Epidural Please: Respecting All Choices in Childbirth

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Commentary Maternity and Birthing

Epidural Please: Respecting All Choices in Childbirth

Martha Kempner

There is a subtle message--often coming from other women--that to truly experience childbirth, women must eschew medical interventions, including pain medication, and go "natural." But some women are happy to put their deliveries in the hands of the medical establishment with its rules and regulations, its operating rooms, its NICUs, and its drugs. That's a good choice, too.

One day last week, my five year-old and I stumbled on an episode of TLC’s A Baby Story, a half-hour documentary-style show in which viewers meet a couple on the verge of having a baby and see the delivery.  I wanted to turn the channel because I was afraid it would make her scared of childbirth as a lot of the women are visibly in pain; many cry, others scream, and, as we witnessed yesterday, some throw up (something my daughter already fears).  In fact, before I had children my husband banned the show from our house knowing that it could have the same fear-inducing effects on me.  But, Charlie insisted that she wanted to see it and I didn’t feel like watching another episode of Team Umizoomi, so we watched as a woman named Melissa had a C-section. Charlie was fascinated by the operation and asked a lot of questions about why she didn’t have to push, why the baby was bloody when it came out, and what the umbilical cord did. It seemed educational, so this morning when she asked to watch it again, I agreed. 

Today’s episode focused on a woman who found out she was pregnant right before heading to Vietnam to adopt twin girls.  By the end of the episode, she and her husband would be the parents of three children under the age of one.  (Far scarier than childbirth or anything that could happen in a delivery room, if you ask me.)  She explained her “birth plan” in interviews prior to delivery saying that she wanted to have natural childbirth (meaning no epidural) because she wanted to experience childbirth completely, including the pain.  And she certainly did; we watched as she was in labor for at least twelve hours.  Over and over she explained to the camera that it really hurt but she was determined to have a true birth experience and not to get an epidural. 

Though I have total respect for this woman’s choices – including her choice to broadcast such a personal event, something I would never want to share with the world – I worried that the message to some viewers might be that those who choose to get epidurals are not experiencing childbirth fully or having a true birth experience. It’s a message that, though often subtle, I think women hear a lot, and pretty much always from other women. 

In what my father would consider a coincidence (he sees them everywhere), when I turned off the TV and turned on my computer, a story popped up entitled “When Did Birth Become a ‘Birth Experience?’”  The author starts out explaining that:

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“Women are being set up by promises of the perfect birth and end up feeling like failures….Though having options about where and how to give birth is worth fighting for, the emphasis on ‘choice’ can feel like pressure rather than freedom.”

Based on the introduction, I expected this article to echo the concerns I was having as a watched this morning’s episode; to argue that women were putting too much pressure on other women to be “strong” and “brave,” to experience this event without the assistance of modern drugs, and above all else to avoid a C-section.  I was wrong; in fact, the blog took almost the opposite approach; once again chiding the medical establishment for having too much control over childbirth, pushing epidurals, and over-using C-sections: 

“In my childbirth classes I have lots of students who hope for a ‘natural birth’ and whose faces start to fade when I mention that in the hospital they will be on an external fetal monitor 20 minutes out of every hour, unable to move. Or when they hear how helpful water is in labor but that there’s no tub in their hospital…. and that one in three births is a C-section. They ask if they can switch to a birth center but for all of Manhattan there’s only one birth center and it can be hard to get into, especially late in the game. So do these women really have that many “choices”? Some might say they should be more “open” (i.e.: just get the epidural, it’s awesome), others might say, get out of the hospital next time.”

The author goes on to say:

As good feminists and Americans, we chant the word “choice” all day long. It’s associated with good things, especially vis-a-vis reproduction, but it’s also definitely bound up with our predatory consumer culture. And it can screw us up when it comes to childbirth (which is unpredictable and messy and incredible but hard and grunty and raw).

I absolutely agree, and I love the description of childbirth as being “grunty and raw.”  However, I would argue that some of the forces that “screw us up” when it comes to childbirth are the very same good feminists who chant the word “choice” all day.

When a friend of mine who lived in the Silicon Valley announced in her prenatal yoga class that she was going to have her baby at Stanford Medical Center, she was met with horrified stares: “But they’re so medicalized there,” her fellow moms-to-be scoffed. When I explained to a friend, who had opted for no pain medication, that I was planning on an epidural from the get go, she reminded me that it slows down labor (something my OB disagreed with), that I’d have to lie in a bed (she’d given birth on all fours), and that they’d probably put me on a fetal monitor the whole time. All of these were presented as obvious negatives that I was too naive (or brain-washed by Western medicine) to see. The conversation (and possibly the friendship) ended with her saying something akin to: “well, if you think you’ll need it.” And, when I chose my new hospital, many people warned me about its higher C-section rates without acknowledging that, by virtue of having the best neonatal intensive care unit (NICU) in the area, it was bound to get more than its fair share of high-risk births.

There is no doubt that many health care providers have their own opinions about how labor and delivery should progress and that some do not take the desires of their patients into account.  I also believe that some women who don’t want epidurals are talked into them by doctors and nurses. I am sorry that some hospitals don’t allow women in labor to walk the halls, soak in tubs, or be visited by an acupuncturist if that’s how they prefer to handle the pain. And, I know that many health care providers are way too quick to order a C-section.  I’m also acutely aware of how much of this is influenced by the threat of lawsuits and the burden of malpractice insurance. I certainly would never argue that our health care system—maternity care included—is anything but broken.

That said some women are happy to put their deliveries in the hands of the medical establishment with its rules and regulations, its operating rooms, its NICUs, and its drugs. As my Silicon-Valley-friend put it: “I know it’s medicalized—that’s why I chose it, you know women die doing this.”

Maybe I’m reading too much into them but I often feel a condescending tone when I get emails recounting a wife’s or a daughter’s medication-free birth which include phrases like “she was so brave, she didn’t even get an epidural,” or “she was so tough, she did it without anything for the pain.” If that’s what she wanted, that’s great and I’m happy for her.  Just as I am glad that the woman in today’s episode of A Baby Story was able to go through with her birth plan.  But as someone who got an epidural as soon as possible both times, I want to say, loud and clear, that I was brave and tough too. 

When we say we are for choice, we have to be for all choices—without condescension, without assumptions, and without judgment.