It's Not About Epidurals; It's About Support
A study was released last week that claims laboring women who opt for an epidural to relieve pain are less likely to end up with pelvic floor damage. The news was met with mixed reviews. In fact, the news was delivered in a variety of ways, from the informative to the judgment laden. At the very least, the study got people talking.
The study says that epidural usage may reduce the amount or frequency of pelvic floor damage. According to their findings, such damage can eventually lead to the collapse of pelvic floor organs (called pelvic organ prolapse) and incontinence. They took photos of the mother’s pelvic floor before delivery and three to four months afterward. The numbers favor the epidural.
Of the 488 women in the study, published last week in the British Journal of Obstetrics and Gynaecology, about 13 per cent experienced “avulsion,” or tearing, of their “levator,” or pelvic floor muscles. Women who had had an epidural had a lower incidence of tearing. A forceps delivery was associated with the greatest risk of injury.
Of course, the numbers are the bigger issue for some. 488 is hardly a large sampling of laboring women. The study is being called out for that fact in the comments of most posts on the Web right now. With such a small sample, I don't know if I believe the results either. Maybe they couldn't find more women who wanted to have their pelvic flood photographed while a) at their heaviest and b) again shortly after the process of pushing head, shoulders and body of their baby out. Personally, I'd like to see a bigger sampling as well as a study that talks about different positions for laboring and pushing than just your typical in bed stuff.
In the case of “levator microtrauma,” there is absolutely no data whatsoever linking the author’s definition of microtrauma to pelvic organ prolapse or other important pelvic floor problems such as incontinence or sexual dysfunction. The aforementioned corporate-sponsored researcher showed in an earlier study that macrotrauma (aka levator avulsion) is an appropriate surrogate for pelvic organ prolapse, but remember that epidurals were not associated with macrotrauma in this study. Forceps deliveries were – and what’s the major modifiable risk factor for forceps delivery? Epidurals!
Interestingly, the senior author of the study replied to MidwifeAmy’s post. A slew of comments, which at times get heated, followed. That heated slew of comments is actually my biggest problem with this study: lack of support for mothers by mothers.
I’ll be honest. I had an epidural when I was induced with my oldest son. For the nosy: My kidney shut down due to chronic unilateral hydronephrosis, and it was either induce or we both die. Easy choice, very difficult labor. (Pitocin = death.) Despite the fact that my induction was medically necessary, I got flack for accepting the induction. I then got flack because I went the epidural route after hours of various positions and attempts to handle the pain on my own. For each thing that went wrong, I got flack. Nevermind the fact that I was just trying to bring my son into the world with the flawed body that I was given. Nevermind the fact that I didn’t want the induction or the epidural. Nevermind the fact that my kidney had simply given up on me, a result of a birth defect not discovered until my previous pregnancy during which I had two surgeries. It was all my fault. And I was a birthing failure.
That’s what Todaysparent suggested with this gem of a tweet.
Gave in? Burn.
Shortly after my tumultuous birthing experience that resulted in a happy, healthy mom and baby, a dear friend of mine delivered her similarly sized seven and a half pounder. Like us, they were both happy and healthy. Unlike me, my friend had made it through her natural birthing plans. Know what she experienced? Nasty comments and flack from nurses, doctors and family members.
You’re apparently damned if you do, damned if you don’t and, really, you can’t carry the kid forever. What's a mom to do?
I "gave in." I couldn’t hack it. Fine. Call me a wimp. But before you do, simply don’t. And before you call my friend a dirty hippie who cares more about nature than her baby (no, really, I wish I was making that up), you should probably shut your face, too. If you want more women to experience epidural free births, don’t be an ass about it but don’t sugarcoat it either. Present women with the facts and, here’s the kicker, offer your support.
In fact, I think the best way that mothers can encourage others to experience their best possible birth is by sharing their stories. Over at The Connected Mom, a brilliant post titled, "Signs I Missed That My Practitioner Would Not Support a Natural Birth," can really clue mothers in about some things they might not realize they're missing. Reading up on alternatives like hypnotherapy could help moms, but so can researching the risks of epidurals. But if a mom friend knows you're willing to help her through labor and still support her if she chooses an intervention that you might not have, she'll be more likely to pay attention when you're talking about natural birth.
When it comes down to it, however, I'd love to see mothers supporting mothers after the baby is born. A little less arguing about something that is already over and done with and a little more lifting up during the crazy journey of parenthood might do us all a little good. Then again, what would we have to argue about on the Internet?
Other posts about epidural controversy:
- Whole Woman Village Post further dissects the recent study with some great resources. A must read for more information on the topic.
- The blog at Glamour covered the news, and the writer said she’s going to get an epidural. Comment responses varied.
- Another pro-epi post at The Stir conjured up 55 comments of varying (and often unnecessary) hostility.
- The Juggling Matriarch gives a list of other ways to save your pelvic floor in a post with a supportive, encouraging tone. Basically? Do your kegels, ladies!
What are your thoughts on this recent study? Did you have an epidural? Did you go all natural? Did you receive unsolicited, unsupportive comments for either choice? Talk to us about your experience.