Thursday, January 29, 2015

Epidural rate is driven by fear, not science.

In this article, "I liked my epidural, before I read this report", a doctor discusses her experience of a labor that was riddled with intervention and what she has since learned that, if she had known before, would likely have changed some, if not many of the choices she made in preparation for her birth.

This is a great read, and I recommend taking a look, and then please come back so I can share with you some information about what we use for comfort when the epidural is not in play.

For many years, we "natural childbirth" advocates have been decidedly dismissed by the medical community.  While it's nice to have many scientific studies and growing number of doctors recognizing that we aren't the "quacktivists" they once believed we were, I don't really care about being validated.  I don't need a controlled study (I recognize that science demands it) to know what I have seen for years and years and years as a Doula.  I am happy that science has finally caught up with the women of the red tent.

You see, MOST labors, if left alone, would be uncomplicated.  The World Health Organization recognizes that the cesarean rate should be hovering in the 10% range, not the national rate of roughly 33%.  What that means is that 23% of these cesarean sections are being caused by the management of labor, not medical necessity.
Inductions are the number one cause.
When an induction is performed, the pain experienced is different than natural labor.  Pitocin (even though the IV bag is now labeled "Oxytocin") is not natural.  It is a synthetic version of the hormone that is naturally produced and although it does cause the uterus to contract, it is not the same.  Where natural labor contractions are wave like, pitocin contractions are reported as sharper, spikier pains.  When pitocin is admistered to a woman who is already showing signs that her body is preparing for labor (which arguably makes the intervention unnecessary anyway) it can be more effective than when performed on a woman whose cervix is still high, tight, thick, posterior, and firm.  There is nothing indicating that her body knows that the baby is ready to be born.  Generally speaking, it's wise to trust the body that has prepared for, conceived, and grown an egg, into a zygote, zygote into a fetus, and a fetus into a tiny human.  Unless there is an actual medical reason, other than "my doctor will only LET me go one day past my due date".

The number two cause is the overuse of the epidural, and/or the combination of pitocin and epidural.
First of all, the epidural does not treat anything at all.  It is almost universally used to treat "pain", which the medical community has ruled is a "diagnosable and treatable disease".  I'm not here to argue with that.  I'm quite certain that there IS an amount of pain that would cross that line.  I simply contend that for most women, labor pain doesn't cross that least not enough to rationalize the risks.  The epidural OFTEN becomes necessary because of the pain caused by induction.  Not natural labor.  Pitocin has become such a common practice that most women do not know the secret that I know.  I have experienced it twice myself and witnessed in in a VAST majority of women that I have attended.  Labor is mostly quite manageable.  The risk of the epidural (both risking fetal distress, increasing the risk of cesarean, as well as the risks of all the interruptions of beneficial hormonal processes mentioned in the attached article) is almost always, in my experience, going to outweigh its potential benefits.

Welcoming natural labor requires a certain set of beliefs that our current medical community robs women of every day by preying on fears and planting seeds of doubt so that they may intervene when it fancies them.

Here are the beliefs that you need to manifest:

  • My body knows how to do this.
  • Neither the word average, nor the word common, mean "normal". 
  • "Normal" is a pretty broad range of experiences.
  • I am not a textbook.
  • My doctor: does not know everything, has a standard of care, perhaps even an agenda, is payed more when interventions take place, is irrationally financially compensated when a cesarean is performed, has a schedule to keep, is a trained surgeon and therefore is unopposed to the idea of surgery, does not have to take home and newborn and care for him/her while recovering from major abdominal surgery, is often not tuned in to the idea that birth is not just a physical act, but also a shared emotional experience between mother and baby and it is sacred.
  • It is reasonable to believe that my body was made to birth my baby.
  • Complications are rare, and discomfort/reasonable pain is not a complication of birth.
  • I am stronger than I know because I have not yet had an opportunity to realize it.
  • Women have been giving birth for millions of years and I am here because the women in my family can and did give birth.
  • I deserve to feel the power of my body and know that I am capable of more than I know.
If we cultivate these beliefs and arm ourselves with a few tools to help you get through the most challenging moments, the handful of contractions that may feel overwhelming to you, then were in business.  What is needed is a trust in the female body and knowledge of the birth process so that we may better know when to apply the various skills I will discuss below...these are universally proven through application in birth through time and space.  You may call them "old wives tales" "old wives" will gladly accept the credit!

  • Try to ignore your labor as long as possible.  Active labor is NOT SUBTLE.  I promise you will not sleep through it.  Try to get as much rest in your early labor as possible so that you have the energy needed to take on somewhat of a marathon.
  • Treat yourself like a goddess.  This also means that you must surround yourself with others who will also treat you like a goddess.  Nourish your body, stay hydrated and otherwise pamper and be gentle with yourself.
  • When you can no longer comfortably "rest", get up and move your body.  Walk, dance, sway, stretch, listen to your body and follow your instincts.  Women who are active during labor, generally have shorter labors and they experience less pain.  Women who lay down during labor focus more on the discomfort, and gravity is unkind to the supine; adding additional pressure to the back and pelvis. Walking and moving, shifting the hips helps the baby to move down and navigate through the pelvis.  You'll need to have a few spaces to lean or kneel during contractions, as walking through them won't likely be possible once active labor set is, but creating a routine is very common...walk around the living room and into the kitchen, lean on counter during your contraction while your birth partner rubs your back, have a sip of water and begin again.
  • Communicate with your birth team about checking into the birth center when you are in "active labor", and know what physical, emotional and behavioral signs accompany being approximately 6cm dilated.  A few examples might be: 5-1-1 (Contractions that are 5 minutes apart, lasting about 1 minute, for 1 hour or more), intensity of contraction should be causing: perspiration, vocalization, perhaps nausea, sometimes expletives, focus on relaxation and breathing, to name a few.  Ask your medical team to help you evaluate labor over the phone, not relying on uncomfortable vaginal exams to determine your approximate stage of labor.  Ask them to encourage you to stay at home until you actively NEED what they have to offer.
  • Once you are more than 5cm dilated, use back massage, warmth, changing positions, water (shower or tub), continued goddess treatment with nourishment and hydration.  Anyone you choose to have at your labor/birth should be there in service to you.  Your cervix will likely change faster now, it usually takes less time to get from 5-10cm than it did to get from 0-5cm.  The contractions are stronger and making change faster, especially if you are still active and working WITH your baby.
  • Whenever possible, the transition stage should take place submerged in warm water. If no tub is available or you are not allowed in the tub for some reason, having someone providing almost constant back support/massage, and hip support/massage during contractions will be the next best thing.  My secret weapon is a tool called "Synergy Stone".  It is a massage tool that can be heated in the microwave, by submerging it in hot water, or with a heating pad and provides a radiant warmth that is, from what I've been told, AMAZING during difficult contractions. You can check them out here: and then click on the tab titled "SYNERGY STONES" for the drop down menu.  P.S. If you decide to order one, make sure you note that Kristin Dibeh referred you, I have started representing them because I believe in them SO MUCH!  My favorite is the Blissful stone and my second is the  Serene stone for labor, I would recommend getting 2 stones so you can swap them out when one cools down, FYI.
  • Once you get past the dilating (1st) stage of labor, you're needs will change somewhat.  Most women I talk to, fear pushing because of what they have seen in movies and on television.  UGH.  Media has misinformed you.  Pushing is far more effort than pain for most of the process.  Many women even say that it is a relief to push, that it feels good.  You get longer rest periods and the intensity of the contractions that are pulling the cervix back disappears completely and is replaced with a feeling of pressure...granted it is at times a surprising amount of pressure...but it is nothing to fear.  Hopefully you will be supported and guided in your pushing and coached to back off the push when baby begins to crown, to let your body stretch (as it was made to do) and let the baby's head emerge gently.  Once the head is out, the rest of the baby will usually be in your arms with the next push.  Babies who are born without a chemical cocktail in their bodies are more likely to be able to be placed directly on your abdomen, allowing you the immediate gratification of receiving what you have been working so hard for, and the powerful first moments of bonding, having just gone through such an incredible shared experience.  
In closing, your body is a miracle and deserves your respect and the respect of our medical community.  Birthing is a superpower, and that should not be taken away for any reason short of absolute medical necessity.  There are, of course, reasons for interventions.  I am only opposed to intervention being the first thing on the list of things to do when it gets hard, or any little minor deviation from a narrow definition of "normal" presents itself. Do your personal best to be informed, confident, trusting in the natural process, and build a team that shares these convictions.  If a circumstance arises that requires intervention, then you will have the knowledge to provide informed consent and you will have the support around you to help you to accept interventions when necessary, but there is a 90% chance that without pre-intervention, your body is capable of giving birth.

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