Drug Pushers, Natural Birth and “Soft Science” - All About Epidural
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Drug Pushers, Natural Birth and “Soft Science”

Date: July 30th, 2013

While browsing the Net for articles on labor epidural I came across this piece unprofessional garbage, an article in the Midwifery Today by one Judy Slome Cohain, “The Epidural Trip Why are so many women taking dangerous drugs during labor?

The tone of the article is set at the very beginning, in the abstract: “in many ways, epidurals are the drug trip of the current generation. Similar to street drug pushers, most anesthesiologists in the delivery rooms maintain a low profile, avoid making eye contact and threaten to walk out if they don’t get total cooperation. Women get epidurals for one of the main reasons so many women smoked pot in the 1970s—their friends are doing it.

The author, a midwife since 1982, lets her mouth run free: “Today, health authorities tout epidural analgesia as the safest, most effective method of pain relief available for childbirth. You could not pull that off on my generation. We lost enough creative artists—Janis Joplin, John Belushi, Jim Morrison and Lenny Bruce—to injectable pain killers.

The best revelation comes a few paragraphs later: “Birth is not a terribly painful process in the comfort of home, although going to the hospital doubles it… Labor is a series of 30 seconds of pain followed by 2-, 3- or 4-minute intervals without pain. During that interval between pains, a woman can sleep, talk to friends, work, paint, cook, sing, read, do absolutely anything her imagination can dream up. She is in no pain. The task of labor is to breathe and relax for 30 seconds of contraction. (Emphasis added).

Anesthesiologist/drug dealer analogy continues: “Like street drug pushers, the anesthesiologist often seems to makes him or herself scarce… In the same monotonous tone, without ever making eye contact, the anesthesiologist pushes the consent form and pen into the woman’s lap, rattling off all the possible bad effects of epidural… the anesthesiologist is reluctant to answer questions. In response to questions, there is usually a “I have better things to do” tone of discourse…

Then there is the description of how epidural is administered: “The anesthesiologist takes a large gauge needle on a 5 or 10 cc syringe and starts digging into the laboring woman’s back. The hole has to be large enough to fit the drug-bringing cannula which goes in 4 inches, or 10 cm, in and up her spine. Blood flows down her back in a half-centimeter stream from the hole. It hurts to be stuck. The hole will hurt for a few days like any wound…”

The article continues with the list of possible side effects and complications of epidural, such as “Administration of epidural analgesia has been found to delay onset of breastfeeding and to shorten breastfeeding duration in women… most women with epidurals do end up with a Pitocin augmentation because the epidural decreases the release of natural oxytocin.

The footnote at the end of the article points that the author “…is devoted to illuminating the field of women’s health with objective evidence, based on the scientific method.” I sincerely hope that the field of women’s health gets illuminated by something better than this psychotic rant with the fragmented pretense of scientific discussion… The midwife who wrote this piece is a militant pro-natural crusader, lost in her false beliefs that she is trying to force on others.

I am curious about this “scientific method”, because besides this piece being rude and unethical, just about everything in it is factually wrong. I suspect the reason for it is the author’s illiteracy in the methodology and interpretation of research. I will explain why. The article has only four references, and it that most of her information about the risks and bad effects of epidural the author obtained from the review on the website of the Mothering Magazine (similarly biased and flawed). The studies she managed to quote on her own are cherry picked. In fact, the study she quotes in support of her argument that epidural interferes with breastfeeding has nothing to do with breastfeeding at all: it was measuring the effect of labor epidural on hormones.

The use of the gory description of how labor epidural is administered is a typical maneuver to scare women used by many proponent of natural birth. I have heard many stories of birth educators doing similar things. For example, when a woman in birth education classes asks: “What about epidural?” a midwife whips out the largest epidural needle and passes it around the class: “This is it. It goes right up your spine. You can have it if you want…” If surgeons were showing their instruments to the patients there would be no surgery! The fact is, the insertion of epidural is virtually painless, especially when compared with the pain of labor.

The style and attitude of the militant orthodoxy of natural birth, so typically represented by the midwife who wrote the article, is summarized in the article written by Dr. Amy Tuteur, an obstetrician gynecologist, on her blog:

The unalterable bedrock of “natural” childbirth advocacy is that women should refuse effective pain relief in labor. The “ideal” situation is for women to embrace their pain and pretend that it is “good pain.” Of course, there is no such thing as “good pain”: they just made that up. The pain of contractions and the pain of vaginal distention do not differ in any way from any other kind of pain. It is not carried by different nerves, it is not conducted through the action of different neurotransmitters, it is not routed to different areas in the brain. It is exactly the same as any other kind of pain. So the take home message of NCB is that the excruciating pain of childbirth should be ignored.

And not merely ignored. What’s worse is that the NCB movement pretends that women are improved by experiencing the agonizing pain of childbirth, although they cannot think of any other instance in which human beings are improved by agonizing pain. The irony is that “natural” childbirth advocates have beliefs that are strikingly similar to the Victorian clergymen who opposed anesthesia in childbirth when it was first introduced in the second half of the nineteenth century. The clergymen believed that is was wrong to abolish labor pain with anesthesia because God intended for women to feel the pain. NCB advocates appear to believe that it is wrong to abolish labor pain because “Nature” intended for women to feel the pain. There is precisely zero concern for the effect of that pain on a woman herself. (emphasis added)

The hypocrisy of the periodical Midwifery Today where this rubbish has been published is in keeping with the article itself: in the section About Us they claim to deliver “hard facts” and “soft but competent” information. Then they publish a piece where anesthesiologists who practice obstetric anesthesia are compared with drug pushers… I rest my case.

I will repeat it again and again: there is no best way or right way to have a baby. Don’t listen to the rubbish about being empowered by pain. It is as empowering as the pain of stabbing yourself with scissors. The desire to avoid pain does not make you a weaker person or better mother and does not benefit your baby. In fact, as we discussed in the previous article, pain may be harmful and can have long lasting consequences. It is part of reality that every method, intervention and drug used in medicine has risks, and it is eventually up to you to choose which method of relieving labor pain is suitable for you. Just don’t avoid epidural because some people tell you that it robs you of your birth experience or feminine empowerment, it is simply nonsense.

Image from: . http://www.freedigitalphotos.net/images/agree-terms.php?id=10029217

Dr. Eugene Smetannikov is a practicing anesthesiologist with the interest in obstetric anesthesia. He is the author of the most comprehensive book on the subject, The Truth About Labor Epidural

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  1. I am à practitionerMermaid GP and havé 2 children by lscs ( Caesarian section) and epidurals.
    I am a strong advocate for maximum pain relief during labour .
    I advice expecting mothers who will be delivering public ally and in the hands of midwives to ask for epidural early and keep pushing the point ignorings comments like ” u are already dilating – just keep breathing” I remind women that there could still be sutures to come ect ect
    I believe most midwives hate pregnant women and enjoy watching them suffer .
    That belief grew from working in the labour ward and being in general practice for 20 years by now.

  2. Karolina

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