trying for a family – has always been the BCP. It’s like a miracle drug for me. 🙂
God bless the BCP – only reason I kept my uterus till I was ready to have a child.
So sorry to hear that. As well as bad periods-though not so painful as yours-I would get mid cycle pain that made me faint. Most extremely unpleasant. Lucky the good old ocp sorts it all.
Who?: I’m sorry to hear about your troubles, too. The mid-cycle pain sounds horrid. Hang in there!
Thanks Bugsy-ocp and now middle age have sorted it out, but it certainly never got any less scary or miserable however often it happened. I see below that ocp did the trick for you too, that is great.
It’s so good there are many options these days. A number of my friends at a particular age are getting a Mirena implant, and are very happy with the results.
Me too! (Cramps, not epidural.) For years I asked for a hysterectomy for my birthday present. On the other hand, when I went to the hospital I had no idea I was so dilated because I assumed labor would be more painful than cramps – by the time it was, I was 10 cm.
I can completely relate! They sent me home from the hospital at 3 cm dilated, saying that I was in too good of a mood to be in labor. I was back at the hospital 2 hours later still in a pretty darn good mood, so the nurses were stunned to realize I was now 5 cm along. When I asked for my epidural at 7 cm, the nurses repeatedly asked me if I was sure I wanted one. My contractions were still much more tolerable than my menstrual cramps, and I was still in a darn good mood.
(The epidural kept me in that good mood!)
Life can be tough – for decades I looked forward to menopause because it meant no more cramps. Then I found that hot flashes are, while not as agonizing, no damn fun and not restricted to one week a month. My anthem is becoming that favorite college dance song, “I wanna be sedated”…
I <3 you.
Is there more evidence for #9 than just that fairly recent Israel study? That’s great!
newest thing I’ve come across for PPD:
http://journals.lww.com/anesthesia-analgesia/Abstract/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx
http://journals.lww.com/anesthesia-analgesia/Citation/2014/08000/Double_Duty___Does_Epidural_Labor_Analgesia_Reduce.1.aspx
Dammit, no abstract for the second one. I do wonder in the first study (from reading the abstract only) whether the non-epidural group had the added disappointment of their expectations not being met (see also my psychobabble comment on yesterday’s post). You would expect that the group who chose med-free had certain ideas and expectations about how things “should” go that may or may not been met.
The second link is the accompanying editorial which reviews some of the other evidence and evidence linking pain to dvl of depression and anxiety disorders
And a mom who is relaxed, pain-free, and can enjoy the birth of her baby!
How about “provides perineal anaesthesia for any necessary repair of tears or episiotomy without needing local anaesthetic”?
Because that’s not a given. In a large number of women epidural medication won’t spread to cover the sacral nerve roots and is inadequate for perineal repair without supplemental local or systemic analgesia/ anesthesia
But it doesn’t need to be “a given” to be a benefit. If only half the women who have an epidural get pain relief for perineal, that is still a benefit of the drug.
Similarly, it’s “not a given” that it will stop the pain of childbirth in any way. That doesn’t mean the fact that it does so is not a benefit of the medication.
– I would not include numbing the perineum as a benefit of an epidural. Spread of local anesthetic to the sacral nerve roots is unreliable. So unreliable that an epidural would never be the technique of choice for perineal surgery or surgery on the feet and ankles. For perineal repair surgical anesthesia is necessary and can be accomplished by general, spinal or local depending on tear location and severity. Occaisionally I have educated maternity providers about this because sometimes (rarely) they assume local is not required. Whenever I hear a story about how a woman was “stitched up without any anesthetic” I wonder if it was assumed the epidural would be adequate. It’s not.
We do a significant top up of in situ epidural catheters for cs because the standard solutions used in ldr are inadequate for surgical anesthesia even in the dermatomes through which spread is reliable (lumbar and thoracic). So there is really no basis to say that a labour epidural will be reliable for perineal anesthesia even IF the solution spread to the sacral dermatomes.
The opioid component of the epidural solution spreads farther and may provide some measure of analgesia in that area. But the opioid used in most labour epidural solutions is fentanyl which is very short acting (about an hour) so the benefit is marginal.
Counselling patients about risks and benefits is partly expectation management. I would not list something as a benefit that occurs less than half the time.
Is there any way to predict whether or not the epidural will provide perineal pain relief? Are there any other techniques that can be used to provide perineal pain relief during labor/pushing?
I’m a Belgian midwifery student (first year) my knowledge of pain relief in labor and how it works is limited (no classes covering pharmacological pain relief ’til next year 🙁
I already took the classes covering non-pharmacological pain relief, they were underwhelming, to say the least…
“Counselling patients about risks and benefits is partly expectation management. I would not list something as a benefit that occurs less than half the time.”
I see your point about not listing it, because you don’t want to get hopes up. On the other hand, for the great majority of women, an epidural really does help, even if it doesn’t cause complete numbing. Doing a repair on a women with zero pain relief in the system can be seriously miserable because injecting the local can be so painful. Multiple shots to the private parts? Ouch! But when a woman has an epidural on board, there is almost always *some* perineal coverage, so you can get the local in with much less problem.
It doesn’t have to be the gold standard technique of choice for it to make a real difference in women’s experiences.
Exactly. It can still be a benefit, even if it’s not perfect nor sufficient.
This definitely makes me re-consider getting an epidural in my next labor. I’ve done two naturally and (for me) the actual experience of labor contractions isn’t that bad (until transition, then I get a little whack-a-doo). My main reason for considering an epidural is for the pain of crowning WHICH I ABSOLUTELY HATE AND DREAD. Luckily both of my babies were born after a few minutes of pushing but what if my next baby is malpositioned and I have one of those legendary three-hour-pushing experiences? The idea of enduring the ring of fire for three hours terrifies me.
Good point. For most women, the epidural helps both contraction pain and perineal pain. Some women don’t get perfect perineal pain relief and they will need to be given some local, but odds are in your favor!
FYI your link to the Lamaze poster…is in fact a link to this exact same page. It doesn’t go anywhere.
Oops! Fixed it.
There is NO GOOD ALTERNATIVE to epidural for pain relief. I had a patient a while back with a stillbirth and HELLP, her coags were wonky and she couldn’t get an epidural. A less-than-helpful MFM told me, “Oh, just give her a PCA and she’ll do fine!” It’s true we could use way more narcotics than usual because we didn’t have to worry about the baby, but you know what? It still was completely insufficient to manage the pain of labor. Epidurals are pretty much the only thing that works.
PCA is great for steady pain. PCA is sucky/ less effective for pain that comes and goes. Nothing like screaming during contractions and being semi-somnolent between them…
Theadequatemother, I’m a labor nurse and I’ve always wondered about their effectiveness. We use dilaudid pca for post c-section pain management in the occasional pt who can’t have duramorph for whatever reason. And they don’t seem to work at all. I can never get a good answer out of our anesthesiologists. The patients say it provides little, if any, relief. Is it just not sufficient for that large of an incision? Do they need a higher dose or different drug? I’d love to see better relief for these patients!
its not the PCA its probably reduced dosing because of fear of maternal sedation and transfer in breastmilk. We use PCA all the time for other abdo operations with great effect. but see, those patients are expected to just LIE IN BED AND RECOVER so they can be a wee bit sleepy. But moms..oh no. Moms have to be up doing infant care immediately and also they need to entertain visitors and serve tea and biscuits. Okay snark…sorry/ not sorry.
Yep, I’ve always suspected it was something like that. Screw breast milk—these pts are out of their minds in pain, they can’t breast feed anyway. The worst was once I had a pt who said she was allergic to morphine because it made her nauseous. That’s a side effect, not an allergy, but the anesthesiologist wouldn’t give her duramorph. She was miserable for no good reason.
It probably doesn’t help that my hospital doesn’t have a single female anesthesiologist. Wish we had you 🙂
I am so grateful for our anesthesiologists. Our patients get spinals for their C/Sections (unless they have an epidural for labor) with Epimorph. Then we give them Tylenol and Diclofenac suppositories in the RR which are continued for another 48 hours or so. Plus po or sc dilaudid or morphine. They are up within 6 hours or so post-op and most get very good pain relief.
What about pts who are unable to get duramorph/epimorph, like if they require a general for their section? I’m really curious how other places handle this.
Multimodal analgesia – acetaminophen + NSAID + opioids by mouth and PCA. Options – TAP blocks, wound catheters, post OP spinal morphine (for crash ga cs). All pain management is finding the right balance between pain levels and side effects (nausea constipation sedation generally). Opioid sparing techniques are helpful I that regard and more medications working on different pathways tend to manage pain with a better side effect profile than just pushing one.
I have a weirdly high tolerance for morphine, and don’t metabolise codeine at all. Which means I have previously spent time arguing with anaesthetists that if they insist on giving me morphine, they better be prepared to give me a hell of a lot of it.
25-30mg IV morphine 4hrly in a 45kg person is very hard to sell to the people who don’t know me.
For whatever reason Oxynorm and Fentanyl are much better for me, so the anaesthetists who know me sort me out with those instead.
Diclofenac and paracetamol were perfectly adequate post C-section.
12% of Caucasians can’t metabolize codeine (which is a prodrug) to morphine. Strangely my sibling is also impervious to morphine, as we discovered after a bout of appendicitis.
Fentanyl and demerol are synthetic opioids (derivatives of heroine) and interact with opioid receptors differently. The action of opioids is very complex as there are so many types of opioid receptors and their expression has variability between individuals. Red heads are the classic example…some kind of gene variant located next to or near the gene for red hair. I always have a few extra syringes when titrating anesthetic for gingers…
So I guess what I”m saying, is that in my line of work people like you aren’t that uncommon and thank goodness we have more than one option.
I haven’t had much experience with patients receiving GA here, but I’ll ask one of the anesthesiologists next time I work. I think they either get a PCA post-op or IV/PO/SC morphine or dilaudid with the supps (acetominophen and diclofenac) which seems to work very well. They also use Tramadol here too, which also seems to work well.
“-these pts are out of their minds in pain”
What a bummer. I am so happy this didn’t happen to me. Whatever it was the anesthesiologist and/or OB did for my section, it was a miracle. Such a joy to be fully alert but basically completely pain free afterwards. Also no nausea. The only side effect was itching, although I can’t even complain about that. It was really diffuse and subtle and it actually felt good! You know how itching has the aggravating part but also a pleasurable part that happens when you scratch? It was as if I only had the second pleasurable part and not the aggravating part. When I would rub or very lightly scratch my skin anywhere it felt extra good, but if I didn’t scratch there was no itch. It was the strangest thing!
Sounds like you got duramorph, which is morphine that goes in an epidural or spinal. Most patients get it for a c section and it’s wonderful. Occasionally though, like if the pt has to have general anesthesia or is allergic to morphine, they don’t get it and have to rely on IV narcotics. Those are the ones that have trouble. I panic a little whenever I have a pt that can’t get duramorph.
And I experienced something similar with the itching after my c section! I <3 duramorph.
As a side note, this is another really great reason to get an epidural. If you have a crash section (I did) and the epidural is in place, you still get the duramorph for post op pain relief. If not, you'll just get a general and no duramorph.
Oh my gosh, yes, this was my experience exactly! I just thought I was crazy! 😀
Pain relief was one of the best things about my C-section experience. My anesthesiologist was completely on top of it, and my OB does *not* like his patients to be in pain, so he prescribed Vicodin and ibuprofen.
I’ve also heard that you’re less likely to be in pain if your doctor is “good” with C-sections. I had very little pain overall–I never even filled that Vicodin prescription–but I’m not sure if that’s because he was that good, because I have a pretty high pain tolerance, or some combination of the above.
I wonder if some of these women end up revolting against hospital birth because their experience with a C-section was so terrible. It sounds like an unusually bad experience, but how could they know that? Also, why wouldn’t they worry about it happening again?
Also, why not just let them pump and dump for a couple of days? Would that be against hospital policy of pushing BF all the time for everyone no matter how inappropriate?
Pumping creates more work, not less work.
that is EXACTLY what happened to me.
Geez, that’s how I felt without meds…
Poor thing, how terrible.
so true… it’s says something about labor pain that you can give mom the same narcotics that would manage lots of other serious types of pain and for labor they seem to do next to zilch… except for, as you say, between contractions when she’s so dopey she can’t think.
I had some narcotics during my induction — and I do NOT do narcotics well. I was UNCONSCIOUS between contractions and in excruciating pain during. It was crazy. NEVER AGAIN.
0_o
Fun as that does sound, I’m thinking that if I attempt a VBAC with the next kiddo, it’s an epidural for me, thankyouverymuch.
Maybe theadequtemother can weigh in on why this is, but I’ve found that narcotics work really well for me for things like orthopedic pain and post-op pain, but did squat for labor pain or migraine pain. (Maxalt is da bomb for my migraines, though!)
Narcotics don’t seem to be great for visceral (organ) pain – except to sedate and take the edge off.
I loves me some Zomig. The nasal spray works in 15-20min.
I was extremely lucky to be able to get an epidural. I had a L5-S1 fusion and was terrified that an an anesthesiologist wouldn’t touch my back during labor. To my surprise, the anesthesiologist on call had the exact same surgery AND the same surgeon as me. He took a look at my post- op MRI (which I carried in my car after 30 weeks) and took great care of me! After a very painful pregnancy, I was so thankful I could labor with an epidural. Hooray science!
I have several sacralised lumbar vertebrae ( basically, several of my lower lumbar vertebrae were naturally fused to my sacrum at birth, and then we stuck some stuff in there to keep them straight) and the anaesthetists were still able to do my spinal.
Day to day my back gives me no major bother, except I can’t do happy baby pose in yoga, because I don’t bend that way.
If you have a weird pelvis or wonky spine it is definitely worth seeing an anaesthetist before you go into labour. You really do not want to find out that epidurals or spinals are out of the question mid-emergency or at 7cm!
Ummmm… this scares the living hell out of me (only in a general sense because I’m only having the one kid ever so no chance of this ever happening to me)… but if some anaesthesiologist told me s/he couldn’t do an epi on me, I would freak the #*$& out. I wouldn’t be leaving that hospital until someone agreed to put me under general for a CS. I’d literally have had a panic attack if I was told that.
A friend of mine had really low platelets with her third baby and wasn’t able to get an epidural (after having had one with her first two births) – it seemed like it was pretty traumatic for her!
Standards for platelet levels in terms of getting an epidural vary so widely between institutions and among providers. I know anesthesiologists who won’t do it if platelets are under 120k, others who are ok as long as it’s over 100k.
its worse/ more complex than that. There are sticky platelets (like in ITP where some would feel just fine needling at 60-70…or 80) and non-sticky platelets (like in uremia which can occur as part of HELLP) where who knows what the right number is? Platelet dysfunction seems to be more important than platelet number when it comes to SAEs. There was a very interesting series looking at the incidence of epidural and spinal hematoma in pediatric patients receiving intrathecal chemotherapy…often with platelet counts around 5 (FIVE!!!). No increased incidence was found.
Is that why, when you donate platelets, they feel comfortable taking most of them?
The one good thing about learning alternative pain relief techniques -like Lamaze teaches – is that if your epidural could be delayed because the anesthesiologist can’t get to you when you request an epidural. Or, if the epidural doesn’t entirely take effect properly and there is another delay in the anesthesiologist getting back to you to adjust it – if they can. I had one epidural where only the right side was numbed and another epidural where only the top half of me was numbed and I could feel everything way down below. And then I had a really heavy epidural and one that was just right. So, I had 25% satisfaction with my epidurals. I’m all for them – but with qualifiers.
The problem is, groups like Lamaze can’t manage to separate the techniques to manage pain with the nasty, judgmental attitude that med-free, “natural” birth is superior.
Or also for the simple fact that you really might show up too late for it- that happened to me!
Or just ordinary life pain, broken bones, etc. Mental techniques to cope with pain are real and useful things, and there’s nothing wrong with learning them. I just wish the lessons came without a side dish of anti-science.
I agree. I wouldn’t recommend Lamaze because of all their misinformation.
we, as anesthesiologists need to find a way to staff LDR adequately and educate LDR staff about epidural troubleshooting. I think we need to be more aggressive about fixing less than adequate epidurals for women. After all, they do come with some small risks and being exposed to those risks when the darn thing doesn’t work well AND when you expected pain relief is the worst of all worlds IMHO
I so wish I worked with you!
Man, me too.
It is SO HARD to get anesthesia to return to reevaluate when the patient clearly does not have a good epidural. They seem to fall back on “labor hurts, what, she wants to be totally numb?” NO but she would like to stop writhing around in pain like we told her she would. And no it’s not just pressure! Believe her!
If it had been up to the resident, I would have been out of luck for pushing with my second child. My epidural had worked tremendously a good 8 hours, but then I began to feel pain from contractions. When the attending anesthesiologist got out of the section she was assisting with, she discovered that my catheter had dislodged. Her resident didn’t realize this had happened. As she was preparing to fix my epidural, my nurse told me I was complete and asked what I wanted to do. I told her that we were waiting to push until I had anesthesia. I got a full bolus, and was numb clear down to my toes, but I felt pressure and had no problems pushing. It was wonderful because I had absolutely no pain, even when our son was crowning.
Argh! Yes! This reminds me of when I had a tooth pulled and the Novocain didn’t quite “take” by the time the dentist started the extraction. When I stopped him, he said, “Oh, you’re going to feel some pressure.” I said, “No, it HURTS.” And maybe I had a bit of crazy eyes because he believed me and waited a minute or two for the Novocain to finish working its magic.
I do agree. With my first epidural, I could still feel a spot and it hurt. The second, I delivered so quickly and they were only able to get the epidural for pushing. I wish I had prepared for not having any pain management both times just so I could have a plan for it. I would still get another epidural because it was better than nothing.
Yeah, I had an epidural too…it worked wonders for contractions. I could feel when they happened, but they didn’t hurt at all. However, pushing was another story, and I felt that ring of fire for sure.
That’s very true. There are times they don’t work well or are delayed and I think classes have value for lots of reasons. I just wish that more teachers were truly supportive of all safe choice and my pet peeve as a RN is how all those feel good videos and photos show parents faces of joy at unmedicated births… but in reality you see the same ecstatic faces and joy at epidural births and cesareans. Yet its done a bit like the Business of Being Born… put the nice music and soft lighting on the homebirth …. for the hospital birth choose something from 1950 with horror flick music and draw a Hitler mustache on the OB ( only a slight exaggeration).
What they don’t show with the unmedicated births is the exhaustion and trauma some of those moms feel from all the pain. I know crunchy women who were really traumatized or totally exhausted who couldn’t even old their babies they were so tired.
Sorry to go OT here, but I am expecting my first and I plan to get an epidural as soon as they will let me. Do I need to take a birthing class if this is the tripe I am going to be fed? I also plan on formula feeding exclusively so I feel these classes will be nothing but guilt ridden wastes of money. Thank you. Love this blog – my birth club is full of woo and this is my one place of sanity 🙂
I think hospitals vary quite a bit. Personally, I found the classes helpful because we toured the hospital, went over policies, what would happen after the birth, etc. So my husband and I felt more confident knowing that we knew what to do/where to go when the time came. Plus, the class went over the logistics of an unplanned, emergency c-section. Again, this mostly just helped my husband not feel so bewildered when everything started moving fast. The class did go over ways to handle the pain until you get meds/don’t choose medicine. I found the breathing techniques calming in general (as in, it helped me not to panic…not so much lessen the pain).
That said, I know other people have had very judgey, woo-filled childbirth class instructors. Unless you know someone who has already taken the class at your hospital to ask (or maybe your OB/OB nurse?), I guess it comes down to luck.
It depends a lot on the hospital, I think. My birth class that I took covered alternative pain management techniques such as breathing, what happens when you get an epidural, when to go to the hospital and what to bring when in labor, and postpartum care for mom, as well as a tour of labor and delivery, the recovery ward, and the well-baby nursery and pointed out the NICU. I felt a lot more confident after taking the class.
If your hospital offers one, and it isn’t a huge time or money commitment, it’s probably worth doing just to learn about how that hospital does things.
I took a birth class. It was a giant waste of time. You can learn more in 5 minutes of reading a labor diagram than in their entire how-many-week course. Unless you are really fascinated in how it feels to sit on a bouncy ball (also probably registered by lamaze) and be asked to make a list of your favorite candle scents and music.
My husband and I took a twins-specific class, and it was nice because there were only 3 couples there, including us. This allowed the teacher to ask US what we wanted to learn, and the overwhelming majority was: techniques to deal with newborn twins, to make life as easy as possible. So, can you contact whoever runs the class, and ask what is covered? Find out if there is any room for Q&A? Ultimately, I ended up with an unexpected vaginal birth and the nurse was able to coach me, after a 2 minute crash course in Giving Birth 101. I did get an epidural, so there was some pain, but it was manageable.
We took one the first time and it was a huge waste of time, even though the instructor was good. Most if the other class participants were so clueless about human anatomy that it’s a wonder they got pregnant in the first place. We dropped out, actually. So, it was a waste of time and money. You could always just go tour L&D without taking the class.
Our class had us (PhD and veterinarian) and another older couple (dentist and educated mother) and then a bunch of very young people like you describe. The instructor told us afterward it was one of the hardest classes she had to teach because there were some who were so clueless, and then others like us who knew a lot.
The best example was in the discussion of breastfeeding, I asked her how common mastitis is. She answered the question, and then one of the young ones asked, “What’s mastitis?” So that’s the range of background that she was facing.
We had a young couple who weren’t aware of the connection between the vagina and the uterus.
:O
I did not know what mastitis was before i read a pregnancy/nursing book. I don’t know if it’s “clueless” so much as not necessarily knowledgeable about specialized aspects of childbirth. it’s not basic human anatomy by a long shot.
The hospital I will be delivering at has the hospital tour and the birth class as separate entities. I work full time and I don’t want to spend my evenings going to a worthless class when I can be dealing with everything else that needs to get done on a day to day basis and getting more sleep.
I will talk to my OB to see if he can direct me to whom I should ask about the class further. He has delivered at that hospital for over 25 years so he’s got to be connected, right? 😉
I never had a birthing class and don’t feel I missed anything. I knew I would be having a C-section and FF fairly early on, though. My hospital used to have a C-section class but they canceled it for lack of takers. A nurse that used to run it sent me some information. Honestly, a lot of the childbirth classes are devoted to breastfeeding. If you know you’re not going to do that, then it seems like a waste of time to me.
I’m trying to remember…I was in Japan and I know we took a parent class where they showed us how to change diapers and stuff…but I don’t remember an actual birthing class. Even if there was one, there’s a good chance I’d have skipped it because I wanted nothing to do with a vaginal birth and watching one would just have terrified me.
I never took one. I knew I was having a CS. I guess there were a few things that would have been smoother if we had the hospital tour, but that’s it. My brother took one at the same hospital Sounded pretty woo-ish to me. I know a few women who were just too busy to fit one in, and the baby still came out just fine.
I think a tour of LDR is better. Ask questions about policies, avoid confusion and misinformation that way. Some general reading about the stages of labour if you don’t already know is good.
This. The tour was the best part. The midwife that did the tour also quietly told us how to circumvent the paid parking so it was well worth it.
The other thing that was nice was meeting other soon-to-be parents. I wasn’t in hospital at the same time as any of them (mine was a later due date and then I went overdue) but one of the women moved closer to me after the birth and wanted a new mums group and I hooked her into mine to help her make friends.
I took the birth class at my hospital and it talked about things like the monitors you’ll be hooked up to, which I found nice to know. It also gave general guidelines to know when you’re in labor and when to call or come in.
I figured we should go, for my non-medical husband’s sake.
He asked if they would make him watch birth videos or talk about amniotic fluid. I said it was possible.
He went white and asked if I could just tell him what to do once we got to the hospital.
So…we skipped the classes, and the night before my CS I told him what was going to happen.
If this is what they are teaching, then no, don’t do it.
However, see the comments of others with their experiences (like mine), where “birthing class” was all about practical matters such as what to expect at the hospital under different circumstances. Here’s what options you have for laboring, here’s what happens when they give you an epidural (“Dad will be asked to step out a couple of minutes, they put the needle in your back, it usually takes about X minutes before you feel the effect”), if you’ve scheduled a c-section here’s what they usually do depending on the doctor, here are feeding options, here’s how to deal with life when the baby is home (shaken baby education), here are hospital policies regarding various things.
Add in a tour of the hospital, and it can be useful.
I signed up for the least crunchiest childbirth class I could find, mostly for my husband’s benefit. It was taught by a French Canadian doula, and was specifically for couples planning a hospital birth. The couples included 1 other nurse and 3 EMTs.
The class had some woo, including the instructor passing around a “birthing balm” that smelled like my cat. However, she covered pain meds in labor, including Nubain and epidurals. She also covered cesareans. It was all very matter-of-fact.
The class included a tour of the local hospital’s L&D and post-partum units, which are on different levels of different buildings (a new LDRP unit is opening sometime next year). Our tour started with a nurse saying “You are here to have a baby, not a birth experience.” Our instructor visibly cringed. We got to see the labor tub, shower, birthing balls, and other stuff. We also saw an OR (we didn’t walk in) and the NICU.
A lot of stuff didn’t apply to me, since I wasn’t planning to have my baby at the local hospital; I only filled out paperwork in case I had to deliver there before we got to Boston (which is exactly what happened). Some of the non-medical pain relief methods came in very handy when I was in labor in the helicopter.
If I had to do it again, I would’ve signed up for a class at my OB’s office. It would’ve been cheaper, and provided more facts and less woo.
Maybe you can just ask a lot of questions here or on Dr. Amy’s FB page. Between all of us we can probabl answer most questions, lol.
See which ones your OB office recommends, They might know one that is more about practical matters.
I am seriously considering getting certified as a childbirth educator and designing an evidence-based class. I think I will call it “Birth Without Pain.”
There’s no guarantee of no pain though. Epidurals work really well most of the time, but they’re not perfect. An evidence based class would be great though, think of all the women who could be actually helped by accurate information.
True. Maybe “Birth with Less Pain,” or “Birth with Facts, Not Ideology?”
“Informed Birth”
Plus, most people have at least some pain after.
True, I used the breathing techniques to cope with the horrible pain of breastfeeding 🙁
I would have found it helpful to have more instruction about postpartum care in my class, plus more of an idea of how recovery would be impacted by different scenarios. We were repeatedly told that vaginal delivery would guarantee a fast, easy recovery. That simply is not true if you have tearing, a pph, or other issues. It would also have been nice to have someone advocate for why it is important to control mom’s pain after delivery. There are effective means of doing this, even if you are breastfeeding.
I did use focused breathing while waiting for my epidural to cope with contractions, and I do see benefits in having as many coping mechanisms as possible for labor. I would love to see accurate informAtion about the risks and benefits rather than all the fearmongering.
Exactly. There will always be a need for alternatives, an epidural may not be available or available quickly enough, it may fail, or the mom may have spine problems that would preclude an epidural. The classes should cover the whole useful spectrum, without bias.
I like “Birth Without Woo.” I would be all over a class like that telling you to shut up and take my money 😉
The infant toys are actually really good products. Of course, I feel dirty buying them knowing the lies Lamaze has been peddling lately, but toys!
HAHAHAHHAHAHHAHAHHAHA.
This is actually WAY better than the epidural video we watched in my Lamaze class, which was, I kid you not, written in blood-dripping red horror movie font and had “side effects” that went on for pages and pages. My husband knew I wanted one and after watching the video, he looked at me and said, “Are you sure?” and I had to go up and find TRUE info to share with him to convince him those idiots were nutbags.
Also that day, we watched a “birth video” that was basically a woman who said she wanted an epidural right away but had somehow managed to get a nurse who when the patient asked her to go find a doc to get her epidural started, just… didn’t, saying she thought the patient was a whiner and not in real pain and telling the patient she couldn’t find anyone. And then by the time the doc came in, she was ready to push. The post-interview is all the patient holding her beautiful baby and going, “I never realized I could do it without pain meds!” The Lamaze instructor asked what we’d learned from the video, and I raised my hand and said that I learned that the nurse was a horrible liar who should be fired and brought up on ethics charges.
I don’t think that was *supposed* to be my takeaway, btw.
BTW, trying to find the TRUE info on epidural risks was what got me to this page in the first place. It’ SHOCKINGLY hard to find anything that’s not woo-y and if you want to do a post on that that I can point people to, I’d be so grateful, Dr. T.
I admire your ovaries in speaking up like that! No way would they film the version where the woman afterwards is shaking and sobbing and traumatized thanks to Activist Nurse. 🙁
Thankfully, L&D nurses like that are few and far between, at least where I work anyway! We are all VERY pro-epidural and anti-pain. It’s horrible to watch a woman trying to “tough it out” on the alter of NCB when you know she could be pain-free.
Oh man that would have been me. I have no tact and no patience for bias. This is why I need to avoid such a class lest they come after me with pitchforks and torches.
BTW, what reply did you get after you uttered that awesome statement?
She was like, “Anyone else?” I skipped the last class and she emailed me and was all, “Um, I don’t know if you want your certificate, but I have it….”
I was induced with my daughter due to pre-e. Never got an epidural because I was 13th on the list. I had my daughter in 5 hours but it was so painful I losr consciousness between contractions.
Question though.. I always hear people claiming epidurals increase your chances of complications leading to c sections . How true is that?
Not true. The best evidence that it’s not true is this: During the 90’s, many hospitals hired additional anesthesia staff so they could provide epidurals to all women who wanted them. Epidural rate skyrocketed, practically overnight. No change in c-section rate.
Now, many people BELIEVE epidurals lead to c-sections, but the fact is, when labor is going very quickly and easily, women are less likely to ask for an epidural, and when labor is dragging on or things are starting to go wrong, women are more likely to ask for an epidural. The supposed connection is an illusion, due to the confounding variable of labor difficulty.
Thank you. I’m currently pregnant with my second child. I have found that the pregnancy forums I am in are mainly a bunch of anti science, unintelligent people that cannot give any kind of factual information. I’m lucky that i have a doctor that will actually talk to me this pregnancy, unlike my last. I am still resentful of how my labor went last time, I think if I had an epidural i could have actually wanted to hold my baby afterwards, instead ifelt like I was going to drop her while the nurses told me I could have a seizure at Any Time while also saying “Arent you going to try to nurse?” It was just ridiculous. I also had untreated ppd with no support system and my husband treating me like an ungrateful whiner. Hoping he has got some damn sense by now after reflecting back on how horrible things were.
There was a rumor back in the 90s that couples taking Lamaze classes had a higher C/S rate than non Lamaze couples. Lamaze Intl. did a study and found that this was true. Thus, they began to focus more on a “Normal Birth for Every Woman” campaign.
Instead of asking if it was what they taught that was leading to a higher C/S rate, or if the couples who came to them may have had other characteristics that predisposed to C/S, they began to blame technology and doctors.
Um, older first time mothers would probably explain the entire difference. I don’t think Lamaze was too anti-induction at that time, so it probably wasn’t cause and effect.
My OB said that the joke in her practice is if they come in with a natural birth plan, to get the operating theater ready. Because they won’t accept ANYTHING that might help them avoid a c-section — pitocin to augment labor, pain relief to help them stay rested, etc.
She is right! And the joke is the longer the birth plan, the more complications they’ll have, ie- meconium, FHR decels, malposition, etc, etc, etc!
Whatever happened to the old adage “my body my choice?” It just reinforces the fact that NCB and it’s interested parties, such as Lamaze, are not interested in giving women choices. They exist solely to promote a strict set of arbitrary values so they can remain in business. The idea that these women are claiming to “help” other women is pretty sickening to me.
One woman of my mother’s generation at work was pressuring me about why I hadn’t bothered with a childbirth class. “You can’t just get an epidural the minute you go into labor!”
I told her, no, no, I would need a c-section. (At that particular time, I didn’t give a shake about birth, I was just grateful that my poor baby had made it to 35 weeks in one piece.) I should have said, “Why not, I totally plan to.”
She’s so nice and positive normally. How does she not recognize that she’s supporting the patriarchy in the true and classic fashion, by trying to shame younger women into correct behavior?
Ok, but in a way she’s right depending on the circumstances of the labor (and the larger context of what she was talking about). I was in labor for a couple hours before contractions were close enough together that I could go to the hospital. By then I was about 3-4 cm dilated and they weren’t sure if I could be admitted to a room/out of triage, until I said “I’m really looking forward to that epidural.” The nurse and resident laughed and a few seconds later they came back and said I was going to a room with the anesthesiologist on the way. Then about another hour until I actually got the epidural (getting the IV set, the monitors, signing consent forms, etc etc etc., no delay tactics). That meant about 12 or so contractions just between triage and the epidural, not counting all of the ones the couple hours before. I really needed the breathing and visualization exercises to get me through all of them until the epidural, and I believe this sequence of events is fairly typical.
Give her the benefit of the doubt — she might have been told she had to wait until later to get hers.
It’s “choice” as long as it’s the choices THEY advocate..
Maybe the “no judgment” thing means that they aren’t judging you if you are one of the empowered warrior mamas who is bravely choosing a homebirth instead of one of the sheeple that chooses to go to the hospital. However, the no judging thing doesn’t exactly apply if you’re one of the sheeple.
A pox on them for making any mother feel guilty for two seconds about her epidural. Getting mine was a Wizard of Oz moment for me – there are blatant liars behind the NCB curtain. One would have to be truly evil to deny pain relief to a woman in labor based on deliberate falsehoods.
One thing I’ve seen among women who were pro NCB and wound up getting an epidural is that they have excuses. It was Back Labor. They forced me to have EFM, so I couldn’t move around. I wanted to be awake if we needed a c-section. (Actually, that one is a really good reason.)
Let me say, no one needs an excuse for an epidural beyond “I was in labor,” and I have issues with anyone who promotes the idea that excuses are needed.
It is true, though, that longer, more painful labors that progress slowly make people more likely to get epidurals.
I was grateful for my epidural but didn’t like the sensation of feeling trapped in my body. I was willing to get one again only if I had another labor that progressed slowly. My threshold for the tradeoff between pain relief and not being able to feel my body was probably higher than most. None of this is more than individual choice, though — I don’t care what anyone else does.
“My threshold for the tradeoff between pain relief and not being able to feel my body was probably higher than most. None of this is more than individual choice, though — I don’t care what anyone else does.”
This is about how I feel. My reasons for not getting an epidural were about my personal reactions to needles, spinal procedures, and not being able to move being a worse experience than my pain. I had no medical concerns, I knew epidurals are safe and effective.
Given what’s been written here about the UK system, I’m going to be using the C-section one as my excuse if I need to push the issue, and will be bringing up my desire to get an epidural at first OB appointment. I already know I’ll be high-risk and will have increased likelihood of c-section, so I really want to be awake for my kids’ birth. Also, I spend pretty much all of my life in some degree of pain, I see no need to add to it when I don’t have to.
That said, I might be more flexible if I didn’t have lupus; but I think I’d probably still see no reason to not get pain relief.
This reminds me of when I went out for lunch with a few members of a local parents group that pushes the NCB information pretty heavily (back before they kicked me out) and the topic of epidurals came up. One of the ladies said in a hushed voice, like she was afraid someone would overhear her, that she loved her epidural and that the whole experience was so much better than her first natural birth. There were lots of nodded heads around the table, and nervous laughter like they were saying something that could not be uttered out loud.
What’s funny is that I remember this woman posting right after her baby was born how sad she was that was so “weak” getting the epidural and how she felt she let the group, her baby and her husband down. Not sure if she changed her mind on the experience, or just felt like she had to tow the party line.
I loved my epidural! BEST decision, asked for it when I walked in the door. Calm, restful alert birth, why put myself through the worst pain I’ll feel in my live for bragging rights?
What does Lamaze gain from women avoiding epidurals? What do they lose from women getting epidurals?
Do you mean that if all women understood the truth about epidurals, they wouldn’t bother going to a Lamaze class? I think some women would still want a medication free labor and delivery if they could have it safely, and may want to learn non-medicine-based methods of coping with delivery. If a woman signs up for a Lamaze class, she’s probably already decided she wants to go med-free, or at least try to, and the people running the class already have her money, regardless of what she actually does.
Now, I agree here: this poster and all the lies are reprehensible. I had planned to get an epidural during labor, and therefore avoided natural childbirth classes, books and groups. I’d like to believe that if I’d seen that poster, early in my pregnancy, I either would have ignored it or asked my doctor about it if I was unsure. I knew a lot of people who had epidurals, and they were all fine, as well as their babies. Also, I could have deduced that epidurals were safe, because I knew they were so widely used. Doctors wouldn’t use something so frequently, if the risks outweighed the benefits, despite the NCBer claim that doctors don’t follow evidence.
So, I guess the Lamaze folks think that a)women considering a med-free birth, using Lamaze techniques, are morons with the deduction skills of a rock and b)because those morons will be too scared (of judgement and bad side effects) to ask for an epidural, they will see no other option but Lamaze, and spend money on the books and/or classes. Am I understanding this? That the gain Lamaze gets from demonizing epidurals is somewhat indirect?
The ideal Lamaze follower does not use medication of any type during her pregnancy or labor and delivery. That basically summarizes it. “Educated” and “normal” women don’t submit to the establishment of medicine.
So, they try to rope in followers by scaring them into med-free births, and then the newly indoctrinated will spend money on Lamaze classes and products, right? And she’ll tell all her friends and try to shame them into doing the same, so more customers, for free advertising. So they don’t really lose money when a woman chooses an epidural, more they fail to gain it.
I attended the hospital Lamaze class that was recommended by my OBs office. It was mostly a waste of time. I did like getting a tour of the L&D floor and info about the nursery and NICU but even though the teacher was a retired nurse she was quite woo-ey. Very “breastfeeding is best, you must at least try ! ” also very cloth diapers are the only diapers (Yeah ok lady, you haul your baby and laundry up and down stairs to the scary laundry room every day, I lived in an apartment in Long Beach at the time…)
I wish I had not wasted my money, and this was 20 years ago, so it seems the classes are being taught by the same sort of people in some cases…
Ugh. We got a private, personalized lesson about the NICU when I was at the hospital for 4 weeks on bed rest for pre-term labor. Luckily, my boys never needed it,but, someone came from the NICU, to my bedside and gave me tons of information, in anticipation, since it looked like the babies might arrive early enough to warrant it. I did meet with an LC at some point, and did go to the breastfeeding class, the day after the babies were born, but no one was super-militant with me about it.
Because lots of Lamaze educators are also doulas.
That’s a good point: “Hey Preggo! Your labor and delivery will hurt a lot. But you can’t get an epidural because that means you are a bad person and terrible things will happen to you and your baby. But guess what? I’m here, Ms. Lamaze Doula, to help you out, for the low, low, low price of 800$, so you can breathe your way through the pain-with-a-purpose and achieve enlightenment via med-free birth! If you act now, you’ll also get this nifty rebozo scarf and an ounce of essential oil (to protect you and the baby from Ebola) for only 19.99$!! Act now! Operators are standing by!”
I took a Lamaze class because I thought it was about childbirth, not “natural childbirth.” Oops. The class was cuckoo crazypants, and I ended up ridiculing the instructor’s BS advice every week (like “don’t tell your medical provider if your water breaks because then the clock is ticking” — “Um, you want me to lie to my doctor about my condition? How can they provide accurate care if I don’t give them accurate info?” and “I recommend making a castor oil milkshake in your favorite flavor” “What for? I don’t want to be vomiting or have diarrhea on top of my labor.”) Honestly, castor oil? WHY would that be better than drugs proven to enhance or kick tart labor, like pitocin?
The castor oil thing really blows my mind. I understand wanting to go into labor already, dammit! But one of the few things less comfortable than late pregnancy is late pregnancy with angry guts. Deliberately adding angry guts to labor is just bonkers.
So, effective medical induction is evil but plant-derived-toxic-chemical induction is just fine because it’s ”natural”?
(Or more likely because it’s available without prescription)