Pain in childbirth 'a good thing'

[Anxious Patient]

Dr Denis Walsh, associate professor in midwifery at Nottingham University, said pain was a "rite of passage" which often helped regulate childbirth. It helps strengthen a mother's bond with her baby, and prepares her for the responsibility of motherhood.

He said epidural rates had been rising over the last 20 years, despite the fact that alternative, less invasive ways to manage pain in labour were available.... pain in labour was known to have positive physiological effects, such as helping to establish a rhythm to childbirth.

(Pain) also triggers the release of endorphins which helped women to adjust to pain.

http://news.bbc.co.uk/2/hi/health/8147179.stm

interesting pro and con reader comments, plus the predictable criticism that this 'wisdom' is coming from a man.

http://newsforums.bbc.co.uk/nol/thread.jspa?forumID=6738&edition=2&ttl=20090716185015

[GilaRRT]

Epidurals are fairly well-known in the OB community for increasing the need for c/sections, for a start. Bupivicaine epidural = decreased mobility = inability to assume the most effective position for baby's descent.

Midwives have been saying for many years that labor pain has a beneficial purpose. Generally, the positions that are best at nonpharmacological pain relief (standing, squatting, rocking, all fours) are also best at moving baby down and out.

I would like to see the evidence. If epidurals do in fact increase morbidity and mortality, then perhaps reconsidering the proliferation of epidural interventions is warranted.

[Elvish, BSN, DNP, RN, NP]

I'm not knocking anyone who had an epidural - heck I had one myself with baby #1. I'm looking to have a homebirth with baby #2, which will effectively make an epidural a non-option. So please, nobody think I'm knocking your choice. I'm not. They are a great tool to have in a toolbox; I just also happen to think nature knew what she was doing when she designed women's bodies and the labor process. I don't think we appreciate that enough.

[Baloney Amputation, BSN, LPN, RN]

I wasn't trying to be a hero when I went without an epidural. I just wanted to see how far I could tolerate labor without pain intervention. If I needed meds, then I needed them. I learned that not only was I able to give birth without pain medicine, but that this was absolutely incredible and empowering in a way I didn't realize and cannot express in words.

The thing I think that helped me the most in the no pain med births was laboring at home until 6 cm and 7 cm dilated for my 2nd and 3rd labors, respectively. I handled my pain my own way, how my body thought I needed to behave without me thinking about it. My instincts took over, and it was amazing.

[CEG]

I would like to see the evidence. If epidurals do in fact increase morbidity and mortality, then perhaps reconsidering the proliferation of epidural interventions is warranted.

There is copious evidence of this. I don't have time to do the research at the moment, but a simple google search will give you this info. No one who works in the OB field should be surprised at this and if they are, it is a very scary thing.

Epidurals increase c-section rate, augmentation rate, operative deliveries, and perineal injury to name a few.

[SouthernBaby]

There is copious evidence of this. I don't have time to do the research at the moment, but a simple google search will give you this info. No one who works in the OB field should be surprised at this and if they are, it is a very scary thing.

God, you're so right!

[NurseKitten, MSN, RN]

Respectfully, I'd like to disagree.

Epidural analgesia does not increase the C-Section rate. The C-section rate currently in the US (2006) is 25-33%, depending on who you listen to. The majority of those are indicated for other reasons other than epidurals, including repeat c-sections (not even gonna talk about VBAC's here, that's a whole 'nother story), malpresentations, non-reassuring fetal status, failed instrument deliveries, etc. Not telling y'all anything you don't already know.

It does not prolong labor, appreciably. The studies that state that it does could be argued to have selection bias, effected by the type of patient requesting analgesia. They're often the ones who have been in labor longer, to begin with.

Even if it *did* prolong slightly, this has not been proven harmful to a well-monitored mother and baby.

Some studies have shown epidurals to increase the incidence of instrument deliveries, which can be questioned as to selection bias as well. Women recieving epidurals often have more pain, which can be a sign of possible complications. Complications will increase your incidence of instrument deliveries.

Epidurals have been shown to decrease maternal and fetal morbidity and mortality when surgical intervention is needed. It is far preferable to the risks of general endo-trachael anesthesia, when appropriate.

The clinical benefits, among the usual ones, like being awake and alert, but in less pain, include a decresed level of circulating maternal catecholatmines and a decreased hypo-hyperventilation cycle.

Yes, there are drawbacks to it - it is anesthesia, after all - including hypotension, hematoma, systemic toxicity, infection, etc. The incidence is low, if you have an experienced anesthesia provider who knows what they're doing. Low, but definitely present.

It all comes down to a woman's preference, and what she feels is right for her. She needs to have ALL her choices, without provider bias as to what her choice should be.

[CEG]

reasons other than epidurals, including repeat c-sections (not even gonna talk about VBAC's here, that's a whole 'nother story), malpresentations, non-reassuring fetal status, failed instrument deliveries, etc.

The clinical benefits include a decresed level of circulating maternal catecholatmines and a decreased hypo-hyperventilation cycle.

Yes, there are drawbacks to it - it is anesthesia, after all - including hypotension, hematoma, systemic toxicity, infection, etc. The incidence is low, if you have an experienced anesthesia provider who knows what they're doing. Low, but definitely present.

She needs to have ALL her choices, without provider bias .

Sorry if my response is hard to read- the multi-quote function eludes me :)

The reason listed for a c-section is never going to be epidural. The thing is epidurals cause the other issues: nonreasuring fetal status following hypotension, malpresentation, failed instrumental deliveries. So epidurals may not be cited as the reason for the surgery but they are contributors. Certainly it is harder to reposition a woman having variables who has an epidural.

Maternal catecholamines are actually beneficial to the fetus in labor.

The next set of complications you list are relatively rare in my experience with the exception of the hypotension. That is something I see if not every day I would say at least twice a week. Perhaps the anesthesia providers in the major academic medical center I work at do not know what they are doing, but I doubt it.

I agree that women should have their choice, my objection is that women are not properly informed of the risk and in many cases, the staff are not even aware of the risks. I would imagine that in 100 women requesting labor epidurals, 99 of them would still get it even after they were truly given informed consent. It's the lack of consent that bothers me.

[RNperdiem, RN]

Things were simpler when pain was standard and nobody had a choice in the matter.

[joyouter]

I distinctly remember having my third baby and being told I was 10 cm. However, the nurses were not in any hurry and just letting me push when I was ready, which I decided after about 5-6 more contractions. At that point I had about 3 contractions where I thought, "These are very different contractions. I'm going to try to push." Her 9-pound 1-ounce body was out in 2 contractions. That was an incredible feeling to feel that control when many things were not in my control, and it still is something I remember very fondly, though I can't go bragging about it too much without looking like a goon.

My second daughter just started crowning after I had moved to the side at my nurse's urging. She came out in 2 pushes, all 10 pounds of her. I felt very accomplished after this birth. The pushes were intense and incredibly painful, but there was an inner strength that just burst in me with both these births.

Neither one of these were medicated births, either.

I received an epidural with my first birth. There were several factors at play, surely including the fact that I was a primip, but there was something that left me out of control with the epidural, besides being unable to move. It gave me relief from the pain for some time, but it help deaden that urge to push, though I had great pain during pushing (like I should, of course...but the urge would have helped me feel more in control).

I am slightly saddened to hear women say, "I want an epidural as soon as I get to the parking lot!" I can't explain why, but I am. I think some women would surprise themselves - if the pain remained tolerable - to power through a delivery and have that incredible feeling of control when there sometimes is little control in the hospital setting (mine were hospital births).

I'm no OB nurse, just a mother. Take my comments with a grain of salt. :)

Your examples present two sides of labour, the natural way without pain control and that with an epidural. I have worked with both and personally had a natural childbirth although I was really exhausted in the end. I had been told that no analgesia would be offered at this particular. hospital. Things have changed a lot since then. From a midwife's perspective, natural childbirth is wonderful when the mother truly desires this, the baby lies in an ideal position and there is the constant 1 on 1 support throughout labour and delivery. The prenatal period, mother's emotional status and psychological frame of mind are all key to good natural childbirth. Today, mothers give birth with a lot more stress in their lives overall, some may be able to cope well naturally, some will not. It is the mother's choice in the end and her right to decide what works for her. The fact that pain may release certain endorphins in labour can be argued against long protracted labour which exhausts even a healthy mother. It is not an argument which I like as such statements tend to produce feelings of guilt and failure in a labouring woman. The fact that this was written by a man also strikes me as annoyingly hypocritical. Unless one has physically experienced childbirth, it is almost impossible to describe it. Today, when weighed against the relatively simplistic lifestyle of a few decades ago, pain, dehydration, childbirth and the mother's coping skills are influences which can't be ignored

[Not_A_Hat_Person, RN]

I just also happen to think nature knew what she was doing when she designed women's bodies and the labor process. I don't think we appreciate that enough.

I can't agree. For thousands of years, childbirth was the leading cause of death for women of child-bearing age. Maternal mortality is still very high in developing countries. OBs may not get it right 100% of the time, but neither does nature.

I've never been through childbirth, but I once let someone talk me out of pain relief for a tooth extraction. I wanted "twilight", but since it was a matter of money, and the person I talked to said they were fine with local anaeshesia, I went for local. It was horrifying. I was in tears when it was over, and I've been afraid of dentists ever since.

Since dental work isn't "natural", what about menstrual cramps? Some women manage cramps with heat patches. Others need ibuprofen. Still others need Tylenol 3 or Vicodin. Neither choice is "wrong", but what works for one woman may not work for another. One person's manageable pain is another person's agony.

I think the midwife in this case is insane (would he get a root canal without pain relief?), but I wonder what kind of reaction a woman would get if she said the same thing?

[Elvish, BSN, DNP, RN, NP]

I can't agree. For thousands of years, childbirth was the leading cause of death for women of child-bearing age. Maternal mortality is still very high in developing countries. OBs may not get it right 100% of the time, but neither does nature.

For thousands of years, germ theory of disease was unknown. For thousands of years, rickets left women's pelvises (pelvi?) so grossly misshapen that no AGA term baby would fit through. Malnutrition did not allow for optimal health during and between pregnancies. When looking at morbidity/mortality in developing countries, these things have GOT to be taken into consideration. But morbidity/mortality and pain during childbirth aren't really correlated. I think I was pretty clear that I'm not knocking pain relief during labor, however.

The difference between childbirth and the other things you mentioned - menstrual cramps, toothaches - is that the latter are the result of something abnormal, in some cases a disease process. Pregnancy and childbirth are a normal part of the human lifecycle.

Nature does not get it right 100% of the time, but when she's left to her own devices in a normal process without mucking around from humans, she does a pretty damn good job.

[CEG]

I can't agree. For thousands of years, childbirth was the leading cause of death for women of child-bearing age. Maternal mortality is still very high in developing countries. OBs may not get it right 100% of the time, but neither does nature.

You may want to check out some perinatal stats. The US ranks 27th worst among developed countries in perinatal mortality. We are worse than many developing countries. Women and babies in the US die due to our "improvements" in maternity care- including anesthesia/analgesia.