Monday, March 14, 2011

"My" Epidural

Have you ever noticed that when a woman refers to getting an epidural, she uses the word "my" epidural, not "an" epidural?  It is the only time I can think of off the top of my head that someone refers to pain medication as "mine."  If I have a headache, I don't say, "I took 'my' ibuprofen."  I say, "I took 'some' ibuprofen." 

So why is there ownership of the epidural?  Even the L & D nurses refer to it as "your" epidural, or "her" epidural.  You own it -- you better claim it before someone else steals it!  It is the weirdest thing.

When doctors in Europe were using a combination of different drugs to "help" women through childbirth towards the end of the 19th century, American doctors didn't want to use them.  They didn't feel they were safe.  I know, hard to imagine now, isn't it?  It was the women who demanded to have the rights to these drugs.  Up to this point, the majority of American births were assisted by midwives, not doctors.  More than 95% of all American births took place at home.

Much like today, women were afraid of childbirth, just for different reasons.  When male doctors started assisting in childbirth, women were willing to put modesty aside (no small thing) at the promise of having "pain-relieving" drugs for childbirth.  The doctors found it easier for the women to come to them in the hospital rather than have to travel to their homes.

And so it began.  Hospital birth.  In the beginning, only the affluent could afford to birth in the hospital.  It was fashionable to be "delivered" by a male doctor with his drugs and forceps.  Eventually, if you had a midwife-attended homebirth, you were obviously too poor to afford a hospital birth.  By 1940,  two-thirds of American births took place in the hospital.  (Both my parents were born at home.  They lived in southern Illinois in the middle of nowhere and were poor!)  By the 1950's, only 1% of babies were born at home.  It has largely remained the same after 60 years.

Historically, women fought for the right to vote just a couple of decades after drugs in childbirth were introduced, and birth was migrating from their bedrooms to the hospitals.  Women entered the workplace in the late 1930's during WWII to support their families.  During the Women's Rights Movement of the 1960s, women wanted equal pay and treatment.  We deserved it!  We wanted rights!  In the same decade, midwives began to resurface and the natural birth movement began rising up.  Make no mistake, 99% of women were still giving birth in a hospital with the drugs.  Just like today.

For the last 110 years, women have demanded drugs in childbirth because we should not have to endure the pain of childbirth, no matter how dangerous it may be for the baby, right?  As a woman, I have rights to those drugs!  I owned an epidural from the minute that pee-stick told me I was pregnant!  The doctors warned the women early on that the drugs went straight to the baby and were not good for the baby.  The women didn't care.  Today, we have doctors telling women that epidurals are safe -- there are no risks.  Why would you not have one, they say?  "There is no medal at the end of this race."  Oh, I beg to differ --  a drug-free mama and baby is quite a reward to behold.

Yes, women's rights have done some very important things.  But at what point did we get so wrapped up in our own discomfort that we can't see beyond ourselves?  Is it just human nature?  That sense of entitlement?

Here's the real kicker -- if women only knew the absolute empowerment that comes with giving birth to your baby without intervention or medications, they would understand that that is real Women's Lib.  Don't own the epidural ladies, own your birth!


Kaitlin @ More Like Mary said...

What an awesome post!!

Danie Nicole said...

I love this post!
I am hoping for a home birth when we decide to have another child. My first delivery was a hospital induction. After thirteen hours, I gave in and let myself be talked into the epidural by my nurse who wanted me to get one so I would be more compliant and my mom who said I didn't need to be in pain. I do not claim it as mine. I hope to never have one again or pitocin for that matter.

Regina said...

What a great post!

Gatorhap said...

Wow, amazing. Perfectly said, thank you. I especially love the last couple of lines.

Jes said...

You worded it perfectly!

Kendra said...

Great post! I lve the info you provide!
If I had known 9 years ago what i now know about sons birth would have been med free.
Keep sharing the truth!

Ela Grace said...

YES! Preach it, Mama! ;D

SuperMommySometimes said...

Wonderful post! Loved it and wholeheartedly agree.

.tasha said...

GREAT post!!! i fully agree :)

T said...

I have mixed emotions about when I got an epidural. My first emotion is that I feel cheated. Why did I let myself give succumb to the pain like that? Then on the other hand I think about when I got the epidural, I still had 12 hours to go and had been in labor for 24 (12 in the hospital) and all of it was in my back. Part of me goes, oh it was was just as well that I got it when I did. I don't know if that is that part that is just trying to justify my actions or what. Next birth totally getting a Doula. You can use your flex spending on their services. TOTALLY saving for that investment next time. Kinda makes me sad that hubby only wants 2. The first one you learn so much on. Then you can only apply that knowledge to one more. :(

Laura @ our messy messy life. said...

I literally clapped at the end of this post!

Sarah said...

When my husband and I told his 80+ year old grandmother we were having a baby, she squealed with delight and then prompted added "Do not do that little back needle thing the doctor will try to give you. I had 6 children, all with midwives and all without those drugs." It made me laugh to see her some adamant about something. But two births later, I didn't do "that little back needle thing" and am so thankful!

DoulaFaye said...

WOW WOW WOW WOW WOW! well said!

SlapItHigh said...

Based on my extensive research, this is actually not how it went down at all. Women were essentially forced into hospitals for birth so that OBs could hone their skills...aka, they needed guinea pigs. Women's rights and powers were undermined when male OBs lobbied all male congress before women had the right to vote and this did influence where women birthed.

I like what you are saying in general but not the part where it makes it seem like women were the ones who wanted to be in hospitals for pain relief. Based on the scholarly historical books that I've read, women were scared shitless to birth in hospitals and rightly so -- maternal and fetal deaths rose sharply when birth was moved to hospitals.

Jessica - Mom of all Trades said...

Love this post!! I have given birth to not one, but 7 children and an epidural has never crossed my mind. (I take that back, several times during transition I yelled out "Why didn't I get the stupid epidural!?") I am now expecting my 8th and this one, like all the rest, will be born drug free. Tired of doctors downplaying risks just because of how often drugs and interventions are used.

Donna Ryan said...

SlapItHigh, we are obviously reading different books. I'm not making this version up because I want to believe it!

Licensing for midwives became the issue of the day and the male OBs made it impossible for the midwives to continue practicing. I don't believe women were scared to birth in the hospital. That is contrary to everything I've ever read. How is it that you and I are reading such different historical accounts? Depends on the slant of who's writing it, I suppose.

Your comment about maternal death rates rising when birth moved into the hospital is also contrary to things I've read. There was this perception that birth was safer in the hospital, not because it actually was, but because hand-washing caught on about the same time this migration was taking place.

Look around today. Do you see women scared to birth in the hospital? If this were true, as you claim it was 100 years ago, why are 99% of babies still born in the hospital? Women want the drugs. They want to own the epidural. They are as much to blame as the doctors who tell them it is safe.

In almost 3 years of writing this blog, I've never had anyone use a swear word in their comments. Please be considerate of other readers, including myself. I don't care to have foul language displayed here. I appreciate your comments, but let's keep it clean. Thanks.

Mamatao said...

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SlapItHigh said...

Everything I've posted can be back up in the following scholarly books:

From Midwives to Medicine: The Birth of American Gynecology
by Deborah Kuhn McGregor, Rutgers University Press, 1998

Lying In: A History of Childbirth in America, by Dorothy Wertz and Robert Wertz, Yale University Press, 1977

Brought to Bed: Childbearing in America 1750-1950, by Judith Walzer Leavitt, Oxford University Press, 1998

Birth as an American Rite of Passage, by Robbie Floyd-Davis, Uni. of California Press, 2nd. ed. 2004

I'm afraid this conversation could be very lengthy if we dig into it. The information provided in the above books is significant. The only "slant" in the books above are historical and/or anthropological. They are not opinion pieces such as many popular non-scholarly books currently in the media.

Too much to right in one post, I'll add another....

SlapItHigh said...

I think that women want and need drugs for the type of births that typically go down in hospitals and surely for the types of births that went down in hospitals in the early 1900s.

"Lying In" gives extensive historical accounts of how it was the norm for women to be brought in, placed in a bed in a room alone, tied down to it, administered morphine and scopolamine, and ignored until such at time as the nurse or physician decided she was close enough to be delivered. Then, she would be wheeled into the OR, given another dose, after which the physician would give an episiotomy, after which unless the baby's head was on the perineum, would apply mid-to-high forceps and literally pull the baby out of the insensate woman, and immediately whisked away to the nursery for several hours, as long as it wasn't born blue.(f it was born blue, it was just as likely to be discarded and named a "stillbirth," as there did not exist a standard measure of vital signs and fetal responsiveness until Virgian Apgar, who was a surgeon-turned-anesthesiologist, developed the Apgar scoring system in 1949.) The mother was carted away back to her room, until she wakened and was presented the infant she "gave birth to" during her drug-induced semi-conscious state. That was the face of modern obstetrics.

I'm not necessarily saying women didn't want pain relief but rather that was not the main reason that childbirth moved to hospitals. They were forced there.

There is no escaping the fact that it was physicians (all male) who specialized in obstetrics who all lobbied Congress (again all male members) to outlaw and criminalize midwifery in the early 1900's, before women had the right to vote. They did this because they were frustrated and disgruntled by the fact that most women refused to come to hospitals to give birth, [sanely] fearing as they did, infectious illnesses. Of course, it was safer for the women to give birth at home, but so long as they did so, doctors had no "material" on which to practice and hone their skills and conduct research on. This is proven by the fact that maternal deaths sharply increased after the passage of legislation effectively began driving women into hospitals, along with the panacea of "painless birth" being presented in a campaign waged by physicians. Thus, it was misogyny and paternalism which gave birth to the field of obstetrics as the standard in the U.S.

The premise that women have historically desired reprieve from the pain of childbirth does not justify the facts that they had nil political representation in the establishment of this obstetric paradigm, nor does it mean that they desired such pain relief at the cost of greatly increased risk of death due to contracting puerile fever, and of permanent injury to themselves and their their babies thanks to the gratuitous use of forceps. On the contrary, the misery of women increased exponentially concurrent with their rise in power, and has only been mitigated by the contributions of other more evidence-based branches of medicine and political forces at play: such as, the introduction of antibiotics, the introduction of aseptic technique, the development of the Apgar scoring system, inproved nutrition of the populace, and thus greater resilience to disease, and finally the feminist movement in the 1960's, which sought to restore legality to midwifery, and to counter the stranglehold OBs have had on the standard of obstetrics in this country.

SlapItHigh said...

This quote answers all of your questions and shows exactly why they wanted women forced into hospitals (and were willing to risk lives to do so) and exactly why women are still there today:

"Ideas and ideals are the hardest things in the world to establish, but once established they are impossible to eradication and they raise the plane of human existence. It is therefore, worth while to sacrifice everything, including human life, to accomplish the ideal. Knowing this I am willing ... to close my eyes to what the midwives are doing and establish high ideals. Then all, poor and ignorant, as well as rich and educated -- the 40% as well as the 60% will enjoy the benefits of improved conditions.

In all human endeavor improvement begins at the top and slowly percolates down throughout the masses. One man runs ahead of the crowd and plants a standard, then drives the rest up to it. Search history, biblical and modern, and this fact stands out brilliantly." [Dr. Joesph DeLee, MD 1915]

D'Anne said...

On the history piece--you are both right. Drugs and hospitals were definitely a show of affluence and a badge of arrival into the middle class(back then, the middle class was wealthy.) The Twilight Sleep Association was organized by socialite New York women, one of whom would die from it the next year.
The poor and working class were happy enough with their community midwives--and because OB's graduated w/o having seen a birth and it would not do to practice on affluent women, lower-class women were recruited to be "learning material" for this purpose. Co-conspirators for this were the aforementioned club women along w/ public health nurses and settlement works--all who had been co-opted by the nascent obstetrical profession. Predominantly an urban phenomena, especially in the South, midwives would continue to serve the poor until Medicaid in 1965. I am at this time researching and writing about women's agency in the demise of midwifery.
It was a rainy Hill Country night that saw the arrival of Lyndon Baines Johnson in 1907. With the swelling of the creeks and Pedernales River preventing his father from going for the doctor, and to his mother's everlasting shame, the local midwife attended the birth.

D'Anne said...

SlapItHigh, i agree of most of what you have written--and you have left big chunks out. Women were less the victims you make them out to be--and history is repeating itself with present day midwifery movements.
Also Congress had nothing to do with it. Midwifery was first controlled then eliminated on the state level, as Organized Medicine took control over all other practitioners through state Medical Practice Acts in the 1920's--with strong connections to Eugenics--as a sidebar.
One thing you are absolutely correct is that both infant and maternal--especially maternal--mortality skyrocketed with the hospitalizationn of birth. Even a 160 years after Semmelweis 1/3 of docs do not wash between patients--or after toileting themselves. And then there are Nosocomial infections. Hospital has never been a sanitary haven, and twasn't till the advent of antibiotics that the hospital birth woman had the same chance of her homebirth sister to survive. Along w/ blood transfusions, which came about the same time, and put out the iatrogenic-set fires.

SlapItHigh said...

Yes, I've definitely left out many pertinent details. I could literally sit here for hours writing on the matter. Maybe it would be easier to upload dissertation!

While male OBs certainly did lobby congress (and congress did get involved), most legislation was enacted at state level. However, it's important to note that regardless of state or federal involvement -- all were men.

For anyone interested in learning more about the history, there is a five part article here -

D'Anne said...

Yes, I recognized Faith's work in you comments. Great lady and good work. And women aspiring for power aided these men. Again, something that continues today.

Erin & Nick + 2 said...
This comment has been removed by the author.
misscrissy34 said...

It is refered as "my" epi is because it is actually prescribed to you. It isn't a one size fits all med like tylenol. It is a custom dose for your height, weight, bp,etc. But it's not a "hurry and get one before they are gone" yours it's a "this is specific to you" yours. Example I don't say I took some bp meds I say I took my bp meds.

Anonymous said...

Though I agree with you wholeheartedly, since I aimed for a natural traditional homebirth, alas it was not so. I 'needed' a forceps delivery when I transferred to the hospital, something I was not going to go through without an epidural. They literally tore me a new one and I am glad I didn't feel them do it. Do I hate epidurals and what it did to my son? Yes, I do. Do I regret taking it? Not really. I would never opt for one to escape birth pain right off the bat, but after 46 hours of back labor, I think I earned it. I think it depends on the circumstance, really. You wouldn't tell a woman who is having a c-section to opt to do it without anesthesia would you? I think women who choose epidurals without medical need fear birth and pain in general and this is sad because it can be empowering, as long as nothing goes 'wrong' and you have to throw your intentions out the window. Don't get me wrong, I still don't like epidurals, but they can be awesome too.

eulogos said...

It seems that the only thing offered now is the epidural. I had a pudental block for my forceps delivery, a local sort of thing like novocaine for dental work. This didn't affect my walking afterwards at all, and it was nowhere near my spine, which I appreciate. I wonder what happened to paracervical blocks and pudental blocks? I heard the paracervical block caused some drops in fetal blood pressure, but so do epidurals. I wonder if it isn't that epidurals cost more and only anesthesiologists do them. The blocks I mentioned were done by OB's. Maybe they feel they can't cut the anesthesiologists out of the picture!

I happen to think that being told by the doctor to have the paracervical, so that I wound up not feeling a desire to push, is what caused the need for the forceps delivery and the pudental block. So I am not saying, oh, everyone, have one of these!
But there are options short of a needle next to your spine which work.

Susan Peterson

Ilaria said...

Great, great post!!!