In Sunday’s Observer there was an article entitled ‘Its good for women to suffer the pain of a natural birth,’ says Medical Chief. Good old journalists- we can always rely on them to throw something eye-catching, controversial and ultimately misleading into the ring. And in this case, what a red rag to a bull Dr Walsh’s comments have been.
To say that the debate has been heated since Sunday is an understatement. The column inches suggest it was Sunday months ago, not just two days ago and the debate is without doubt coloured by anger and vitriole. A trawl through websites , comments boxes and online mothers forums makes you hope that Dr Walsh is not reading. Whilst the odd woman meekly puts her hand up to say she had a drug-free birth and-god-forbid- quite enjoyed it, the vast majority are angry women who feel that they are having their choices squeezed or are being made to feel guilty for them. And if this was the case- if women were being denied choices, or we were somehow being told that childbirth is our due punishment a la Old Testament, then the outpourings might well be justified.
But misunderstandings can start wars, and I am increasingly convinced that this outcry is exactly that. A misunderstanding. No one is saying that women shouldn’t be allowed epidurals. They are available, many women’s experience with them is positive- in fact I have a friend who very proudly proclaims that she has given birth three times without ever feeling a contraction, thanks to early epidurals, and no one is condemning her. Epidurals are often described as the rolls royce of anaesthesia and they can sometimes mean the difference between a positive birth experience and a traumatic one. And for that reason alone they should be an option for all women.
But to think that we can have something for nothing is equally just short-sighted. It is essential that women recognise that to debate the pros and cons of an epidural is nothing but healthy- and that is exactly what Dr Walsh, admittedly rather big-footedly, is trying to do.
To say that there are downsides to epidurals is not to condemn the women who opt for them. It is simply to state a fact. There is that saying ‘ you cant get something for nothing’ and in the case of epidurals it is absolutely true. It is a fantastic and usually very effective form of pain relief but it has a downside that we need to acknowledge and consider.
What concerns me is that we seem very happy with understanding the risks of anything else when it comes to medicine- the pros and cons of HRT, the potential downside of an anti-cancer drug, even the possible side-effects of paracetamol, but for a doctor dares to suggest that not enough consideration has been taken of epidural downsides, he is painted as the devil incarnate.
It also ignores the again very healthy and in fact very interesting debate as to why on earth there is pain in labour and whether it is of any great benefit. In fact pain is a topic that I believe is actually undercovered in child birth classes. We talk about how to cope with it, and different forms of pain relief from aromatherapy oils to epidural, but it is never truly dissected and understood. Instead, woman’s idea of pain is simply the trauma, the extremes of it and the idea that it is the most pronounced characteristic of birth. And yet time and time again women come back to my classes after they have given birth, and speak of pain as though it were an aside. They dont deny it was painful, but emphasise that the experience was so much more than that. It is not unlike a mountaineers description of his successful attempt to reach the summit of some treacherous peak- whilst there was undoubtedly pain involved in the ascent, it does not dominate his story.
So who are these women? Are they super-human, smug, lucky or plain stupid?
No, they are just normal women, like any other, but with a caveat. They are normal women who’s cultural perception of birth has been supersceded by something else. They are almost always well mentally and physically prepared for birth, they have been bolstered in confidence and in their sense of what birth entails, and are suitably convinced of the place of pain in labour to give it a go. They also labour under good conditions - those conducive to a physiological birth ( see Primitive Brain at this link ), usually with outstanding one-to-one midwifery care, and sometimes with the luxury of having a doula.
To try to bring down epidural rates without recourse to anything else is foolhardy to say the least. It is no different to trying to cap elective c-section rates without recognising that their rising is a product not of a weakness in women but an inherent problem in our cultural perception of birth and more importantly, the system in which women in this country are pregnant and labour. Women have access to unprecedented levels of information- books, websites and endless forums. And yet most of them are more unprepared and crucially more fightened than any generation of women before them. Our interventionist system, which promotes electronic foetal monitoring and unexplained hospital protocols, induction and intervention makes contemplating a natural birth nigh on impossible for many women. And the fact that we have too few midwives, whose ideology and caring gets swept away in a plethora of rules and the madness of overwork means that women are simply not cared for enough during their pregnancy or throughout their labours. The single biggest emotional state to ensure a woman copes with labour, and might experience the pain without the suffering ( for the two are potentially mutually exclusive) is confidence, and until we find practical ways to instill this in the next generation of mothers, we need to offer them the next best thing, and very often that is an epidural.