To Epidural Or Not To...
I read an article called The Truth About Epidurals by Melinda Wenner Moyer on the Washington Post Social Reader through Facebook and of course I can't help but comment. If you haven't read the article you can find it here.
The article itself appears to be this mothers justification of her choice and right to choose an epidural as pain management during her labor and delivery. Stuck between a rock; those who warn against epidurals, and a hard place; those who tout their safety, she seeks out scientific research to help in making the decision; to epidural or not to epidural.
As Moyer finds, scientific studies tend to be flawed and in this instance the inability to control the test group by either forcing or denying epidural anesthetics becomes an unethical dilemma and obstacle. The human condition and its instances such as birthing a child vary widely and as such conclusive yes or no answers are almost impossible to find. This is only the beginning of choices a mother will make for the health and well being of herself and her child and judging by Moyer's article it seems as if she initially desired the comfort the epidural can bring to labor but was made to feel judged by that decision and thus proceeded to research.
When you are a first time mom you have no idea of what to expect. You have a whole host of choices to make with no previous experience to help make those decisions. Every aspect of labor and delivery is new to the first time mom from the very first pang of a contraction. Sometimes as I found out even the doctors do not know what they are doing.
April 1st 2009, the morning of my last in office pre-natal appointment with my ob/gyn I was pretty sure I was having contractions. After checking me my doctor told me there was no way I was in labor because my son's head was still way too high. I had a feeling something was wrong and that she was wrong and we would find out four months later why his head never descended. I arrived at the hospital around 2am, now April 2nd at 5 centimeters dilated and at around 4am I received my epidural.
At the time I did not necessarily need the epidural as I was coping well with the pain but I had a feeling deep down that something was wrong and that my labor would end with a c-section. I liked the anaesthesiologist and figured since I was comfortable with him I would be better off getting it sooner than later after a shift change. Being heavily tattooed most people think I eat needles for breakfast. Not so. I am actually very afraid of needles. But I will say getting the epidural was relatively painless for having a giant needle put into my back and the pain of labor almost immediately disappeared.
Moyer goes on to dissect the reasons why some might take an anti-epidural stance. One such issue is that having the epidural impedes a woman's ability to push the baby out and she goes on to say that "the women who had the epidurals were equally as able to lift their knees, wiggle their toes, and walk as those who had no additional meds." Unfortunately this statement is a bit deceiving. What the anaesthesiologist insert into the epidural spinal cavity is lovingly referred to as a "walking epidural." However by this point you are most likely hooked up to an IV as well as fetal and maternal monitors. This is not just an "argument" "proponents of natural childbirth might make" but standard hospital procedure you can expect.
After receiving my epidural I decided I was still going to be able to get up out of bed and go to the bathroom on my own. I unhooked my monitors. Grabbed my IV. Headed to the bathroom. And sat there unable to do or feel anything. The entire nursing staff came rushing into my room thinking something terrible had happened. I was told that although I had a "walking epidural" that I wasn't actually allowed out of the bed. I was then given a catheter.
Moyer continues on to the theory that epidurals contribute to the rising rate of Cesarean sections being preformed in hospitals today. Here I believe that we are on the same page in thinking the problem is not necessarily rooted in the use of epidurals but in the rising rates of inductions taking place. Many women are not allowed to even get to "full term" let alone the point in which they naturally begin the labor process and quite frankly pitocin is nasty stuff. Doctors like to tell you it is no different than the bodies naturally producing oxytocin but this is a ridiculous fallacy. Induction methods all lead to pitocin. Which brings you to the epidural. Which in 50% of woman leads you straight into the operating room. Pitocin is derived from animal hormones. Is synthetic. And works to speed up your labor by creating unnaturally stronger and longer contractions.
The doctor arrived around 11 am on April 2nd to check my progress. At this point I was only 6 centimeter dilated. The epidural had effectively stopped my labor. She proceeded to break my water and began the pitocin. Towards the early evening I was receiving pitocin every 10 minutes or so at a dose which the machine needed an override to give. At around 9pm and 9 centimeters dilated the doctor decided to shut off the epidural.
As it turns out I happen to metabolize very, very quickly and in about 30 minutes I was not only experiencing the full pain of labor without the benefit of slowly and naturally progressing into such a state but I was pumped full of a drug which made it much, much more painful than any natural labor. I know this because my second son was born naturally, without any medication.
While commenting on a trial done in Mexico, Moyer writes that "unsurprisingly, 100 percent of the women who had no drugs described their labors as 'very painful,' compared with just 9 percent of the women with epidurals." I think that the word Labor pretty much sums it up here. Labor is a hard, painful experience. It is an time in which you reach your breaking point and then push past it to see not only what your made of but to reach the other side. It hurts and it sucks. But when the moment finally comes to push that baby out it is the most amazing experience I think life can offer a woman. I wonder how many of those unmedicated women described their "very painful" labors with a smile on their face.
In both births where my unmedicated baby was able to nurse immediately and my highly medicated c-section baby had to wait upwards of 60-90 minutes before nursing both were able to establish healthy exclusive breastfeeding. There was a remarkable difference in my boys post delivery. My natural baby came out awake and alert. My c-section baby slept for 12 hours after delivery and I worried about whether I should have woken him up to nurse in that time.
What I appreciate about The Truth About Epidurals is that Moyer's ultimate message is to research your options, decide what your goals are and what you are comfortable with and then make those important decisions. What disturbs me is what seems like a need to justify those choices to others and her use of lackluster science to do that. As you may already know science and I don't mix well.
As a woman who has experienced both kinds of births I can say that I am neither for nor against the use of epidurals. Natural labor is the hardest work you could ever do in your life and the epidural was developed for a reason. There is no shame in using it or wanting it and no one should judge you for having it. But having had a natural birth and knowing what that feels like, I would love nothing more than for every woman to be able to have that experience if they want it. Often there are women who desire a natural birth but are either unprepared for one or in the case of my first delivery essentially laughed at. The statement Moyer's makes that "anesthesiologists have published books about why women should embrace epidurals, arguing that they might even be beneficial because they reduce the baby’s exposure to labor-pain-induced stress hormones," is to me the most bothersome part of the article. It not only sounds absurd but dangerous to perpetuate that notion.
Women have been birthing babies. Without medication. Naturally. For thousands of years. It is what we were made to do. To say that the epidural is more beneficial because it protects a baby from the mothers stress hormones is like saying genetically modified food is better for you because the chemicals kill the bugs that might otherwise destroy the crops.
For me I found more negative judgment placed on my lack of petition for an epidural and exacerbation at my choice to actually go through with a natural birth. Until, that is, it was over and I had done it. What we need to do as women is to make educated decisions and to support each other in those choices. If the pain is too much for you. Go ahead and get the epidural. If you don't want the epidural. Don't let anyone push you into having one. We are the lucky ones who get to choose. Who have the option. If you are preparing for the birth of your first child the best advice I can give is to talk to other moms. Those who have gone before you. As many as you can. Listen to their stories. Ask questions. There are many things within a birth which are typical or common practice and then there are the things you can never be prepared for like in our case craniosynostosis. But speaking with other moms with an open heart will better prepare you than any clinical trial or scientific study can.
In short I hope Moyer had the birth she dreamed of and that you and every woman gets to have the same.