Taking sides - Pain relief in labour
What a relief
by Liz Breslin
Childbirth hurts. That much is obvious. But when we
get down to talking about how much it hurts and the best things to
do about the pain, we come up with an interesting problem.
It's unquantifiable, and therefore there's a lack of useful
statistics about pain and pain relief during labour.
While some online forums discuss whether
passing a kidney stone or giving birth is more painful, and others
liken labour pains to having root canal surgery without an
anaesthetic, these comparisons are monumentally unhelpful. There
have been some interesting studies on the language of labour pain,
but nobody has been able to make nice neat statistics out of this
information.
So I went down the fully anecdotal
research route and put out questions on my Facebook page to collect
some raw (sometimes very raw) data to work with. "Childbirth is so
wavelike", "uncomfortable and bizarre", "fulfilling pain",
"contractions from the core", "incomparably intense". Wrapped up in
their descriptions of pain were descriptions of pain relief.
"Mooing", breathing down, epidurals, water-birthing, Entonox,
Caesareans and husband's-arm-biting all got good mentions, as did
morphine during the aftermath. Earth Mothers and elective Caesarean
chicks - we all do what we have to, to get us through. And leave it
to a man to write, "It was a breeze - I didn't feel a thing."
I would have UNliked that if I could.
Just like I UNlike this. In July 2009,
Professor Denis Walsh caused more than a few ripples in the
birthing pool pond when he suggested that maternity units should
stop giving out pain relief in order to let expectant mothers "work
with the pain" to increase the bond with their baby. Good one,
Professor. I'd tell you exactly where to stick that comment if I
thought it would hurt even a tenth as much as giving birth. It's
all very well to tell us that pain helps us prepare for the
responsibility of motherhood, but as Wellington obstetrician and
mother, Anju Basu, pointed out in response on TV3.co.nz, "I don't
think that you have to experience immense pain just to be able to
be a good mother."
I had one baby naturally, although I was
induced, and the other was a full-on emergency Caesarean. Neither
birth automatically made me a better mother. And I love them both
as the individuals they are, regardless of how they were
born.
The use of pain relief
during childbirth is negligible in studies of birth outcomes.
Infant mortality rates are affected by two major factors - access
to medical care and maternal nutrition. We are in the fortunate
position to have good provision for both of these in New Zealand,
which may be why we rate quite highly on United Nations Population
Division rankings - 27th out of 195 countries. We are lucky enough
to have the choices to embrace or eschew pain relief in the
knowledge that whatever we choose, we are statistically safe and
well cared for.
Of course there are risks involved with
pain relief - Pethidine has to be given at the right time, and too
much Entonox can make you spew. Epidurals give you backache - or is
it lifting babies up that does that? The key thing is to be well
informed and to work with a LMC that you trust implicitly; to share
your views on pain relief and to be flexible as to the best birth
plan for your baby. Complications can happen even if you are fit,
healthy, and firmly in your happy place.
I suppose at this point I should come clean about my own
pain-relief experiences. That natural birth and that emergency
Caesarean I mentioned before - they were actually only two hours
apart. If anything, the more traumatic birth, for me, and for my
poor son with his head wedged for hours in a tight, tight space,
was my first. I had no energy left to birth the gorgeous girl who
had no interest in descending anyway. Birthed both ways in one day.
And boy, did the pain relief have to kick in afterwards. In a big
way. Incidentally, a 2008 study conducted in Switzerland, Belgium,
and the USA, documented in the Journal of the International
Association for the Study of Pain, showed that the management of
pain relief after delivery had more of an impact on post-partum
depression rates than whether the birth was natural or assisted in
any way. Pass the painkillers, please.
I wish I'd had the courage to rip up my
own preconceptions, and plan to just do whatever was best for me
and the kids. After all, isn't that what we learn further down the
line? That parenting is a two-way street and things don't go
according to plan. That sometimes pain relief is the kindest option
for all concerned.
Yes, pregnancy is not an illness, it's a
natural process. Yes, going to your happy place, breathing
yogically, and birthing in water can all be enormously beneficial.
But sometimes that's not enough. And just as each baby is
different, each birth is different and each woman's pain thresholds
and perceptions are different. We have to trust the men and women
who work with us to assist with birthing our children. We have to
allow ourselves to do whatever we think is best, at the time, for
us and our kids.
Giving women the power, and the
information, to make their own pain relief choices can only enhance
their feelings of trust in themselves, control over and connection
to the birth experience.
Liz Breslin is a freelance writer based in Hawea Flat, New
Zealand. Her short stories, poetry and articles, including a series
of opinion pieces called "Mum's the Word", have been published in
New Zealand and abroad. She has also written a play called Losing
Faith: A Tale of PND, exploring the issues of postnatal depression
through the constraints of coffee group culture.
It's only natural
by Laura Williamson
We live medicalised lives.
When it comes to minor complaints, there is very little we can't
fix with a pill: Sprain a knee, take an anti-inflammatory; get a
headache, pop an ibuprofen. And why not? No one likes a headache.
So it should be for birth, some would argue. After all, labour
really hurts, and we have the means to make it better, so why
suffer?
Because it's not that simple, that's why.
The pain of childbirth is different from other kinds of pain, that
of a broken arm, say, or a burn. Broken bones hurt because
something is wrong; childbirth hurts even when things are going
right.
Case in point: When the first modern
anaesthetic was introduced in the 1840s, doctors were hesitant to
use it in childbirth - they were afraid that stopping the pain
would stop labour itself. Laughably untrue (let's face it,
nineteenth century medicine was shonky at the best of times), but
interesting. Early medical professionals were grappling with a
question that we are still debating today, whether labour pain is a
symptom that should be cured or a valuable, even necessary part of
the birth experience.
Early experiments in labour anaesthesia
had mixed results. Queen Victoria supported the practice,
commenting, when her daughter gave birth in 1859, "what a blessing
she had chloroform." But the use of "twilight sleep", a blend of
chloroform and scopolamine, had a limited effect on pain and could
be toxic. It also left many women with no memory of giving birth at
all. By the 1940s, obstetricians such as Fernand Lamaze were
advocating a return to natural childbirth.
The feminist viewpoint has swung about in a similar way. Pioneering
feminists such as Isadora Duncan fought for pain relief. She called
childbirth a "monstrous torture", and argued that if painkilling
technology existed, we should use it: "It is simply absurd that,
with our modern science, painless childbirth does not exist as a
matter of course." Duncan certainly disagreed with the old claim
that labour pain is God's punishment for Eve's Garden of Eden
shenanigans, and good on her. But today, many feminists deem
medicalising childbirth a patriarchal intervention in the most
empowering event of a woman's life. As Gloria Steinem told Ms
magazine, "childbirth is more admirable than conquest, more amazing
than self-defence, and as courageous as either one." Many women now
argue that pain is a part of birth, and birth is an experience we
should cherish in its entirety.
I took Pethidine when I was in labour. It
wasn't good. I threw up on my midwife and had a hallucination which
haunts me to this day. (It involved Jimi Hendrix and the wee man
with the hunchback from The Rocky Horror Picture Show. Really). The
drug may have been necessary - I certainly asked for it. But since
then, I have wondered whether my attitude towards labour beforehand
affected my outcome.
To be honest, I was a bit with Isadora
Duncan as my due date approached, scared and more than a little
peeved that my lot as a woman was to endure immense physical
suffering in order to be a parent. It had never occurred to me that
I wouldn't use pain relief, and so I did. But talking to other new
mothers afterwards, I was struck by how positive the experience had
been for some of those who did it without drugs. They described
immense pain, sure, but also the immense power of a moment that,
for me, was nothing but a blur.
Experience aside, as with many things
medical, there are good reasons to avoid intervention unless it is
necessary. An epidural, for example, can slow a woman's labour by
affecting the function of her pelvic floor muscles, increasing the
likelihood of a Caesarean. Pethidine can impair early
breastfeeding, and Entonox makes you sick and dizzy, not to mention
babble like an idiot.
Natural pain relief options are, by comparison, benign. These
include water (a bath or a shower), TENS, massage, breathing,
music, visualisation and moving around, choices which are all now
actively encouraged in hospitals, a far cry from the 1940s when my
grandmother gave birth. She recalls being strapped to a bed and
sedated with chloroform, and that's all she remembers. For her, the
rest is darkness.
When it comes to natural childbirth,
we are at an advantage in New Zealand. In this country, midwives
can be independent lead maternity carers, meaning women can opt to
be in the care of a midwife whether she gives birth at home or in
the hospital - here, birth is not strictly defined as a "medical"
procedure requiring the presence of a doctor. As well, Plunket
offers free antenatal classes in which all pain relief options are
explained, including natural ones, and we have resources such as
the Pink Kit to help us prepare for labour. These are all things I
wish I, when pregnant, had taken more notice of.
Childbirth is a natural process, one
which can be as profound as it is painful. Can we fix it? Sure we
can. But we should think twice before we do.
Laura Williamson is a Wanaka-based freelance writer and
editor who has been published in newspapers here and abroad over
the last 15 years.Her work has appeared in Brain, Child magazine,
she writes a regular column for Spoke, a New Zealand cylcing
publication, she is the Wanaka correspondent for QT Magazine and
has written for the Otago Daily Times.
As seen in OHbaby!
magazine Issue 12: 2011
Subscribe to OHbaby!
magazine
Purchase Issue
12