ShareThisBy JOSEPHINE MARCOTTY
Thursday, November 16, 2006
When Libbi Zeien talks about childbirth with her friends, they all agree on one thing.
"Drugs," said Zeien, 28, who gave birth to her second child this month. "A lot of people think, 'Why go through the pain if you don't have to?' "
Natural childbirth _ no pain medication _ was the ideal for many women a generation ago. But for today's mothers, natural childbirth is not a goal, it's a choice. And increasingly, they are choosing something else _ epidurals, the powerful pain medication injected into the lower back during labor.
But some in medicine are expressing new concern that the use of anesthesia is becoming so widely accepted, and expected, that many pregnant women no longer realize they have a choice.
After all, epidurals not only make labor easier for mothers _ they make it easier for doctors and nurses, too.
"The pendulum is swinging to epidurals," said Dr. Patricia Fontaine, an associate professor of family medicine at the University of Minnesota. "We are giving the woman the choice to have something done with her body. But by the same token, we don't want to be foisting procedures on women for the convenience of the medical system."
A survey published of 1,300 hospitals nationwide last year showed that between 1981 and 2001, the rate of anesthesia-free deliveries dropped by two-thirds, to 6 to 12 percent of all deliveries.
Childbirth, as half the population knows, is one of the most painful of all experiences, and women have tried to avoid that pain for centuries. In the late 1800s the use of anesthesia became more commonplace during birth. Starting in the 1930s doctors began using drug combinations that also made women forget the birth experience altogether. The practice, called "twilight sleep," lasted into the 1970s.
"My mom didn't have a choice; the doctor didn't prepare her for childbirth," said Dana Jensen, 36, who had her first child this past Halloween. "They medicated her, and out came the baby. She doesn't remember most of it."
Those birth experiences, in which doctors had all the control and their patients none, gave rise to natural childbirth in the 1960s. Being awake to welcome their child into the world and experiencing it without pain medication became the goal for many women.
"We had to fight for that," said Maggie PaStarr, who bore her first child in 1984 and works as a midwife at Hennepin County Medical Center in Minneapolis. "Midwives come from the place that labor and birth are normal processes."
But in the 1980s epidurals started showing up in delivery rooms. These drugs, injected into a space below the spinal cord, numb the body from the waist down while leaving the patient fully awake. Depending on the dosage, women are still aware of contractions, and can push when the time comes. With rare exceptions, they are safe for the mother and the baby, experts say.
Cindy Frederickson, a childbirth educator at Abbott Northwestern Hospital in Minneapolis, said that nowadays the pregnant women in her class breeze through the first part of the pain discussion, in which she explains all the things they and their partners can do to manage discomfort.
"But they wake up when you come to medications," she said. "An epidural solves all the problems." And when they hear that about 70 percent of women get one, the discussion is pretty much over.
Doctors, nurses, midwives and educators say that women should have as much choice and control over their birth experiences as possible. That should include everything from the music they hear, to whether or not their mother-in-law is in the delivery room to when _ or if _ they get pain control.
Many women arrive at the hospital with elaborate plans: how much they want to walk during labor, birthing tubs, what kind of lighting and who should be present for the delivery. But nature has a way of derailing the best-laid plans.
Are women really missing anything by avoiding labor pain?
Melissa Mendez, 35, says yes. She had her third child last month, and her third natural childbirth. Her reasoning was that if most women in the world deliver without pain medication, "why can't I?"
She also had doulas (birthing assistants) for all three of her births, as well as a midwife for the most recent one. Research shows that women who use trained birthing partners are half as likely to use pain medications.
"There is purpose for the pain," Mendez said. "If you feel it, you know what to do. When it's time to push, you know it's time to push. And that euphoria right after _ everything clicks in."
In the end, the amount of pain that women experience has little effect on how satisfied they are with their birth experience, research indicates. What matters far more is their relationship with caregivers and how much control they have over birthing decisions.
But women who are now in their 50s and 60s who advocated for the right to feel birth wonder if new mothers today are missing out on something intangible.
"I would like to have more families experience it as the life event it is," Frederickson said. "But maybe I'm just goofy, and women don't need this life event. Maybe this generation can learn more about themselves in other ways."
