Sunday, May 3, 2015


I heard secondhand that there was recently a big argument online about epidurals. My understanding is that women who were pro-epidural were piling on women who expressed misgivings about them. I didn't read it, but it got me to thinking about epidurals.

I have never had an epidural, but because of my labor history, I have never felt like I should take a side in the argument. Due to the nature of precipitous labor, epidurals are not really a reasonable option. I suppose I could have had one the two times I was induced, but it seems silly to stick a needle in my back to avoid an hour's worth of pain. I did have a dose of the narcotic Stadol when Grace was born. I despised it. It only made me incoherent and unable to cope with the pain. And that's my entire experience of pain relief during labor.

I watch these arguments unfold feeling like I do not have a right to voice an opinion. I feel like my experience is so outside the norm that my opinion would only cause eyerolling or resentment because, really, one hour labors aren't that bad. It is an unexpected tidal wave that crashes on you all at once, but then it's done.

I am inclined to say that I would never have an epidural. I don't generally take medicine when sick anyway. I suffer through head colds and fever and headaches and rarely take anything for it. This is just my nature to think it isn't so bad, that it is almost over, that if I go to sleep it will be better when I wake up. It isn't any long-developed character trait in which to take pride. As I type this I remember that as I get older, I have taken more ibuprofen for fever than I used to because I ache when feverish now whereas I never did before. Knowing this stubbornness about myself and apparent high tolerance for pain, I want to say that if my labors were of average lengths, I still would not get an epidural. The truth is that I have no idea what I would do if labor lasted for eight hours.

I have mulled on it for awhile and I have figured out why the topic of epidurals irritates me. The reason I get annoyed with the blase approach to epidurals is two-fold. First, they are not risk-free endeavors, but they are often presented as the no-brainer response to labor. 'Why would you want to feel pain when you could avoid it?' is the argument. But epidurals have drawbacks as well as benefits. There are complications, side effects, and unintended consequences from an epidural. Sometimes the benefit far outweighs the risk (hello, c-section) and sometimes the risk isn't worth the benefit (a one hour labor). I am not going to list all the possible reasons one might want or need an epidural, but they exist, there are many, and it is a blessing to have this kind of pain relief available. But to decline an epidural does not mean that one is a glutton for pain. It could mean only that for any particular woman, the benefit is not worth the risk.

The second and major reason I get irritated with overwrought discussions about epidurals is that American hospitals are run with epidurals being the default treatment for labor. The standard hospital procedures for childbirth in America require that women give birth in the most painful positions possible. Women are immobilized and strapped to machines for "safety." Safety from liability, mostly. They are poked and prodded and subjected to painful exams which serve little purpose except to satisfy the curiosity of the doctors and nurses. Women are routinely starved for hours at a time on the very slight chance they will need general anesthesia. They have their bag of waters habitually ruptured artificially to "speed things up" which dials up the pain level exponentially. Who is in such a rush besides the medical team? I suspect most people would prefer a longer, less painful labor for themselves if it was explained that the presence of an intact bag is a significant cushion to the pain. Women are put into bed on their backs where they have to fight against all the laws of gravity in order to deliver, but the doctor has a convenient chair and easy view. They are habitually cut to mitigate the problems borne of the ridiculous, yet expected birth position, and have to deal with the consequent stitches for weeks. 

Every coping technique and mechanism is routinely stripped away from women at their most vulnerable time and then the hospital asks, "Do you want an epidural?" Only the most stubborn decline. Childbirth should not require such stubbornness in order to have access to more humane birthing practices. We accept all the fallout and complications from epidurals as a normal consequence of childbirth, but it really isn't. We have a culture that fears birth in large part due to the conditions we are subject to while giving birth, but we don't recognize that the conditions can be changed.

I have had conversations, in the past, with women from Europe who thought the childbirth scenes in American movies were a joke. Nobody could possibly think the practices depicted were a good idea. Surely, it didn't happen that way in real life. They were gobsmacked when I explained that, while the movies were dramatized and somewhat absurd, the shell of the procedures were the same: the positions, the counting, the confinement in bed.

So while a skirmish in the Mommy Wars consists of one group of women declaring their superiority in their all natural childbirths, another group of women accusing the first group of being masochists and perhaps insane, and the rest of us trying to find our ways through the happy middle of those ideas, the medical community skates along mostly unnoticed in their culpability for creating conditions where such drastic pain relief is almost always required.

Childbirth is painful. There are not many ways around that basic fact. If hospital procedures were more humane, childbirth would still hurt. There still would be a need for epidurals and pain relief in many cases. The use of pain relief is not a failure on the part of the woman. But what could change is the cultural expectation, borne of fear from real experiences, that childbirth is so excruciating that the only reasonable response is to be numb from the waist down. 


Elizabeth said...

I actually had an epidural for the first time ever with my fourth L&D back in February. I have a few friends who have had epidurals and absolutely loved them. I was not impressed by mine. It really didn't work that well, and for all the trouble it causes (staying in bed, being catheterized, slowing things down), I would say it was not worth it. I opted for it only because my labor was an all-nighter, and I'd been given pitocin to try to get my contractions to become stronger and more regular. Being exhausted in the middle of the night left me more afraid of the pain than I've ever been before. Having decent nursing care that helps keep you moving and managing pain is really important, and nearly impossible to find in a hospital setting. It shouldn't be that way.

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