There was a fascinating post on Nursing Birth today about the giving and taking of informed consent for anesthesia (epidurals, etc.) for labor and birth. Already, there is a very eye-opening discussion brewing among her readers.

I really liked the way the author, who is an anonymous practicing labor and delivery nurse, is willing to really talk about epidurals. It can be tempting to gloss over the impressive pain relief that an effective epidural can provide. But if we do this, then any discussion of alternatives to complete numbness can seem to some that we're just telling women to needlessly suffer. We need to tell women they can have pain without suffering, and that doing so may help them meet some very significant needs.

It is OK for women to need

• a chance to feel every ounce of her urge to push. It might be exactly the force that is needed to get her baby out, in which case numbing this intense energy means she won't be able to birth her baby without help (which may come in the form of an episiotomy, a vacuum or forceps extraction, or even a c-section).
• to safely avoid infrequent or rare (but still possible) side effects. If she's the one - in a hundred, or a thousand, or a million - who experiences the side effect, she is the one who experiences the consequences, too. In addition to injury or illness, these consequences include the increased possibility that she and her baby will have to spend some number of moments, hours, or days apart after the awesome journey they have just taken together - birth. Time that they could have spent together.
• the ability to physically feel her baby be born and to experience her birth as her own power and strength. Women can and do draw on this power when they face challenges in parenting, relationships, work, physical endeavors, and society. Perhaps all women shouldn't take the decision to trade that lightly.

People will argue (each side citing evidence) about whether and how much epidurals can result in harm. In the meantime, we have impressive research on the safety and benefits - both physical and emotional - of the kind of birth where a woman, soaking in the strength, confidence and trust of the circle of people helping her, moves and sways and groans and grunts and curses and breathes her baby out, and experiences a hormonal state that she will never again achieve until the next time she gives birth.

Our culture's image of a woman giving birth without pain drugs is one where that woman is suffering, "behaving badly", and feeling desperately out of control - not a woman who is powerful and ecstatic. As long as this is the case, women will want their epidurals and they should be supported in getting them. In our system, too often laboring without an epidural is suffering, because the woman can't move around as much as her body needs to, and she can't eat or drink, and she has an IV in her arm and two monitor belts around her waist, and there are strangers present, and not enough of them know how to really meet her where she is with the intensity and pain and help her through it.

I think many people see epidurals as a means to an end. We have focused quite a bit on the means - touting how well breathing a certain way, soaking in a jacuzzi, or self-hypnosis "works". Now I think we should begin also focusing on the "end" - the prevention of safely avoidable injury and so many other benefits, some of which are frustratingly intangible, even to those of us who have experienced them.

Published: May 04, 2009

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