Labouring over options for pain relief

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Ma.Fe Jackson didn’t want to miss any part of the birthing experience, so she refused to have an epidural ...

“Childbirth is very, very painful, but that’s normal and it’s only for a short time,” says the new mom who gave birth in February to first baby, Angelique.

Jackson is Filipino and most Filipinos don’t have epidurals, she explains. Besides, she’s scared of needles, which is how an epidural is administered.

Pain may be a normal part of childbirth, but most North American women today don’t experience it.

In Edmonton in 2009, 57 per cent of the 11,782 women who gave birth in hospital asked for an epidural ... The majority of those who didn’t have an epidural had some other form of pain relief ...

Thirty years ago only two to four per cent of women had epidurals.

“We only used them for longer, more complicated labours,” ... “There was a general desire to have a natural childbirth because there was a feeling that birth had become medicalized.

“Now, I would say the majority of women are coming in and they’ve already decided that they will have an epidural as soon as they get into labour. It’s really swung the other way.”

Even women who plan to have an epidural only as a last resort, usually end up having one ...

Dr. Michael Klein, a family physician, pediatrician and neonatologist from Vancouver, thinks the trend reflects the lack of knowledge that women having babies, especially first babies, have about labour and delivery.

His maternity research ... shows one-third to one-half ... aren’t fully informed about childbirth, including the effects of an epidural.

That may have something to do with the fact that only one-third of first-time moms-to-be sign up for prenatal classes. The majority get their information, or misinformation, as Klein calls it, from highly questionable Internet websites.

A similar survey of 5,000 health providers who care for these women, found they too were similarly lacking in information, says Klein, professor emeritus of family practice and pediatrics at the University of British Columbia, and senior scientist emeritus at the Child and Family Research Institute in Vancouver.

Although the epidural is considered safe, there are risks ...

“ ... epidural headache, and in very rare cases you could have a significant neurological problem because of it,” ...

“ ... it will lengthen the first and second stages of your labour significantly, that you’re more likely to have an epidural fever, and that it increases the likelihood of forceps or vacuum ... You’re more likely to have an episiotomy or perineal trauma, and the issue of caesarean sections tend to be avoided altogether because doctors actually believe that even an early epidural will not cause a problem.”

... in general, younger obstetricians (under age 40), were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, than physicians over 40, and they were less appreciative of the role of women in their own birth. They also saw caesarean section as a solution to many perceived labour and birth problems.

“ ... I think women really need to know the full picture,” he adds. If they were fully informed he believes fewer women would ask for an epidural.

Klein is best known for his research that found routine episiotomies caused the very problems they’re supposed to prevent ...

... Klein acknowledges that birth is painful, but argues many women would be able to handle it without drugs if they had support.

“There is a difference between pain and suffering, and no one is in favour of suffering,” Klein says. “You suffer when you are abandoned, when people aren’t there to help you with your pain.

“Nobody is going to deny there is pain in labour nor that it is significant, but if you are cared for by somebody who understands the pain and tells you only have a contraction or two as intense as this until you’re fully dilated and you’ll be much more in control of the pain, if you had that kind of information, you might decide to hold off (having pain relief).”

... “Midwifery intervention has positive outcomes that no other intervention that we have to offer in medicine can even touch. If we all practised that way we wouldn’t be having this discussion,” ...