A common form of obstetric violence in industrialized countries is denying a woman an epidural


Apparently, the term birthrape didn’t work out so well for the natural childbirth industry.

It was in vogue for several years, but generated not the outrage at obstetricians that midwives and doulas were hoping for, but rather revulsion at their appropriation of the suffering of rape victims to publicize their cause.

The new term is obstetric violence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns for normal birth are institutionalized obstetric violence.[/pullquote]

According to Birth Monopoly:

Obstetric violence is normalized mistreatment of women and birthing people in the childbirth setting. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

That’s a definition I strongly support. Sadly, natural childbirth advocates can’t stop sensationalizing all obstetric care as violence.

Amie Newman writes on Medium:

I was born in a snowstorm from a woman whose body was stolen. She was knocked out and drugged up hours after arriving at the hospital where she planned to birth her first child. Her doctor told her to stop screaming as she writhed in pain on a white-sheeted gurney, in a crowded hallway of a New York City hospital. She didn’t oblige his request and was eventually sedated, sighing deep with wet-cheeks. She did not know what she was given.


Whose hand held the scissors that cut us apart? Was it the doctor who delivered babies only on Wednesdays? It’s unlikely it was my father’s. He was not allowed in to the room until much later. My mother still does not know who severed the vessel that kept us connected — that kept me alive while in her womb. But she still wishes she knew.

Although unmedicated childbirth with a midwife is often recommended as the “cure” for obstetric violence, the truth is that midwives are among its leading perpetrators. Midwife led “campaigns for normal birth” are a common form of institutionalized obstetric violence in industrialized countries and denying a laboring woman an epidural is a common manifestation.

How could that be?

Consider Amie Newman’s definition of obstetric violence:

It is an umbrella term that includes disrespectful attitudes, coercion, bullying, and discrimination from care providers, lack of consent for examinations or treatment, forced procedures like C-section by court order, and also physical abuse.

It’s hard to imagine anything more disrespectful than telling a woman how she ought to give birth and ignoring what she might want (pain relief, interventions, maternal request C-section), yet this is precisely what campaigns for normal birth do. By campaigning on behalf of a process instead of for patients themselves, proponents of unmedicated vaginal birth are explicitly ignoring the needs and wishes of those patients.

A good rule of thumb for respectful care is: “Nothing about me without me.”

Declaring that unmedicated vaginal birth is an institutionally supported goal instead of one choice among many possible choices, midwifery organizations are most definitely making policy and determining practice WITHOUT the input of women.

Proponents of “normal birth” insist that it is safest, confusing cause and effect. Sure women who have easy vaginal births have fewer complications than women who have C-sections, but that’s like saying people who spend their hospital stay in regular rooms have fewer complications than those who spend their hospital stay in the ICU.

It isn’t the ICU that is associated complications, it’s the need for the ICU. Similarly, it is often not the C-section that is associated with complications, but the need for the C-section. Campaigns of normal birth are as effective in reducing complications as closing ICUs. Not only do those actions fail to prevent complications, they cause more serious ones.

Even if unmedicated vaginal births were safer, that wouldn’t justify pressuring women to aim for them. Paternalism is never a justification for ignoring the specific needs and desires of an individual woman. It is not a justification for obstetricians to do what they want and it is not a justification for midwives to do what they want. Women do not reclaim their agency from obstetricians by handing it over to midwives.

Denying a woman an epidural, delaying her epidural or trying to chivvy her out of getting an epidural are all forms of obstetric violence. There’s something perverse about an entire industry predicated on the concept that excruciating pain is good for women. And there’s something racist about an entire industry that expropriates the (imagined) experiences of indigenous women — who lack access to pain relief — as “authentic.”

Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia, offers a way of conceptualizing childbirth pain. In her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain, she observes:

… 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…

Denying pain relief to a patient is a human rights violation and just because labor is a natural process doesn’t change that fact.

Pressuring women to breastfeed — mandated visits from lactation consultants, withholding access to formula, withholding pacifiers — is also a form of obstetric violence, a particularly infatilizing form. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

Ironically, the vaunted indigenous women often have greater freedom to choose when and how to start breastfeeding than women in “Baby Friendly” hospitals. Prelacteal supplementation is common in many indigenous cultures.

Closing well baby nurseries in an effort to promote breastfeeding is also obstetric violence. Many cultures have mandated weeks after birth as a time when women’s only task is to rest and recover. Only one culture demands that women begin caring for their babies on their own the moment the placenta is delivered: our culture!

The natural childbirth and breastfeeding industries must STOP trying to control women’s bodies and decisions. They must END violations of women’s autonomy and dignity. NO ONE should be trying to reduce epidural rates. NO ONE should be making it difficult for women to access formula. NO ONE should be mandating rooming in for new mothers and their babies.

The natural childbirth and breastfeeding industries are committing obstetric violence when they fail to heed these admonitions.

136 Responses to “A common form of obstetric violence in industrialized countries is denying a woman an epidural”

  1. a small person
    August 26, 2019 at 2:35 pm #

    I agree with a lot of what you have said here, but you cannot possibly say with a straight face that the only culture which forces women to care for their babies right after birth is ours. Please. Do you think Salvadoran women who give birth in the rural villages have maids to come take care of their infants? No, they get up at 4 a.m. and make tortillas for their husbands, take care of the baby, gather wood and take care of the house and the other kids. They do have a 40 day period in which they are supposed to be cared for, and their friends will come and help as they are able, but on what fantasy planet does everyone have the resources to not take care of their kids? Canadian moms get a year off paid leave, no one is taking their babies for them. What nonsense. French moms have post-partum support at home, but they are an anomaly. Let’s just be honest, shall we?

  2. EMT2014
    March 22, 2019 at 11:48 pm #

    I gave birth for the first time in a Japanese hospital (not American military). The Japanese OB/GYN and L&D system is really, really great–except they do not do pain relief. AT ALL*. I don’t know why. No one could give me a good answer. I asked for literally every painkiller I could think of, starting with epidural and going through Demerol, morphine, nitrous, even opium (I meant opioids, but I only knew the old word). I was told epidurals were only for C-sections, the others were out of the question (they just laughed at opium), and I could have some Tylenol after it was all over. :-/
    The doctor (not my usual) at the last checkup before my due date ruptured my membranes with her digital exam and sent me home leaking amniotic fluid, so I had to be induced. No pain relief for that either. They started the Pitocin at night, so I didn’t get any sleep. Kiddo was completely uninterested in making his entrance. I was so exhausted and had made so little progress by the next evening the doctor (my usual one, who was called back from his holiday 2.5 hours away, possibly because no one else wanted to deal with the American lady) wanted to cut the Pitocin and let me get some rest, but the thought of having to go through all that again was enough to get me pushing, and Kiddo was born without incident. The upside is that I got to spend a week in the hospital being very well taken care of! I still remember the misery of that night, though, and the horror on my husband’s face when he came into my room the next day and saw how awful I looked and felt.

    This time around, I gave birth at a Kaiser hospital stateside and was told I could have nitrous oxide, fentanyl, and an epidural, any of them, whenever I wanted. The nitrous made me not care about the pain (kinda) but not for very long, the fentanyl just made me feel drunk *and* in pain, and Baby came so fast I didn’t have time for an epidural (although I did have one the next day for my tubal ligation–it didn’t work far up my abdomen enough and I had to be put under general anyway! I really did not like the sensation of a numb lower half, though, and I was glad when it wore off). Luckily the delivery was so fast and easy I almost felt like I hadn’t had a baby at all. If not for the tubal ligation surgery I would have been back to normal in less than a week.

    *I was in a rural area, although it was a Red Cross hospital (which should theoretically adhere to international standards of care); I’ve heard that pain relief is available, if expensive and sometimes difficult to find, in larger cities

  3. GraceAlexander
    March 19, 2019 at 7:45 pm #

    God I love you. THANK YOU.

  4. Amazed
    March 17, 2019 at 8:37 pm #

    Another OT: Amazing Niece did get her measles vaccine! I’m so relieved!

    A side effect: her mom had to paint clothes on some 100 naked girls in colour books because Auntie’s Little Treasure declared them too boring for her to colour otherwise. Capriciousness, that’s it. Since she got the shot, she got labeled Naughty Treasure, and for good reason!

    • March 18, 2019 at 10:21 am #

      Well, you’re not in the US, or I’d say report it to VAERS. Parents need to know important side effects like capriciousness for true informed consent.

      • March 20, 2019 at 4:48 pm #

        That’s why my toddler will sign “food” then scream and throw all of the food we bring him on the floor! We vaccinated him! It’s also clear now 😛

        • AnnaPDE
          March 21, 2019 at 12:07 am #

          You don’t know it yet, but those shots also set him up for tantrums over stuff such as his tongue being too pink.

  5. Amazed
    March 17, 2019 at 9:22 am #

    OT: Dr Amy’s facebook page has been hilarious! They’re too dumb to figure out how facebook works even after being instructed what to do step by step but they think they’re smart enough to argue science?

    Go to your kids, ladies. Go to breastfeed them, that’s all you’re good for. If you can figure out that you have to put the nipple to the mouth, I mean.


    • March 18, 2019 at 3:51 am #

      I’ve had postpartum patients call me, point to a screaming newborn, and plaintively ask me “What am I supposed to do with it?” (Yes, “it”). They’ve got college degrees, but can’t equate crying baby at mealtime, and hunger, and the bottle in the cot or their breasts.

      It was when I almost answered “Feed your baby, cow!” That I realized I was becoming burnt out.

      • AnnaPDE
        March 21, 2019 at 12:12 am #

        Admittedly, the “boob milk is magic and drops are enough for a newborn” brainwashing, the gaslighting from real-life nurses that the crying can’t mean hunger because the baby has definitely gotten lots of milk from the previous hours of suckling, plus the residual side-eye from the older generation for spoiling a baby if your first move is to feed them when they cry, add up to a very toxic mix that can make you not see such obvious things when you’re in the thick of it.
        First hand, this.

  6. March 16, 2019 at 9:09 am #

    My OB walks into my room while I’m being induced and says, “So, you’re doing this all natural, right?”
    “Hahaha! You’re so funny, Dr. C. But I’m doing okay right now, think I’ll wait to get the epidural.”
    “Okay, but let me recommend you get it now, because you have had babies before and you could go very quick, and then deliver before you can get the epidural.”
    “Won’t that slow down labor?”
    “Nah, you’ll be fine.”
    And that was how my third child came into the world without my experiencing more than the mildest discomfort possible, thanks to my old, male obstetrician.

    This same male obstetrician told me not to worry about taking my narcotic pain meds when I was pregnant and broke my feet, because a few days’ worth of opiates weren’t going to harm my baby and there was no reason for me to suffer when I didn’t have to. Love ya, Dr. C!

    • demodocus
      March 16, 2019 at 10:20 am #

      My Dr E is pretty cool that way, too.

    • Caylynn, RD, MPH
      March 16, 2019 at 6:08 pm #

      What an awesome physician! I’m glad to hear you had that experience!

    • MaineJen
      March 18, 2019 at 10:22 am #

      My awesome OB told me that for first time moms, there is no such thing as “too late to get the epidural,” because even if you’re fully dilated it could still be hours before you deliver. Boy, was I relieved to hear that!

      • Angharad
        March 19, 2019 at 4:44 pm #

        Both times I had babies, the nurses and doctors commented afterward that it was a good thing I had topped up on my epidural right before the birth (I had the kind with a button I could push every so often to administer more medication) because I had severe tears both times that required lots of stitches, and a postpartum hemorrhage the second time that required fundal “massage” that was more like the nurse throwing her full weight on top of my uterus. Not feeling the stitches or the massage was a plus.

        • GeorgiaPeach23
          April 9, 2019 at 1:37 am #

          I loved my ceserean but hated the fundal compressions that followed. That part was never explained to me ahead of time.

          • AnnaPDE
            April 9, 2019 at 7:38 am #

            What are fundal compressions and why are they done? I never had anything like that, and now I’m hearing all these “I had a big heavy thing placed on my stomach for hours” and “the nurses pressed on my stomach” things from fellow CS mums that I can’t make any sense of…

  7. BH
    March 16, 2019 at 8:33 am #

    I was having a conversation only a few hours ago with a friend discussing our labours and how we were both denied epidurals by our midwives when we requested them. My friend’s midwife told her not to have an epidural because it has “serious long term side-effects” (didn’t explain what they were) but she scared her out of the epidural when she always planned on having one. At the time she was a newly arrived migrant from a country where nearly everyone has planned CSections so had no birth preparation whatsoever in an unfamiliar country. We both had reasonably fast labours and unmedicated births in the end. I only asked for the epidural once, when I arrived at hospital mainly because the pain intensified quickly and I feared it would become far worse but it remained bearable for me. I’m glad I didn’t have one because my contractions slowed from 2-3 mins apart to 5-7 minutes whenever I lay down. I had to remain upright (standing, walking, squatting, yes sitting on a ball) to progress, especially during the second stage. It is definitely unethical to exaggerate risks to ‘scare’ women out of epidurals and continuing to deny them when they are clearly not coping. To decline an epidural on arrival and observe things for awhile first if the woman is managing labour okay is not necessarily a bad thing. There’s no harm in trying other pain relief options such as nitrous oxide, which doesn’t restrict movement. If labour becomes unbearable then epidural with pit to speed things up if needed is totally fine too. try to find a happy medium which suits the individual woman and her labour.

    • fiftyfifty1
      March 16, 2019 at 10:24 am #

      “To decline an epidural on arrival and observe things for awhile first if the woman is managing labour okay is not necessarily a bad thing.”

      Same thing for any pain then, right? Vasectomy? Testicular torsion? Postoperative hip replacement pain? You can tell me you’re in pain and need medication, but I’m the doc, and I’ll watch you for awhile and decide whether you really merit it, or whether you’re just a pussy who is whining and would be better without.

      • fiftyfifty1
        March 16, 2019 at 10:41 am #

        Very seriously, though, as a doctor i’m pretty uncomfortable with what you are proposing. Basically some women are better off getting pain relief, whereas others are better off, you know, being made to feel their vaginas tear…and as a doctor it’s my job to decide who is who. No thanks.

        • BH
          March 17, 2019 at 2:27 am #

          I wish I could 100% agree, I wish there was a way to completely eradicate labour pain without limiting mobility. You would probably disagree that epidurals slow labour & perhaps they don’t most of time. But in my experience being horizontal massively slowed my contractions. I know there’s such a thing as a ‘walking epidural’ which allows more mobility but that wasn’t an option at my hospital. It’s crazy that NCB fanatics label medical interventions obstetric violence, but by the same token I don’t believe most midwives are trying to withhold pain relief just to be sadists. There are some so committed to their ideology that they allow women to unnecessarily suffer and that’s not right. I was better off without pain relief, but I think myself lucky though that it was quick and the pain really not that bad. Every labour is different. Saying that every woman is better off with an epidural is the same as the NBC crowd saying every woman is better off doing it naturally.

          • fiftyfifty1
            March 17, 2019 at 7:48 am #

            “Saying that every woman is better off with an epidural is the same as the NBC crowd saying that every woman is better doing it naturally.”

            Nobody is claiming that every woman is better off with an epidural. What we are saying is that there is no better judge of whether a woman should have one than her own self.

            “You would probably disagree that epidurals slow labour”

            It’s not me that disagrees, it’s the data. Sometimes contractions space out temporarily with change of position, but well designed studies show that total labour length doesn’t appreciably change. But in any case, it should still be the mother’s choice. A midwife’s impatience for what she (wrongly) believes will be a faster labour should not trump a woman’s access to safe and effective pain relief.

          • Sarah
            March 17, 2019 at 2:39 pm #

            Your experience of a slowed labour when you had an epidural simply isn’t any kind of reason to deliberately deny another woman an epidural when she asks for it. Every woman isn’t better with an epidural, but every woman who wants one and where there isn’t a contraindication is.

            Also, I appreciate that you’re saying walking epidurals are uncommon where you are, but don’t assume that’s the case everywhere.

        • Sarah
          March 17, 2019 at 2:38 pm #

          All women are better off being made to feel their vaginas tear. For bonding. And microbiome.

      • Caylynn, RD, MPH
        March 16, 2019 at 6:07 pm #

        Sadly nurses have that power in some instances! Despite being prescribed IV pain meds (I’m assuming opioids of some kind) post-surgery by my surgeon and the resident, the overnight nurse decided I could “make do” with Tylenol! The day nurse actually listened to me and the written orders, so when I was in pain, if it wasn’t too soon, she gave me the stronger stuff.

        • rational thinker
          March 17, 2019 at 7:58 am #

          Did you report the overnight nurse?

        • GraceAlexander
          March 19, 2019 at 7:58 pm #

          I had an emergency c-section – not a pretty bikini cut, a splash and slash hip to hip gash and afterwards was supposed to be in the hospital 4 days before discharge on Monday – my doctor was giving me injected toradol and said he’d send me home with some Vicodin because I could barely breathe from the pain.

          Other doc came in to discharge me instead on Sunday, no explanation, and wrote me a scrip for extra strength ibuprofen. I said “Look at my chart – I have a bleeding stomach ulcer, you can’t give me NSAIDs – I’ll be in here vomiting up blood.”

          So he wrote a scrip for naproxen sodium. I said, patiently “That’s also an NSAID, I cannot take that.” So he started writing a scrip for Celebrex, and I said a little tartly, “THAT. IS. AN. NSAID. I cannot take that.”

          He sneered at me “I am supposing you want VICODIN then?”

          Uh, yeah. My doctor said that was what I needed, and if you think you are sending me home with a 10 inch incision in my belly and the equivalent of Pez that make you puke blood, you got another think coming.

          I was livid.

      • MaineJen
        March 18, 2019 at 4:42 pm #

        No one told me I had to ‘wait and see’ if I needed medication for my kidney stone that took a day and a half to pass. They saw me writhing on the gurney and responded accordingly.

    • Azuran
      March 16, 2019 at 2:44 pm #

      There is no reason to decline pain relief and see if the woman can ‘manage’ it, unless there is a real medical contrindication.
      I can ‘manage’ period pains or a headache. But why would i? Why should I? When we are very safe pain control option availlable.
      Is someone can have and wants pain control, they should get appropriate relief. Not an evaluation of their managing capability

      • BH
        March 17, 2019 at 3:30 am #

        An epidural is not as simple as taking a pill for a headache or period pain. It requires a highly specialised physician to administer one and an IV, EFM, catheter. You are unable to walk or toilet yourself! If epidurals pose no additional risks to the foetus then why is EFM required? There’s a lot of scare-mongering among NCB advocates about that but I would genuinely like to know if there are risks and the incidence of them.

        • mabelcruet
          March 17, 2019 at 6:10 am #

          Walking epidurals are common, it’s not quite correct to say that an epidural leaves you unable to walk or toilet. Walking epidurals have been around a number of years and provide effective pain relief with minimal side effects or complications.

          • BH
            March 17, 2019 at 6:38 am #

            My understanding is that epidurals keep you restricted to the bed. Walking epidurals are uncommon here in Australia.

          • momofone
            March 17, 2019 at 12:13 pm #

            But if people want that, or are happy to accept it as part of that method of pain management, that’s a valid option. If others don’t want it, they aren’t required to choose it. I personally am a huge fan of the pre-labor c-section, so I have no need (and no interest) in walking around before giving birth.

          • mabelcruet
            March 17, 2019 at 3:32 pm #

            Epidural anaesthesia is a very effective method of analgesia, far better than using opioids in labour, and there’s no risk of depressing the baby. The techniques have become more and more refined over the last 30 years or so, such that women can still walk around, and still feel pressure (but not pain) so they can actively labour and push. As a medical student 30 years ago doing obstetrics, the epidural technique was different and I remember the midwives had to keep their hand on the woman’s abdomen to know when she was contracting so they could tell her to push-that’s completely changed now.

            There are a lot of old wives tales about epidurals (you get long term back pain afterwards, it increases the risk of you getting a section, it slows down labour, its got lots of side effects etc etc) none of which are true and all of which have been debunked again and again. Yes, you need an anesthetist to place them-but any hospital where surgery is carried out will have anesthetists. In the UK, stand alone midwife units can’t offer them (because they don’t have anesthetic staff) but along-side midwife units can (because they are geographically located in the same hospital as the medical led maternity unit). And they don’t tie you to a bed, you can be up and around as you want.

          • BH
            March 18, 2019 at 1:04 am #

            Thanks for there info. Information I’ve read says you can move around on the bed, but usually not be able to walk with an epidural, and even walking epidurals the woman needs to have support and it’s not a guarantee she’ll be able to walk. I’m not anti-epidurals by any means, but had concerns about the risks. how do we make informed decisions without all the facts and who do we believe when there’s this ob-midwife tension going on? Each is saying contradictory things about whats best for mothers and babies and quoting their own research (not just about epidurals but a multitude of things). Mothers are caught in the middle, we just want ourselves and our babies to be as healthy as possible and be not traumatised in the process.

          • Who?
            March 18, 2019 at 4:12 am #

            Not to quibble, but I could not have walked unaided during unmedicated labour, either.

            I’d believe the OB, since they are a doctor with years of training, and the person who will end up stepping in if things don’t go well. Midwives are great-I had shared care and laboured and delivered with midwives, but OBs were around and certainly were critical to safe deliveries for several of my friends.

          • Sarah
            March 18, 2019 at 9:53 am #

            I couldn’t have either. It’s not like labour is this incredibly mobile time across the board. I don’t look back at my forcibly inadequately medicated labour and think about how much walking I could have done if I’d liked.

          • BH
            March 20, 2019 at 6:52 am #

            I couldn’t walk in the middle of contraction, and I wasn’t exactly hiking the corridors. During second stage when I was on the bed it didn’t matter what position i was in the contractions became very weak, barely painful at all, far apart, no urge to push. Once I stood up and walked around the room and that sped things up again, but still took 2 hours of pushing, with a lot of conscious effort and direction from midwife. It was not an uncontrollable urge as some women describe it. This was after a very quick (3.5 hr) first stage. They didn’t mention baby’s position, Dr came in and they were talking about forceps/vacuum or csection and starting to prepare for that.

          • fiftyfifty1
            March 18, 2019 at 9:53 am #

            The book I recommend to my patients is Epidural Without Guilt by Gilbert J. Grant. It reviews all the latest research. Of course you may never need this info because it sounds like your labours tend to be pretty fast and straightforward. Then again, having the info can’t hurt. One of my good friends had straightforward and fast labours with her first 2, with well-positioned babies and manageable levels of pain, and did not choose an epidural with those. But then baby #3 was a totally different ballgame with a very painful and dysfunctional labour. and she was glad to know the latest research about epidurals so she could get one with confidence.

          • Karen in SC
            March 20, 2019 at 10:26 am #

            and it is a free ebook on Kindle last time I checked!

          • mabelcruet
            March 18, 2019 at 4:32 pm #

            The main problem is that the information an expectant mother gets is very dependent on source.

            In the UK, we have a model of midwife-led care-pregnancies are assessed as high risk or low risk with high risk mothers being put into medical consultant led care and low risk streamed into midwife care. There is some degree of flexibility (women can request to be seen by a consultant) but a lot depends on your midwives. Midwives actively steer women away from epidurals; a midwife cannot place an epidural and there is an issue that some midwives consider this unnecessary medicalisation of pregnancy-look at the Royal College of Midwives propaganda- about ‘protecting normal birth’ (not protecting mothers and providing the pain relief they want, protecting the normal birth process as a process. So a woman thinking about an epidural is likely to face a lot of pressure about it, and its reflected in the general ‘see how you go without one first’ approach, or putting women off by telling them they aren’t far enough along for one, and then suddenly, oops! they are too far along to have it done now.

            So if a woman is relying on her midwife to provide information about an epidural, it depends very much on the midwife, and this is where a lot of the misinformation arises (delayed labour, you’re tied to the bed, you’ll have life long back pain etc). It is difficult for a lay person to judge whether the information she is getting is accurate or representative, and I’m afraid that there are certain midwives who use their position and make decisions for the woman rather than let the woman get all sides of the story. The way NHS obstetric care is set up, any woman in the UK who wants to be referred to an obstetrician should be able to, but I have heard of women who struggle to get their voice heard and end up relying on less than accurate advice from those who have a bias.

          • mabelcruet
            March 18, 2019 at 4:43 pm #

            I’m not an obstetrician-I’m a paediatric pathologist and undertake autopsies on babies who are miscarried or stillborn, so I have no side in the arguments about epidurals as they are really nothing to do with me. But I have to say, I’ve seen midwives at times provide extremely biased information and basically frighten women about medical interventions, and demonise medical staff, and its under the umbrella of ‘protecting normal birth’. The Royal College of Midwives has ‘protecting normal birth’ as one of its main aims. Protecting the process of birth, not protecting mothers and babies and not providing mothers with accurate, unbiased, evidence-based information, but protecting the actual process. Having an epidural means that a woman is taken out from midwifery control and that the labour has been ‘medicalised’, even if the baby is still delivered by a midwife. My impression is that this is seen as a ‘failure’. There is a big push in midwifery circles to change the language of birth-there was a paper published a few months ago about changing language (https://www.rcm.org.uk/news-views-and-analysis/news/alternative-language-guide-for-midwives) on the grounds that talking about labour as being painful was frightening for women. My argument was that if a woman experiences labour as painful, to contradict her and say ‘it’s not painful, its a ‘power surge’, is undermining her by dismissing her pain and not acknowledging it.

            So on the whole, a woman is best getting information about specific parts of labour from the person who is responsible for it-so for an epidural, an obstetrician and an anesthetist would be the appropriate people to talk to to get unbiased information.

          • GraceAlexander
            March 19, 2019 at 7:52 pm #

            ‘it’s not painful, its a ‘power surge’ <—THIS. Thank you for pointing this fallacy out!

            In the US, we have doulas and midwives yammering on about how "it's not pain, it's just pressure".

            Yeah, ok, and a car tire rolling directly over your fucking face is just pressure, too. 😀

          • mabelcruet
            March 19, 2019 at 8:18 pm #

            There’s a person called Milli Hill in the UK-she’s a birth hobbyist, not medically or midwifery qualified, but has written a book about ‘positive birth’. She produced a truly nonsensical piece the centred on the ‘fact’ that during a average 8 hours of labour, you were only getting contractions for about 20% of the time. The rest of the time was spent between contractions and so these were painfree periods. So basically, if you had to use pain relief even when you’re only in active labour for less than a quarter of the time, you’re obviously weak, spineless, and couldn’t be called a mother because you haven’t experienced a true birth (I paraphrase, but that’s essentially the thrust of her piece).

            She’s an utter tit.

          • demodocus
            March 20, 2019 at 2:48 pm #

            Power surges can fry your computer’s motherboard.

          • mabelcruet
            March 21, 2019 at 9:29 pm #

            And shred your perineum.

          • demodocus
            March 22, 2019 at 7:55 am #

            You mean that’s not a goal? /s

          • March 22, 2019 at 8:39 am #

            Oh no. Only weak women have perineal damage. All-natural warrior mamas never tear or experience pelvic dysfunction!

          • Inmara
            March 19, 2019 at 10:01 am #

            The same is pretty much going on in my corner of Europe; midwives actively discouraging women of getting epidurals, even if it’s a big hospital and anesthetist is available (unfortunately in smaller regional hospitals anesthetist is kept in place only for surgeries, so an epidural might not be available at all, not to mention that it’s to be covered out of pocket, contrary to all other maternity care). In our prenatal class, midwife bragged about delaying epidural for a woman who had her 3rd birth with said midwife. I was quite appalled when I met the same midwife in my labour ward, but she was not caring for me anyway (and I ended up enduring pain quite well and saving a lot of money). Also I haven’t heard of walking epidurals provided in our hospitals, so it might be very different from country to country.

          • GeorgiaPeach23
            April 9, 2019 at 1:52 am #

            Charging extra for pain relief is appalling. We don’t do that to men who undergo painful processes, do we?

          • BH
            March 20, 2019 at 5:53 am #

            UK system I think is very similar to our public system in Australia where women with low-risk pregnancies are in the midwifery-led care program.

        • Azuran
          March 17, 2019 at 7:43 am #

          And seeing as people who are giving birth are generally in a hospital, there are specialised physician availlable to provide the epidurals. So that is not a valid argument for delaying them any longer than the time it takes for the anesthesist to go to the room as soon as he can.
          As for not walking and peeing. Thats something you discuss with the patient because id bet people generally care a lot less than NCB advocates are pretending . I cared exactly 0% about walking. Getting out of bed had been extremely painfull to me for months because of back and nerve pain and id been living with a near constant need to pee for months.
          Having an epidural and an urinary catheter was bliss. I hadnt been this confortable in over 6 months.
          People should just trust women to be able to advocate for themselves and make their own choice. If you fear epidurals and want to wait, thats you. But if i want it as soon as i walk the hospital door, my choice should be equally respected.

          • The Bofa on the Sofa
            March 17, 2019 at 8:04 am #

            The main reason to walk around and move is for pain relief. With an epidural, you don’t need to do that

          • Tbird
            March 18, 2019 at 5:49 pm #

            Any truth to the claim that you can effectively turn an OP baby in labor simply by walking around, all fours position, etc? My baby was in direct OP position and I pushed for a few hours with no change from +1 position. I also felt no contractions or urge to push with ny epidural. OB tried manual rotation but didn’t work. Head circumference was 15 inches so I’m sure that factors in.

          • March 19, 2019 at 6:26 am #

            Maternal position has no effect on presentation. Whether the baby’s head was well-flexed, so that its smallest diameter is at the pelvis, is much more important. Generally speaking, this is the reason OPs get hung up; cephalopelvic disproportion is relative. Even if this was your first baby, you should not have pushed for more than 2 hours. If the baby’s still only at +1 station, that’s a clear indication for C/S.

          • Tbird
            March 19, 2019 at 11:09 am #

            Interesting! Anyone I talk to that is NCB oriented tells me if I had been upright and changed positions, baby would have flipped. They told me my baby was posterior because I declined during pregnancy. They tell me it’s my “fault” and the position could have been prevented. They told me the epidural caused the problem because they said I probably didn’t push effectively and that most people vaginally deliver a posterior baby with no problems. Doctor was going to let me push for 3 hours but then the baby’s heart rate experienced non reassuring heart tracings and mexonium in fluid. I had the peanut ball for 30 minutes between my legs after pushing for an hour but it didn’t help.

          • Azuran
            March 19, 2019 at 12:49 pm #

            Seriously…..a term babyisnt that mobile that if flips position every time we move. And if it wa that easy, obviously OBs would have noticed and studied it and it would be a widely known medical fact and we would be prescribed specific movememts we had to do.

          • Tbird
            March 19, 2019 at 2:54 pm #

            I agree! I would imagine the shape of the pelvis would have more to do with the way the baby settles in the uterus. Also, I’ve read more than 90% of babies rotate to OA during labor anyway. I’m just guessing I was one of the few unlucky ones that didn’t. Baby was really high up the day I went into labor and not engaged. I had my 39 week appt the day I went into labor. Cervix was super high and closed, not even a finger tip dilated. When I pushed baby would come down a bit and “suck back up” between pushes. I’m guessing baby was hung up somewhere but a NCB told me I didn’t push hard enough. It was always my understanding that even if you didn’t push an unobstructed baby would come out on its own with the contractions after enough time.

          • MaineJen
            March 19, 2019 at 3:03 pm #

            That’s correct…unconscious women can (and do, sadly) give birth without actively pushing. Also, once a baby’s head is ‘engaged’ in the pelvis during labor, I wouldn’t think it could just flip around that easily. Don’t you love how, whenever something doesn’t go according to plan during labor, the NCB types will *always* armchair-quarterback your labor for you??

          • Tbird
            March 19, 2019 at 3:09 pm #

            Exactly!! I developed some PPD following the birth mostly from the way people responded to my birth story. Even my own mother (who was present in the delivery room) remarked that I simply didn’t “push hard enough”. I have to imagine even weak or ineffective pushes would have eventuallly got the baby out after two and a half hours of pushing and 30 minutes of rest halfway through.

            People made me feel awful. Made me feel like it was my fault, that I could have prevented it or corrected it. Told me I got an epidural too soon. I felt horrible especially since my baby ended up in NICU immediately after delivery due to respiratory distress and meconium aspiration. I felt awful because everyone (not my doctor) was telling me it was my faulet. It was the worst way to spend my first few months as a mother.

          • MaineJen
            March 19, 2019 at 3:17 pm #

            Oh man. Fellow PPD sufferer here! I feel for you. One thing the NCB crowd just doesn’t want to accept is that *we don’t have much control over the process at all.* Most of the time it goes fine (which is why you get some women crowing about their glorious, easy births), but sometimes it doesn’t. The important thing is that everyone comes out healthy and whole in the end…and luckily that’s possible nowadays! But birth plan or no birth plan, sometimes shit just happens that we can’t control.

            Also: epidurals are awesome, and there is no such thing as ‘too soon’. You got it when you needed it and it’s nobody’s business!

          • Tbird
            March 19, 2019 at 5:32 pm #

            Exactly!!! Thank you so much! 🙂

          • seenthelight
            March 20, 2019 at 12:12 am #

            No! Ask women the world over who don’t have hospitals to go to for help when their babies get stuck and they both die after days of suffering.

          • fiftyfifty1
            March 20, 2019 at 8:33 am #

            Yes “come down a bit and suck back up” is proof of the baby being hung up on something. Think of the baby’s body and head as 2 different objects attached by a spring which is the neck. During a contraction or a push, the head comes down because it can, but after the contraction/push it springs back up. Of course even a head that is stuck can seem to come down a bit, because the contraction will push the scalp down even if the skull is stuck. A 39 wk first time mother with a head not engaged in the pelvis was the first clue. This is not typical at all. First time mothers typically experience the baby “dropping” into the pelvis a few weeks before term. I’m sure your OB was like “Ruh roh! this probably won’t end well” when s/he saw that your baby hadn’t. A hard closed cervix, fine, this can soften during labor. But a head that for some reason hasn’t engaged in the pelvis? That’s a problem.

          • Tbird
            March 20, 2019 at 11:26 am #

            That’s interesting! What would make the head not engage prior to labor? Too big? Posterior position? My OB didn’t indicate what pod ition baby was in at my last appt (the day I went into labor, several hours after the appt). I’m guessing posterior because I felt a lot of kicks near my belly button. She just noted baby was head down. She has mentioned she thought I probably had “at a least a week and a half to go”.

          • Elizabeth A
            March 20, 2019 at 1:23 pm #

            Reasons for heads not to engage include breach positions, and short or tangled umbilical cords.

            Babies move around rather a lot in utero, so commenting on position at any given moment isn’t particularly useful information.

          • fiftyfifty1
            March 20, 2019 at 1:34 pm #

            Big heads, short cords, wonky pelvis shape, wonky uterus shape (heart shaped etc), malposition, these are all reasons that a baby might not “drop.”

          • Tbird
            March 20, 2019 at 4:47 pm #

            It all makes sense. If only the NCB community could see it…

          • GeorgiaPeach23
            April 9, 2019 at 1:47 am #

            Pretty sure my baby didn’t drop because he prefered to head butt my diaphragm. Also pretty sure he got his stubborn streak from me! Jokes on you, baby, I had scheduled a csection before we found out you were breech.

          • fiftyfifty1
            March 20, 2019 at 6:10 pm #

            “thought I probably had at least a week and a half to go.”

            Yeah, sounds like she hoped that the reason the baby hadn’t dropped on time was that you were just trending late. Turns out that was wishful thinking. (Which as a doctor I can understand! You hope for the best if there isn’t anything you can do to fix something.)

          • Tbird
            March 20, 2019 at 6:14 pm #

            I totally understand! I trust her judgment and there wasn’t anything that could be done, just thankful that c-sections exist for this very reason! She even offered me a vbac for my second kid but when his EFW hit 9 pounds at 37 weeks she suggested the c-section to avoid shoulder dystocia as the abdomen was measuring bigger than the head circumference. Nice and smooth scheduled c-section it was!

          • fiftyfifty1
            March 20, 2019 at 6:17 pm #

            Glad #2 went well. CS is for sure better without hours of pushing first!

          • AnnaPDE
            April 9, 2019 at 7:50 am #

            Getting baby’s head stuck in the pelvis a can’t-go-further position got the trick done for me. He was planned as a “gentle” CS with baby basically emerging mostly by himself etc., but the doctor ended up having to pry him out with forceps.
            Said 99% percentile head is the result of two big-head-producing lineages combining in their full glory, my husband bringing the wide forehead and me adding in the big, round occiput.

          • MelJor
            March 25, 2019 at 10:36 pm #

            For real: I was so sad when they took my catheter out because I spent my whole third trimester and immediate post partum period SO SO thirsty, and I was sick of having to get up (in pain) to pee all the time.

        • Desiree Scorcia
          March 17, 2019 at 3:12 pm #

          My epidural dient restrict my mobility at all. In fact, i was more mobile for it, because i didn’t have any pain to slow me down. So when the nurse told me to get on my left side, then right side, all fours, all fours with my butt in The air, i was there instantly.

          • March 19, 2019 at 6:21 am #

            The epidural of 30 years ago did keep you in bed; no longer.

        • Jazz Let
          March 18, 2019 at 11:25 am #

          I had an epidural to control pain after a hysterectomy, it didnt stop me walking, and I was encouraged to walk around to speed up my recovery.

        • MaineJen
          March 18, 2019 at 2:05 pm #

          During and after my husband’s abdominal surgery, he had an epidural in place for pain control. It even caused a drop in blood pressure during his first surgery, a common complication of epidural anesthesia. Despite this complication, AT NO POINT did anyone suggest that the pain control was not worth the risk, that he might not be in unmanageable pain after all, or that he should just tough it out.

          A man’s need for pain relief is accepted without question; a woman’s need for pain relief is always questioned. Just an observation.

    • Sarah
      March 17, 2019 at 2:36 pm #

      It is necessarily a bad thing if it involves deliberately denying a woman the pain relief she has asked for when she has asked for it. There is great harm in trying other less effective options when she has asked for an epidural.

    • guest
      March 18, 2019 at 11:02 am #

      I asked for an epidural upon arrival in the hospital because my contractions were quickly ramping up and I knew it may take a while before they could administer it. I was managing fine at the time, but didn’t want to have to continue without it. I was told by the nurse I needed to be at 5 cm to get one (I was currently at 4 cm). My response was “I’m not leaving the hospital am I? And you are very busy tonight so it might take a while to get the epidural, right? Then I’d prefer you call whoever you need to right now to get me on the list.” I really don’t know why they were stalling me getting one when my doctor expressly told me multiple times that I could have it whenever I wanted (unfortunately for me she was on vacation at the time). I complained at my 6-week postpartum check-up and it sounded like I wasn’t the first patient this nurse had done this to.

  8. mabelcruet
    March 16, 2019 at 6:57 am #

    I don’t know if the denial of pain relief is a nurse/midwife issue, or if it’s a misogynistic issue. There is a lot of data showing that women in pain from any origin are taken less seriously than male patients in pain-chest pain, for example, there was a study showing that women presenting with chest pain were more likely to be told it was indigestion or another relatively benign cause rather than cardiac. Period pains and endometriosis pains are still not taken seriously and written off as ‘put up with it, what do you expect, you’re a woman, it’s what women get.’

    My only pain relief story was after abdominal surgery, and for various reasons I was admitted to the high dependency unit. I wasn’t on a PCA pump but pain meds had been written up for me. A (female) nurse asked if I was in pain, and when I said yes, and requested pain relief, she said ‘I’ll come back in an hour and see how you’re doing then’. A (male) anaesthetist was in the unit and he intervened and got me pain relief. I’m a large, gobby, confident and educated professional and normally have absolutely no problem speaking up for myself, but being naked in a hospital bed, nauseated, in pain, unable to move, catheterised and dizzy sucks that confidence right out of you. It’s appalling how vulnerable patients are treated sometimes.

    My sister has a severe dislike/phobia of medical things, she doesn’t even like looking at her wrists because she can see veins and it freaks her out. When we were younger I used to poke her in the ribs because she had a wierd fear that my fingers would poke right through, so it was a good way of getting rid of her when she was annoying me. Anyway, she had a fairly traumatic labour and delivery with a lot of tearing that had to be reconstructed under general anaesthesia and she had a significant post partum haemorrhage. She was labelled as a difficult patient by her midwife (they actually wrote that in the notes, in black and white) because she asked why they wanted to take blood and what tests they were going to do-all she wanted was a bit of information. I was there when they came to take blood so I told her it was to check whether she was anaemic or not, that sort of thing, but the nurse didn’t bother finding out, just said ‘so you’re refusing the tests, then?’, which she wasn’t at all. Afterwards, my sister put in a formal complaint (there were a lot of issues with her care), and in the investigation the midwife claimed my sister had been shouting, abusive and rude-all complete lies that she eventually got an apology for.

    • rational thinker
      March 16, 2019 at 9:36 am #

      I have had to deal with this myself. If you are a woman and then add just under thirty they dont believe you on the basis of age and sex. It took me two years of suffering before I could get a Doctor to believe I was in pain. By that point I was extremely depressed and becoming more and more suicidal every day. It is horrible the way women are treated and unethical.

      • mabelcruet
        March 16, 2019 at 4:46 pm #

        There’s a huge body of research looking at sex-based differences with pain-both with pain perception, pain-related distress and emotional upset, and sensitivity to painful stimuli. Men and women react differently, and reactions also vary because of a host of other factors-age, ethnic and cultural issues, psychosocial issues such as being exposed to severe pain in early life, even things like having siblings or parents can impact on how you perceive pain. But even with all this, there is still a definite reluctance to accept a person’s perception of pain as being ‘real’.

        During his terminal illness, my grandfather was in severe unrelenting pain (bone cancer). He was a pragmatic Yorkshire man who had done heavy labour all his life, and he saw pain as something to be embarrassed about. I spoke to his GP (family doctor) who agreed to write him up for pain relief, but the district nurses refused point blank to set up the infusion because when they asked him if he was in pain, he usually said he could cope. I told them to ask ‘how bad is your pain?’ not ‘Are you in pain?’ because that gave him an opening and an ‘excuse’ to say his pain was severe.

        It worries me when there are midwifery pushes to relabel labour pain as ‘surges’ or ‘pressure’. I can see their point of view to some extent in that focusing on pain prior to labour might make the mum anxious or scared, but denying that there is pain involved is equally as bad. And to pretend its not pain, its a ‘power rush’ will undermine her confidence and the therapeutic relationship because she’ll feel lied to, or feel like she couldn’t cope and that getting pain relief for something that she’s being told isn’t pain makes her a failure.

        I know there is a big problem in USA with opioid prescriptions, and its likely to continue (and spread to the UK too), but denying pain relief to someone in genuine pain isn’t fair or just.

        • rational thinker
          March 16, 2019 at 5:47 pm #

          Yes there is a big opioid problem here. I had no history whatsoever of drug abuse but they still just treated me like I was an addict or drug seeking when I went to the er and my regular doctor didnt do any tests on me past a blood test and did not send me to any specialists either. Even years later it upsets me to talk about it. I have had this pain for seven years now but the past 5 years I have been on medication so I wont feel it. I still shocks me how nobody gave a shit they wouldnt even run tests on me. A nurse in the er told me one to”stop crying” and she said “if you were really in pain your heart rate would rise”. I normally have a very low heart rate so in pain it would go up to a normal level and of course she did not believe me that it is normally very low for me. I do think some of it was a power trip and people like that should not be working with patients. Also I was 28 when it started so because of my age most of the older doctors said I was too young for it to be real or something serious.

          • mabelcruet
            March 16, 2019 at 7:32 pm #

            In the UK, some hospitals use a visual pain score indicator-its little cartoon faces with increasingly upset and worried expressions. Point 1 in the scale is perfectly painfree (smiley cheerful emoji face), up to point 10 (worst pain imaginable, crying and red-faced miserable emoji). Matching your patient’s facial expression with the scale faces is supposed to help the nursing staff decide how bad your pain is. I’m not a clinical doctor so I don’t know how much weight is placed on your facial expression in order to prescribe or provide pain relief, but it risks misidentifying those patients who try and cover up their pain for whatever reason.

          • rational thinker
            March 17, 2019 at 8:41 am #

            We have those in the US too. Over here they ask you what number your pain is. I know there is a problem with opiate addiction but they shouldnt make people with no history of drug abuse suffer because of it. After my first year of suffering I was begging them to amputate my legs and They said”you dont mean that” I guess they thought I was a drug seeker and saying anything just to get a presciption. Now that its been years and my pain is under control I am not having pain affect my judgement and I can honestly say I was dead serious that I wanted an amputation.

          • mabelcruet
            March 17, 2019 at 1:37 pm #

            In the UK we can buy codeine over the counter (without a prescription). It’s only available in a low dose-something like 10-12 mg per tablet combined with paracetamol or ibuprofen. A higher dose is only available via prescription. I’ve occasionally had to buy it (I used to get really painful menstrual cramps) but the interrogation you got was unpleasant-the pharmacy won’t sell it to you unless they know what you want it for-this is in front of other customers, not private-and they want to know what other medication you are on and for what (again in front of other customers), and they make you verbally accept that you won’t use it for any more than 3 days and you understand the risk of addiction. Thankfully I’m now menopausal so no more cramps-woohoo! I don’t have to face the pharmacy interrogation any more. I understand that they have to make people aware that there are risks with using certain pain meds, but I’m sure there’s a better way of going about it.

          • Jazz Let
            March 18, 2019 at 11:37 am #

            Pharmacies now have to have private space where they can go through anything you don’t want to discuss in front of other patients. That’s been the case for several years now, so should you or anyone else you know be in that position again ask to speak to the pharmacist privately!

          • mabelcruet
            March 18, 2019 at 5:27 pm #

            Yes, its definitely changed for the better-my local pharmacy does pharmacist consultations and pharmacist prescribing so you can get things like thrush medication without needing a doctors appointment.

          • rational thinker
            March 17, 2019 at 3:58 pm #

            One time I overheard a nurse talking to a patient in the bed next to mine. They were talking about the pain level poster and the nurse said this ” if we ask what your pain level is from one to ten and a patient says ten we know right away they are lying or greatly exagerating because 10 on a pain scale is the equal to having put your hand in a deep fryer with boiling oil”. that pissed me off cause do the patients know that about the pain scale probably not and a lot of people say ten are they all lying? It is good to be cautious about drug use but they should not accuse every patient of it. Thats just how it is over here now.

          • mabelcruet
            March 17, 2019 at 4:36 pm #

            I’ve heard that sort of thing before-anyone saying 9 or 10 is exaggerating and seeking drugs and are faking it for whatever reason. So what? How one person experiences pain is different from another-the pain of renal colic is supposed to be ‘worse’ than that of labour pain. But someone who has had both might say it isn’t. How I experience the pain of gallstones might be different from someone else-I spent 5 hours rocking on my knees on my kitchen floor with the cat looking at me very strangely (I lived alone at the time and couldn’t even reach the phone), and a couple of days later got acute pancreatitis because of obstruction, which quite frankly put the colic pain at the level of a stubbed toe in comparison.

            Pain is such a personal and individual response that its not good medical or good nursing care to try and rank pain, or to compare and contrast with other patients reaction to pain, or to undermine a patient by denying they are in pain. There are people who do seek drugs, who do go round various hospitals to the Emergency dept claiming to have renal colic etc, but in comparison to people with genuine pain, those numbers are small and we shouldn’t provide sub-standard pain relief to patients just because some patients are playing the system.

            That said, there are alternatives to simply medicating someone-other treatment modalities that could be used rather than just higher and higher doses. We need to be investing in that as well as simply throwing pharmacological agents at them. My father had severe lumbosacral pain-he ended up having spinal fusion of several vertebrae. He was on all sorts of medication too. He was an engineer and his company modified his work and his environment-he had a standing desk and it made a huge difference. He was able to go for a walk every hour or so to stretch for a few minutes and those very simple measures by a flexible employer allowed him to stay in work for several more years, and meant he could reduce some of his medication.

          • EmbraceYourInnerCrone
            March 18, 2019 at 1:29 pm #

            This reminds me of a woman, who I think, made up my favorite “realistic” pain scale. I keep forgetting to print it out and bring it to the doctor…


            This was number 10: I am actively being mauled by a bear.

            I feel this should be adopted int he place of the current pain scale, which I have always felt was crap anyway.

            I also found out when I started getting migraines again that being used to chronic pain did me no favors, it just meant that combined with being over 45, overweight and female meant my pain was basically invisible. I spent a year going to work with almost daily migraines before I got someone to prescribe a med specifically for my migraines. And surprise no more migraines.

        • Caylynn, RD, MPH
          March 16, 2019 at 6:02 pm #

          My grandfather was similar. Despite telling us (family members) that he was in a lot of pain, he would never tell the doctors or nurses that he was in pain, and so didn’t receive pain relief, beyond Tylenol, even though he had been prescribed stronger stuff. I mean, he had called my mother onen day, telling her he was in a lot of pain and couldn’t get himself out of bed, but when the paramedics came to get him and bring him to the hospital, he told them he wasn’t in much pain at all.

          With regards to opioids, I’ve had patients in my office, crying because their physicians have reduced their opioids, and they are still in so much pain (I’m a dietitian). I understand that opioid abuse is a huge problem, but denying appropriate pain relief to individuals who truly need pain relief (and who aren’t addicted) seems cruel. I even had one patient, who never abused drugs and never became addicted to opiods, told that her only option was the local methadone program. I’m not a physician, but that didn’t make any sense to me (I was seeing her for type 2 diabetes, not for the issues that caused her pain, which were legitimate).

          I’ve also had other patients on medical marijuana. I’m hoping now that marijuana is legal in Canada, we’ll obtain higher quality research and evidence on its use for a variety of conditions, including some that cause pain. Anecdotally, I’ve had a handful of patients who responded positively to medical marijuana. I really hope we’ll get some better guidance in the future as to what conditions and whom it can truly benefit.

          • rational thinker
            March 16, 2019 at 6:44 pm #

            I dont usually tell anyone this but since you mentioned it I will. After the first 2 years I got a new doctor and he put me on fentanyl patches immediately on the first visit. Not long after I had to cut my hours at work I was only staying for the health insurance at that point. A few months after my job took away my insurance so I left the job. Then I had to pay out of pocket for the doctor and my medication soon I could not pay anymore so I went back to suffering. A little while later a nurse at the hospital told me to go to the methadone clinic and take some kind of opiate pill before the appointment so it would show in my urine. I did have to lie and say I was a drug addict which was degrading because I was not a drug addict, but I didnt care at that point. I have been on methadone for almost 5 years and it helps my pain better than fentanyl did. Also you dont get that high/groggy feeling which I always hated, I dont know why people seek out that feeling I hated feeling that way. So on this medicine my pain is gone and my head is clear and I have gotten my life back and feel like I did before the pain started. I did try weed before the methadone clinic but it did not work and I dont like weed anyway the smell of it makes me vomit. So I think methadone should be looked at further for a type of round the clock pain control. Also after I had been at the clinic for a while I found out that about 30% of the people there were there because of pain not addiction.

        • Jet King
          March 18, 2019 at 11:50 am #

          The opioid crisis has resulted in a lot of doctors being unwilling to prescribe painkillers, even after surgery. In 2010, I had laparoscopic surgery and was given Demerol, which I stopped on my own after a few days as my pain was minimal. Fast forward to 2018 and I had a second surgery due to complications, more invasive and a LOT of pain. But I was given T3s because they’re seen as safer in terms of dependency. Never mind that T3s make me incredibly nauseous and the idea of vomiting after abdominal surgery made me shudder. So I quit the T3s the morning after surgery and coped with the pain. What else are you going to do? But I definitely think the pendulum has swung too far the other way. It seems unlikely to me that a single course of 7-10 days of opioids could result in addiction, so we are denying people adequate pain relief out of fear.

      • Caylynn, RD, MPH
        March 16, 2019 at 5:49 pm #

        Ten years for me. Ten years to be correctly diagnosed. And I was only diagnosed because my family physician sent me to the hospital to rule out appendicitis, because I was in so much pain and was vomiting. Nope, not appendicitis at all. The OB/GYN on call suspected endometriosis, confirmed a few months later through a laparoscopy. But for ten long years, my pain was dismissed or called “normal” despite its impact on my life (I remember having to leave my OAC/Grade 13 biology final exam because I was in SO much pain when writing the exam and being so embarrassed when my teacher came to see me in the nurse’s office).

      • FormerPhysicist
        March 21, 2019 at 9:11 am #

        If I suspect my teenage daughters are developing endometriosis, what do I do? What can I do? Their current doctor is not very responsive to period pain, but did put the older one on hormonal BC (mostly because she’s 17, so the doctor thinks she’s having sex or will shortly, no matter what she says.). It’s not so easy to switch doctors. And we can’t find a gyn that will even look at the 13-year-old. “Nope, we don’t see them that young.” FU. She’s been menstruating and in pain for over 3 years, I think she deserves a specialist.

        • EmbraceYourInnerCrone
          March 21, 2019 at 1:39 pm #

          You can try to see if anyone in your area is offering this – (I think they are still in clinical trials though)


          There is also some good information here; scroll to the bottom of the page for some specific teen aimed links.


        • rational thinker
          March 21, 2019 at 3:10 pm #

          I had friends that started going to a gyn at 13 and one of my sisters went at that age. That is not right that they wont see her. It just seems if you are young and female they think you are to young to have anything wrong with you and thats not right. I think they can check with ultrasound to see if it is endometriosis and the easiest way to get them to do one is to go to the emergency room next time she is in pain. There is a better chance of getting them to do an ultrasound on her if you are in the emergency room.

          • FormerPhysicist
            March 21, 2019 at 4:12 pm #

            I thought I heard that ultrasound can’t see endo. Which is why I’m kind of feeling mama bear.

          • rational thinker
            March 21, 2019 at 4:28 pm #

            My sister had endo for years she had a hysterectomy a couple years ago I will ask her what kind of test they need i will get back to you with that info. She used to go to the er for it alot I think she said ultruasounds were how they found it.

    • Caylynn, RD, MPH
      March 16, 2019 at 5:46 pm #

      This! It took 10 years (yes, 10 years) for me to be diagnosed with endometriosis, because apparently, it’s normal to be completely curled up in the fetal position, unable to function for 2-3 days, every time you have your period.

      I had a hysterectomy last May, and while the surgeon and resident had both ordered IV pain relief for me, the nurse on duty overnight “decided” that I should be able to make do with Tylenol! Needless to say, that didn’t do much for the pain, I couldn’t sleep at all from the pain, and was incredibly nauseous. When the resident visited me in the morning, and I mentioned that I was in a lot of pain, she mentioned that I hadn’t received any of the prescribed pain relief overnight. Well, duh, that’s why I was in pain and why I was nauseous and hadn’t slept.

      I ended up staying an extra night in hospital to get the pain under control. That may not have been needed if the overnight nurse had actually listened to me.

      Thankfully my endometriosis pain, that had become a constant low-level pain, is now completely gone. I realize it can come back if my surgeon didn’t manage to excise all the endometriosis tissue outside of the uterus/ovaries/Fallopian tubes, but it’s incredible not to be in constant, daily pain any longer. And I have a pretty high pain tolerance. I’m the person who, when she fractured her L2 vertebra falling off a horse while jumping, got back on the horse, finished the riding lesson, untacked and groomed the horse afterwards, cleaned the tack, and drove herself home, then got in the tub for a nice soak. It was only when I had problems getting out of the tub after that I thought “hmm, maybe I should get this checked out?” When the doctor told me I had fractured a vertebra, I didn’t believe him, because I didn’t think I was THAT hurt.

      • mabelcruet
        March 18, 2019 at 5:01 pm #

        Thankfully I’ve never suffered from endometriosis-its an awful disease. We very occasionally get specimens in the pathology lab from women with endometriosis, the glandular tissue from the endometrium can ‘seed’ around the abdominal cavity and stick onto the outside walls of the bowel, and then that can scar and fibrose up and the bowel then gets narrowed causing horrible problems.

        There’s also the very weird condition of catamenial pneumothorax-the endometrial glands end up at the pleural surfaces of the lungs and that makes your lung collapse. I can sort of see why it can sometimes take forever to get diagnosed with endometriosis-the symptoms can be bizarre and so distant from the uterus that the diagnostic connection isn’t made. But it really should be well up the list of differential diagnoses in females of menstruating age with odd symptoms.

  9. March 15, 2019 at 3:07 pm #

    I’m recovering from a hellish few days where the diagnosis I got on Sunday early morning for a gallstone attack ended with surgery on Wednesday morning where the surgeon discovered that my gallbladder was gangrenous. Apparently most people get fevers when that happens. Not me….

    A couple of thoughts about pain control:

    1) Obs, pain control couldn’t happen immediately after I made it into the ER until a physical exam was done – but everyone on my medical team worked hard and fast to do said exam and get painkillers into me.

    2) I was hospitalized from Tuesday night through mid-day Thursday. At no time did anyone hand me a newborn to care for. I did not see or hear any newborns on the med-surg ward I was on so I’m going to assume that care of newborns is not ordered for patients there. (Therapy dogs did show up once; that was nice)

    3) At no time did anyone seem worried that my inability to care for my toddler was going to harm our bonding. No one recommended we room him in with me. (Spawn was being spoiled rotten by my parents – so that worked out fine.)

    4) My wishes about pain control were respected. Opioids make me anxious and very paranoid if I’m on them for more than 24 hours while toradol did far better at minimizing the pain without making me feel like a lunatic. I had some breakthrough pain the night after my surgery and my bedside nurse did a great job of contacting the surgery team to add an order for Norco since the current orders were either Tylenol or morphine. Turned out that Tylenol did the trick for me – but knowing that there were other options if I needed it felt good.

    I am very pleased at how well everything went – but it’s sad that some medical professionals are denying women pain medication because they are giving birth instead of having an infected internal organ.

    • yentavegan
      March 15, 2019 at 3:09 pm #

      Refuah Shlayma..a swift and full healing

    • demodocus
      March 15, 2019 at 4:40 pm #

      Oh man, glad you’re recovering!

    • StephanieJR
      March 15, 2019 at 5:53 pm #

      Yeesh, glad you’re doing better. And seeing doggies is always nice.

    • mabelcruet
      March 16, 2019 at 7:03 am #

      A gangrenous gallbladder sounds utterly manky! Hope you’re feeling better soon

      • March 17, 2019 at 7:08 pm #

        It’s pretty gross – but I think it’ll make a great grunge rock band name….

        • mabelcruet
          March 19, 2019 at 6:06 pm #

          We get a lot of really manky appendix specimens in the lab-typical acute appendicitis mostly in kids. Some of these are so inflamed, and completely necrotic and dead (poor kids must have been in agony) that I use the term gangrenous appendicitis sometimes. One of my surgical colleagues told me that he’d shown the pathology report to a patient (early teenage boy) and he was so excited he had had gangrene that he asked for a copy of the report to take home and show his friends. Kids are weird.

          • GeorgiaPeach23
            April 9, 2019 at 2:17 am #

            I was one of those kids and it was indeed intense agony. My parents downplayed it to the point that when we got to the ER, I had emergency surgery during which the organ ruptured upon removal. I held it against my parents for many, many years.

    • rational thinker
      March 17, 2019 at 8:42 am #

      I hope you are feeling better, get well soon!

    • mabelcruet
      March 17, 2019 at 4:44 pm #

      Did you get to keep your gallstones? Mine went missing in theatre-they’d been put in a little pot and then vanished.

      My gallbladder went to the pathology lab where I was working as a consultant at the time. When I got back to work I looked up the report, and all it said was ‘histology confirms the presence of cholecystitis and cholelithiasis’. I was very put out-one line of description did NOT cover rocking on my knees for 5 hours on the kitchen floor unable to reach the phone, then getting acute pancreatitis and then going yellow. I was expecting something like ‘OMG, this patient must have been in absolute agony-this is a horribly inflamed and diseased gall bag’. Something more descriptive than just ‘yeah, you had a stone’.

      In the department where I started my pathology training, the professor kept his gallbladder on his desk (in a pot of formalin) and used it as a paperweight. He was a bit odd…

      • March 17, 2019 at 7:07 pm #

        I did not. The residents had a quirky habit of starting to have a consultation with me while I was still waking up from my cat-naps before the surgery so I just plain forgot to ask if I could see or keep the stones. I’m thinking mine were fairly small since they had not been visible on a CT ~6 weeks earlier when I had a similar attack that cleared after an injection of toradol.

        It took me a few tries to get an explanation of how someone gets a gangrenous gallbladder in the first place after surgery. Pretty much, I refused to let the resident remove my drain until he explain a hypothetical way for it to happen or two…

    • Amazed
      March 20, 2019 at 7:01 am #

      Wow! It sucks to get gallstone attacks but I’m happy you’re better now.

    • PeggySue
      March 21, 2019 at 2:16 pm #

      This sounds absolutely awful. I’m so sorry. Hoping for fast and full recovery.

  10. The Bofa on the Sofa
    March 15, 2019 at 2:49 pm #

    Yeah, there’s a pretty simple test to see if you are serious about ending obstetric violence: How do you feel about women who want an MRCS?

    If your answer is anything but “It’s not my business” then I know right off that you aren’t serious.

  11. mom of three
    March 15, 2019 at 2:26 pm #

    Thank you for this. I’ve read every single text you posted for the past five years and this has been the best by far: a precise description of the ugly side of obstetric care and hospital deliveries.

    I’ve been denied an epidural twice during a hospital delivery (it was delayed until they pretended it would be too late for it). I was screaming in endless and excruciating pain while my so called care providers stood beside my bed, listened to the radio and chatted about random stuff. The lack of compassion and care were traumatic. It felt like nothing about me, my dignity, my feelings and my body mattered. My “healing birth” was not at home with candles and toddlers but in a different hospital: planned induction at 39 weeks, epidural, an amazing doctor who was nothing but kind and caring.

    • Cartman36
      March 15, 2019 at 2:51 pm #

      Wow! was this in the US?

      • mom of three
        March 15, 2019 at 3:14 pm #

        No, in Germany, a country well known for its excellent health care.

        • March 16, 2019 at 9:30 am #

          But also a country rather enamored of “the natural,” isn’t it?

          • mom of three
            March 16, 2019 at 2:20 pm #

            It appears to be.. Especially when it comes to pregnancy, birth and children’s healthcare.

          • mabelcruet
            March 16, 2019 at 4:53 pm #

            Isn’t homeopathy still very popular in Germany? It’s where it was invented-Samuel Hahnemann was a German physician who discovered people will believe in any old nonsense as long as its wrapped up in a flowery pseudo-scientific glamour.

          • mom of three
            March 17, 2019 at 2:28 am #

            It is extremely popular even though there is zero scientific evidence to support the use of it. I was offered homeopathic pills in the hospital for post labour pains and during delivery instead of an epidural. Most parents use it for their children and pets. Doctors offer it because they are afraid to lose clients. We give our children candy instead when they are sick as it is less expensive ;-).

          • mabelcruet
            March 17, 2019 at 4:57 pm #

            In the UK, we have Professor Edzard Ernst-he was professor of complementary medicine at Exeter medical school (which produces proper medical doctors). When he was appointed, the alternative medical practitioners (homeopaths, crystal healers and so on) were all crowing about how wonderful that they were being taken seriously and that proved how their specialities were scientifically validated and proven. They thought he would be their champion.

            Except he’s done the exact opposite-he basically debunks all the crap and the quacks by subjecting their work to proper review, treating it the same way as standard medical research is treated-all evidence based, statistical analysis, assessing methodology and so on. When something works, he says it works-so there are some ‘alternative’ treatments where there is proof of efficacy (like acupuncture for muscular pain, aromatherapy specifically as part of palliative care). But for 95% of it, there’s no evidence of efficacy and he’s very happy saying that, so all the alternative practitioners were up in arms about him.

  12. demodocus
    March 15, 2019 at 1:45 pm #

    How is it “violence” for the attendant to cut the cord? Lots of cultures don’t even let men anywhere near the laboring mother.

    • Azuran
      March 15, 2019 at 2:12 pm #

      Seriously, what a weird and pointless thing go get stuck on. I have no idea who cut the cord on my baby (father declined, because he didn’t feel comfortable doing it and was overwhelmed about suddenly being a father)
      I also have no idea who any of the people who were at the birth, and cared for me the next 4 days, are. I have no idea what their names are and I would never recognize their face. I don’t even know who did my c-section.
      Every single one of those people have actually personally introduced themselves to me, my SO and my Mom as soon as they stepped into my room, telling me their name, their job and what they were here to do. I just didn’t bother remembering any of them because seriously, why cares who cut the cord, and who wiped the baby.

      Same with the mom not knowing what medication she was given: what would that have changed? Over 95% of people will have no idea what the drug is anyway, it’s really superfluous information that a laboring woman screaming her lungs out is very unlikely to seriously care about.

      • demodocus
        March 15, 2019 at 4:46 pm #

        Yeah, the only person whose name I remember now is my own ob, who was on duty for Girlbard. He had to scramble across town, though, and for a town with so many straight streets, the phrase “you can’t there from here” really applies.

      • mabelcruet
        March 16, 2019 at 7:06 am #

        But this is probably one of those women who think about ‘their’ birth every day, who blog about it, who endlessly relive every second of their performance, because obviously, the actual birth is more important than the end product.

    • rational thinker
      March 15, 2019 at 3:24 pm #

      She is probably a lotus birth proponent.

  13. MaineJen
    March 15, 2019 at 1:06 pm #

    This. 100% this. The main reason I didn’t want a midwife-led birth was that I didn’t want anyone talking me out of getting pain relief.

    • Spamamander ctrl-alt-right-del
      March 15, 2019 at 6:32 pm #

      My CNM was awesome about chasing down the anesthetist when I finally broke down and asked for an epidural. She made it clear that there was NO shame in needing a break, and I took a nice nap. But I know not all midwives are like that- many take minimal intervention too far.

      • Sarah
        March 17, 2019 at 2:42 pm #

        This is the problem. They range from the wonderful to the appalling, and everything inbetween.

  14. rational thinker
    March 15, 2019 at 12:22 pm #

    First do no harm. Doing nothing IS doing harm.

  15. yentavegan
    March 15, 2019 at 11:28 am #

    There is nothing helpful about closing healthy newborn nurseries. I had my last baby by c/sec and they left her alone with me against my better wishes. It was not a pleasant nor restful experience.

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