The modern woman is task-oriented. She lives in a world demanding of her competence, attention, and efficiency. We use technology, tap into our communities, plumb the depths of our reserves to navigate an often hyper-masculinized world while retaining our most vital feminine powers. The power that fundamentally defines our exemption from this contemporary lifestyle trajectory is baby making.
This primal empowerment forms the bedrock of a woman’s most untouchable gifts.
We have lost sight of this fact; however, and have allowed our inner compass to be co-opted. It’s certainly no wonder, that after 9 months of hypermedicalized pregnancy “management” (often following months to years of assisted reproductive technologies), birth is considered another task on the to-do list to complete.
As a type-A taskmaster, myself, I understand the lure of a predictable and painless depositing of your newborn after the long and fear-punctuated journey of pregnancy.
I’m here to tell you; however, what your obstetrician won’t.
Labor is a physiologic process that recruits neurochemical, endocrine, and immune systems into a dance that we barely have the tools to conceptualize.
When we meddle with this, when we attempt to standardize it, we put women and their babies at grave risk – physically, psychologically, and even spiritually. We rob women of an opportunity for psychospiritual transcendence.
As a science-minded medical doctor, I don’t wield this phrase with ease!
The process of conception, gestation, and birth cannot, however, be reduced to daily activities and routine life occurrences. There is something built into our consciousness that makes room for its own expansion around these life transitions. The process of bodily separation – woman from her newborn – involves a passage through a space of trance-like awareness.
I can only describe it as the sensation of floating and grounding, simultaneously. It is an experience that demands we move out of the space of our mind and into a space of sensation without judgment. It is being present, truly present, to behold a glimpse of what we are capable of as mammals and most importantly, as a human female.
In this way, a natural birth is an opportunity for redefinition and reconnection to one’s most core self. It is the way women were intended to pass through the gates of motherhood, to the next chapter of their actualization.
If you buy the potential significance of these considerations, you may want to know what represents your greatest obstacle and impediment in achieving this life milestone. You may be surprised to learn that it is epidural anesthesia. This discussion is meant to shine a light on elective epidurals – that, “Why not? Who wants to feel crazy intense pain?” choice that 2/3rds of women (and up to 90% in some hospitals) opt for every day. In my opinion, the epidural intervention is the most reprehensible of all – because of its largely dismissed risk profile, and because of its auspicious position in a cascade of interventions, unnecessary, ill-conceived, and rife with unintended consequences including death.
If we can empower women to question the validity of this procedure, then they can retain the right to preserve the integrity of their birth experience.
What’s the big deal with Epidurals?
A 60% rise in C-sections since 1996 is prompting the American College of Obstetricians and Gynecologists to fidget self-consciously in their white coats. A study revealing the prolongation of the second stage of labor thanks to epidurals has been influential in identifying the iatrogenesis – doctor-caused harm – at the root of the cesarean problem.
It appears that, thanks to an antiquated but still sanctioned construct – Friedman’s curve – the hospital clock starts ticking loudly upon arrival, and the alarm goes off after 3 hours of second stage labor with an epidural. At this non-evidence-based juncture, interventions including IV fluids, continuous monitoring, food and drink restriction, and immobilization conspire to invite pitocin, forceps, episiotomy, and surgery into the delivery room.
Obstetrics is vulnerable to practicing consensus medicine – habitual practice that is not predicated on sounds science. As I discuss here, metanalysis has demonstrated that only 30% of current obstetrical recommendations are based on quality data. What’s the rest based on? Fear-mongering and personal opinion? Let’s look at what the evidence suggests about the risks of epidurals, considering that up to 41% of women never properly consented for this intervention.
Epidurals are offered with a plethora of accoutrements including catheters for involuntary urination, blood pressure monitoring and IV fluids for changes to vascular physiology, and continuous fetal monitoring because of risk to the baby of decreased oxygen flow.12
The changes to natural labor progression are compounded by risk of fever in the mother that leads to further separation of mom and baby after birth, secondary to testing and assessment for infection. This separation represents a stress to the shared adaptation to early postpartum life and may predispose to psychiatric pathology in both mom and baby through early epigenetic influences on gene expression.345
This separation may also interfere with breastfeeding establishment. In this way, epidurals may be directly and indirectly responsible for breastfeeding struggles67. Breastfeeding appears to prevent the onset of postpartum depression if it is established within 3 months, in addition to being a continual source of immunologically essential information trafficked from mom to baby.
Shooting Up You and Your Baby
Epidurals are a delivery method for narcotic pain-killers that pass through the placenta to the baby and have largely unpredictable effects on the birthing woman. Evidence supports risks to the baby including reduced tone, poor feeding, jaundice, withdrawal, and sensorimotor impairment.8
Physiologic risks to the mother include acute and persistent problems such as numbness, tingling, dizziness, respiratory paralysis, cardiac arrest, nerve injury, abscess, and death.910A user-friendly description of these considerations was explored by Pathways to Family Wellness, here.
Hurrying Up
When epidurals lengthen the second stage of labor, Pitocin, or synthetic mimic of the brain hormone, oxytocin, is delivered to augment the process. Because Pitocin does not cross the blood-brain barrier, it does not stimulate endorphin release. It also interferes with feedback loops suppressing natural oxytocin production while hyperstimulating the uterus without appropriate relaxation between contractions. The significance of this is just being revealed and may even reach to risk factors for autism.
Cutting Up
The increased risk of c-section1112 in the wake of epidural anesthesia is easily explained by relaxation of pelvic muscles that detach a woman from the instinctive guiding forces of an uninhibited labor, by the baby’s increased distress secondary to narcotic exposure and malposition, by the recruitment of Pitocin which causes uterine and therefore fetal distress, and fetal monitoring which, while superficially reassuring results in increased interventions (2-3x c-section rate) without improved outcomes.
Your doctor may fail to mention that a surgical birth brings with it these risk considerations: protracted recovery, infection (including necrotizing fasciitis), organ damage, adhesions, hemorrhage, embolism, hysterectomy, wound dehiscence, early infant separation, higher risk of respiratory problems for baby, and an exponentially increased risk of placenta accreta, a potentially lethal complication of surgical birth, contributing to a 3.6 fold increase in maternal death after cesarean relative to vaginal birth.
Of primary interest to clinicians who appreciate the role of the gut microbiome in child and adult health, abdicating a vaginal transfer of beneficial bacteria may set the stage for chronic disease including a 20% increased risk of obesity.
Opting out of epidural anesthesia: Choosing to feel
What are the best ways to help your body, mind, and spirit align for this tumultuous but life empowering journey?
Movement – Staying active during pregnancy is optimal mind-body medicine. Yoga, home-based routines, and swimming in unchlorinated water are excellent choices, at least 3 times weekly.
Chiropractic – With advanced perinatal training, holistic chiropractors are critical experts in proper alignment and nervous system support to facilitate a physiologic birth.
Acupuncture – Applied before and even during labor, acupuncture can gently and effectively facilitate a healthy labor and delivery. According to a Cochrane Review, acupuncture and hypnosis meet evidence-based efficacy criteria for pain management in labor.
Controlled Breathing/Meditation – Perhaps the most important tool for a new mother, learning to engage the relaxation response in pregnancy will help you to know what it feels like to be present to the labor experience, to go inward, quiet your mind, and release fear. Hypnobabies and hypnobirthing are well-regarded methodologies. If you are extremely anxious, breathing small amount of nitrous oxide mixed with oxygen can help.
Diet – The physical experience of labor and delivery is best supported by stocking the shelves up front for a healthy hormonal response with minimization of inflammation and maximization of nutrient-density. Eat sustainable, organic meat, fish, eggs, veggies including root vegetables and squash, fruit, nuts, and seeds. Leverage the complexity of food-based information to promote optimal gene expression in that growing baby, and support a healthy delivery and postpartum experience.
Doula – Preparation for labor, and support for mother and spouse have been traditionally left in the hands of a woman’s most doting partner, a doula. No woman should birth in a hospital without this advocate. Evidence supports a doula’s ability to help you achieve an intervention-free birth.
While my most heart-filling emails every day are from my homebirthing patients, I aim to sit in a place of true advocacy for the women that I treat and advise. I believe in informed consent, and I observe that this is not occurring in hospitals today. Explore resources that will help to expose you to the known risks and popularized benefits, so that you are making your own decision with your eyes wide open.
As most women who have experienced natural birth would attest – just when you think you can’t do it and your mind demands surrender – you meet your baby, and the world stands still in a moment of unparalleled beauty and wonder.
Sources:
1 http://www.ncbi.nlm.nih.gov/pubmed/15957994
2 http://www.ncbi.nlm.nih.gov/pubmed/12011872
3 http://www.ncbi.nlm.nih.gov/pubmed/24552992
4 http://www.ncbi.nlm.nih.gov/pubmed/12011872
6 http://www.nutricionhospitalaria.com/pdf/6395.pdf
7 http://www.internationalbreastfeedingjournal.com/content/1/1/24
8 http://www.ncbi.nlm.nih.gov/pubmed/12011872
9 http://onlinelibrary.wiley.com/doi/10.1016/S0091-2182%2897%2900052-9/abstract
10 http://www.ncbi.nlm.nih.gov/pubmed/17447690
12 http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour
I like articles that encourage women to have a natural birth…but sometimes this is not possible. I prepared myself for a natural birth with classes, regular exercise during pregnancy and healthy eating.
I was in labor for 20 hours and then got stuck at 9 cm for 3 hours. Usually the transition lasts about 15 minutes, mine lasted 3 hours…I was in hell, literally. The first intervention was an IV with saline water as I was vomiting at every contraction b/c of too much pain. They told me I was completely dehydrated and I needed that IV, which I hated hated hated. When I heard that I was still at 9cm after 3 hours of extreme hell, I thought I was going to die. I started screaming for an epidural. I had to be moved to another room, as I was in the “alternative birthing center” where they don’t have equipment for doing an epidural.
I don’t know why my labor was so horrible, and why I got stuck at 9cm during the transition stage. I was always lean and fit, religiously exercised during pregnancy…pretty much did everything I could to birth naturally.
After the epidural my contractions became much much slower and went from no break between them to having 5-6 minutes between contractions. Then, they gave me pitocin to speed up my labor. After 3 hours of pushing I had my baby with the help of a huge episiotomy. The only part I liked about my labor was that I did NOT have a C-section. The rest was horror and hell. Literally!
The article talks about “floating and grounding” and a transcendental experience. Really? I think this is total BS. Any natural birth is painful. My mother told me that labor is worse of better depending on the duration. 20 hours of hell are worse than 5 hours. My mom had 4 natural births and she told me mine was worse that her 4 combined. She was with me in the room together with a doula, a midwife, my husband and a doctor at the end who did the episiotomy. I know women are different and some feel less pain than others, but ANY NATURAL BIRTH IS PAINFUL IN HUMANS!!! The only people who believe otherwise are those who never gave birth to babies!
I’ve given birth to two, one two years ago and one three months ago, and I can tell you that for some of us, the pain really isn’t that bad.
Nobody is saying there is no pain, but some women have the ability to manage. I found personally that paying too much attention to it made it hurt. Letting go all control made everything so much easier.
I have 4 children. I had epidurals with my first two, unmedicated with my third, and an epi with my fourth. I totally understand your point, but think you may be a little harsh in your delivery. My first two experiences with epidurals was great but I read about the possible side effects and decided to go all natural with my third using the Bradley method. The labor was very manageable until the last hour and (excuse my language) then all hell broke loose. Maybe other people have a higher tolerance for pain but for me it was TRAUMATIC! I screamed uncontrollably. I had no control over my breathing or body. The contractions were coming so fast and the baby came out in 3 pushes. Yes the pain was short (about 45 minutes of intense pain) but that didn’t diminish the trauma of it. I was in so much pain, I really didn’t experience the joy of seeing my baby for the first time. For my fourth, I decided I would go unmedicated again. Not because I liked that way, but because I felt so much guilt for kind of wanting an epidural. I thought I was a better mom because I didn’t expose my child to all those drugs. My husband was very supportive but honestly the last delivery scared him to death. He didn’t want to see me suffer so much. After 8 days over my due date I opted to be induced due to a lot of scheduling issues with the care of my other 3 children. I tried to avoid an epi but it is extremely difficult to do with all the crap they attach to you in the hospital. My husband and I decided I would get an epi and y’all it was wonderful. The delivery process was so calm and I could really focus on my baby instead of being so consumed with the pain. My baby was perfect just like the other 3 and I didn’t have any trouble nursing her. I am totally supportive for those wanting to go unmedicated but let’s stop making those who do feel as though they are not good mothers and they are threatening the safety of our child.
Typo: I WASNT connected to the epi IV drip, I basically just had the small tube in my spin connected to an empty syringe, that gave me my initial dose.
Please be very careful to communicate actual facts in a way that leaves no room for misinterpretation. Most studies do not do this- they,as does this article, cherry-pick various bits of information in order to further an agenda. You leap to conclusions that are not proven or justified.
Women are having more interventions because they are demanding them. More and more women seek elective induction of labor, with all the increased risks. Some also try to demand elective cesarean sections. I’m not in favor of either of these things, but am aware that it’s because they are taking charge of their lives and pregnancies, not because they are being pushed from health care providers or the hospital. Women are also self advocating with regard to pain management.
I’ve been a labor and delivery nurse for 25 years. I’ve done this on both sides of the country, and while working primarily in 2 vary different settings over the past 20+ years, I’ve also filled in at almost a dozen others. Women come to their first birth with either a plan to go “natural”, a plan for an epidural, or (most common) a “wait and see” attitude. Nobody likes the idea of a needle going into their back. Obviously, since the GREAT MAJORITY of women request or demand an epidural before transition, there is something happening that makes this seem like a good idea. We try to support the patient, and to honor their plan. Sometimes they/we are successful, others not. Our hospital has a cesarean rate of less than 20%. Our midwives (who see low risk patients) have a c/s rate below 10 (yes- ten) percent. Most of the patients have epidurals. As in- the big majority.
From a personal perspective- my first birth was “natural”. It sucked. I spent a great deal of effort blocking out what was happening- trying to be somewhere else in my head. This was before I worked in L&D. I chose to have epidurals for the next birth- and the ones that followed. The labors were much shorter, obviously this is the norm for multips. I was present, happy and aware of every contraction. This is not something I share with my patients, as it has NO bearing on their labors. I am careful to never, ever let my feelings or history impact someone else’s decision.
After looking at your Bio I’m left wondering exactly what sort of experience you have. Have you even done a residency in OB? How many births have you taken part in? Because you present yourself as an expert- but what does “science-minded medical doctor” actually mean in the hard currency of experience? I’ve only delivered a hundred or so babies myself, but have cared for thousands of women in labor. What exactly is your experience based on? Because you don’t really sound like you know from experience. You sound like you’ve read many studies. Or at least enough to convince some people that you know what you are talking about. People who don’t know better.
Thanks for sharing!
It hit home because I’m sick of women who are naturally thin taking the moral high ground and lecturing those who have to work hard to maintain a normal size and in many ways are healthier than those unfit skinny people who are doing the lecturing. Your ability to stay slim is likely assisted by your healthy lifestyle but I promise you that your genetics have had a far larger role in that than you would like to admit. You can take very little more take credit for that than you can for the color of your eyes. If you have never struggled with your weight you will never understand this. Never in my life will I have been described as slim having the muscular build that I have but for most of my life I have been far fitter and healthier than many of the skinny people around me. And being that fit did not help me in my pregnancies not gaining a lot of weight and/or having difficulties (much to my surprise). Despite my plan and desire in my first pregnancy to have a drug free natural childbirth I ended up with a caesarean and then a scheduled one the second time, yet I have had no recovery problems and no issues whatsoever breastfeeding.
Megan,
You can have your opinion as I have mine.
If you didn’t like my opinion it must have hit home with you!!
Be Well..
Annie
What I do not understand is, where are YOUR own personal Gyno Dr. that you went to for almost 9 months?
Where are your Babies Drs.Why are they not checking your babies when there 1st born?
Why are your Drs. not delivering your babies?
Who doesn’t have there own Dr. to deliver there baby, but leaves it up to a nurse when they are in labor, and get to the Hospital!!
All this should have been discussed with your Drs. when you first got Pregnant, not when you get to the hospital to have your baby..
I have two grown children, and Grandchildren. One has a 7 mo.Healthy baby, and is nursing..Her choice..
She had a Epidural after 7 1/2 hours of labor at the hospital, and had the baby in another 1/2 hour..
Her Dr. was there to deliver the baby…
Never a mention of a C section..
Nobody is going to like this remark..but we all exercise , and are slim…
My Daughter had a easy birth with a Epidural, her baby was over 9lbs..she gained 20 lbs, and lost it right away..She is also considered a older parent to have a baby..
That said, ALL my friends that where heavy before getting pregnant, never even went out for a walk to exercise, and had little babies, about 6 lbs, and where in labor for hours, if not a couple of days!
I do think its important to eat healthy..When I hear some people that are over weight say to me, I can’t afford it! (whining)/
It is very affordable to eat health (organic). If they stop eating processed food, junk food, no sugar & fast foods…
I’m not saying all Women that are thin have easy births , but most do, and most over weight have a hard time being pregnant and giving birth..
If anyone is seeing a Dr. that from the get go says, mentions a C section, Run..It seems now that allot of Drs. would rather give a C section, cause that fits in to the play time!
I’m no martyr, and I do not see a reason to suffer with pain in the last stages of labor.
All our Children are Healthy, happy, and so are we..We all had an Epidural.
Years ago there was something called a Spinal when you gave birth..If you had a un-esperiance Anesthesiologist, he/she could hit a wrong place in the spine, and you could become paralyzed. Never heard of that happening with a Epidural before. Although the shot is in that area.
Interview more then one Dr. when you get pregnant..
Take Care,
Annie
Half of your post is senseless rambling and the rest is offensive.
Annie, I think your post would be more well-received with some grammar checking and complete sentences. I think that’s why Megan called it “senseless rambling.” I did not find your comment offensive at all, I just wanted to give you some constructive criticism as to how to come across more articulate in a public forum.
I’m not slim and I worked an office job. I somehow managed to calmly birth two children with no medication in less than half a day each.
This is an informative and thought provoking article, and I appreciate knowing that there are alternatives that may be effective for women… I have long felt that women are often under-informed about the potential issues with various treatment choices. That said, your comment to megan that your article “hit home” seems harsh. I have had experiences where perhaps less than ideal methods were used in an emergency and experiences when I got to choose a wiser approach for me… the healthy lifestyle and staying fit advice I had read and heard and sought was greatly insufficient for me until factors began to be addressed that most doctors didnt even seem to be aware of. I sympathize with Megan’s concern that she was doing the ‘right’ things and didn’t have the expected results, because a lot of women with hormone issues, allergies, autoimmune and other issues do not necessarily know what to do besides what their doctors and the media have told them. That is why information like this is helpful, so we have alternatives to consider, however I think responding with compassion is imperative- while she may be incorrect that it’s genetics, she is probably correct that it wasn’t all her fault… In a world with many toxins, that is probably true! I think one aspect of the higher reality you describe is compassion. Everyone is different, but perhaps the fault is less due to the women accepting what the doctor says in crisis. Perhaps people in the medical community could begin to research alternatives considering the risks you mention.
I had 2 epidurals and 2 c sections. Beautiful healthy babies and I wouldn’t have had it any other way. I guess my point is, to each her own.I am so tired of authors like this telling us what is right for all, I have no issues with home or natural births. I enjoyed my epidural and the first c – section was medically necessary (thankful was in great hospital) and I chose my second c – section (happy for the right to choose, although probably was necessary).Don’t be so preachy. Btw…chose not to breastfeed….no problem with those that do. Don’t even start…my tween and teen are bright and healthy (healthier than the kids who were breastfeed but I am sure it’s a coincidence that my kids never miss school, never had strep or earaches or viruses….. )And….no organic foods. Let’s not judge each other. That’s worse than be in preachy 🙂
every woman is different, every labor is different. a hundred years ago women and babies died during childbirth so you can’t argue that it’s always best to go all natural. personally i would rather have myself and my baby monitored. also, many women labor for days without any dilation…sometimes even after their water has broken which was the case with me. i was not offered an epidural at all for fear it would prevent me from being able to dilate. i was given a c-section after 36 hours in labor with zero progress. THANK GOD for modern medicine or my baby may not have survived. clearly i have a faulty cervix. and BTW i had NO mental fog during or after my c-sections (yes, i had 2) and my babies latched right after birth. i had no real problems recovering and both my babies thrived.
I had two natural childbirths. No pain control at all. This was due to less than careful monitoring at the hospital and I was in transition before they administered. I can say the pain does take you to a new level. For a while after, nothing seems to be worth worrying about. Perhaps this is natures way of preparing the mind for the new baby. The focus changes. But it is not without side effects. It took me 6 years to have my second child. I was afraid of the pain. Some people tell me it is not pain, but pressure. And then I ask how much Demerol they got. I made the doctor promise I would get meds the second baby, though not an epidural. They blew it again. You will have benefits the more natural you go though. It prepares you mentally somehow. But you have a right to know it is really going to hurt.