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 Grant argues that the old adage of 'natural' is best when it comes to birth is no longer applicable.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
