Before you get that epidural ...

In many US hospitals, it's
reported that as many as
90 percent of women choose
an epidural when giving birth. 

Many people think that babies - especially newborns - are just floppy, drooling blobs that sit there and do nothing, completely unable to move under their own volition. This incredibly awesome video shows us how they can move up to their mother's breast - many within less than an hour of being born.

There are two groups: those who were the product of a natural, non-medicated birth, and those whose mothers had epidurals. Their behavior is markedly different, and yet most people think that medicated labors do not produce any effects in the newborn.

I don't know how that's possible. We know that babies can be effected by things in utero that we ingest; even taking Sudafed while nursing, for instance, can produce a jittery baby. There is some debate as to whether the medication crosses the placenta, and I think we can see in this video that there is definitely something going on, to say the least.

I've heard many people say this, including a labor and delivery nurse with supposed years of experience. I'm guessing she hasn't seen many unmedicated births in a while - and she holds the notion that painful childbirth is unnecessary and "why bother?" when you can get pain meds. One mom I talked to said she had an unmedicated birth and that hospital staff were "amazed" at how alert her baby was. No kidding!

In this PregnancyToday question and answer forum, a nurse who teaches childbirth classes asked if epidurals cross the placenta, mainly because a Bradley instructor was telling her clients that they do. The concerned nurse said that it was "her experience" that they didn't. I'm wondering how many natural births she's attended to know what to compare it to - it's a sad reality that many doctors and nurses have never, or very rarely, ever attended a non-medicated birth to know the difference in newborn behavior.

The response (it doesn't say from whom, by the way) immediately slams the Bradley instructor as having an 'extreme' view, and I'm not even sure the answer they gave makes any sense, really:

"As with every extreme position, there is a string of truth. Here are the facts: Local anesthetics cross the placenta. Local anesthetics are used in epidurals. Some local anesthetics placed into the epidural space will be absorbed into the bloodstream and cross the placenta. The small amount of local anesthetic from a properly placed epidural that is absorbed into the bloodstream and crosses the placenta should not affect the mentation of the baby. The lack of affect on the mentation on that baby is an advantage that regional techniques, such as spinals/epidurals, have over intravenous medications."

I'm not sure this really answers the question, and assumes way too much before suggesting that it doesn't ever affect the baby. In one breath, they say the drugs will go into the bloodstream and cross the placenta. Then they turn around and say they should not affect the "mentation" of the baby, but we can see, and some women experience, that it does in fact. Does that mean there are lots of bad anesthesiologists running around, giving bad epidurals? And does this mean they should really admit that the Bradley instructor is right?

I had two cesareans, so obviously I had a spinal for both. In my vaginal birth, I had Nubain but no epidural. I noticed a huge difference in behavior between my babies after birth. Coupled with my inexperience at breastfeeding the first time around, it was difficult to get my oldest to latch on and we spent days - literally - working at it before we were successful. With my second, she took to the breast as soon as I offered it (which, unfortunately due to mother/baby separation that is so typical in American hospitals, was probably at least an hour or two after her birth) and behaved much differently than her brothers did. I don't remember my third being that particularly alert or interested in the breast after birth (again, after being separated from me for several hours).

It could be said that in some babies, the epidural or similar anesthesia can diminish or totally destroy a successful breastfeeding relationship between mom and baby, or at the very least, create a more difficult start to breastfeeding than need be. An inexperienced breastfeeding mom may take this as a sign that baby is totally uninterested in her, and will decide before she even leaves the hospital that breastfeeding is not for her.

It's important to realize that epidurals can be great tools for allowing the mother to relax and labor to progress. But in some cases, they can slow down labor. This is another point of contention among some, but just the other day I heard the amazing birth story of a first-time mother who said that her labor was going pretty fast, and she noticed how the epi slowed it down. For her, this was a good thing because she felt that it allowed her to get her thoughts together. For others, it can be a nightmare that leads to more (and more) interventions, that can sometimes lead to a cesarean - or at the very least, a rather traumatic, difficult vaginal birth.

Studies have shown that epidural use can increase the need for tools such as vacuum suction and forceps - mostly no doubt because some women can't feel what's going on, nor can they get up and change positions when an epidural is in place. Many talk about "light epidurals" (even an anesthesiologist told me about these) but still lots of women say they were completely unable to move due to having one. Again, the jury is out as to whether this is really widespread and may depend on a number of factors, including mother's position and doctor/anesthesiologist preference.

Lastly, we must look at the standard procedure for birth in many hospitals: the mother is likely allowed no food or drink in labor, is encouraged to lie down frequently for cervix checks, is hooked up to a monitor for continuous fetal monitoring, and as a result, is not allowed to move around or really change positions. When it comes to pushing, she is often told she must assume the lithotomy position (flat on her back). When you add all that up, it's not a wonder so many women ask for epidurals and it's amazing a woman can even birth a baby at all.

Remaining upright in early labor can actually make the first stage of labor go faster, and being mobile during labor can help mothers cope with the pain better. Being flat on your back , confined to bed, does not.

It's important to realize that studies have been done, some of which produce completely counterintuitive results. Like, it would seem perfectly plausible that epidurals - especially ones that are "heavy" and allow the mother no sensation whatsoever - would slow down labor. Studies have shown, apparently, that this is not the case. But it's not just as simple as that: it's a multi-faceted issue with lots of pieces to the puzzle that need to be put together before you can draw any conclusion. Since many hospitals and doctors have little idea what normal birth is like, we base the results of many studies - and thus our conclusions about birth - on a completely skewed model of care. Therefore it's important to remember that some studies, however official-sounding, are inaccurate and inherently flawed, especially if they do not take into account those differences.

As I wrote about in this old post , if you choose to get an epidural, that's your decision. It should not be one that's taken lightly, but rather with as much information as possible, so that you have made an informed decision, not one that's based on someone else's perception of pain.

Do epidurals cross the placenta?
Facts on Epidural Anesthesia

Stars who 'ditched the epidural'

A few months ago I posted a link to a study that suggested poorer, less educated women refuse the epidural.  When you see a list of celebrities who are opting out and choosing natural birth, it makes you wonder how accurate that study really is.

Granted, I know they're not in the majority. But it's refreshing to see celebs choose a more user-friendly approach to birth. And young women, too - I think that's awesome. They are sending a message that yes!, this is possible and no, you don't have to grow your armpit hair long and braid it or eat Grape Nuts cereal every day in order to want a natural birth.

Among the list are:

Gisele Bundchen - At the top of the list is supermodel-turned-birth-activist Gisele Bundchen. Everybody's heard about her bathtub home birth, and while some are riled about it, who gives a crap. She should be at the top of the list - but I'm not sure many people understand why. Given the fact that in her home country of Brazil the c-section rate is around 36 percent, and she chose an unmedicated home birth, I think this is of the utmost importance. We can only hope that her fellow countrywomen are looking on from afar, thinking, "Hey, maybe a vaginal birth isn't such a bad idea." I'd love to hear what Brazilians think of her as a result. And the reaction elsewhere? The Daily Mail says, "Gisele claims son Benjamin's birth didn't hurt." Claims? What, do you think she's lying?

Nicole Richie - The actress refused "even an aspirin" in labor with her daughter, which the author describes as "hardcore." Considering Nicole is a recovering drug addict, I can see her reluctance to have pain meds. What makes that "hardcore"? I think it's smart. This is probably one gray area that is often ignored - the addict who is managing pain of labor. I remember reading (maybe on The Unnecessarean?) about an addicted mother who refused pain meds, and the nurse made sure to come in early and often to badger the patient into getting an epi. I can't think of a more humiliating experience - having your addiction thrown in your face, especially when you're trying so hard to overcome it. 

Jessica Alba - This young, first-time mom had a very 'zen birth' with daughter Honor and apparently 'didn't make a sound.' The author's comment: "Ok, somebody's lying." Huh?

I found that vocalizing during labor helped, but it's different for everyone. Many women make noises, many are quiet - it's not all the way you see childbirth portrayed on soap operas. I've heard women claim that screaming is a 'sign of weakness,' which I think is complete garbage: we know that for some, vocalizing can help them manage pain and works as a release, of sorts. I tell people, "I screamed in labor not because of the pain, but because it was freaking hard work!"

Joely Fisher - Carrie Fisher's younger half-sister gave birth to daughter True Harlow Fisher-Duddy at home, in the company of doulas, midwives, and a doctor, according to mom. The author's comment: when we can't think of a jab to make about her opting out of pain meds, let's say something creative, like "Maybe each person got to pick one of the baby's million names?" What?

Interestingly, the article's author mentions a friend who'd recently had a baby and felt that she was manipulated into having a c-section for fetal distress. Of course, when the baby was born, it was perfectly fine. The author even mentions Ricki Lake's movie "The Business of Being Born." And yet, the overall tone of the piece is that women who choose to opt out of the epi are somehow crazy, liars or "hard core," which attaches sort of a freak label to the whole thing. For some who might be curious about a natural birth, this association alone might be enough to completely scare them away from the idea, and 'poor and less-educated' seems to have little to do with it: "Women who give birth without drugs are out to prove something, and are completely nuts." 

'No epidural for me: I'm brave'

I love Flair on FaceBook. But this one I didn't love - the "epidurals are for sissies" button. A literal "vag badge," perhaps?

That's kind of like the stupid comment I heard on a Baby Center board about VBACs: "No VBAC for me - I love my baby!" What the heck?

I know the person who made this Flair means well, but unfortunately comments like this only serve to further polarize the birthing community. We know that every woman is different, and thus every pregnancy is different. So is our individual level of pain tolerance. What is relatively painless for one woman might be excruciating to another. Add another set of circumstances in there, like fear, psychological issues like prior sexual molestation or abuse, medical issues like vaginismus, and the level of pain for one woman is completely different than the next.

I'm all for natural birth, and feel that out of my three births, the ones with spinal anesthesia produced infants who were slower to take to the breast and generally sleepier. But considering the risks of having an epidural, not to mention the unpleasant side effects that can sometimes happen, sometimes I wonder if the women getting the epidural are the brave ones. It's a good thing you can't see what's going on behind your back.

I'm sure if I looked hard enough, I'd find the "NCBers braid their toe hair and eat granola" Flair or something similar. Private thoughts aside, sometimes I think we need to just smile and nod, keeping our mouths shut. I would hate to have this flair posted to my wall and hurt the feelings of my friends, maybe one of whom had a horribly long, posterior labor that was quite painful. I had back labor for the first hour or so of my VBAC labor before my baby turned; I don't know how I would have coped had it lasted the entire time.

And some women who know the risks and go into it with an open mind end up getting the epi, whether because they were pressured or because the pain was just much more than they expected. I'm sure the one mom I know who suffered major internal damage as a result of her rather botched vaginal delivery was thinking that. I suppose, unless we don't have a horror story to tell, it's hard for us to remember that neither side is a complete walk in the park, and just about anything can happen.

I just like to say, "Maybe you won't need one; just wait and see what happens."

Low Expectations: Labor Pain Management

I often visit a ton of forums that deal with pregnancy and childbirth, and am saddened, shocked and amused at what I read. The perceptions that women have - and pass on to each other - often frustrate the crap out of me, and I wish we could somehow erase all those myths, misperceptions and unfounded fears that often swirl around being pregnant and giving birth. 

Pain management is one of them. One forum that I used to frequent often had first-time soon-to-be-moms asking questions like "How will I know I'm in labor?" or "How badly does childbirth hurt?" All perfectly good questions, that are usually met with total crap answers. Of course, the minute the semi-crunchy granola mom like myself answers those questions you're usually scoffed at or blasted for your opinion that pain is different for each woman. "Trust me, honey," one woman says, "you'll want that epidural!"

Well, not necessarily. I am totally not trying to sound like SuperMom in need of a "vag badge" (good Lord, I hate that expression!), but geez, pain management is different for everyone! I usually tell people, when they ask, that you should take it as it comes - not insist for an epi the minute you step off the elevator - but wait and see what happens. You might get through it and say, "That wasn't too bad," or maybe need something like Nubain instead. There are alternatives to an epi that can bring some relief, or at least relax you so you can focus on the business at hand. 

I had Nubain with my vaginal birth and while it didn't do squat for the pain, it at least made me not care about it. LOL I remember getting half way through my delivery thinking, "Maybe I should get an epidural." Then I thought, "Nope, too late for that." (Maybe it was the Nubain talking? Who knows. LOL) 

With my third child, I essentially went through the entire labor, minus the pushing stage, and didn't have anything. It wasn't anything terribly unmanageable until my water broke, and even then, changing positions totally helped. That's the thing - pain is different for everyone, and can be totally dependent on a number of things: your positioning, the baby's positioning (back labor stinks!), and especially your state of mind. If you go into it with another woman's idea of what pain is, simply because they told you "you'll want that epi!," then you're bound to be scared to death and clenched up tighter than a clamshell about to relinquish its prized pearl. 

Midwife Ina May Gaskin has a terrific analogy for this, which she calls "Sphincter Law," as far as relaxation and dilatation during labor. Picture a man who's been offered a $100 bill, if only he can pee in front of 50 people. There's no way that's happening, right? Just like some people can't go to the bathroom in strange places, giving birth can kind of be the same way for some people. If you're more focused on the pain, or especially the idea that strange people are in the room looking at your female parts, then you cannot relax and neither can you effectively dilate. Some women no doubt become exhausted at this point and stall, causing the cervix to stop opening. 

One thing I did to encourage dilatation was to meditate and picture in my mind the cervix opening up, almost like a flower. I pictured the chart in my doctor's office that shows the different stages of dilatation, and made a circular shape with my hands to further illustrate that point to myself. For my third baby, I actually carried the lid of a coffee can (which is roughly the same size as a fully dilated cervix - can you believe it?)  around in my purse LOL and looked at it whenever I thought about it. (Perhaps it worked a little too well, then, when I showed up at the hospital and my water broke as I was signing myself in!)

Other ways to manage pain in labor can include massage, walking and changing positions. With my second baby, she was nearly posterior, which meant painful back labor. Lying on my left side encouraged her to turn, which made the pain much more manageable. Having a doula present can also help by keeping you focused on something other than the pain, and has been shown to decrease the rate of epidural use. Either way, if you decide to have one, then that's perfectly okay - some women have other issues going on that might necessitate having one, and there's nothing wrong with that. 

Whatever happens, I encourage women to take it on a "let's wait and see" basis, because you just never know how things will turn out. If you go into it having low expectations, then they will almost always be met. But if you think positively and say to yourself, "I think I can do this!," you might be pleasantly surprised. 

Better Late than Never: A VBAC Success Story

Just the other day I got word that an acquaintance had a successful VBAC. The baby was ten days (yes, 10) days overdue and weighed 9 lbs. 6 oz., I believe - the high side of normal and nothing terribly huge. The mom told me that she hired a doula for this labor (yes!) and had a great practice of midwives (even better!) and it sounded to me like a much better experience than before. 

With her first, she labored for about 17 hours and failed to progress. I think she did mention how nurses were very pushy about getting an epi and finally, she caved, which is probably why she never fully dilated. I assured her early on in this pregnancy that a doula would help her to stay more focused, and while she could have the epi this time around, her doula would be a non-partial advocate for her that could take her mind off the pain. 

I didn't want to be too pushy about suggesting a VBAC but was elated when she told me she was going to try for one. I figured I'd offer her advice based on my experience but not get too overbearing. So when she told me she was hiring a doula, I figured she'd done all the right research and would be just fine.

Welcome to the world, little man, and you can thank your mommy later for letting you come in your own sweet time.