Grin and bear it, ladies: pain is supposed to be positive

Apparently, women today aren't as stoic as their ancestors when it comes to pain in childbirth.

Dr Denis Walsh, a senior midwife and associate professor in midwifery at Nottingham University, said: "A large number of women want to avoid pain. Some just don't fancy the pain [of childbirth]. More women should be prepared to withstand pain."

"Over recent decades there has been a loss of 'rites of passage' meaning to childbirth, so that pain and stress are viewed negatively," he added, arguing that patients should be told labour pain is a timeless component of the "rites of passage" transition to motherhood.

Now, while I think that in certain contexts epidurals are sometimes overused, why on earth should women suffer through pain if they don't have to? Does it make you a better mother?

Thoughts?

"Hee hee hooo": breathing no good when it comes to birthing outcomes

A new Swedish study published in BJOG: An International Journal of Obstetrics and Gynaecology reveals that antenatal breathing classes have no measurable benefits. Couples that were taught relaxation techniques, massage and breathing fared no better than couples who were enrolled in standard antenatal classes. The researchers thought that relaxation techiques and breathing would help couples with the stress during birth, lower rates of epidural use and more pleasurable birthing experiences overall. They found, however, that the experiences in both groups were largely identical.

Professor Philip Steer, BJOG editor-in-chief, said: "The findings of this study are contrary to what many of us would expect."

"The lack of benefit from psychoprophylactic techniques is disappointing, and suggests that parents' experience of childbirth is affected more by their personality and previous psychological orientation than by the relatively limited training that is possible during pregnancy. An alternative view is that standard antenatal classes are 'good enough' and therefore represent an effective use of limited resources

What are your thoughts? Did any of you use breathing or relaxation techniques during your labour?

Epidurals on the way out in the UK

In Australia, it is no secret that medicalised birth is increasingly becoming the norm. With a greater push for less intervention and more one-to-one care, maternity reform is a red hot issue on the national agenda. Nevertheless, while the prospect of having wholly funded home births and more accessible birth centres throughout the country is exciting, should less intervention mean no intervention?

In the UK, doctors and patients are struggling over new regulations surrounding the use of epidurals during birth. As new guidelines have characterised the use of epidurals and caesareans as 'unnatural' in a bid to reduce interventions by up to 40%. The goal of the new guidelines is to ensure that more women are having 'normal' or 'traditional' birth. Obstetricians, however, have problems with this.

Kim Hinshaw, a consultant obstetrician at Sunderland Royal Hospital, said: ‘I have major concerns with this. I don’t think we will ever reach a figure of 60% normal delivery using this definition. For example, in Sunderland we have an epidural rate in first labours of 60%.

‘This definition implies that if you ask for an epidural for pain relief, but go on and deliver normally after a six-hour labour, your birth was not ‘normal’. That is a disgrace.’

And Professor James Walker, a consultant obstetrician at Leeds Teaching Hospitals NHS Trust added: ‘This is a very rigid definition of what normal birth should be. Epidurals should not be done without reason; they should be kept to a minimum. There are some women, however, who require an epidural because they cannot cope with the pain in any other way.’

I have to agree. While I am fully in favour of supporting national guidelines that seek to minimise the unnecessary interventions, at the same time, I bristle at the thought of women giving birth in pain and not being allowed to have relief if they ask for it.

Would you be happy with this model of care in your own country?

Source: http://tinyurl.com/ccz8vh

Why is birth painful?

I came across an interesting article in Salon suggesting that the pain of childbirth basically serves no purpose and is merely a hangover from evolution. Some anthropologists have argued that labour pain served as a means of letting women know that they should seek assistance, ultimately, as a mechanism to lower rates of infant and maternal mortality. If women received help, they were less likely to bleed to death. The strongest evidence seems to be that all cultures have traditional birth attendants which suggests that assistance during birth was considered to be critical.

The question remains, it seems, as to whether labour pain has lived out its usefulness for women. As the author of the article suggests, this theory is problematic for natural childbirth advocates because this evolutionary perspective implicitly argues that birth is dangerous and not 'natural'.

I'm not sure I agree with this argument in general. After all, babies heads have become substantially larger over time and a woman's pelvis has pretty much stayed the same. In a nutshell, it seems pretty clear to me why giving birth would hurt.

Source: http://open.salon.com/content.php?cid=31854

Angelina 'uncensored'

Ange is on the latest cover of Vanity Fair and she's not doing the proverbial 'Demi' although she does talk about being pregnant and Shiloh's caesar in Africa in which she found it necessary to comandeer an entire country in order to give birth. Oh and despite recent reports, she has not yet given birth to the twins in France....

On being pregnant:
“I love it. It makes me feel like a woman. It makes me feel that all the things about my body are suddenly there for a reason. It makes you feel round and supple, and to have a little life inside you is amazing. Also, I’m fortunate. I think some women have a different experience depending on their partner. I think that affects it. I happen to be with somebody who finds pregnancy very sexy. So that makes me feel very sexy.”

On Shiloh's birth:
“We were in this little hospital in Africa when Shi was born. I don’t think there was anybody else in the hospital. It was just a little cottage, the three of us. It ended up being the greatest thing…. I had a C-section and I found it fascinating. I didn’t find it a sacrifice and I didn’t find it a painful experience. I found it a fascinating miracle of what a body can do.”

Sorry, I'm just sick of Ange's sappy 'happy family' shtick. The article is called 'Angelina Uncensored' and for all intents and purposes, she's completely censored. Everything that comes out of the woman's mouth is just how happy she is, blah blah, how much she loves being a mother, blah blah. Not that there's anything wrong with that. Surely, motherhood is incredibly fulfilling but give us a little dark and twisted, a little bit of reality because no one can be that insanely happy nearly 7 months pregnant with twins and with 4 other children to look after (in spite of having a cavalcade of nannies). Motherhood is hard.

She's pregnant with twins. Surely, SURELY by this stage, she's not feeling so sexy anymore. The woman in my study who was giving birth to twins had to stop working at about 27 weeks because she was so uncomfortable that doing anything was a chore. I'm not going to qualify my statements here because any woman who has had twins knows that it's really hard work to be pregnant with two babies at once.

And what about the recovery from her caesar with Shiloh?! Sure, it's a 'fascinating miracle' that a doctor can slice your abdominal muscle in two and remove your baby in four minutes or less and you may not feel any pain during the surgery but what about after?! Give me a freakin break.

Oh and in case you had forgotten what Ange's 'bump' looks like (because we haven't seen enough pictures of her pregnant, Us magazine has an entire gallery devoted to her stomach) in the link below.

In other news, I'm happy to report that I printed out a full draft of my dissertation and had it bound....lots of work ahead for the next 7 weeks until submission but it's a big step forward..yay!

Source: http://www.usmagazine.com/angelina-jolie-brad-pitt-finds-my-pregnancy-very-sexy

Epidurals: get one even before pain starts

I know it was only recently that I wrote about epidurals and the post generated quite a large response...Nevertheless, epidurals are back in the news as a result of a new book Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. Grant argues that the old adage of 'natural' is best when it comes to birth is no longer applicable. In fact, Grant suggests that women should have an epidural even before they experience any pain associated with birth.

Whilst I agree, as Grant contends, that there is relentless pressure on women to give birth 'naturally' and that many women feel guilty when they choose to manage pain with epidural, the fact is that Grant suggests the opposition or at least the feminist critique of pain management methods in misogynist. He says:

"Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception."

Hmm. While there are contingents of 'natural' birth advocates who argue that all pain medication in birth is 'unnatural' and 'bad', the majority of feminist critiques surrounding the use of epidurals is not that women are 'bad' mothers if they choose to use them. Feminists argue that it is the way in which epidural is presented as the default option for pain management in a highly medicalised environment that is problematic. Grants continues:

"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”

In fact, I don't think the work of any feminist scholar of childbirth suggests that women 'should be in pain' in order to have a 'real' or 'authentic' experience of birth. Whilst this might be part of cultural narratives or even imperatives surrounding how women should 'do' birth correctly, this is a much different angle from scholarly work in this area.

Even more alarming is this suggestion:

"Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth."

What really bothers me about this statement is the association between control and technology. Women clearly can be empowered with medical advances in pain management as well as with other forms of reproductive technology. However, Grant fails to recognise that 'empowerment' rests on choice and in many American hospitals, for instance, the notion of 'choice' becomes blurry when women become part of a cascade of interventions which limit her ability to make decisions on her own. For instance, the reason so many women in America use epidurals is not just because they want them; with the induction rate close to 90% in some New York hospitals, for instance, epidurals become essential because contractions are so intense without a gradual build up. In these case, an epidural becomes routinised as a necessary medical intervention when perhaps many of those same women might not have chosen an epidural had they been able to allow labour to progress 'naturally'.

Nevertheless, I think it is a very dangerous proposition to suggest that epidurals should be part and parcel of birth without the inclusion of their risks. Moreover, this whole 'epidural before pain' framework only entrenches the notion that birth is scary and painful. Again, of course for some women it is intensely painful and everyone should acknowledge that, but the idea that women should be pre-medicating in anticipation is just ridiculous. Why not encourage women to learn alternative ways to manage pain before resorting to chemicals?

Moreover, the idea that pain must be pre-managed also suggests that women can never have 'positive' experiences with intense pain. If the pain of birth was so horrible, women would never have babies. Many women tell me that whilst birth itself was one of the most challenging moments of their entire lives, they felt like they had accomplished something; not because they had endured alot of pain and survived. They felt accomplished because birth is an intensely visceral experience and for some women, feeling childbirth in every ounce of their being is something they would not want to give up with medical intervention.

In the Netherlands, women are not allowed to have epidurals unless the mother is in a high-risk category. Whilst, I do not necessarily agree with this more extreme measure, the truth is that the majority of Dutch women give birth at home with a midwife and the maternal and infant mortality rate is extremely low. Why is it that in rich, 'Western' countries maternal and infant mortality rates are still relatively high? The answer lies in the unnecessary invocation of medical interventions (and not only epidural).

What do you think?

Source: http://women.timesonline.co.uk/tol/life_and_style/women/families/article3625980.ece

Pain-free birth just a pipe dream?

A new study says that women are kidding themselves if they think they can get through birth without pain relief. British researchers from Newcastle University reviewed 32 studies on expectations of labour pain, finding that most women who didn't want to have pain relief ended up with it.

However, what about home birth? 99% of women in America give birth in hospitals. Definitely not places which are conducive to quelling women's anxieties. 90% of births in New York hospitals are induced and epidurals are often doled out without any measures in places to help women manage pain naturally before the drugs are in place.

A 1988 U.S. study found that mothers that underwent labor in a hospital rated their pain as significantly higher than did a home-birth group. In the spirit of Sheila Kitzinger, what about accounting for those mothers that report euphoric, even orgasmic, feelings during what is supposed to be the most painful event in their lives. This study was obviously not included in the current review. More recent studies suggest that knowledge, confidence, and lower anxiety are predictive of positive childbirth. Also where is the discussion of the value of midwives? Studies show that midwives can help birthing women to find their own ability to cope.

This new review basically shuts down any positive feelings pregnant women may have in anticipating birth. Sure, it hurts and there is nothing wrong with choosing to have pain relief. However, why suggest that women are setting themselves up for failure by even thinking that they could possibly give birth drug-free?!

Source: http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/women-are-misled-into-thinking-that-childbirth-can-be-painfree-795721.html

new elective caesar policy

This article is causing some profoundly mixed emotions for me. On one hand, it's truly fantastic that the NSW government (that's New South Wales, the most populous state of Australia for non-Australian readers) has acknowledged that not only is the rate of elective caesareans increasing but that it is also possibly endangering the lives of women who are uneducated about the procedure.

However, I have strong feelings about taking women's responsibility for their own bodies away from them and giving control over to the government to decide what is best for birth. Clearly, major abdominal surgery is a significant leap from vaginal delivery but is it really fair to insist that women must not have a technologised or interventionist birth if that is what they really want? Sure, some of you might say 'Well, how does she know what she wants if she doesn't know the risks?' That goes without saying but adult decision making is kind of like that. We make decisions about lots of things without knowing all of the associated risks. With birth, it seems like everyone seems to know what's best for pregnant women except women themselves.

We dont have to agree with the choices other women make but I think we need to respect them. I might not choose to have an elective caesar but I don't think my choice not to have one should prevent another woman from having one if that is what she feels comfortable doing. I think it would be a completely different story if for instance, the NSW government decided to ban women from having pain-reducing drugs during labour because pain relief is non-surgical. All of the most common pain killing drugs have side effects and there is plenty of research to support that. Hell, epidurals are injected into the spine. That's a major risk; but women who want to have less pain in labour should never be forced to 'suffer' needlessly and many women are willing to take a risk to be comfortable. I think this is the same issue. Maybe it seems a little strange to some of us that a woman would rather have surgery than give birth vaginally but in my own work, I have interviewed a number of women who have had elective caesars for various reasons. Fear of pain is a primary reason and who can really fault them for that? It's not my place to do so and it's not the government's place either. Women need to make up their own minds about how they have their babies. Caesareans should remain an 'option' because women should have every opportunity available to them to have a comfortable birth and if that means being cut open, who am I to judge?

Caesars can either serve or impair women's agency not so much by the inherent character of the procedure (in terms of obvious physical risks), but in how the politics surrounding elective caesareans coalesces with the needs of variously situated women (economically and politically and also varying by race, class, and sexuality). What is 'good' for some women is not necessarily appropriate for all women.

NSW hospitals move to block caesarean option
7 April 2007, The Age

WOMEN will not be allowed to insist on caesarean deliveries in NSW public hospitals without a medical reason, under a new health department policy. Under the new rules, women must be told in detail about "the benefits and risks of caesarean section compared with vaginal birth specific to the woman and her pregnancy". The policy cites a US study of more than 5 million births, which found that babies born by medically unnecessary caesarean were three times as likely to die in the newborn period as those born vaginally.The new policy also obliges health professionals to advise women about the implications for subsequent pregnancies. A 2005 study of 136,000 second pregnancies across NSW found those women who had had a caesarean first delivery were at much greater danger of a ruptured uterus, hysterectomy orinfection, while their babies were more likely to be premature, have serious breathing problems or need intensive care. Elective caesareans have increased by 25 per cent since 2001, and now account for one in six births. Many of these are for medical reasons, but doctors say more women are opting for caesareans from preference. Andrew Child, a member of the NSW Health Maternal and Perinatal Committee,which drafted the directive, said that while first caesareans were generally safe, dangers escalated steeply with subsequent births. Hannah Dahlen, secretary of the NSW Midwives Association, said: "People are... thinking of it as just another option for birth, rather than major abdominal surgery."JULIE ROBOTHAM