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Knock me out!

By Laura Owens

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From my hospital bed, I could hear the women screaming down the hall. I was 38 weeks pregnant -- childbirth, I decided, could wait awhile. But when I was diagnosed with life-threatening pre-eclampsia, I no longer had a say in the matter. I could however, decide how to manage my labor pain. Yet when I handed my two page birth plan to the nurse, she almost looked amused. She knew what I didn't, that the only thing that ever goes "according to plan" during childbirth is that a baby is coming, and that it hurts like hell.

Susan Maushart, author of Mask of Motherhood, agrees. "Childbirth is largely a lottery and that 'success' has more to do with the vagaries of timing, the baby's positioning and the woman's innate physical endowments, matters of pure chance, all of them, than any of the variables we can control." Childbirth isn't the orderly process you read about in popular pregnancy and birth books -- it's more like a biological crapshoot. No matter how many pain relief contingencies we try to map out, a woman can never predict how she'll feel once the hard contractions hit. Even women who are firmly resolved to go drug free can crumble under the crushing, unbearable weight of pain.

Enduring the pain of childbirth has held significant meaning for women throughout history. "It's clear to historians that the pain gave these women social status," explained Dr. Donald Caton a physician at the University of Florida Health Science Center, in an interview with Science Daily Online about his book, What a Blessing She Had Chloroform. "The pain and the sacrifice had value, similar to wounds men received in battle." I understand. Pain means something to me too. It means, "This hurts. I want it to stop."
Looking back on my experience, I'm quite sure I would have embraced the tranquil state of a c-section or even general anesthesia if I was given the choice, and the risks were low enough. Because in my case, a series of unforeseeable events and medical interventions resulted in such tremendous pain that what little power I had to determine the comfort level of my childbirth disappeared. After being poked full of holes for an IV insertion to get my dangerously high blood pressure down, I agreed to be a guinea pig for a new cervical dilation drug that ultimately didn't work. I realized I'd drawn the short-end of the pharmaceutical straw when the doctors doubled the dose, but it only tripled my discomfort. The brutal pain that followed disintegrated my plan to resist narcotic pain relief.

Despite the fact that I knew I wanted an epidural from day one, I forbade the hard stuff after I read that narcotics cross the placenta and could negatively affect the baby. My moral ban ended, however, the moment I screamed at the nurse to give me every drug she had. I became a feral animal, ripping off the fetal monitor, uttering sounds I'd never heard before. As doctor's continued testing what was clearly an ineffective dilation drug, my resolve to protect my baby from the harm of narcotics was drowned out by the flood of relentless and brutal pain that seared my body.

Finally, two days in and the doctor on call poked her head into my hospital room and proclaimed the following golden words, "You've gone through enough. It's time for an epidural even if you are only dilated 3 centimeters." As I nearly hyper-ventilated through third-stage Pitocin-induced contractions, the anesthesiologist ordered me to freeze so she could insert the needle into my lower back. But I must have flinched because she tried again, a medical mistake that days later, caused an excruciating epidural headache. By the time the doctor told me to "push like I was pooping," I was completely spent. And since the hospital had a goal to lower their caesarean rate and test their dilation drug, a c-section probably wasn't on my menu of delivery options anyway. Instead, my daughter arrived via a vacuum and forceps "extraction," an ironic twist of "best for baby" fate because these procedures carry greater risk to the child than to the mother.

How manageable childbirth pain is depends more on good luck than good planning, including the mother's ability to tolerate pain, the health of her baby, and how her labor is progressing. And while obstetrics has forged a number of advances on behalf of women, the field has a near circular history of giving birthing women control over their pain management and then taking it away. "Chloroform, which physicians often used during labor in the 1800s, had a downside." explained Tina Cassidy, author of the article, "Taking Great Pains: An Abridged History of Pain Relief in Childbirth." "It could make breathing difficult, even deadly, for the newborn, and the drug was iffy to dispense; you splashed some on a handkerchief and hoped for the best."

By 1914 physicians discarded chloroform, but their new hope, "twilight drugs," came with its own share of dangers. "Doctors in Freiburg, Germany, were using a much more precise technique called Daemmerschlaf, or 'Twilight Sleep,'" writes Cassidy. "The mother was injected with morphine and scopolamine (a drug that caused amnesia) so that she'd be in a state of finely balanced semi-consciousness, without feeling pain and with scant memory of what happened" (Not necessarily a bad thing for those of us who want to forget our birthing experience). Yet, twilight drugs brought the burden of brutality for women and put them at the complete mercy of the medical staff. Women had to be restrained and tied to gurneys to keep them from thrashing around and harming themselves when the drugs removed their inhibitions. Some were even clamped into stirrups for long periods of time until the doctor came to see them. Eventually mothers protested, and in 1958 many wrote to Ladies Home Journal about the "tortures that go on in modern delivery rooms."

Women no longer wanted to risk their babies' and their own lives, be reduced to an animal, or feel powerless and disconnected from their childbirth. They were ripe to grab the reigns of humane treatment and navigate their own experience. From 1960 to 1975 natural childbirth was born when French obstetrician Fernand Lamaze and his predecessor, British OB Grantly Dick Read, believed that if they could reduce a woman's anxiety by providing support and education, they could minimize pain and create the conditions for a more positive childbirth experience. The power of positive thinking is a nice idea, but I wonder if Read and Lamaze would have adopted their own methods if they ever had to pass a kidney stone? Lamaze's technique in particular was based on the concept of psychoprophylaxis, or mind over matter. Apparently if I didn't mind the pain so much, it wouldn't matter.

From 1975 on, pregnant women had more options than ever before. They could deliver at home, in a hospital, go drug free or not. Husbands could join the fun or leave the room. Epidurals became available, an offshoot of spinal numbing discovered in 1898 when August Bier injected cocaine into his assistant's spinal column. "By the nineteen seventies, the numbing agent lidocaine was dripped into a tube inserted by needle into a woman's spinal column," Explained Cassidy. "The hitch? The procedure numbed women to their chests, causing breathing difficulty and, sometimes, heart problems." Once doctors learned that the needles had to be smaller so less spinal fluid would leak from the dura, the thin membrane that surrounds the spinal cord, epidurals became a safer and more popular method of pain management.

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