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.      

News Abortion

Anti-Choice Leader to Remove Himself From Medical Board Case in Ohio

Michelle D. Anderson

In a letter to the State of Ohio Medical Board, representatives from nine groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Anti-choice leader Mike Gonidakis said Monday that he would remove himself from deciding a complaint against a local abortion provider after several groups asked that he resign as president of the State of Ohio Medical Board.

The Associated Press first reported news of Gonidakis’ decision, which came after several pro-choice groups said he should step down from the medical board because he had a conflict of interest in the pending complaint.

The complaint, filed by Dayton Right to Life on August 3, alleged that three abortion providers working at Women’s Med Center in Dayton violated state law and forced an abortion on a patient that was incapable of withdrawing her consent due to a drug overdose.

Ohio Right to Life issued a news release the same day Dayton Right to Life filed its complaint, featuring a quotation from its executive director saying that local pro-choice advocates forfeit “whatever tinge of credibility” it had if it refused to condemn what allegedly happened at Women’s Med Center.

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Gonidakis, the president of Ohio Right to Life, had then forwarded a copy of the news release to ProgressOhio Executive Director Sandy Theis with a note saying, “Sandy…. Will you finally repudiate the industry for which you so proudly support? So much for ‘women’s health’. So sad.”

On Friday, ProgressOhio, along with eight other groupsDoctors for Health Care Solutions, Common Cause Ohio, the Ohio National Organization for Women, Innovation Ohio, the Ohio House Democratic Women’s Caucus, the National Council of Jewish Women, Democratic Voices of Ohio, and Ohio Voice—responded to Gonidakis’ public and private commentary by writing a letter to the medical board asking that he resign.

In the letter, representatives from those groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Contacted for comment, the medical board did not respond by press time.

The Ohio Medical Board protects the public by licensing and regulating physicians and other health-care professionals in part by reviewing complaints such as the one filed by Dayton Right to Life.

The decision-making body includes three non-physician consumer members and nine physicians who serve five-year terms when fully staffed. Currently, 11 citizens serve on the board.

Gonidakis, appointed in 2012 by Ohio Gov. John Kasich, is a consumer member of the board and lacks medical training.

Theis told Rewire in a telephone interview that the letter’s undersigned did not include groups like NARAL Pro-Choice and Planned Parenthood in its effort to highlight the conflict with Gonidakis.

“We wanted it to be about ethics” and not about abortion politics, Theis explained to Rewire.

Theis said Gonidakis had publicly condemned three licensed doctors from Women’s Med Center without engaging the providers or hearing the facts about the alleged incident.

“He put his point out there on Main Street having only heard the view of Dayton Right to Life,” Theis said. “In court, a judge who does something like that would have been thrown off the bench.”

Arthur Lavin, co-chairman of Doctors for Health Care Solutions, told the Associated Press the medical board should be free from politics.

Theis said ProgressOhio also exercised its right to file a complaint with the Ohio Ethics Commission to have Gonidakis removed because Theis had first-hand knowledge of his ethical wrongdoing.

The 29-page complaint, obtained by Rewire, details Gonidakis’ association with anti-choice groups and includes a copy of the email he sent to Theis.

Common Cause Ohio was the only group that co-signed the letter that is decidedly not pro-choice. A policy analyst from the nonpartisan organization told the Columbus Dispatch that Common Cause was not for or against abortion, but had signed the letter because a clear conflict of interest exists on the state’s medical board.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

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