August 4, 2022
MD, DO, NP, PA & MA: Understanding the letters next to your provider’s title
- Value-Based Care
October 19, 2015 • Family MedicineOB/GYN
A century and a half ago, women had few options when it came to birthing. Pain management options were few. Most women had their babies at home, and they may or may not have had an experienced attendant to assist with the birth. In the years since then, childbirth practices have evolved and changed, in some ways for the better and in some perhaps for the worse. During the era when my mother was having her babies, it was common practice to give medications that made the mother’s memories of the experience vague. These medications caused an increase in forceps use, since mothers were unable to push their babies out. Additionally, fathers were often banished from labor and delivery areas of hospitals, and were notified of their children’s birth after the fact.
We have come a long way since that time. Most women giving birth these days are fully awake and aware of the experience. Childbirth education classes prepare women, and their partners, for the birth experience. Significant others can be full participants in supporting their partners through labor. Pain control options are safer and easily available.
Even as we have made advances in the way that labor is managed these days, some interventions have become commonly used with no medical reason. Caesarian section (C-Section) birth and labor induction are examples of interventions that are done far more often than would be justified by medical indications. The World Health Organization has recommended fewer unnecessary interventions in birth since 1996, yet the rates of such interventions have continued to climb. For additional information about this subject, see the document “Normal, Healthy Childbirth for Women & Families: What You Need to Know,” which can be found at http://www.ourmomentoftruth.com/OMOT-Normal-Healthy-Childbirth-Document.
One of the most common interventions is epidural anesthesia. Epidurals came in to common use for labor during the mid to late 1970s. They had the advantage of giving women nearly total relief from the pain of labor, while allowing them to remain awake and aware during the birth. When epidurals were first developed, the medications and dosages used resulted in women being so numb that they were unable to move to reposition themselves in bed; most could not even wiggle their toes! Pushing a baby out while so numb was problematic and sometimes not possible. Over the years, the procedure was refined, and most women who have epidurals these days have some mobility and sensation. There are still possible complications with epidurals. A woman may experience a drop in her blood pressure when an epidural is administered, making it necessary for her to be given additional medication to counteract that drop. However, epidural anesthesia is generally a very safe procedure, and usually provides women with great pain control for labor. So why would every laboring woman not want one?
Well, not every woman has the same perceptions and expectations about labor, and not all women experience labor in the same way. Some women believe their bodies were made to birth and that laboring without intervention is the healthier option for themselves and their babies. For these women, childbirth without anesthesia can be an extremely empowering experience, one that leaves them feeling strong and capable of anything. In some ways, the experience is similar to backpacking, something I love to do. Certainly carrying a forty-pound pack over a trail of tangled roots and rocks is not every woman’s idea of a good time. Yet for me, it is exhilarating and brings a great sense of peace and fulfillment as I camp at the end of each day. Women who choose un-medicated births recall a similar feeling of accomplishment. The feelings it can bring to a woman are beyond description.
But then, just as some women would much prefer to vacation on a beach with a book and would never think of going backpacking, not every woman wants to experience every sensation of labor. Truthfully, labor is usually painful. Part of the perception of pain is based on a woman’s preparation for labor—more about that below—but some will simply be traumatized if they do not have pain relief. For them, an epidural may be the best option. Ideally, no woman should have to recall her birth experience as a painful, terrible time.
For women who do choose un-medicated labor and birth, one key to making it a positive experience is preparation. Labor is challenging. Women who prepare by learning all they can about birth, relaxation techniques and managing the discomfort will have a much greater likelihood of having the kind of birth they desire. I strongly encourage taking childbirth classes. At minimum, I advise taking a general childbirth education class such as hospitals offer. Ideally, taking a class that teaches very specific coping techniques is most useful. There are a number of methods available: Hypnobirthing (www.hypnobirthing.com), Hypnobabies (https://www.hypnobabies.com) and Bradley (https://www.bradleybirth.com) are just a few of the excellent choices.
The International Childbirth Education Association (www.icea.org) advocates “freedom to make decisions based on knowledge of alternatives,” which says a lot. If a woman is not fully informed about benefits, risks and alternatives of any intervention, she essentially has no choices. A woman who knows exactly what she is choosing, whether it be an epidural or any other intervention in pregnancy and birth, will be much more likely to be happy with the entire experience.
Leanne Bedell, CNM - She grew up in Covina, California. Following high school, she attended Brigham Young University and received her bachelor’s degree in nursing. She fulfilled the dream she had since taking her obstetric nursing class in college and became a certified nurse-midwife. Leanne currently works at Revere Health’s Pleasant Grove, and Eagle Mountain OBGYN departments.
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.