accouchement sans péridurale

27 Dec

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.

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19 Responses to “accouchement sans péridurale”

  1. Erin Zoller December 27, 2012 at 8:08 pm #

    I had an epidural, it was something that I have always known I wanted and I never ever ever, waivered. That being said, it is a totally personal choice, and there is no judgement from me either way about what anyone else does.

    I think it is interesting that you mentioned that you wanted to go without because you wants to prove something to yourself. I partially think I didn’t feel that need because at that point I had gotten my PhD and that was such a ridiculous process that I’m not sure I ever have to prove anything to myself ever again. I already knew what it was like to reach my potential and found out it kinda sucks. I also know that while I have a decent pain tolerance, pain puts me in a bad physical and mental/emotional place. That was not the place I wanted to be as I brought this new life in the world.

    I would argue that the epidural doesn’t (at least for me) keep me from experiencing the birth with the baby. The whole process (I like to believe because I was in such a positive and rested place) was so calm and zen and focused that I felt truly present through the whole thing. Besides, you can still feel stuff, it just doesn’t hurt.

    I labored unmedicated for 9 hours before the epidural, so I certainly feel like I ‘paid my dues’ so to speak, and I was just pleased as punch to meet Tim, my magic medicine man and his cart full of numb when I got to the hospital.

    Again, to each her own. Way to go on a successful delivery. Because as long as the baby leaves your body in one piece, you did your job.

    • annaojesus December 28, 2012 at 10:00 am #

      Thank you for the thoughtful comments, Erin. I’m really glad it was a good experience for you and your family, and I’m a little envious of how well you know yourself. I kind of went into the birth like, “I’d like to try without meds, but we’ll see how it goes…” I was very happy to have midwives who included epidurals in their practice and were outspoken about the benefits.

      Pain tolerance: I have none. I don’t believe that doing this without an epidural says anything about my pain tolerance…maybe just my stubborn nature and, in this case, my idiocy since we waited way too long at home (I kept thinking, “It doesn’t matter that my contractions are 90 seconds apart. This shit is supposed to last for 15 hours. I don’t want to get sent home!” I’m an idiot.) I like the way you thought of your mental and emotional state when bringing in a new life.

      Experiencing birth: I think it’s kind of crap shoot either way. My experience on OB is limited, but I saw a decent number of births. There were plenty of women I saw who labored with an epidural and still felt a good deal of pain and discomfort. Then there were others who literally did not feel anything below their navel and had to be told when they were having contractions. But it seems like what you were describing is that the experience is as much (if not more) mental/emotional than it is physical. In that regard, we could argue that for some women pain control is an aid for experiencing birth to greater extent. But as you said, to each her own.

      “Paid one’s dues”: I realize that you’re being sarcastic, but I hope you don’t think that I feel this way. Along similar lines, I keep seething over the criticism, one mother to another, toward my friend with the scheduled c-section. I just want to shake the woman who preferred “all things natural” and remind her that a c-section is major surgery with it’s own risks and a much longer, more painful recovery! This woman is readily consenting to it for the sake of her child–that’s strength.

      Thank you on the “way to go.” Labor was a scary experience; I’m SO relieved and thankful that it ended with a healthy, screaming child. She is a total beefcake–love that girl! I hope you and your family are well. Thank you again, Erin!

      • Melissa H-K December 28, 2012 at 1:10 pm #

        Please go easy on yourself for “being an idiot”!

        No doctor has told me this, but you can tell me if it makes sense. When you’re in labor, you can’t count on making good decisions, because the blood and oxygen that you need for that are being diverted elsewhere. With #1, apparently I asked the same question three times. Finally, the doctor said (more with amusement than exasperation), “The woman’s in hard labor, and she wants to understand!” I didn’t find it amusing at the time, of course, but now I do, a little. And I still don’t think I remembered the answer to the question!

        What do you think?

  2. Jenny G December 27, 2012 at 8:44 pm #

    I have a ton to say about this but I’ll keep it brief 😉

    First, what a well written, thought-provoking piece!

    I wish wish wish that people who were on the fence about epidurals could be on OB call with an anesthesia provider one day. I know you mentioned your anesthesia rotation, and I feel like epidural placements are the closest thing to instant gratification that you get in anesthesia. These women requesting epidurals are miserable, crying, and in pain. 15 minutes later, they are often smiling and holding their birth partners hand. All of the epidural stories aren’t perfect, but I feel like the vast majority are pretty pleased with the pain relief. And I know it’s a biased sample as these women all asked for an epidural.

    Childbirth pain is considered near that of the pain of an amputation of a digit (I’ll try to find the studies that made this claim). If for some reason our male partners were to present to the ER having cut off a finger and refused pain medication and wanted to tough it out, I kinda doubt we would think it was manly. But we completely, as you said, puff out our feathers if we were able to “push through the pain.” I totally agree with you that there is this “mother bear” culture that has overtaken American opinions on childbirth. I think it completely find to not plan on an epidural, but if you’re miserable and hurting, it’s ok to change one’s mind.

    Found the article 🙂 Congrats on your beautiful baby girl, however she got here!
    American Journal of Obstetrics and Gynecology
    Volume 186, Issue 5, Supplement, May 2002, Pages S16–S24

    • annaojesus December 28, 2012 at 10:12 am #

      Thanks so much, Jenny! I’m really flattered that you liked the post.

      I wish I had seen more epidural placement when I was on anesthesia, but I only saw one. Unfortunately, it was for a woman who was delivering a stillborn child, so it was definitely a sad situation all around. I got to see the result of epidurals during a lot of deliveries however. How fantastic that there is a way to minimize pain and trauma to the mother without drugging up the fetus. It’s really incredible.

      Yeah…how did this “mother bear” culture, as you put it (I like it!), get started anyway? I haven’t researched, but I kind of think it’s an overly strong and sustained reaction to the 1950s/60s habit of drugging mothers out of their minds. In part it’s likely also part of a larger, quite hostile movement against many obstetrical practices. I’m curious what you’ve observed. I am completely on the same page as you with regards to pain management plans, or anti-plans for that matter.

      Thank you so much for the article. I need to log into my med school account to access it, but the babe awakes…I’m looking forward to reading it. I really want to know how they were able to make that comparison. Should be fascinating! Thank you again!

      • Jenny G January 1, 2013 at 4:41 pm #

        In my (albeit limited) experience, this is an upper middle class problem. I did most of by OB cases in eastern Kentucky/southwestern Virginia, and people generally came in and received an epidural if they were less than 9cm. I don’t recall anyone who voiced any strong opinions on the matter (we have to preop the patients even if they’re planning to go natural just in case we end up with an emergency).

        Fairfax was a totally different story. My last OB patient there told me she was “disappointed in myself” for needing a C-section. She had a placental abruption. Gritting my teeth . . .

      • phantomdiver January 1, 2013 at 5:05 pm #

        The cattle are lowing, the baby awakes . . . Please excuse my jumping into this convo with somebody else. I just wanted to shoehorn that in.

        So much of birth and child-raising is affected by one’s social milieu. I find it especially sad that in the US, breastfeeding is less prevalent among mothers of less education and income, those whose babies can especially use the extra boost of immunity and tenderness, not to mention money. Judging by what Jenny says, the prevalence of epidurals in the US is similarly politicized. No surprise there.

        I just don’t like seeing people pressured into *any* cause of action that should be an individual decision, not a knee-jerk “well, my sister did it, and I’m like her, so I’ll do it.” I’m not writing this well, what with having flu, but I know that you know what I mean, Anna.

  3. Dad December 27, 2012 at 9:21 pm #

    Good one, Anna

    One of your best of all time

    I’m just very proud of you, and I never worried for a minute about any of the procedures other than how hard and lengthy it was. You now have a beautiful little girl. That is everything

    Love

    Dad

    • annaojesus December 28, 2012 at 10:13 am #

      Thanks so much, Dad! Very, very sweet of you. I’m so happy that you’re proud but, as you said, having a healthy little girl in our lives is everything.

      Much love!

  4. phantomdiver December 27, 2012 at 9:40 pm #

    Bill Cosby said that the only way that a birth could be “unnatural” was if the baby came out of the mother’s nose.

    And as for bragging rights—I think the way you raise Aurelia will be far, far more important than her healthy delivery!

    • annaojesus December 28, 2012 at 10:16 am #

      I love Bill Cosby. Got to watch a couple episodes over the holiday…still hilarious, still brilliant!

      And I could not agree more! Right now I’m just loving her like crazy and hoping she feels it.

  5. Donna December 28, 2012 at 1:33 am #

    Wonderful post, Anna!! I could really relate… I was also really ambivalent about the whole epidural thing before giving birth, but instead of confusing transition with early labor I got it the other way around (since I was retching and had been having contractions for several hours…) And I happen to have a ridiculously low pain threshold, so nine hours later, when I was still at three centimeters I finally got the epidural and when the anesthesiologist came to give me an additional dose I said to him “you know you are an angel?”…seriously I have no idea how anyone is able to endure the pain of childbirth without an epidural! You really are a hero 😉 …but as you and others have already said, what’s most important about the whole experience is the bundle of joy you end up with! Thanks for writing such a great post, you are amazing!

    • annaojesus December 28, 2012 at 10:33 am #

      Thank you so much, Donna!

      Nine hours of contractions and retching does not sound like a low pain threshold to me! Sounds horrible. I was lucky to have a ridiculously fast, albeit absolutely terrifying, labor. The short time that I was retching was the worst! I think one of our professors said that severe nausea is considered by many pain specialists as worse than searing pain.

      I am definitely not a hero, but I’m very touched that you would even think of using such a word to describe me. I’m really happy with the outcome, and I’m immensely proud for my part in creating this being I love so fervently. But I’m pretty embarrassed by some of my “I want to prove it to myself” feelings.

      Also, regarding enduring childbirth, I think it’s largely based on the hand you’re dealt. If I had nine hours of contractions and retching, I’m not sure what I would have done with myself–lost my mind, perhaps? I’m honestly not sure if I have a low or moderate pain threshold…I’m always curious when people say that they have a high pain tolerance…how does one know? Adrenaline is a wonderful thing when shocked with sudden pain, but I don’t think all the breathing and relaxation techniques in the world could have made transition much easier. By the way, the only reason I confused it for early labor was because it came on so quickly after the onset…I thought I must be doing something wrong!

      I think you are amazing! We hope to make it to Israel this year. I would love to see you and meet your beautiful daughter! xoxo

      • Donna December 28, 2012 at 12:58 pm #

        That would be wonderful! I would love to see you and meet your gorgeous girl too 🙂
        And please keep writing! I love your blog!

  6. Ted Gudmundsen December 28, 2012 at 3:11 am #

    Anna,

    I agree with your dad: this was an incredibly strong post. I found it very, very interesting. I read your links, sent it to Alison, etc. I don’t know anything about this debate or this world, but you brought me up to speed quickly. Then you smoothly blended clinical research, others’ writing, your own experiences, and some insightful reflections. I loved it. Thanks!

    Happy Belated Birthday,

    Ted

    • annaojesus December 28, 2012 at 9:23 pm #

      Hi Ted,

      Your comment (and compliment) are lovely and so thoughtful. Thank you. I’m so glad you liked it, and I’m flattered that you sent it to Alison. I didn’t know the scale of this debate until I got pregnant; one of the questions I got asked most frequently was whether or not I planned on getting an epidural.

      Thank you so much for your comment–it meant a great deal to me. I miss you. Please give Alison a hug from me, and I wish you both a very happy new year!

      xoxo
      a

  7. Karen July 24, 2013 at 4:33 am #

    Please excuse this very late response to this post as I’ve just started reading your blog — love it 🙂

    I’m not sure how familiar you are with delivery protocols in the UK, but as an expat planning to have her children here, I find it all fascinating.
    A) Births are attended by midwives and doctors only respond if there are complications.
    B) They discourage the use of epidurals mainly because then you are forced to deliver on your back which is considered more difficult [whether or not this is actually true, I have no clue — not a mom yet]. If you insist on an epidural, you can most certainly have one, but it might take awhile to get an anesthetist to your room and it is greatly discouraged before you reach 5 cm of dilation (in order to not slow the birthing process down).
    C) Nevertheless, they are great believers in pain management! You can get shots of pethidine into your buttocks! Or “gas and air” aka laughing gas — as much as you want. Having experienced laughing gas at dentists offices, I’m not sure I’d like that option :/
    D) Home births are starting to be a thing, encouraged by the health system (for women with uncomplicated pregnancies). That one scares the heck out of me!!

    I like the idea that there are other pain control options available. That way, if you do show up to the hospital and it’s too late for an epidural, there’s still something! But I wish they wouldn’t turn their noses up at epidurals.

    Anyway, sorry for the ramble, but I just find cultural differences like these fascinating!
    xoxo
    Karen

Trackbacks/Pingbacks

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    […] the most throughout my pregnancy, whether or not I wished the have an epidural, I tried to tackle in this post.  The next topic of interest: birth […]

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    […] Dina scribbled our goals of care.  Under pain management, she wrote “natural childbirth,” and I couldn’t help but cringe a little.  (Ever since an attending once corrected me on the wards [You mean “unmedicated” or […]

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