Monday, February 18, 2013

"Please Just Get the Epidural" said the OB

A while back, an out-of-state couple of mine was trying to find a good care provider who is supportive of natural birth.  I posted the question on my BFBS Facebook page and several of you jumped right in with some great responses.  One person simply stated, "Just tell the doctor you don't want medicine."  She deleted the comment, but it had gone to my email first.  I'm not sure why she deleted it.  I reflected on her comment the rest of the week.

If only it were that easy - just tell your OB that you don't want medicine.  And yet, for the majority of women that choose to birth without medication, it's an uphill battle.

Why I (Your OB) Push the Epidural


First, if I'm an OB, I rarely see a birth without medication, mostly because the majority of women want the epidural.  It's what I am comfortable with.  It's what I learned in medical school and in my residency.  It's what I do.  When you tell me that you don't want the epidural, I think, "I've heard this one before!"  Lots of women tell me that, but few actually follow through.  I can have a great influence in how your labor goes.  I'll play along though and tell you exactly what you want to hear.  A couple of my favorite lines:

"You can hang from the rafters for all I care!" (She's making fun of you with a statement like this.  She believes that a civilized woman would never choose to birth without an epidural.  She doesn't get it.)

"As long as everything is going smoothly for baby and everyone is safe, I'll let you do whatever you want."  (A statement like this reminds a confident woman that birth is dangerous and she might need to be rescued.  It's definitely passive-aggressive.  You think you're getting what you want, but really, the doctor is putting you exactly where she wants you -- on the verge of thinking you and your baby are not safe. She will come up with a reason to interfere with your labor.)

Unless your care provider is actively helping women have unmedicated births, she doesn't know how to help you.  Just because she is catching babies doesn't mean she knows a thing about natural birth. 

The noises of a laboring woman make me very uncomfortable, all the moaning.  If she's doing it "right" they sound a little too sexy. Eew.  You can tell a lot about where she is in her labor, and more importantly, how she is handling her labor.  Are the sounds high-pitched and short breathed?  She's struggling.  Are they low and long deep breaths?  She's on top of it.  Is she tightening during contractions or letting it all hang out?

Back to my roll-play as the OB, I like it when you have an epidural because ultimately, I'm in control of your labor.  I can increase the pitocin and really get this show on the road!  I don't want to be at your labor all day/night.  With an epidural, you will do whatever I want you to do.  If I think breaking your water should be done (I can come up with a million reasons why this is good or necessary for your labor/baby to progress), you'll do exactly what I say.

I also prefer you to stay in the bed on a monitor.  When you have an epidural, I like this.  You aren't going anywhere - none of this silliness of walking around, bouncing on a birth ball, or moaning like a wild animal in the shower or tub.  No, I like you acting civilized in a bed, on a monitor, preferably sleeping.

I also prefer to "deliver" your baby while you are flat on your back with the bright lights on your vagina.  Then I can see what I am doing.  You can't feel how uncomfortable this is anyway since you have an epidural.  This really makes my job much easier.  I like a compliant patient.  It's easier on my back too.  Imagine leaning over a birth tub to catch a baby!  Honestly!

In the end, if I decide a c-section is the way to go, you already have an epidural.  I can make that call and have things move super fast.  If you don't have an epidural placed early on, this delays the c-section.  I can always use general anesthesia, but then I really have to justify the emergency factor.  The epidural is just so .... easy.

So, please.  Just have the epidural and make this easier on us all.  Thank you.

Love-
Your Typical American OB


12 comments:

Cait Marie said...

As a labor nurse, I find this post to be somewhat offensive. I am in total agreement that many things about a typical American birth experience should be changed, but I don't think that total blame should be placed on the docs.
I cannot begin to tell you the amount of women that I have seen wheel into L&D, bums seemingly glued into their wheelchair because they "can't walk", screaming for an epidural. Upon my SVE, they are usually 1-3cm, albeit cranking out some pretty good contractions, which I imagine hurt pretty bad! Usually the OB explains that an epidural that soon in the game can actually SLOW labor progress down, and the OB encourages them to hold off a bit longer. I truly have never had a doc "force" a labor epidural on a woman. The vast majority of OB's that I have met have been caring towards their patients, sacrificing much sleep and family time to do their jobs well.
Recently, OB's have been under attack by the people that they try to help. Sure, there are bad eggs. But that's life. Research your provider and her practice BEFORE you see her for care. If you don't like they way she doctors, switch providers. I am tired of American women complaining about their birth experiences, placing all of the blame on somebody else. Research. Make decisions. Go in with a plan. A natural birth can happen any place that you want it to.

ob said...

Donna,
We mostly agree but there is one sticking point here I must comment on. I try to agree with most everything my ncb patients want and I try to be reassuring that as long as momma and baby look ok I will stay out of the way. I do this because I want them to konw I do not have time limits, NOT that I can pull the cut trigger at any time. That I am trying to assure safety, not find a reason to cut. I don't know any other way to get thess ideas across and also, am I not afforded at least the monitoring of a midwife (intermittent) to check on well being? If I cannot say that I will be monitoring at least according to evidence based medicine then why am I following the patient ('s - must include momma and baby) at all? If we cannot reassure her without being suspect then what is any Ob to do?

JoyBelle said...

This has been my experience with my OB-attended births. I was patronized like a little girl. One nurse came into my room and I heard a momma laboring noisily. The nurse rolled her eyes and told me, "We'll see how long she lasts. She is trying to be brave and not get the epidural". Last time I checked natural birth wasn't about bravery but about making the safest choices for yourself and baby.

I had the whole gamut with the ice cold room (poor baby!) and bright lights and being on my back. I felt like my peaceful gestation was ending in this frantic drama where I was no longer calling the shots about MY body but someone else, whom I had only seen for maybe 15-20 minutes of my life, was. Thankfully I had vag. births with them and was able to move on to midwifery care (though, of course, not all midwives are created equal as all OBs are not created equal but I do tend to be biased toward midwifery care).

Becky Coolidge said...

As a doula, I feel like I have written this myself in my head too many times. I would add: the audible collective heaving sigh of relief from the staff as soon as the first contraction on the epidural hits. THEY are more comfortable when SHE is on it. But only I notice it:(

Cori Gentry said...

I kid you not I talked to an OB today, not mine and will not be attending my birth, who tried to convince me to get an epidural over the phone. He said "it will give us more control, just in case." I immediately thought of this post! I laughed at him, he was supposed to be giving me some test results and he's already trying to prep me for pain meds and I'm not even in labor.

The Deranged Housewife said...

Cait Marie, I don't doubt that either - but I wonder if those women ever took a childbirth education class and know how to cope with pain effectively, especially while being made to sit in a wheelchair through contractions. I agree that women need to be more informed about the process, but it's somehow hard to be when people say "Just trust your doctor! He'll tell you everything you need to know!" I've also heard doctors discourage their patients from "reading anything on the internet." Where is this new mother supposed to get her information from? Someone who just says "It's safe, you'll do fine," and not much else? Someone who doesn't have time to answer all her questions, even the seemingly dumb ones, or brushes her off and makes her feel like an idiot for asking? I've been "counseled" at length by two different doctors, in two different practices, about how dangerous VBACs are, all while completely glossing over or ignoring the risks of cesarean birth. That's not adequate informed consent. But if I'm not allowed to read the internet, or any of those newfangled birth books, then I'm not sure where to turn for information. My well-meaning but equally clueless friends?

*Sigh*

Sheri said...

Love this post. It is more true than not. The OBs that listen and support their patients are rare. My OB told me that he had done 7 and 8 c-sections on one patient alone, but having a VBAC was dangerous. What? The birthing process in America is in peril. Please, continue to inform.

noelani said...

I think this article makes too many generalizations. I was married for 27 years to a man who became an OB/GYN, over the first 12 years we were married. Where he was trained, in the mid-80s, they avoided most interventions whenever possible. They did vaginal breech extractions, external versions, delivered twins, vaginally, etc.. In fact, although they had a very high-risk patient population, their c-section rate was less than half the national average.

If someone didn't want an epidural, it was fine with him. He only insisted on them having an IV, so that in case an emergency arose, they could administer medication without delay.

When we were in Germany, with the Air Force, there was a woman who didn't want anything, including the IV. He even said he was willing to take it one step at a time and not insist that she have the IV, unless conditions made him think it was the prudent thing to do. She wanted him to promise that he would not give her an IV. When he couldn't do it, she wrote to Sen. Ted Kennedy and told him that she was being given substandard care by an Air Force physician. This led to an inquiry where my husband, and the whole hospital, was evaluated with a fine toothed comb. Countless hours were wasted, which should have been used taking care of patients. Of course, the findings were that my husband and the hospital were actually providing exceptional care, overall.

After that, no one at the hospital wanted to deal with that woman again, so they sent off-base, to a German physician. The military insurance, CHAMPUS, paid for it.

I appreciate what Cait Marie said. I've personally know some of the "bad eggs" she refers to. Unfortunately, one of them delivered my first grandchild (by c-section, after three days trying to induce, at 39 weeks, without any evidence she was ready) But I also know some of those who would do almost anything for their patients. There literally was not a single thing that we might be doing when my husband was home that was not interrupted, on many occasions. In fact, had he not chosen OB/GYN as a specialty, I believe we might still be married. It wasn't his being gone so much as his priority always being those other women. That makes for a great doctor, but not such a great husband.

The Lows said...

Cait Marie- I too am a labor nurse and agree with you. We live in a society that was raised without a lot of coping mechanisms. There's plenty of woman I help labor all day long and never get an epidural and our OBs couldn't care one way or another. They don't have an agenda....heck, they stay at the hospital BY CHOICE so patients and nurses feel safer. Because of the push by natural childbirth experts that nurses and doctors are "paid paranoids" you're making our job harder and encouraging more and more women to seek unsafe home births. It's time natural childbirth experts recognize that as Americans we are no longer a healthy population and we bring to childbirth a vast array of secondary diagnosis that add to managing birth. I have had some of the most amazing births when patients and they're doulas want to work together with the nursing and medical staff.

Melissa Weber said...

I don't think the epidural is all that bad...
Everyone has their own opinions I know but it helps people get through labor...If it was unsafe, they would not allow people to get it...
I had the epidural for both of my pregnancy's and guess what, I was healthy after my babies came out and ((most importantly)) my babies were extremely healthy...
I agree I think it is stupid for nurses, doctors or anyone other then the soon to be mother to make the decision for natural or epidural birth...
My OB never once forced it on me, she was actually telling me that it would be good to do it natural and I was the one that said NO!! I was the one that wanted the Epidural...Does this make me a bad mom? Hell no in my opinion...Today my babies are still extremely healthy, never been sick and doctors say they are highly advanced for their ages...
I say if you can do it natural great for you...If not then by all means get some medicine and say screw you to anyone who gives you crap for it...

Beth said...

@ The Lows.. Home birth is not unsafe. There is no reason for a healthy woman to give birth in a hospital if her pregnancy is going well. Hospitals are for sick people and all they do in a normal, healthy birth is greatly increase the chances of having unnecessary and dangerous interventions. Yes, things can go wrong but that's not the norm. Usually when something goes wrong, its in a hospital where you have the snowball effect of one intervention after another that destroy the natural birth process. A trained midwife knows what to look for and can get the mother to a hospital if it becomes necessary.
@Melissa Weber.."If it was unsafe, they would not allow people to get it"? Really? That is a dangerous mentality. What about the repeat, unnecessary c-sections they push or the inductions for babies who aren't ready yet? What about the dangers of all of the drugs they give out like candy? Many mothers and babies have died from complications caused by drugs and interventions they didn't even need. Any drug you put in your body has risks and is also going into the baby's body. Drugs in labor disrupt the baby's natural hormones and instincts, making baby less alert which makes breast feeding harder. These drugs also make recovery slower and harder for mom. No, it won't always cause serious problems but there is a chance that it will. I'm not bashing anyone for their choices but women need to be much more informed on the dangers of labor interventions before they make their choice. I think many more women would be choosing to avoid drugs and interventions if they really did the research. We can't trust doctors with everything. I have read cases over and over where the doctor pushed something dangerous and withheld information about safer options. We need to be active in our births and decisions so we're not taken advantage of.

Jennifer Valencia said...

My first birth (with an ob) was just like this. He used the "you can hang from the rafters" and "as long as" phrase plenty prenatally. As a doula, I've been to a birth where you could feel the ob become giddy when she got the epidural and attempt to start pit, which she had the sense to decline. It's such a shame how birth is treated in our society. I think a very important factor is really knowing your care provider and determing not "if you can" do this or that but "how they will" support your birth and knowing what the red flags are.

A couple related posts to finding your care provider and birth in our society you might like.