anna in med school

a.k.a. “giving birth without an epidural.”

I would like to preface this post by saying that I’ve been dragging my feet in the writing and posting of it.  I have many conflicting thoughts, and I’ve tried to restrain myself with hopes of coherence.  Here goes…

One night, when he was on his OB rotation during his intern year of residency, John came home stressed, and the first words words out of his mouth were, “Please tell me you’ll want an epidural.”  At the time, it was a no-brainer to me.  Of course I’ll want and get an epidural.  In the U.S., it’s associated with minimal risk to mother and baby, and it allows mom to experience childbirth with less trauma.  Since it doesn’t act systemically, it doesn’t create the 1950s/60s vision of drugged-out-of-her-mind mama and, consequently, child.  In fact, it many hospitals, it’s use is associated with a lower cesarean rate.  Why the hell wouldn’t I want it?

But I am incredibly susceptible to peer and social pressure.  As more of my friends started considering unmedicated childbirth (note the wording, which is still problematic; personally, I consider birth with an epidural just as “natural” as safe births without), I weighed the advantages and disadvantages.  My thought process on the advantage side was as follows:

1. Having been catheterized twice before, I thought I would prefer not.  That said, I hear once you have an epidural, you could care less.
2. In my mind, I thought it might be nice to be able to walk around, and the ability to do so is compromised by epidural.  Although, as I learned during my OB rotation, anesthesiologists nowadays are really good at their job…if you want to walk, they can try to help you walk with an epidural in place.
3. I did not, and I still don’t, like the idea of continuous fetal monitoring.
4. I kind of liked the hippydippy idea of experiencing birth with my child, and I wanted to at least try to not have any element of that sensation and awareness to be dampened.

Here’s the hilarious thing: not one of my stated advantages actually came to fruition:

1. Although my lacerations were relatively minor (second-degree: into the perineal muscle but not into the rectal sphincter), they were both posterior (toward the rectum, common) and anterior (toward the urethra, less common).  Therefore, a straight catheter was recommended for the repair in an effort to minimize the risks of future problems during urination.
2. By the time I got to the hospital, I was fully dilated.  As soon as I got on my back to be examined, I was not on my feet again until post-repair.  I guess it was kind of nice to be able to get up to use the bathroom and change the chucks saturated with blood…but this was not a highlight of the whole birthing experience.
3. Again, when you show up to the hospital fully dilated, you lose a few options, such as walking around, receiving any type of medicated pain control (epidural, nubain, or otherwise), and intermittent auscultation.  Everyone gets monitoring for at least 20 minutes to look for accelerations and variability…if your baby happens to be delivered before the 20 minutes or up, then looks like you have a monitor strapped to your abdomen during the delivery.  You know what?  I didn’t even remember that detail until I just now jotted down my reasons to try without an epidural; it was a non-issue.
4. Maybe some sense of awareness will come with my next delivery, if I’m lucky enough to have one.  Because this delivery was an absolute shit show.  I was so unaware that I mistook transition (the dreaded limbo period before you’re fully dilated but you feel a strong, uncontrollable urge to push) for early labor, and I thought I might literally lose my mind.  I don’t remember some ethereal joint birth experience with my daughter–I did what I was coached to do by my husband and the midwife on-call to have a healthy birth, and I mostly remember the wave of love, happiness, and relief when my wailing girl was placed on my stomach.

Truth?  I wanted to prove that I was strong enough.  I wanted to somehow feel woman enough to be able to experience labor in full force.  I wanted to be a “war hero.”  And when I was transitioning in the upstairs hallway of our duplex, I desperately wanted anything that would pull me out of it, but I worried about how I would be perceived if I caved.  How absurd is that?  I, at least in that moment, thought more about image than the safe birth of my child.

So it was with both relief and disappointment that I read the passage below in Bringing Up Bebe.  I dislike the attitude toward epidurals that seems to have taken over the culture of childbirth in our country.  I recently found out that a friend of mine (a badass, strong as hell, and brilliant woman) was publicly criticized for her decision to undergo a scheduled c-section when her baby was still breech at full term by a woman who preferred to do things “naturally.”  Are you kidding me??  Or, in reference to this fantastic article (thanks Anne!) that I read every time I feel like my mind is going to explode with all the free advice being doled out, “really?!”  JJ Keith goes on to say, “Childbirth is just one really rough day with — odds are very good — a happy ending.  Prepare for it, but don’t let it define you.  Epidurals suck, but there’s no gold medal for pain endurance.  If you get a C-section, you still get a baby.”

Without further ado, the eloquence of Pamela Druckerman:

Birth, like most everything else, is something we try to customize. My obstetrician says she once received a four-page birth plan from an American patient, instructing her to massage the woman’s clitoris after the delivery. The uterine contractions from the woman’s orgasm were supposed to help expel the placenta. Interestingly, this woman’s birth plan also specified that both of her parents should be allowed in the delivery room. (“I said ‘no way.’ I didn’t want to be arrested,” my doctor recalls.)

In all this talk about giving birth, I never hear anyone mention that the last time the World Health Organization ranked national health-care systems, France’s was first, while America’s was thirty-seventh. Instead, we Anglos focus on how the French system is overmedicalized and hostile to the “natural.” Pregnant Message members fret that French doctors will induce labor, force them to have epidurals, then secretly bottle-feed their newborns so they won’t be able to breast-feed. We’ve all been reading the English-language pregnancy press, which emphasizes the minute risks of epidurals. Those among us who deliver “naturally” strut around like war heroes.

Despite being the birthplace of Dr. Fernand Lamaze, epidurals are now extremely common in France. In Paris’s top maternity hospitals and clinics, about 87 percent of women have epidurals, on average (not counting C-sections). In some hospitals it’s 98 or 99 percent.

Very few women make a fuss about this. French moms often ask me where I plan to deliver, but never how. They don’t seem to care. In France, the way you give birth doesn’t situate you within a value system or define the sort of parent you’ll be. It is, for the most part, a way of getting your baby safely from your uterus into your arms.

In French, giving birth without an epidural isn’t called “natural” childbirth. It’s called “giving birth without an epidural” (accouchement sans péridurale). A few French hospitals and maternity clinics now have birthing pools and giant rubber balls for laboring women to hug. But few Frenchwomen use these. That 1 or 2 percent of nonepidural births in Paris are, I’m told, either crazy Americans like me or Frenchwomen who didn’t get to the hospital in time.

The absolute earthiest Frenchwoman I know is Hélène. She takes her three kids on camping trips and breast-fed them all past age two. Hélène also had an epidural at each delivery. For her, there’s no contradiction. She likes some things au naturel and some with a giant dose of drugs.