A little more food for thought on epidurals

http://www.childbirth.org/articles/labor/epiepidemic.html

	Epidurals: Why the Epidemic? by Holly Richardson, CD(DONA) If birth is a normal, natural physiologic part of being a woman, why are we seeing more than 90% of women having epidurals? Nationwide, the overall rate runs consistently over 85%, with, of course, pockets of much lower rates. (Birth centers, most midwifery practices, and home birth) Ask a group of women who are or have been pregnant and mostly likely you'll hear the epidural touted as the miracle of modern science, a way to labor and give birth painlessly. Why wouldn't you want one? Common remarks include: "You don't get a medal for going without drugs, you know." "Don't be a martyr." "Of course the used to do it that way in the "olden days," but lots of moms died then too." Sound familiar? Why do so many women find themselves drawn to "pain-free" labors? One big reason is fear. Fear of what? Fear of not surviving the pain, fear of "losing it," fear of making the doctor mad, or fear of not having adequate support for non-epidural labor. Where does this fear come from? A lot of it comes from our highly technological society. There is a society-wide view that technology equals superiority, even considering a natural process like birth. The "technocratic" view of birth is one that considers pregnancy a medical event to be managed - something that can be broken down into parts - a uterus, a fetus, a cervix, a blood pressure reading, etc. Most women in our society have unquestioningly accepted this view of birth. If birth is not micro-managed by a surgeon, dire results are waiting in the wings. As an example, a local doula recently hung fliers in a laundromat on the value and benefit of using a doula. Someone wrote across the top: "Please care enough about your baby to use a certified professional in a hospital - this means a doctor!" We all have fears and no one should ever be belittled or patronized for fearing childbirth, as the fears are real, even if unfounded. Suzanne Arms in "Immaculate Deception II" writes that "in a healthy woman there is little fear and much trust in birth... Most women's fears center around the mistaken belief that they cannot successfully give birth to a healthy baby without outside intervention and the aid of a hospital and a physician-surgeon. Most doctors fears have to do with the birth process somehow being faulty and with women not being capable of responsibility for their pregnancy and labor." In the summer 1996 issue of "Birth," two physicians reviewed epidural anesthesia and "revealed" that it is difficult for women to get accurate information. This is because "objective analysis is thwarted by at least two biases. First, health care providers and consumers have steadfast opinions based on their personal opinions that have not been objectively analyzed. Second, fiduciary conflicts of interest exist among some healthcare providers who hold staunch opinions on this subject, some of whom set local and national policies and serve as reviewers for medical journals" Or in other words, they like epidurals and they make money. The first point addressed issues of consent. Are the vast majority of women choosing epidural anesthesia really making informed decisions? Do they really have the information they need to make the choice that is best for them, not most convenient for their doctor, or the nurses on staff at the hospital? I think we all know the answer to that one and that answer, of course, is no. In fact, natural childbirth is now being made out to be a bad thing. One mother was even told by her obstetrician that wanting a natural childbirth was selfish and not caring about what is best for baby. Have you ever helped mothers who asked their care provider what the risks of an epidural are to her baby and were told there is no risk? Or that they have never heard of such a thing as epidurals being linked to fevers, or that there is no increase in cesarean rates? I have. How about the anesthesiologist who, when asked to inform the parents about risks says sarcastically, "Death, permanent paralysis; need I go on or can I just get you comfortable?" By definition, informed consent is a process that "promotes autonomy, personal dignity, active participation, and responsibility," that allows the client "time to think over information given, weigh the risks and benefits, consider alternative treatments, evaluate further outcomes and decide how to proceed." The following are not reasons to not fully inform a client: That the patient might prefer not to be told the unpleasant possibilities regarding the treatment That full disclosure might suggest infinite dangers to a client ... causing her to refuse treatment That the client, upon learning the risks, may rationally decline treatment The information must be given in a manner that the client can fully understand. Copyright © 1998 by Childbirth.org All rights reserved.