Birth in the Fax Lane	Email post from Certified Nurse Midwife about why maternity caregivers (midwives and physicians) prefer that childbearing mothers have unmedicated labors and births --
	A mother's story about her plan to have epidural anesthesia and her very positive experience of giving birth without medication or anesthesia

from OtisSam@aol.com

Would you like to know the real reason we prefer unmedicated births?

The truth is that it is much better for babies to go through the birth process without medication.

Labor and birth are stressful for the baby (in a physiological sense, I am not commenting on whatever psychological stress birth may engender). With each contraction, the amount of blood flowing through the placenta and umbilical cord is reduced dramatically. This means that during contractions the baby is getting very little oxygen. In between the contractions, the baby makes up for this deficit, assuming the placenta is functioning well. For a healthy full term baby and a healthy mom the normal physiologic stress of labor is not a problem. The baby has "reserves" of oxygen (in a similar way to how long distance runners use up their reserves of energy producing molecules) which allow it to weather the stress of labor.

The whole purpose of monitoring the baby during labor is to determine whether or not the baby is tolerating labor; is it running out of reserves? is it functioning well despite the stress? The fetal heart rate tells us how the baby is responding to the normal oxygen deficit of labor.

What does this have to do with drugs?

Well, drugs not only interfere with the ability to ascertain the baby's well being through monitoring, but also affect the baby's ability to withstand the stress of labor. All the narcotics (Morphine, Demerol, Stadol) cause the baby's heart rate to show a "non-reactive" pattern to the fetal heart rate. (Reactivity is good) Professionals in the birth field are aware of this and take it into account in managing a laboring woman and her intake of narcotics. For example, if the baby's heart rate was already non-reactive, most people would not give narcotics, because you then couldn't distinguish between the drug effect and the physiological state of the baby (well, you could do a scalp PH, but that is an invasive procedure). Once the mother gets narcotics, mostly we would not be concerned that the heart rate became non-reactive, because we know it is an effect of the medication.

So, that's one reason to avoid narcotics in labor. Also, if the mother is given too much narcotic or given it too soon before birth, the baby can be born with respiratory depression, in other words the baby is too knocked out to care whether s/he breathes or not. This can be reversed with a drug called narcan, but again, you are getting into a whole mess of interventions.

OK, so narcotics are bad, what's wrong with epidurals? There is much controversy about this issue, but epidurals seem to prolong labor, make pushing more difficult, lead to more cesareans and forceps deliveries, raise the mom's temperature (so we think she has an infection and give her and the baby antibiotics and sometimes the baby is separated from the parents for three days in the ICU while they rule out sepsis, an overwhelming infection), drop the mom's blood pressure immediately after administration (which causes a major drop in blood flow to the placenta and can cause fetal distress, leading to an emergency cesarean), and make it difficult for the baby to latch on during breast feeding for the first few days of life.

I used to work in a hospital where just about every woman had an epidural. Now very few of my clients have them. I see a big difference in how vigorous the babies are right after they are born. I can't tell you how many babies in the hospital just lay there when their mothers tried to breast feed. This caused the mothers much distress, as you can imagine. Now that I see mostly unmedicated moms and babies, I rarely see a listless baby refusing to nurse. And the populations are very similar, except my current clients chose a birthcenter and are mostly committed to a drug-free birth.

Since I am the one responsible if something goes wrong, I would much rather (in the rare instances when this is neccessary) resusitate an unmedicated baby than one that has narcotics on board. It is quite simply much easier.

In short, if the mother can get through labor without drugs, both she and her baby will be better off. She reduces her risk of cesarean, being given unnecessary antibiotics, having metal instruments placed in her vagina to deliver the baby (forceps), being separated from her baby during the first hours/days of life, and having problems breastfeeding.

If non-pharmacological methods are not working or the woman does not want to go through labor without medication, I think most of us are more than happy to give appropriate drugs, if we are absolutely sure that is what the woman wants.

I know that I am not invested in drug-free births, however, most of my clients are fiercely opposed to using medication at any time, especially in labor, and it is sometimes a challenge to get them all the way through to the end without them. Some of my clients ask for drugs towards the end of labor. By that time it is generally too late (because the baby will be born soon) and afterwards they are always happy I didn't listen to them (although I often feel pretty anxious about telling a woman in so much pain that I will not relieve it for her).

As to out of hospital births, for most women and babies, labor and birth outside of the hospital is the safest option and leads to the best outcomes.

For further reading on these subjects, I suggest you pick up a copy of Henci Goer's Obstetrical Myths vs Research Realities.

And please think kindly of us poor hard working midwives. There really is no conspiracy to force our will on unsuspecting women. I could easily give all my clients an epidural and go to sleep while they labor, instead of staying up all night, having them scream in my ear, pull on my neck, grab my clothes, etc. (I am not describing a typical labor, just some isolated incidents over the past few weeks) I don't need to sit with a woman for hours, telling her what a good job she is doing, rubbing her back, encouraging new positions, etc in order to prove that I am all-knowing and superior or to prove that hospitals are dangerous and mostly unnecessary for normal labor and birth. I do it because that is what my clients want. And it is, IMHO, what is best for all involved (except of course the sleep deprived midwife).

Samantha McCormick, CNM>>>>>>>>>>

Birth Story

I would like to share with you my birth story. It is about a woman who fully intended to take advantage of an epidural, and to quote myself, "maximum allowable drugs," but wound up having a 100% natural birth -- not even a Tylenol! If you are interested in hearing this, please read on:

I become pregnant with my first child at the age of 28. Everything about this pregnancy was planned, right down to the month I had hoped to give birth. My husband and I attended parenting and childbirth classes, spoke with friends, read books and articles, and generally felt well prepared for the arrival of our first child. We had decided that I would get an epidural. After all, I reasoned, I wouldn't get a cavity filled without a pain killer -- why not take advantage of technology? Who needs to be a hero? I have an amazingly low tollerance for pain, and the thought of giving birth unmedicated was truly horrifying to me.

The morning after I stopped working, my water broke while walking down my driveway to place the last Thank You note in the mailbox. Again, I thought, what perfect timing! I tried to remain calm, and followed my doctor's advice to to relax, time the contractions, and don't even think about coming in until they were at least four minutes apart. After all, we didn't want to waste anyone's time, did we?

My labor pains were extremely mild from around 9:30 am when my water broke until around 2pm. At this point, my husband started to record them, and they were still quite random, although much more intense -- definitely NOT the neat little pattern I saw in the four pregnancy books I pulled out. Like many women, I started to question whether I was in actual true labor or not. The whole time, I kept thinking, "This is nothing. It's only going to get worse. But hang in there, Dawn, your drugs await you!"

We got to the hospital at 3:05 pm, and the only coherent word coming out of my mouth was "epidural." Looking back, I think the nurses took one look at me and knew the outcome of this. I was 10 cm dialated, so an epidural was not an option, despite my irrational pleading. I couldn't believe this! A drug-free, 100% natural delivery was NOT in my plan. I had considered the prospect of a C-section more seriously than I did a natural birth. I just did not think I was capable of coping without pain-killers.

My son was born at 4:20 pm, just over an hour after we arrived at the hospital. It was truly the most beautiful, meaningful, empowering experience of my life. After he was born, I felt like I could do anything. I was on such an incredible high that words could not do it justice. Looking back, I am not sure if it was from experiencing the miracle of life with a clear head, or simply that there is no pleasure like the absence of intense pain, or that I had accomplished something I never dreamed that I could. As corny as it sounds, I felt connected to womankind.

We are currently trying to conceive our second child, and I am often asked if I will have the good sense to get myself to the hospital sooner so I could claim the epidural I was denied with my son. I honestly do not know the answer to this question yet, but I do know that I would not have changed a single thing about the birth of my first child.

Dawn

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