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.
As epidurals became standard procedure in many hospital births, women's attitudes shifted to more readily accept some form of medical pain relief. Yet although 70 percent of all American women currently choose an epidural, (up from 20 percent in 1975), some feel hospitals are now pushing too hard, that women are once again being forced into becoming a ward of the medical state. "There are many who view the epidural option as yet another attempt by institutionalize medicine to gain control over women's bodies," explained Maushart, "to anesthetize (as it were) not only our pain but the power with which nature has endowed us to survive the pain and to emerge triumphant."
Although this is an impressive stand, I have to believe that just because I decide, "Screw the walking and breathing, give me the epidural," that I let down womankind and dissolve my innate feminine powers. Motherhood, in my opinion, provides ample proving ground without having to use pain endurance to win maternal points. Yet despite the clear evidence that most birthing women want medical pain relief, there is still an unspoken reverence for women who go natural. Until the medical intervention risks are virtually nil for the mother and the child however, and going drug-free during childbirth is viewed as merely another option rather than a badge of courage, women who ask for some form of medical pain relief will remain somewhat ambiguous about their choice.
By 1988 women were back in control when patient-controlled epidurals offered them the flexibility to adjust the timing and frequency of their anesthesia with the push of a button. Researchers soon discovered an interesting side effect. "Women use an average of thirty percent less anesthesia with this method than with the continuous infusion method where an anesthesiologist decides the dosage," explained Tina Cassidy in "Taking Great Pains." It seems when birthing women have a hand on their own steering wheel, they opt for less meds.
Now that's real choice feminism. If you want to grin and bear it you can. If you prefer to numb yourself just enough to stop screaming obscenities at your husband, you can go that route. I'm not against women going without anesthesia or drugs. In fact, I'm convinced the pharmaceutical companies are part of the axis of evil, and that natural medicine works beautifully to cure what ails us. But I will, however, take the hard stuff to dull any pain that hurts enough to make my eyes water.
But pain can serve a purpose. In the right doses it can be a highly effective positive or negative motivator. If we exercise and our muscles are sore the next day, this is solid proof that we did our best; that our efforts produced a result. A sharp pain however, tells us we over did it and we need to go easier next time. "There is this residual idea in the culture as seen through literature, religion and politics that maybe pain has meaning and has important social benefits," said Dr. Caton, "such as establishing family bonds, inspiring people to try harder or as a method of controlling criminals." By my reasoning however, anything that controls criminals can't be good. Sure, pain is a safeguard, a warning sign to halt! But when it comes to childbirth, a cease and desist signal defeats the purpose when the whole idea is to go further. While a contracting uterus forcefully nudging a baby through tight quarters makes sense, the accompanying pain seems about as useful as a vestigial organ.
Unfortunately evolution and society haven't decided there's simply no point for childbirth to hurt so damn much. Women continue to scream bloody hell in maternity rooms and birthing centers everywhere. We live in a super power nation with the best medical advances on the planet, yet in the year 2008 people still believe if a woman experiences childbirth pain that makes her feel like she's splitting in two, it is her heroic and primal rite of feminine passage. No one thinks twice when the dentist wipes a topical numbing agent on our gums and gives us Novocain, but birthing women are left to second guess whether it's okay to accept just one layer of anesthesia or drugs during an event that is arguably one of the most painful human experiences.
Obstetrics hasn't yet been able to deliver options that allow women, doctors and midwives to create mutual empowerment. Moreover, it's inevitable that interrelated and unforeseen forces play a part in every childbirth. Six months after my daughter was born, I was diagnosed with Fibromyalgia, caused the doctor said, by my traumatic childbirth. I don't know if the Fibromyalgia was the result of my blood pressure meds or the ineffective dilation drug that led to my long and hard labor which in turn may have led to the epidural mistake, taking narcotics, and my difficult pushing. I only know that birthing women don't have one perfect solution for pain management. They can't dull the hard labor pain without taking on at least some medical risk and possibly slowing their labor. They can't be fully alert and 100 percent engaged in the experience without feeling the kind of pain, that for some, can become unbearable. Walking epidurals however, come pretty close to offering a compromise. A variation on the traditional epidural, these combine pain relievers and numb only the abdominal nerves. As a result, woman can move about more freely which helps progress labor; she can sense her contractions and push more readily.
Childbirth pain isn't something women should have to endure, revere, or view as a pass/fail performance. It's a side effect of delivering a baby. It's an experience women should be able to manage, by whatever natural or medical means they decide, without feeling guilty. Real feminine power comes when we can accept that once childbirth takes on a life of its own, and our pain begins to speak for us, we can choose whether to accept horrific pain or not. When the decision is based on our needs and wishes at the time, rather than on unrealistic or societal expectations, our voice becomes our own.
mmo : march 2008