The author's intention in writing this article is to provide information about obstetrical procedures which doctors do not generally discuss with their patients. The author also wishes to present women with a real alternative to such procedures. The author has no intention of making anyone feel bad for choices they have made in the past, especially those made without full informed consent. Furthermore and finally, the author urges every woman to consult her inner wisdom before taking any advice with regard to childbirth, including that which follows.

Throughout nine months of pregnancy, women are warned to avoid the use of all kinds of drugs. Coffee, cigarrettes, alcohol, aspirin, even the chemicals in hair dye are all said to be potentially harmful to babies in utero. And yet many in the medical profession actually recommend drugs much more powerful than those at the time of birth. The procedure commonly known as an epidural, even though it has many known side effects and complications, has become the most common form of pain relief for women in labour throughout Canada and the United States.

Epidurals
Epidural anesthesia, also known as peridural anesthesia or simply an epidural, is a method used to eliminate pain during procedures or surgeries performed below the rib cage. During an epidural, an anesthesiologist will insert a needle or special tube through the skin of a woman's back and into the spinal column. (Click here and scroll down to see pictures of an epidural procedure. The first two pictures show an epidural in progress. The others show a Cesarean section. All pictures are graphic).The anesthesiologist will then inject local anesthetics and/or narcotics into the epidural space surrounding the spinal column. The drugs are injected just outside the sac which contains the spinal cord. Depending on the nature of the drugs, the epidural is either supposed to diminish pain (analgesia) or to totally block sensation (anesthesia).

Epidurals replaced "Twilight sleep" as the popular method of pain management for childbirth in the 1960's. The most glaring difference between the two procedures is that "twilight sleep" rendered women totally unconscious, while epidurals numb a woman's body from the bottom of her torso and down as she remains conscious. Just 20 years ago, 22% of women who gave birth in the United States had an epidural during labour. Today that number has increased to 66%. On the largest maternity wards, epidural anesthesia is routine and is given to over 90% of women giving birth there.

Epidurals offer women who are having a cesarean section the chance to see their baby being born and to hold and breastfeed earlier than would be possible with a general anesthetic. However, the value of epidurals in normal, vaginal births is questionable because of the many risks associated with the procedure.

About 1 in 200,000 women will die as a result of her epidural. 1 in 20,000 women will suffer permanent nerve damage, convulsions or heart problems. Another 1 in 20,000 women will have difficulty breathing. This could happen even six to twelve hours after the epidural, a time when most new moms will want to bond with and breastfeed their newborns. 1 in 3000 women will lose consciousness after an epidural, and another 1 in 3000 will experience cardiac arrest. 1 in 2000 women will suffer severe hypertension and headache. 1 in 100 women who have epidurals experience prolonged and sometimes severe headache due to accidental puncture of the dura (spinal cord coverings). 3 months after an epidural, 1 in 550 women experience ongoing numb patches while anywhere from 4 to 18 in 10,000 women experience weakness and loss of sensation in the areas affected by the epidural.

Many women may be willing to risk these odds in order to have a less painful, and thus more enjoyable birth. Ironically, women who have given birth with epidurals, as a group, report the least amount of satisfaction with their experience of the birth one year later. One reason for this might be the woman's expectation that her epidural will take away her pain instantly. Epidurals, quite frankly, hurt. Bending forward to make your spinal column accessible to an anesthesiologist is uncomfortable at nine months of pregnancy. Having a large needle inserted into your back is not much fun either. (If you haven't already, click here and scroll down to see pictures of an epidural procedure. These pictures are graphic). The drugs take an average of 15 to 20 minutes to take effect, but very often the epidural doesn't take and the procedure has to be repeated one or even several times.

Another reason why less women are satisfied with their medicated births is that epidurals often set off a "cascade of interventions" in which one medical intervention leads to another, and another, and another. In her article All About Epidurals, Sarah Buckley explains how the epidural often marks a turning point from where "an otherwise normal birth becomes highly medicalised, and a woman feels that she loses her control and autonomy". For example,

An epidural will often slow a woman's labour, and she is three times more likely to be given an oxytocin drip to speed things up. The second stage of labour is particularly slowed, leading to a three times increased chance of forceps. This slowing of labour is at least partly related to the effect of the epidural on a woman's pelvic floor muscles. These muscles guide the baby's head so that it enters the birth canal in the best position. When these muscles are not working, dystocia, or poor progress, may result, leading to the need for high forceps to turn the baby, or a caesarean section. Having an epidural doubles a woman's chance of having a caesarean section for dystocia.

Women having their first baby are particularly affected; choosing an epidural can reduce their chance of a normal delivery to less than 50%.

The list of interventions goes on and on. Doctors will cut a woman's perineum (episiotomy) when forceps are used or if there is a concern that the second stage of labour is too long. Stitches are generally given afterwards which usually hurt to put in and may make sitting painful for 2 to 4 weeks. Because epidurals numb not only the uterus but the bladder as well, some women are not able to pass urine and a catheter is needed until the effects of the drugs have worn off. This can be both painful and humiliating. Up to one in eight women will be given a drip following her epidural because of the resulting drop in her blood pressure. Not only does the drip further restrict the mother's mobility, but a drop in her blood pressure will affect the amount of blood being pumped to the placenta, and can lead to less oxygen being available to the baby.

So what are women to do? Suffer the risks and complications of epidurals on the one hand, or suffer the pain of childbirth on the other? Is it possible that there is another option? Many women are beginning to believe that there is. I am one of those who believe that women can indeed reduce or eliminate pain in childbirth without resorting to epidural anesthesia. How? The key lies in uncovering the reasons why women experience pain in childbirth in the first place.

Pain
Contrary to the prevailing medical opinion, pain is not a physically inherent part of childbirth. Other mammals give birth without difficulty, as have/do women in tribal cultures around the world. Stories of not only painless but even pleasurable birth abound from women in childbirth books and on the internet. Why then, do so many women in our culture find that childbirth hurts?

Fear
In 1959, Dr. Grantley Dick-Read wrote that the true source of pain in childbirth is fear. No other normal bodily function produces pain, he reasoned, and childbirth should be no exception. Dick-Read explained that when a person is afraid, the "fight or flight" response is triggered and blood and oxygen are instantly diverted to the arms and legs so that the frightened person can either combat or escape the source of danger. The extra blood and oxygen, however, must come from somewhere. People turn white when they are scared because blood drains from the face, an area the body considers nonessential for "fight or flight", and out into the extremities.

Another organ the body considers nonessential for fight or flight is the uterus. Dick-Read observed that the uterus of frightened women in labour is literally white. During labour, however, the uterus needs blood and oxygen to function the way it was designed to do. Without blood and oxygen there is no fuel flowing to the uterus, and no mechanism to carry waste products away. The result is pain.

While pain in childbirth is not normal, fear of childbirth in our culture is certainly the norm. Even if we can acknowledge that childbirth in a healthy person is a normal bodily function rather than a medical emergency, its difficult not to be influenced by the images of birth that surround us. Movie actresses scream in hospital beds until they are given the "miraculous" epidural while TV stars brave the agony of natural childbirth like true martyrs. Nurses and obstetricians offer us pharmaceutical help to "take the edge off". Our own friends and family warn us of the terrible pain of childbirth. And so we come to expect it.

What we experience in life has a lot to do with what we expect to experience. If we expect to have pain during childbirth, chances are we wilI brace ourselves against every contraction, and they will be painful. Grantly Dick-Read wrote that this type of tension, a result of fearing the pain of childbirth, leads to more pain, and then more fear, and on and on. How ironic that pain in childbirth is directly related to fear of pain in childbirth itself.

Breaking out of this cycle of fear/tension/pain is essential for a positive and empowering birth experience. Epidurals can certainly help with the pain, but they do not address the underlying fear or the tension that builds when we expect to feel pain. In this sense, epidurals are a technological solution to what is at root a psychological problem, albeit with physical manifestations. This is not to say that the pain isn't real, but rather that the source of the pain originates not in the body but in our beliefs about birth. Epidurals cut off a woman's body from those beliefs. According to birth researcher Robbie Davis-Floyd, the separation of a woman's physical state from her psychological reality has profound cultural significance:

To numb a woman about to give birth is to intensify the message that her body is a machine by adding to it the message that this machine can function without her. In particular, epidural anesthesia puts the final seal on this message, dramatically illustrating to the woman the "truth" of one of Western society's fundamental principles--the Cartesian maxim that mind and body are separate.

Perhaps this is why epidurals leave so many mothers with the feeling that they have "missed something" of their child's birth.

Changing our beliefs about childbirth may be a long process. Some of our fears may disappear instantly once they have been acknowledged, while others may never be entirely overcome. What is important is to face our fears and to learn from them. Once we do, we will be free to enjoy childbirth, naturally.