William Camann, MD

With the Lamaze/ICEA Joint Conference a little more than three weeks away, final details are well underway to make sure this joint conference offers something for everyone who attends. And if for some reason, you are unable to join the conference in person, there is a Virtual Conference option for some of the sessions. Today on Science & Sensibility, we meet Dr. William Camann, Director of Obstetric Anesthesia, Brigham and Women's Hospital, author and researcher. Learn more about Dr. Camann and hear some of his thoughts today on the blog. Then plan on attending Dr. Camann's plenary session - "What Does the Informed Childbirth Educator Need to Know About Labor Pain Relief in 2015?" at the Lamaze/ICEA 2015 Joint Conference in Las Vegas, NV next month.

Sharon Muza: What is the role of the childbirth educator in helping families to understand their childbirth pain relief options as they prepare for labor?

William Camann, MD: One of the things I often say is that "the most predictable thing about labor is that it is unpredictable". The childbirth educator plays a critical role in properly preparing women and their partners for labor and birth. But the educator is also up against the reality of our electronic age. Much information is available online, and many women utilize these electronic resources as an adjunct to, or even in place of, traditional classes. Openness to all options, realization that things may change as labor begins and progresses, and an understanding of why some common medical procedures and interventions are done, is critical.

The educator needs to be realistic and unbiased and not try to place their own thoughts/feelings/agendas onto the woman and her partner. Just as the woman and her partner need to go into labor with an open mind, likewise those who teach childbirth education must approach the task with all options open. It can indeed be a very tricky interaction. Some do it better than others. Another important thing is for the educator to be aware of particular practices at local hospitals. Not all hospitals do things exactly the same way. Being aware of local practice patterns and preferences can assist with proper preparation of the women for what they can expect. Hopefully conferences like this one will assist with sharing of valuable ideas for all of us to make ourselves better educators.

SM: What are some of the common misconceptions that parents and/or childbirth educators have about epidurals?

WC: Many parents have heard that epidurals:

1. don't work
2. are dangerous, to both mother and baby
3. cause back pain
4. cause headaches
5. contribute to unnecessary cesarean deliveries
6. make it impossible to push the baby out
7. you have to be a certain number of centimeters dilated to get an epidural and if labor has progressed very far, it may be "too late" to get an epidural
8. are not needed in most labors
9. can result in paralysis

All of these concepts need to be discussed in proper context. There is very comprehensive research behind each of these concepts, but it is complex, and sometimes conflicting and confusing. This is where a good, insightful, informed and realistic childbirth educator can be so helpful.

A related misconception is that some, perhaps many, women feel that they do not need to attend childbirth classes if they are planning to have an epidural. Not true!

SM: How have labor pain relief options changed in the past 10 years? What is new and exciting?

WC: The most significant changes have been with regard to the technology and medications used in epidurals. "Low-dose" epidurals with ability to maintain movement, and "patient-controlled" epidurals which give a large degree of control back to the patient, are now very commonly used in most labor units. Small changes in needle and catheter design, and drug delivery systems, have made these techniques more effective, with even lower doses of medications, resulting in fewer side effects. Likewise, technological advances allow for increased flexibility and comfort in how the actual epidural is inserted. Overall, these changes have made the use of epidural anesthesia a much more user-friendly technique, and a technique that can really facilitate a good, safe, satisfying birthing experience.

SM: As an obstetrical anesthesiologist, how has your role as a valuable member of the birth team changed over the years?

WC: There has been increasing awareness, among both anesthesiologists and others also (nurses, obstetricians, midwives, doulas, childbirth educators) that anesthesiologists are a critical part of the entire birth team. We can provide much more than just administering anesthesia. We are often sought after for advice on appropriate pain management choices, particularly in mothers with various comorbidities and other complex medical conditions. We are more often being asked to participate in prenatal education classes. We are very welcoming to learning about alternative methods of pain relief, and how this may fit into the overall paradigm of care during labor. As more and more mothers with complex medical conditions become pregnant, our role as anesthesiologists has expanded to include significant consultations with obstetricians and other medical colleagues to assist with ensuring a safe pregnancy and birth.

SM: You do a lot of work and research around offering a family centered cesarean? Do you consider it important for the mother to have a second support person (doula or other support) along with her partner, in the OR for the birth? How can families advocate for their desire to have two support people during a cesarean?

WC: For those who do want a second support person, if properly chosen and truly desired by the woman, then I believe there is value in this. In my personal practice, I am totally fine with a second support person in the operating room, if this is what the family wants. In the overall picture of women having cesareans, it just is not a common request.

SM: Do you see any challenges to presenting informed consent information to a woman in the throes of labor? How do you do this effectively?

Photo by Patti Ramos Photography

WC: YES! This is an extraordinarily difficult and complex time to properly obtain informed consent. In these situations, we try our best. It is not easy. The involvement of a good obstetrician, labor nurse, midwife and doula can be very helpful. Pre-labor education is crucial, to avoid these difficult circumstances. However, pre-labor it is impossible to really know what the pain is like. We have all seen "best laid plans" rapidly change once the reality of labor pains commence. This is why having an open mind and flexibility is so important for women about to embark on labor and birth.

SM: What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

WC: I always enjoy these types of conferences. I feel I become a better anesthesiologist when I interact with and learn from interested colleagues who may share some different perspectives. I also hope that the attendees at the conference will become better educators, doulas, and midwives as a result of what I will share in my lecture and by attending the meeting.

SM: Is there anything else you would like to share with the readers of Science & Sensibility and attendees at the upcoming conference?

WC: We are all working together to ensure a safe, satisfying birth for mom, partner and baby. Thank you for the opportunity to participate in this conference.

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