Following a link from The Unnecesarean Blog, I read about the recent episode of The Doctors, in which the hosts discussed birthing options with Ricki Lake and Abby Epstein, co-authors of the new book, Your Best Birth.

There's plenty to unpack in this discussion, but one thing that jumped off the screen was this bit of promo from the show's synopsis page:

Sheena reacted poorly to the epidural that she was given at the birth of her first child. Now she's pregnant again and would like to have a natural, or drug-free, birth. She asks The Doctors for advice...

"When you go to the hospital, take a plate of brownies for the nurses and you'll be their favorite patient," Dr. Jim advises with a knowing smile.

Seriously? This is the advice of a health care professional to a woman who wants to avoid being exposed to pain medications and their side effects in labor? In fairness to the show (which I did not watch), they apparently also discussed the role of childbirth education classes, doula care, and comfort measures such as immersion in a tub. But this comment from a doctor, along with his "knowing smile" suggest that women who want a drug-free birth are "difficult patients," and that expecting a nurse to assist with a natural birth is asking her to go above and beyond her call of duty.

I wrote recently about the myth that birthing without an epidural is akin to needless suffering. Now we expose another myth: that modern U.S. hospitals offer the full range of labor pain relief options. Many of them don't. If the nurses are not trained or motivated to provide effective comfort measures, or if staffing patterns or hospital policies preclude them from offering this style of care, then women cannot access many safe and effective pain relief methods. The menu of choices should include far more than two: an epidural or a plate of brownies and a prayer.

In 2002, Childbirth Connection commissioned a series of systematic reviews on labor pain management, a body of literature that still offers the best available evidence on the safety and effectiveness of various pain management methods. They also conducted the Listening to Mother's Surveys, in which we discover that some of the pain relief methods women appreciated the most were used the least. It is not surprising that the first conclusion Childbirth Connection offers in their summary of the evidence is this:

A woman's labor pain relief options depend in large measure on where and with whom she chooses to give birth; women in other western industrial nations appear to have more options for labor pain relief than women in the U.S.

Don't get me wrong - I'm all for treating nurses well and showering them with well-deserved gifts (brownies! mani/pedi! flowers!). But our maternity care system itself - not gifts from laboring women - should encourage nurses to provide excellent labor support and ensure access to the full range of safe pain relief options for women. And to all the women out there wanting a natural birth: rather than taking The Doctors' word for it, try these tips for a healthy, safe, and natural birth from Lamaze International. They're time-tested, supported by plenty of research, and out-perform any plate of brownies (even the gooey melt-in-your mouth kind)!

Nurses and Nurse Managers: Want to improve the labor support skills of your nursing staff and help your nurses obtain continuing education hours? Bring Lamaze International's Labor Support Specialist Workshop to your facility!

Published: May 12, 2009

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