Saturday, August 01, 2009

Love's labour's lost?

As Baby's arrival date looms before us, one of the greatest decisions we have to make is whether or not I'll be doing things au naturale or get an epidural. At this point, we really have no opinion and our friends have been pretty divided on the issue as well- some are of the "You don't have to be a martyr to be a mother" camp and say to just take the epidural and I might be able to sneak in a nap and actually "enjoy" the labour experience; others are of the "Women have been doing this for centuries without pain relief" opinion who believe that the naturally-occurring pain of labor is far more bearable than the potential side effects of an epidural, both on me as well as Baby.

Part of me wants to just try things intervention-free, at least for a while, just to be able to say I've experienced what labour feels like; the other part of me knows how much of a wuss I am and wants to be given the epidural the moment it's medically possible. So what does the grad student part of me do in a situation like this? Well, make use of the university's library resources and access the American Journal of Obstetrics and Gynecology online archives of course... I was tired of reading through message boards filled with birth stories involving terms like "ring of fire", "flood of euphoria", "focusing on the gift", "ride of your life" and actually craved something more objective, more balanced, more... scientific. Give me real numbers, statistics and generalizability please. And to my rescue comes Volume 186, Issue 5, published in 2002, an entire issue of the journal devoted to pain management during childbirth. According to the Executive Summary:
An evidence-based framework, including commissioned papers prepared according to carefully specified scopes and guidelines for systematic review methods, was used to develop more definitive and authoritative answers to many questions in this field. The papers were presented at an invitational symposium jointly sponsored by the Maternity Center Association and the New York Academy of Medicine, were peer-reviewed, and are published in full in this issue of the journal. The results have implications for policy, practice, research, and the education of both health professionals and childbearing women.
And so for "leisure" reading this weekend, Serene Koh will be combing through:
1)"The nature of labor pain", Nancy K. Lowe
2) "Anesthesia for childbirth: Controversy and change", Donald Caton, Michael A. Frölich, Tammy Y. Euliano
3) "Unintended effects of epidural analgesia during labor: A systematic review", Ellice Lieberman, Carol O'Donoghue
4) "The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review", Barbara L. Leighton, Stephen H. Halpern
5) "Epidural analgesia side effects, co-interventions, and care of women during childbirth: A systematic review", Linda J. Mayberry, Donna Clemmens, Anindya De
6) "Pain and women's satisfaction with the experience of childbirth: A systematic review", Ellen D. Hodnett
7) "Labor pain management in the United States: Understanding patterns and the issue of choice", Theodore R. Marmor, David M. Krol

Oooh... goody.


Tym said...

I look forward to hearing what you make of your readings! All I've read is Naomi Wolf's Misconceptions.

serene said...

At this moment, the articles have been full of info-- and a little to the "epidural is fine IF it was your decision" side of the fence-- but just aren't the most scintillating reads. Lots of medical jargon which I guess is what I should have expected from a medical journal. I've never read Misconceptions although I've heard from the people who've read it that it can be a very polarizing book. What did you think about it?

Dot said...

At my hospital, up to 90 percent (or more) of women take the epidural. We heard that statistic at our birthing class. There is no risk as far as I know. I am sure half or more of those women went in thinking they were not going to do the epidural. In my PEPS class, ALL the women except me wanted natural birth (that's 6 out of 7 couples) and all of them, me included, took the epidural.

Ironically, I went in wanting the epidural, and of all of the 7 women's experiences, had the worst because the epidural went SUBDURAL, and made me incapable of feeling anything under the neck for a lot of the labor. I can tell you a lot more about what happened. In the end, everything was fine....

Good luck! You'll be fine :)

the terrible child said...


you the champion, serene "mom to be" koh. i dont know many young mothers, but you have got to be the one armed with the most research! -hugs-

Amy W Cook said...

Ahhh.... I have to comment on this one, but I'm not even sure what to say. Every Mom has a story to tell. I guess I would just say to go in with a Plan, but remember it's just that. A Plan. It was our first lesson in child-rearing that none of it ever really goes as planned and you just have to go with the flow. As you know, my labor was 54 hours long. Finn was occipital posterior and would not flip over. He just banged and banged on my pelvis causing awful back labor. I went 48 hours before considering the epidural. When I was that time on the clock, I called a meeting with Eric, the doc and our doula. It was time for me and everyone else agreed that I gave it my best shot w/o drugs. I spent 7 hours in the hospital tub that day because it was the only thing that would relieve the pressure. At that point, the epidural was the best thing I could have done. I was able to relax for a bit and that helped Finn come down and out much easier. And, by the way, he never flipped over. He came out sunny side up. :-)

So, there it is.... my two cents. :-) I have a lot more, but that's the short and sweet story.

Oh, and be prepared for some possible drama after birth with the baby, too. They seem to like to breathe funny, turn yellow from jaundice or not be able to regulate their temperature. Finn spent a few hours in the NICU on the day after he was born.... Ahhh... parenthood. :-)

BUT it's all worth it!!!!!!!!!! It's the best thing you will ever do in your entire life. At least, in my opinion. :-)


A said...

So...cut to later...and Sophie's decision to be born on her own terms. (My kind of lady, BTW.)

What did you decide??