Sunday, February 06, 2011

Pain

Beautiful Eve

Am I rushing in where angels fear to tread?

A recent post at the Science and Sensibility blog about Epidural Anaesthesia, written by well known Canadian family physician, Michael Klein MD, will be of interest to anyone who is interested in pain and childbearing. Dr Klein's paper is well referenced, and a reliable review of current medical knowledge about the topic.

The comments by readers reveal to me some of the myths and misunderstandings about pain and childbirth that I encounter from time to time. Comments quickly become defensive, assertive, and even aggressive in defending one camp or the other.
For example,
"Why are some women so hostile to their sisters who want to birth without cocktails of narcotics and to those professionals who want every woman to have a birth that makes them feel good with as few risks to mother and baby as possible?"


Before making my own comments, I would like to tell you about a birth I attended this past week. The mother knew she was preparing to give birth from about 9 in the morning. I went to the house, listened to the fetal heart rate, prepared my equipment and paperwork, and waited quietly in the bedroom. After having a shower, the mother reclined in her bed for an hour or so. She asked me if I needed to check internally for dilation, but I said not unless we were worried about something. Then she went to the bathroom, and after about 10 minutes she told me she could feel the head coming down. She stood as her baby was being born.

Baby was supported by my hands as he quietly took his first breaths, then mother reached down and took him to her breast. The umbilical cord was thick and pulsing strongly. Mother sat down on a chair, and we put warm wraps around her and her child. After about 15 minutes mother stood again and the placenta was expelled without difficulty. Blood loss was minimal. Baby suckled strongly for the next 2 hours or so, then went to sleep.

I have not asked that mother if she experienced pain. I did not hear any deep breathing or moaning or other sounds associated with pain in childbirth. The labour had progressed over 3 or 4 hours, plenty of time for preparations to be made for birth. With no interruptions or distractions, the mother and child were able to move through the awesome journey of birthing.

This is one end of the pain spectrum.

From a physical point of view, the harmonising of mother's body, her uterine action, the shape of her spine and bony pelvis, the resistence of her tissues and skeletal muscles in the birth canal, the shape and molding and positioning of the fetal head as it presents for birth, the size of the baby ... Everything was optimal. From a psycohlogical point of view, the mother chose to accept the work of giving birth, and prepared her mind, her family, and her environment to support her in that work.

The other end of the pain spectrum includes physical obstruction and damage to tissues, in a way that if not relieved, both mother and baby can be harmed. It doesn't matter how well prepared or how optimally supported a woman is in this case: if her labour is not able to progress normally, the pain is a key indicator of her need for another pathway to be found in bringing her baby into the world.

Between the two poles of the spectrum are the many different experiences of pain that women have when giving birth.

There is no doubt that a spontaneous, drug free birth is a wonderful start to life for a baby, optimising bonding and the transitions both baby and mother have to make.

There is also no doubt that some women need to go to Plan B, which may include epidural, assisted vaginal birth, or surgery. While I would never encourage a woman to move lightly to Plan B, because there are consequences and risks inherrent in every medical and surgical procedure, I am thankful that Plan B is available, and relatively safe in the world in which we live.

1 comment:

Joy Johnston said...

Henci Goer has written more on epidurals at http://www.scienceandsensibility.org/?p=2215