AmyTuteurMD

AmyTuteurMD
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Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School.

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OCTOBER 21, 2008 8:36AM

Why does childbirth hurt?

Rate: 17 Flag

What if pain in childbirth is an unnecessary remnant from human evolution?

Natural childbirth advocates often claim that the pain of childbirth brings a variety of benefits. Indeed, there are some who claim that the pain triggers a hormone cascade that is necessary for maternal infant bonding. Others insist that childbirth is not painful and is actually "ecstatic" and provides sexual pleasure. These varying theories hinge on the notion that the pain of childbirth adds something of value to the experience birth, and that the pain is good and beneficial. However, evidence derived from the study of ancient childbirth suggests that natural childbirth advocates have it precisely backwards. The pain of childbirth is not needed to trigger good things, it is vital to prevent maternal and neonatal death, and is a vestigial response that is no longer needed.

Before we consider ancient childbirth, it makes sense to think about the role of pain in the human body. Pain is almost always a sign that something is wrong, perhaps seriously wrong. Indeed, pain is so important to human survival that it can stimulate reflexive reactions. Put your hand on a hot object and you will actually begin pulling it away before you consciously feel the pain. That's because there are nerve circuits in the spinal cord that allow you to unconsciously perceive the pain and pull away, skipping the step of consciously noticing the pain so as to save time and limit damage.

When you think about it, there is no instance in which pain is not designed to protect against damage. At the level of the skin, pain tells us what is safe to touch and what is dangerous. At the level of bone, the pain of a broken bone is so great that it forces immobility, and that probably helps the bone to heal properly. The pain of disease makes people search for ways to diminish the pain, and perhaps improve survival from the specific problem. So, at the most basic level, there is no reason to believe that the pain of labor is beneficial in and of itself. Unless labor pain is different from all other types of pain of human existence, labor pain exists to warn.

Human childbirth has existed in its present form for millions of years. During that time, the death rate of both mothers and infants was extraordinarily high. Evolution would certainly have favored strategies that lowered the risk of death. Perhaps labor pain, like all other forms of human pain, existed to warn women to seek assistance.

Seeking assistance in childbirth may have lowered infant mortality by having help in situations like breech birth (which usually cannot be accomplished without some manipulation of the baby's body) and may have lowered the death rate from postpartum hemorrhage, because the assistant could massage a woman's uterus after birth. Assistance in childbirth must be very important from an evolutionary perspective because anthrologists report that all human societies have birth attendants.

According to Karen Rosenberg (a paleoanthropologist who studies human birth) and Wenda Trevathan (a biological anthropologist and trained midwife) writing in Scientific American special edition, New Look At Human Evolution, 2003:

... [W]e suggest that natural selection long ago favored the behavior of seeking assistance during birth because such help compensated for these difficulties. Mothers probably did not seek assistance solely because they predicted the risk that childbirth poses, however. Pain, fear and anxiety more likely drove their desire for companionship and security.
Psychiatrists have argued that natural selection might have favored such emotions—also common during illness and injury—because they led individuals who experienced them to seek the protection of companions, which would have given them a better chance of surviving. The offspring of the survivors would then also have an enhanced tendency to experience such emotions during times of pain or disease. Taking into consideration the evolutionary advantage that fear and anxiety impart, it is no surprise that women commonly experience these emotions during labor and delivery.
It would be quite ironic for natural childbirth advocacy if the role of pain in labor was to alert women to the inherently dangerous nature of childbirth, so they would seek assistance. It would also mean that labor pain has outlived its usefulness. Far from being beneficial, labor pain may turn out to have only harmful effects.

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I'd like to meet one of these people who claims that childbirth "is not painful and is actually 'ecstatic' and provides sexual pleasure". I've been through it three times, and during all three times, I've never felt closer to death's door.

I do think that much can go wrong during childbirth, particularly now that evolution has made our pelvises and birth canals more narrow. It makes sense to me that pain would alert a woman to get help. I can't imagine giving birth completely unattended. And while I'm at it, God bless the person who invented the epidural! Discovering the wonders of the epidural during birth #2 made the entire experience much more bearable.
Lisa Kern:

"I'd like to meet one of these people who claims that childbirth "is not painful and is actually 'ecstatic' and provides sexual pleasure"."

Ina May Gaskin, a lay midwife who is quite influential in the natural childbirth community, claims that it exists. There's actually a new movie called "Orgasmic Birth" created to publicize the concept.
Evolution has also made babies' heads larger and harder to deliver, although I think a lot of the pain happens during the contractions and less during the delivery. I only have a n of 1, though, because baby #2 was a breech C-section.

There may be no significance at all to the pain. It might just be that because all organs are innervated (particularly muscular organs like the uterus), stretching or contracting them causes pain.

I found childbirth to be extremely painful and pretty scary, but I also know what they mean by the birth orgasm, believe it or not.
buckeyedoc:

"There may be no significance at all to the pain. It might just be that because all organs are innervated (particularly muscular organs like the uterus), stretching or contracting them causes pain."

You're right. That's just as likely as Rosenberg and Trevathan's theory.
My sister was told by a nun teacher that childbirth was not painful. Huh?

I also understand, that besides enlarged heads, that the shape of the pelvis (more narrow) due to standing upright makes labor more difficult and prone to complications. If true, the need for pain as you describe above is even more important than for other primates.
skeptic turtle:

"I also understand, that besides enlarged heads, that the shape of the pelvis (more narrow) due to standing upright makes labor more difficult and prone to complications."

That's right. The process of human birth is a compromise between competing evolutionary pressures. On the one hand, a more neurologically mature newborn is more likely to survive, so there is an advantage for a baby to be born more with a bigger head and, therefore, neurologically more mature. On the other hand, there is a limit to the size of the woman's pelvis. That's because a larger pelvis renders walking more difficult and if the pelvis is large enough, walking upright is impossible. There is both tremendous evolutionary pressure to increase the size of the neonatal head and equally large evolutionary pressure to limit the size of the maternal pelvis.

Those competing pressures lead to the baby's head being unable to fit through the pelvis on a fairly regular basis. Hence the massive death toll from obstructed labor in the places where C-section is unavailable, and an increasing C-section rate in places where it is commonplace.
Excellent post. It's interesting to think that pain has this socializing effect, or rather, predisposes human beings to seek assistance. It is the best explanation for the evolution of such acute pain sensors as we have, and your analysis of childbirth is a great window into that reality. I respect tremendously the journey that women take to arrive at this experience, and I think whatever the evolutionary explanations, each woman's approach to the experience must fit her own physical and spiritual readiness (i.e. some may find it an ecstatic experience, others agony, and others something where it is best to minimize discomfort and focus on the joys involved).
Why do periods hurt? (evolutionarily speaking)
"Others insist that childbirth is not painful and is actually "ecstatic" and provides sexual pleasure. "

Pain is a very individual thing. Having said that I do think it is POSSIBlE for a woman to have a pleasurable birth.

"Ina May Gaskin, a lay midwife who is quite influential in the natural childbirth community, claims that it exists. There's actually a new movie called "Orgasmic Birth" created to publicize the concept."

I'm actually interested in seeing this film, judging by the trailer it seems fairly "middle of the road" (it seems like the people in the film were saying "this is a real possibility" (vs trying to saying that every woman SHOULD try to have it), but I would have to see the entire film to have an opinion on it.

Will you watch the film, Amy?
J.E. Robertson:

"each woman's approach to the experience must fit her own physical and spiritual readiness"

Absolutely.

Unfortunately, there are some advocates of unmedicated childbirth who claim that the pain is necessary, because otherwise a woman will not bond to her baby. That's entirely false, and extremely mean spirited.
hyblaean:

"Why do periods hurt? (evolutionarily speaking)"

For most of human existence, periods occurred very infrequently. Over the course of a woman's life, from her first period in her early to mid teens, to her death at the average age of 35, a woman was almost always pregnant or nursing. Some bio-anthropologists have argued that the average woman probably had only 4-5 periods during her whole reproductive life (probably the only good thing about being a woman in pre-historic times).

Painful periods were probably not very much of a concern for most women.
I gave birth without medication, but I came to that decision not because I had read materials that glorified natural childbirth, but because of my negative reaction to what I had seen of hospital birth. I had attended my sister's birth at a hospital, taken child birthing classes with a nurse from the local hospital, and toured the hospital. With every glimpse I caught of the hospital birth, I was profoundly uncomfortable, and so I sought out something else.

I did fear the pain, like all first time mothers. However, from what I saw, the hospital was offering me pills in the place of the companionship I craved more than painkillers.
Pain may or may not be useful, but there are different ways to cope with it. Medication only treats the nerve response. There is also a psychological response that you can alter without medication. Instead of responding to pain with fear, you can respond with an openness, and that will diminish the experience of pain, make it more bearable. When you resist and tense up against pain, it worsens the experience. Being receptive to pain doesn't change the nerve response, but it does change how your brain perceives the nerve signals.
Amy:

On Oct 31 "2o/2o" is doing a special on the film. I wonder what "angle" is going to be presented.
LadyMiko:

"I'm actually interested in seeing this film, judging by the trailer it seems fairly "middle of the road" (it seems like the people in the film were saying "this is a real possibility" (vs trying to saying that every woman SHOULD try to have it), but I would have to see the entire film to have an opinion on it."

I don't believe that it happens. Ina May Gaskin is simply making it up.

If orgasmic birth is a physiologic possibility, then we should have reports of it from all times and places, and in all nationalities and ethnic groups. That's not the case. Instead, it seems that the ONLY women who have orgasmic birth are Western, white women who have read and subscribe to the philosophy of natural childbirth.

Gaskin has publicly said this about orgasmic birth in an interview posted on MSNBC.com:

"That's not a metaphor. Gaskin says that under the right circumstances women experience a sort of birth ecstasy.

"I mean, it’s not a guarantee," she said, shrugging her shoulders and smiling, "but it's a possibility.

"It’s the only way I can think to market it [unmedicated birth] to (this) generation."'
The Buzz:

"Instead of responding to pain with fear, you can respond with an openness, and that will diminish the experience of pain, make it more bearable."

You are paraphrasing Grantly Dick-Read. You probably don't realize that he was a racist and sexist who fabricated his claim that childbirth pain is caused by fear. Read was a sympathizer with the eugenics movement in the 1930's and wanted to convince middle and upper middle class white women to have more children to prevent "race suicide."

There is NO evidence, none, zip, zero, nada, that the pain of childbirth is caused by fear.
Child birth hurts the people that don't pop out kids to receive government benefits. It is a slap in the face to every gay person that pays taxes to support heterosexuals that don't give a damn about their children. I am paying for their school and health care but I am not entitled to shared benefits with my partner of many years. This country should be happy that there are gay couples that try to adopt the poor off spring of straight people that don't give a damn.
I would be inclined to believe that modern nutrition probably contributes to bigger babies.

As far as pain is concerned, I would argue that all animals feel pain while giving birth and yet they are unable to assist each other the way humans are. In humans, I think there is a lot of psychology involved with pain, especially when it comes to giving birth. That doesn't mean I'm saying there is no pain, just that if you're taught to shake it off, you tend to be more stoic about pain. And it doesn't help to have overly dramatic representations of the birthing mother on the screen.

Also, not all cultures promote assistance in the birth of the child.
Amy:

"If orgasmic birth is a physiologic possibility, then we should have reports of it from all times and places, and in all nationalities and ethnic groups. That's not the case. Instead, it seems that the ONLY women who have orgasmic birth are Western, white women who have read and subscribe to the philosophy of natural childbirth."


So you completely deny that it can even be a possibility?

As far as reporting it (just being devils advocate here) has some social barriers thought. Think about it, what would be said about a woman who truly had that experience? The possibility of birth being a sensual experience, isn't exactly "socially accepted" (Yet we have a multi-billion $ adult film industry, go figure)

Perhaps its just me, but the idea doesn't seem that "out there" to me.
LadyMiko:

"So you completely deny that it can even be a possibility?"

That's right!
marcelleqb:

"I would be inclined to believe that modern nutrition probably contributes to bigger babies. "

That's definitely true. The size of the average baby has been rising continuously. However, good nutrition also has advantages for mothers because it dramatically reduces the incidence of rickets and the pelvic deformities that go with it.

"Also, not all cultures promote assistance in the birth of the child. "

According to Rosenberg and Trevathan, all cultures have midwives or midwife equivalents, and from what I've read, that appears to be the case.
I disagree that pain universally signals danger. Phantom limb pain, for example, is a remnant of well-worn nerve pathways that fail to stop signaling after the injury is healed and the limb long gone.

Childbirth pain may be merely accidental; it occurs in the same place as sexual pleasure, so we are well-endowed with nerve fibers for strong evolutionary purposes in the nether regions. Also, of course there is pain in those same regions in response to cancer, trauma, and other noxious stimuli. In other words, we need ennervation of the perineum and sexual organs for reasons other than childbirth.

Pain might also act as a signal to the woman that something important is happening, and she had better prepare. Sensationless birth would indeed be dangerous!
Amy:

At least your honest. :)

Do you feel that way because of "lack of evidence" or because you think sexuality and birth are incompatible?

No snark intended, just curious.
Um, I know this is a very serious place where very serious discussions are had among very intelligent and thoughtful people, so I beg your pardon for this rather simple and possibly unserious hypothesis to explain why childbirth hurts:

Relatively speaking, babies are really big and vaginas are really small.
Ok, I'll weigh in on this discussion.

I am a Labor and Delivery nurse and before that, did OB/Gyn Nurse Practitioner work.

My job, as I always saw it, is to advocate for my patients. If they choose Natural Childbirth, then I actively assist them. If they change their minds and choose narcotics or/and an epidural, I support them.

If they are successful in seeing the birthing experience through without drugs, what I notice is an amazing inner meditative attitude toward their bodies, the pain and the emotional response at the time of delivery is more pronounced, a type of ecstatic release, as mentioned here.

Natural Childbirth takes preparation. If a patient just sort of wishes she would like to go natural, without anything other than a wish, she may not be successful, unless the labor is moving very, very fast.

Also, people are less likely to get medical intervention if they are fully dilated upon arrival to our hospital.

Years ago, before I was a nurse, I participated in setting up a clinic in Northern California whose sole purpose was to deliver babies naturally.

The nearest hospital was 200 miles away, down a mountain road with 1000 foot drops at different junctures.

Ina May Gaskin was often referenced by the doctors, nurses and patients as well as other Natural Childbirth pioneers. The whole childbirth experience there was a way of life, a movement. I got the feeling that what was happening at this clinic was fairly radical, and some would say foolish, given the actual distance to the nearest help for mother and baby.

But curiously, the clinic for a 2 year period, had 100% perfect outcomes. The physician had the gift of a gentle touch and he prided himself in delivering the baby through an intact perineum and he never had to resort to episiotomy.

He was a healer for sure. But he had a rare form of testicular cancer and had to move away to be closer to medical intervention, himself.

I loved having that experience with these radical childbirth pioneers. They seemed to have the angels on their side, until the beloved Doctor became so ill. And the nurse responsible for setting up the clinic died in a tragic airplane crash with her 2 beautiful children, both girls, and her husband, as well as the pilot.

A very intense time in my life. Probably had something to do with why I became a nurse, with an emphasis on women's health.
No, my comment about pain having a psychological aspect is from a passage from the book Pain The Gift Nobody Wants which was quoted in the book Childbirth Choices Today by Carl Jones.

The cited book is by a researcher who worked with people who had leprosy (Hansen's disease).
LadyMiko:

"Do you feel that way because of "lack of evidence" or because you think sexuality and birth are incompatible?"

Lack of evidence.

I've delivered more than a thousand babies, cared for thousands more women in labor and had four of my own.

Childbirth in every place and time, across millenia and across the world, has always been described as agonizing. No one ever described it as anything else until Grantly Dick-Read sought to influence white women to have more children with his fabricated claim that "primitive" women have painless childbirth.

As I pointed out above, the only women who have ever claimed to have had orgasmic birth are Western, white women who have lived within the past 50 years or so, and have read the natural childbirth literature.

Orgasmic birth is like the Emperor's new clothes. It seems like the only people who can experience it are those trying to curry favor with others in the natural childbirth community.
Kate Loving Shenk:

"But curiously, the clinic for a 2 year period, had 100% perfect outcomes."

Since neonatal mortality is measure per thousand, I should hope that it had no deaths in a two year period. That is only to be expected, not a sign of clinical skill.
Agreed, pain is not caused by fear. However, the perception of pain can be reduced by letting go of your fear of the pain.

I've been practicing yoga for many years and this is not just blather. Part of the practice is to let go of fear of, say, being upside down, or going into a more intense stretch than you think you can do, in order for that to be possible. It's a constant releasing of fear, letting go in order to go deeper. The whole practice is to confront fear and pain, the intersection, and redefine the concept of pain. Anyone who has taken a yoga class will tell you about the teacher talking about "it's not pain, it's awareness," meaning, don't be so scared, don't label pain something that is tolerable. You never go into a place that will hurt you, but you do go deeper than you imagined was possible.

And so with childbirth, you can also let go, not to CONTROL the pain but to go with the pain, be willing to let it take you on its journey, let go of the fear of pain...not just grit your teeth against it, but join yourself with it.
The Buzz:

"And so with childbirth, you can also let go, not to CONTROL the pain but to go with the pain, be willing to let it take you on its journey, let go of the fear of pain...not just grit your teeth against it, but join yourself with it."

Why? And why not let go and let the pain of menstrual cramps take you on their journey?
I know women who have had pleasurable, med-free birth experiences. Several, actually. They did a lot of spiritual, physical, and emotional work in preparation, and it seems to have worked for them.

My mother-in-law, back in the seventies, wasn't planning on a med-free birth, but she felt so little pain that by the time it occurred to her that she might actually be in labor, the baby (my husband) was pretty well out. (Surprise!) She says that it wasn't pain free, but it just didn't feel remotely painful enough for her to think it was real labor. It just felt like a little bit of stomach cramping.

It's rare, of course, but it does happen.
My own decision to have a natural childbirth did not come from reading books on natural childbirth, or some need to "do it right," but on my experiences with yoga and my observation of hospital birth.

I didn't think it would be painless, and it wasn't, and no amount of meditation or breathing would make it not painful. But it did make the pain bearable. I just wasn't scared to experience pain, and felt that there would be a benefit to experiencing it, to allowing my body to follow the pain.

Yeah, I remember the pain. It hurt like hell. I don't know what that Brantley-Reed guy was talking about if he was saying he thought it wouldn't hurt. I wasn't delusional; I knew it would hurt! But, it was a cool experience nonetheless...I was totally in the present moment like I have almost never been before.

Why be so fearful of pain?

Do I think it made me a better mom? Well, doing it differently from most everyone I knew, but in a way that felt right to me, and actually achieving the whole painful experience without drugs gave me the courage to do things my own way. It gave me confidence. As a mother, I felt free of all those right and wrong ways to be a mom. I know that made me a happier person. And I am a damn good mom, too!
That's a good question about the cramps. I generally take Advil for that. But then, I'm not having a baby when I have cramps.
I don't agree that pain always signals that something is wrong.

It is painful to run a marathon, but people do it all of the time for a sense of accomplishment and to see what their bodies are capable of doing.

It is painful to go through Basic Training but it is a part of becoming a soldier.

It is painful to climb a mountain, etc. etc.

Saying that natural childbirth is unnecessary is the same as telling a mountain climber to take a helicopter to the top of Mt. Everest instead of preparing and challenging herself to do it.

As a former doula, I have helped many women give birth to babies--many have given birth to their first baby with medication and their second without. They ALWAYS say that they are more satisfied with the un-medicated birth.

I have only done hospital based births and most of the clients I had did ask for medication and I supported their decision and them even more, but the clients who chose to have their babies un-medicated had amazing experiences and I was always in awe to be a part of it.

It is not for everyone, but it is a choice that should be supported in every area of birth professionals.
Two of my three childbirths were medication free, and that was my goal for reasons related to the trade-offs of ease of recovery and "feeling normal" the minute the baby was out, not to mention whatever slight risk there was to the baby if meds were used. I was no zealot and at any moment would have used meds as soon as the trade-off went the other way. I'm wondering, Amy, if you think a goal toward a med-free labor and delivery is even worthy or are you proposing prophylactic pain relief?
Actually, I have let menstrual cramps take me on their journey, come to think of it.

Back in my early yoga practice days, the place I studied encouraged women on their periods to do a supported practice in the center of the room, laying over various props while the rest of the class did their thing. It was really a lovely experience. I always hated that yoga moved away from that practice over time.

It's hard to find the right postures to work into the pain of menstrual cramps and back pain from menstruation so you can breathe into it and go with it, but it is a very nice practice.
Marple Frank:

"She says that it wasn't pain free, but it just didn't feel remotely painful enough for her to think it was real labor."

Plenty of women have babies without medication because they don't feel like they need anything. I've done it myself ... twice. That doesn't change the fact that for most women childbirth is INHERENTLY agonizing, and preparation make absolutely no difference.

The point that Rosenberg and Trevathan were trying to make was that painful labor was evolutionarily advantageous for humans because human childbirth is quite dangerous, and women who have assistance are more likely to survive. If that's the case, childbirth pain is like the appendix. It's outlived its evolutionary usefulness and now serves no purpose.
Kathryn Martini,

"Saying that natural childbirth is unnecessary is the same as telling a mountain climber to take a helicopter to the top of Mt. Everest instead of preparing and challenging herself to do it."

Childbirth is not an extreme sport, and doulas are doing a disservice to women by pretending that it is.

Having an unmedicated childbirth is hardly an achievement. Almost all the mothers who have ever lived have done it (or died trying) and the majority of women around the world have unmedicated birth each and every day (or die trying).
Amy:

You seem to have this view that only WHITE, Westren women want natural birth.

Well, I don't know about your neck of the woods, but it would be fair to say that there are women of all racial backgrounds that desire and have natural birth.
Lainey:

"I'm wondering, Amy, if you think a goal toward a med-free labor and delivery is even worthy or are you proposing prophylactic pain relief?"

Unmedicated childbirth is like dieting to a size 2. Neither are medically indicated and both are cultural fads. Just as there is no intrinsic value to women wearing a size 2, there is no intrinsic value to unmedicated childbirth.

As a physician, it is my job to support people in whatever they want. If someone wants unmedicated childbirth I would support her in that desire, just like if someone wanted to diet to a size 2, I would support her in that desire. However, there is no objective reason why either is better than other available alternatives.
LadyMiko:

"You seem to have this view that only WHITE, Westren women want natural birth. "

It's not my personal view. It is well known that natural childbirth is almost exclusive to middle and upper middle class white women. Women from other countries, and other ethnic groups are not particularly attracted to it.

That's not surprising, because it is a cultural fad, and therefore very much determined by race, class and nationality.
So Amy, are there no reasons whatsoever to refrain from meds during childbirth? What about the risk of meds getting to the baby? I seem to remember that being an issue (it's been a while). Certainly you don't advocate someone simply selecting a C-section for reasons of personal preference, right? I assume that a C-section carries more risks than a vaginal birth with meds, so it's not a first option.
Judging from this and at least one previous article on this blog, you really seem to be on a mission to discredit natural childbirth advocates as a bunch of reckless, clueless naifs turning their back on all the wonders that the medical profession has to offer them.

I would love to see you as an ob/gyn apply that passion to pushing for a universally safe, universally effective drug to remove the pain of childbirth without sharply raising the statistical likelihood that a woman choosing that option will face counterproductive labor monitoring as well as invasive, major surgery and its attendant risks.

The epidural is great when it works, or so I'm told. For many women, myself included, it was completely ineffective in removing childbirth pain, and when it failed to work there was absolutely no other pain relief options short of narcotics, which don't numb the pain so much as space you out for a time, and risk endangering the child.

For me, the epidural only numbed the pain of childbirth in one palm-sized area of my abdomen, despite repeated doses. My ob told me that it's just not effective for some women. Meanwhile because I chose an epidural I was hooked up to monitors, forced to labor on my back from that point forward rather than with gravity which is far more efficient. My labor slowed to a halt, as it often does when an epidural is applied, my blood pressure went down (ditto) and pushing became an hours-long ordeal unhelped by the preceeding measures. I narrowly escaped a c-section. Basically, I was thoroughly disgusted by my lack of options for pain control. Though I live in a major city, there's only one other hospital that even offers the walking epidural, which would at least allow for gravity and movement to help move the baby down the birth canal.

I gave birth to my second child drug-free in a hospital that was wonderfully supportive of my options. If I'd found any option to numb the pain of childbirth in the intervening years, I would have taken it. It hurt like hell, but I birthed my baby on my own steam and without attendant hookups and monitorings (save a handheld monitor to listen to the baby's heartbeat) to slow down or otherwise impede the process of labor.

Any doctor who legitimately cares about giving equal weight to both the safety of the woman and child in labor and childbirth as well as removing the pain factor needs to be honest and upfront about the limitations of our current solutions, and their attendant hazards. Call me crazy, but in this day and age we should have a safe, effective drug that addresses childbirth pain without raising risks for both mother and child.
The Buzz:

Yoga is great. I jog to ease cramps or have some strong orgams (TMI I know) but O's have their benefit, besides the obvious! :) Keeps hubby happy too!
Lainey:

"So Amy, are there no reasons whatsoever to refrain from meds during childbirth?"

There's no medical reason to forgo an epidural once you are in active labor. They are extraordinarily safe, very effective, and have no demonstrable impact on the baby. That's the medical reality. That doesn't mean that every woman should have an epidural. It only means that women who choose them do not need to fear that they are compromising their babies or themselves in any way; and that no one should imply that they are.
Amy:

Do women have an epi because they are trying to follow some trend, no . . . they do because they want pain relief.

Why is it that if a woman wants a natural birth, she's ONLY doing it to follow a trend, (and it is assumed that she buys into the Grantly-Dick Read BS and trying to IMPRESS other women)

Did it ever occur to you that some women choose med free birth because they feel it best for them, and not trying to follow a "fad"
Bluestocking2:

"Judging from this and at least one previous article on this blog, you really seem to be on a mission to discredit natural childbirth advocates as a bunch of reckless, clueless naifs turning their back on all the wonders that the medical profession has to offer them."

No, I am trying to discredit them as people who have created the faux "achievement" of unmedicated birth and endowed it with all sorts of fabricated "benefits" for the sole purpose of demeaning women who make different choices.

The central fact about the philosophy of natural childbirth is that it was created by men, in order to control women's reproductive choices. Now it is being used by some women as a way of feeling superior to other women. It has no basis in the scientific evidence.

"Call me crazy, but in this day and age we should have a safe, effective drug that addresses childbirth pain without raising risks for both mother and child."

We do; it's called an epidural. The risk of dying from a labor epidural is less than the risk of dying from a lightning strike. The danger to women comes from childbirth, which is inherently quite dangerous, not from medications used to relieve pain.
LadyMiko:

"Did it ever occur to you that some women choose med free birth because they feel it best for them, and not trying to follow a "fad"

It would have if I had found that the desire for unmedicated birth crossed social classes, races, nationalities and ethnicities, but it doesn't. It is almost exclusively a phenomenon of Western, white middle and upper middle class women.

Plenty of women forgo epidurals because they feel that they don't need them. There's no other medical reason to forgo an epidural.
I really enjoyed your post; a thorough and open look at the subject of pain in relation to childbirth; modern and old-time views, and from the angle too of pain in relation to 'survival'!
From my personal experience; if I had not had assistence I would not be here today. As it turned out, the physiological damage left it's mark upon me, changing my life forever!
But having said that; I had the utter pleasure of raising my daughter and survived 6 months of undetected bacterial infection of the blood! [My GP thought I was a `miracle on legs'!!
En avant the modern medical approach.....
I always enjoy reading your posts, Amy. This one is no exception.
I have only been a witness to the birth of my three children, 2 born at home and one in a hospital after a very long labor. I remember my ex-wife's comment on being pregnant. She said she felt like she was facing death - not because she was scared, but because the birth was now totally unavoidable. I have been fascinated by that comment for 31 years now.
I do remember all the "new" concepts of birthing, such as giving birth in a pool of warm water to ease the newborns entrance. Think we even saw a movie on it. In the end we chose homebirth with the best support we could find, which at the time was not easy to locate. But all in all, I remember mostly how quickly any memory of pain must have faded, as my children were placed on their mother's body. So whatever the reason for pain, it seems that the experience overrules it enough that we keep procreating!
Thanks Amy. Rated
I think I read somewhere on the UN site or the WHO site that more than 10% of women in the world give birth unassisted and most of these are in underdeveloped countries. The more nomadic a family, the more likely of this happening.

I am not for unassisted childbirth, but I do understand women who dislike the way they are treated in the hospital and want to have their child at home. I have several family members & friends who did this, but they were not unattended - there was a midwife present and they were prepared to go to the hospital if something went wrong. They also were not high risk pregnancies.
nahatsu:

"From my personal experience; if I had not had assistence I would not be here today."

You are in good company!

Over the last 100 years, modern obstetrics has lowered the maternal mortality rate by 99%. If maternal deaths in the US were occurring at the same rate they were 100 years ago, approximately 40,000 American women would die in childbirth each year. That would make it a leading killer of American women, slightly behind breast cancer.
Tim4change:

"She said she felt like she was facing death - not because she was scared, but because the birth was now totally unavoidable. I have been fascinated by that comment for 31 years now."

I'm glad that she was not worried about dying. Fortunately that's very rare now. Prior to the 20th century, it was fairly common for women to make a will in the weeks before the due date.

Professor Judith Walzer Leavitt explored the ways in which this constant fear of death in childbirth, and the frequent experience of the deaths of sisters and friends in childbirth, shaped the lives of women in the 19th century.

In Under the Shadow of Maternity: American Women's Responses to Death and Debility Fears in Nineteenth-Century Childbirth, Walzer Leavitt writes:

Maternity, the creation of new life, carried with it the ever-present possibility of death. The shadow that followed women through life was the fear of the ultimate physical risk of bearing children. Young women perceived that their bodies, even when healthy and vigorous, could yield up a dead infant or could carry the seeds of their own destruction... Nine months' gestation could mean nine months to prepare for death. A possible death sentence came with every pregnancy.
marcelleqb:

"I think I read somewhere on the UN site or the WHO site that more than 10% of women in the world give birth unassisted and most of these are in underdeveloped countries."

That means that they give birth without trained medical assistance; they are attended by mothers, sisters and friends.
good post and discussion, Amy.

And to whoever wrote that "It is painful to run a marathon, but people do it all of the time for a sense of accomplishment and to see what their bodies are capable of doing."

Actually, if you train correctly, it is NOT painful to run a marathon. I've run more than 50, and in the ones where I bothered to do the training correctly, I was able to do yoga the same night.

But the vast majority of people do not train correctly, or knowingly push themselves beyond their boundary of fitness, which of course causes pain.
sandra miller:

"Actually, if you train correctly, it is NOT painful to run a marathon. I've run more than 50, and in the ones where I bothered to do the training correctly, I was able to do yoga the same night."

Wow. That's impressive.
I am a labor and delivery nurse and I see the detrimental effects of epidurals on a daily basis. I see unnecessary c-sections due to intervention and doctor impatience/bias/preference every day I work.
There is evidence to suggest that babies born to moms who have epidurals have more problems integrating. This is due to the protective effect maternal pain has on the infant. To keep it simple, mom has pain, she produces endorphins. These enodorphins travel to baby, to protect baby from the enormously painful journey he must take. Think of the enormous pressure on babies cranial bones, soft tissues, skeletal and muscular systems. If mom gets an epidural, she feels great, but the baby endures the full brunt of labor. What mom would choose to expose her baby to that if she truly understood what was at risk? I think you are being niave, and frankly, a little dishonest. There are risks associated with epidurals. A drop in mom's blood pressure due to an epidural leads to decreased blood flow to baby. This can be protected against in some, but not in all, cases and often varies greatly based on the skill of the anesthesiologist. Then you add to that the over 90% rate of pitocin augmentation ( I would bet it's a standing order in your practice) which decreases baby's blood flow due to increased contraction intensity and frequency and you have the recipe for the astonomical rate of c-sections in this county as a result of fetal intolerance to labor. That's not even taking into consideration the unnatural position of delivery that is thrust upon women in hosptials. The pelvic inlet is at it's narrowest on your back, but most conveinent for practitioners.
I have been a labor and delivery nurse for 10 years. In that time I have had three children, all at home in the care of competent midwives. I did that not because of some fad or to add notches to my belt. I did that because I see every day the result of women trusting themselves to their doctors and hospitals. I was not brave to have my babies outside of the hospital, I was simply too scared to subject myself, or my babies to the side effects of a hosptial birth.
Thanks for this post and discussion, Amy. I had my children back when "painless natural childbirth" was just becoming popular; I felt slightly guilty for having pain, in spite of diligent preparation. I have known a few women who claimed they had no pain. I suspect about one woman in ten has a rather painless birth, regardless of preparation; perhaps they are just less innervated in the perineal region. For the rest of us, it hurts, no matter how well we relax, give up control, breathe according to instructions, and all that stuff.

Preparation does, I think, result in less pain. But it doesn't result in no pain at all. And from my marathon-running sister-in-law I learned that a marathon is nothing, compared to a birth.

I did have the experience of feeling the memory of pain being wiped out, almost like my brain being sponged clean, shortly after the birth. I could remember the fact that I had felt pain, but the vivid memory of the painful sensation simply disappeared, muffled in a pinky golden glow of joy... until the onset of the next labor, when the sensation-memory came back in force.

If I hadn't remembered what I said during the delivery, I too might have come to imagine that I had given birth without pain.
Amy, I understand that your agenda is to make it 'OK' for women to choose medication during childbirth to alleviate pain. I don't have a problem with that, but I do have to share this story which my mother told me at least a zillion time. When she was ready to deliver my younger sister (her third delivery) in 1949, she had read about the Dick-Read book, but not the book itself. She decided that if anyone could have childbirth without pain, she could (she was like that). So, whenever she felt a contraction coming, she visualized what was happening inside her. She completely surrendered to and 'aligned' with the contractions, and her pain went away. Went away completely . . . so much so, that she was afraid that she might be 'stopping' the birth process. So every few contractions, she would sort of bear down, and let the pain happen. Finally, she called the nurse to say the baby was coming, but because she was not screaming her head off, and experiencing pain (except when she chose to) the nurse did not believe her, and walked out of the labor room, with a dismissive wave. When mom felt my sister's head emerging, she insisted the nurse come back. The nurse finally took a 'look', freaked out, told my mother to hold her knees together, and ran out to call the doctor.

My mother did what the nurse told her, and my sis was born after the doc scrubbed up, but mom always felt guilty about trying to hold my sister back.

Just saying.
a b:

"There is evidence to suggest that babies born to moms who have epidurals have more problems integrating. This is due to the protective effect maternal pain has on the infant."

You seem to have missed the point of the article. There is NO benefit of labor pain for mother or baby. There is NO evidence that epidurals have ANY impact on babies. You are paraphrasing Dr. Michel Odent, who simply made up that claim in order to demean women who make choices that do not meet his approval.

Dr. Odent is very fond of making up outlandish claims, or substituting his personal psychological issues for research findings. His latest fabrication? Having husbands (or male partners) at birth hinders a woman's labor and interferes with a man's sexuality.

In an interview in the Daily Mail in April 2008, Dr. Odent said:

"That there is little good to come for either sex from having a man at the birth of a child.

For her, his presence is a hindrance, and a significant factor in why labours are longer, more painful and more likely to result in intervention than ever.

As for the effect on a man - well, was I surprised to hear a friend of mine state that watching his wife giving birth had started a chain of events that led to the couple's divorce?"

Odent appears obsessed with the psychological impact of birth on MEN:

"Over the years, I have seen something akin to post-natal depression in many men who have been present at the birth.

In its mild form, men often take to their bed in the week following the birth, complaining of everything from a stomach ache or migraine to a 24-hour bug.

Their wives, meanwhile, are up and about, caring for their baby and in good spirits, and tell me how unfortunate it is that their husband has been struck down by one ailment or another.

But it is well known by those who study depression that rather than admit a low mood, men often offer up a symptom as a reason to why they have taken to their bed.

There are also men who try to find ways to escape the reality of what they have been through.

This could just be a night at the pub, or a day playing golf when their child is a day old.

I've known of perfectly well-balanced men who held their wife's hand through labour then left the next day never to return again.

And in the most graphic example, one perfectly healthy man had his first experience of schizophrenia two days after watching his wife give birth. Was this his way of escaping reality?"

Odent is sure that no man can watch a partner in labor without resulting sexual problems:

... [W]hat, if a man is present at birth, will be the effect on the sexual attraction he feels towards his wife over the long term?

When men first started standing at their partner's side during labour, I remember my mother's generation saying, very matter of factly, that the couple's intimate life would be ruined as a result.

And, given that the key to eroticism is a degree of mystery, I am left believing they had a point.

There are many things we do in private in order to preserve a degree of modesty and mystery.

And, for the benefit of our sex lives, it may be worth adding childbirth to this list."

In fact, childbirth evidently had such a deleterious effect on Dr. Odent, that he actually abandoned his partner in labor:

... [M]y youngest son was born in 1985, at home.

As it happens, at the exact moment our son arrived in the world, the midwife was on her way down the street and I, having made my excuses realising he was about to be born, was fiddling with the thermostat on the central heating boiler downstairs.

My partner did not know it, but I had given her the exceptionally rare, but ideal situation in which to give birth: she felt secure, she knew the midwife was minutes away and I was downstairs, yet she had complete privacy and no one was watching her."

a b, as a health professional, you need to be guided by the scientific evidence, not by mumbo-jumbo made up by men to demean women who don't behave the way they have decreed. You owe it to your patients to base your care on science, not the made up claims of professional natural childbirth advocates.
Rachel Findley:

"Preparation does, I think, result in less pain. "

That's probably not true, since the majority of women who claim to want unmedicated childbirth change their minds during labor.

Certainly, it is impossible for a doctor to notice any difference between the amount of pain experienced by women who insist on unmedicated childbirth and those who opt for medication. The only real difference appears to be in what they tell their friends afterward.

Most natural childbirth advocates have no idea of the rather sordid history of the claim that preparation results in less pain. In the late 18th century and early 19th century, European physicians became obsessed with the idea of racial differences. One of the claims advanced at that time (with absolutely no evidence) is that "primitive" women (read Black women) were hypersexualized and experienced no pain in childbirth because they understood that having children was the entire purpose of their existence. In contrast, white women of the "better" classes were "over-civilized,"
shriveling their ovaries and giving them diseases of the uterus like hysteria (from the Greek word for uterus). Painful labor was just another symptom of this over-civilization.

According to the theory, further refined by Grantly Dick-Read and others, "over-civilized" women could be "trained" to understand that the pain is all in their heads, the result of inappropriate ideas like demanding political and financial independence. Hence, the claim that preparation reduces labor pain.
Brinna:

"When mom felt my sister's head emerging, she insisted the nurse come back. The nurse finally took a 'look', freaked out, told my mother to hold her knees together, and ran out to call the doctor."

It's possible that it happened because of her thoughts, but it could just as easily have happened because this was her third labor. The same phenomenon is responsible for all those unexpected deliveries at home or by the side of the road. Some women simply do not realize that they are in labor until the baby is about to be born.
I have never before mentioned my birth orgasm experience, not to anyone, not even to my husband. I'm sure no one in the delivery room even knew it was happening. I have to mention it here because it compels me to disagree with Amy's contention that only white Western natural childbirth types report this kind of thing. It was a concrete and obvious experience.

It was during my first son's birth. The labor and delivery were not going "well" in any sense of the word. I has been in labor for close to 24 hours, the whole time with water broken, much of the time with pitocin augmentation. The pain had long before overwhelmed my coping mechanisms. I was hungry, exhausted and generally freaked out. I'd had a "walking epidural" about 7 hours earlier, which was essentially a single epidural dose of pain relief rather than a continuous drip. It lasted for about 1 to 1-1/2 hours, so it was long gone by the point of delivery. I was pushing and pushing for close to 90 minutes and was by that point in kind of a trance out of fear and exhaustion and not out of any positive feelings. I knew by this time that there was meconium in the amniotic fluid, and a crew of people were waiting in the room to take my son as soon as he was born in order to aspirate his airways. The nurse midwife told me that an episiotomy was going to be necessary at this point and that it was an emergency. I remember saying "no" and pushing with every last bit of energy I could muster, and I pushed him out. At the moment of crowning, the birth orgasm happened, and there was no mistaking it for anything else. But here is the thing you might not expect. I HATED it. I felt betrayed and humiliated by my own body. The whole birth experience was feeling like a sexual assault, so to me, it was like having an orgasm during a sexual assault. Thus, I can only conclude it was a reflexive, neurologic event completely unrelated to my psychological state at that moment. I would not have believed such thing was possible if I hadn't been there.
I have a ton of pain during my menstruations. It's due to issues I have in the muscles of my lower back and pelvis. The pain is not there to tell me that the situation is dangerous; however, it is there as an effect and to give me info... an effect of there being issues present in my lower back and pelvis and to give me info about that.

It terms of childbirth, the biology of the human body and also of each individual will determine what kind of pain one will have when she goes through childbirth. Why is it that some women can have children, completely naturally, and not experience any pain at all while others experience extraordinary pain?

For one thing, a baby is MUCH larger than the pelvis of women, so obviously, there often will be pain. I think it's more a matter of a warning... that something could go wrong and to have help during childbirth rather than the body saying something is dangerously wrong.

When I read this article, I thought of my massage therapy sessions. At each session, there are areas of my body that are sore, and sometimes they are completely in pain. The pain doesn't necessarily serve to say that those areas of my body are in great danger. Rather, the soreness and pain serves to tell me that those areas are "not happy" at the moment... that they aren't in balance. So, in that way, the pain is serving to give me information.

I don't think pain serves just one purpose. I think it serves several purposes. In the case of putting your hand on a very hot burner, the pain is a warning and is making you react to remove your hand from the hot burner so that you don't do damage to your hand.

In other cases, pain serves to tell us that something is very wrong with a part of our bodies and that we should seek help immediately.

In the case of childbirth, the opinion that pain during childbirth is there to warn us of danger doesn't make a lot of sense to me. If childbirth was that dangerous, I don't think humans and other beings would be reproducing that way. I'm not saying that there aren't risks involved, but it's more a warning system to prevent danger rather than saying that there already is danger present.
I'm not sure that I'm on board with the idea of childbirth as orgasmic or necessary to bond with your baby (I did just fine after my c-section), but feeling pleasure and sense of accomplishment from pain is not unique to childbirth. Marathoners do it all the time, for instance. I think the real point of any ultra-challenging activity such as childbirth is not to deliberately feel pain, but understand and manage the pain in a positive way as we reach our goal.
I'm completely in favor of natural childbirth, and I don't feel that way JUST TO FOLLOW A FAD. I do things as naturally as possible (I use all-natural cleaning products rather than toxic, harmful, poisoning national-brand products that the status quo is so hooked on, I use all-natural bodycare products... toothpaste, shampoo, conditioner, soap, I use all-natural laundry and dish detergents, etc.). I also DON'T USE MEDS, because I don't believe in them because of how harmful they can be. Rather, I use natural remedies (while working on keeping my body in balance), and they benefit me greatly, and I RARELY ever get sick.

I don't trust the traditional medical community in most ways (I've seen many relatives and friends go through turmoil and torture through treatments that got them no where... and in some cases, they died). I'm all for living as naturally as possible, because that's what I strongly believe in.

To say that all women who choose natural childbirth are doing so JUST TO FOLLOW A TREND is a completely gross inaccuracy. You don't know the motives behind every person. Trusting a poll or some sort of research to get all your answers from is unsafe.

You want to talk about following trends? The traditional medical community is FULL of trends (hysterectomies, pulling wisdom teeth, yanking tonsils from one's throat, C-section births, unneccessary surgeries of all kinds, etc., etc., etc)... including financially raping patients to make a killing. One one fad fades, the med. community is on to another one.
I have very painful periods, and I've never had a baby. I'm 37. What's your answer to why I have painful periods?
I've experienced 4 unmedicated childbirths and they varied monumentally. I believe that, while there are certainly medical situations we cannot control that just plain hurt, knowledge and confidence can make a huge difference in the experience of childbirth sensations in many cases.

My first delivery was a "typical" old-style hospital childbirth (legs in stirrups, no attendant besides my bf) in 1993, when I was a scared, uninsured single mother. It was frightening and extremely painful.

Determined not to repeat that experience, I had my next child at a hospital "birthing center" with a different GP. Unfortunately there were complications (baby turned diagonally in pelvis) that my inexperienced new GP didn't know how to handle. Nonetheless, I got through most of labor feeling considerably better than the first baby, and things didn't get really bad until the baby got "stuck" during transition for 2 hours. I believe a competent doula/midwife would have made a huge difference at this point had I had one.

Early in my 3rd pregnancy I began researching everything I could about positive natural childbirth and came upon the Grantley Dick Read book mentioned previously. Yes, I know the author had some questionable attitudes, but he also had some really interesting and helpful information about preparing for childbirth. Just because a scientist/doctor has moral or ethical flaws doesn't mean their technical knowledge is necessarily flawed in and of itself (don't flame me here . . . I'm just talking about my childbirth experience).

The book suggests specific exercises from early in pregnancy designed to mitigate the small pelvis problem, and also 3rd trimester exercises to help baby move into optimum position for labor and deliver. I also began attending a wonderful, supportive midwifery practice with a wonderful woman with over 20 years midwifery experience. I drew up a detailed birthing plan and considered numerous comfort measures.

I believe these 3 changes made a TREMENDOUS difference in my next experience. In fact, I was so comfortable during labor that I didn't even realize how far along I was in labor because "it wasn't hurting enough yet." I barely made it to the hospital in time and had the baby within 30 minutes of walking through the doors. There was some severe discomfort for about 30 minutes but it went by in a blur and was quite manageable with my partner's help and support.

4th experience (2003) was more difficult than the 3rd, possibly due to my age, but still wasn't nearly as frightening or painful as the first 2. It was a long and tiring labor, but only painful for brief moments and largely manageable due to my partner and excellent midwife. In my experience, having a loving and knowledgeable partner (kudos to my spouse!) transformed the potentially frightening contractions into a relatively gentle but intense bonding opportunity. My midwife, who had become a friend by then, helped tremendously as well.

It's quite established that people's first reactions to fear and pain cause them to clench up, contract muscles, and breathe shallowly, all reactions that intensify pain. Conversely, learning to breathe slowly and naturally, and consciously loosening and opening up muscles, dramatically reduces the pain. It was very difficult, but not really what we'd traditionally call pain. More like a really intense workout.

I've experienced "the birth orgasm" as well, and I believe it's misnamed. In my case it was a combination of 3 things. First and most important, Relief! Imagine (not to be crude) having to hold in a tremendous BM for hours, then suddenly reaching a bathroom. It's the intense release of finally getting to do what your body has been aching to do for hours and not allowed to. Second, the position of baby's head coming out of body sometimes brushed against clitoris so there's some pleasant stimulation, but for me it was minor and almost unnoticed. Last, there's the abrupt ending of pain once the baby finally comes out of the body, first when the head is born (the largest and most difficult part of delivery) and again when the rest of the body is born. Suddenly, about 90% of the pain of mother's body being stretched beyond its limits ends and everything can relax. So there's another huge release from pain, which can be experienced as pleasure by default.

In addition to all this there's the dramatic hormonal shifts just before and after delivery, as well as (hopefully) the mind-blowing positive feelings of love and gratitude when you finally get to see and hear your baby. It's not like a typical "orgasm" but it's definitely a peak experience.
Shawna Macurio:

"If childbirth was that dangerous, I don't think humans and other beings would be reproducing that way. "

But childbirth IS dangerous. That's why so many babies and women die around the world each year. The reason it does not seem dangerous to most Americans is because modern obstetrics has been so successful in lowering the neonatal mortality rate and the maternal mortality rate that people no longer understand how dangerous it is.
Yo Shawnna,

All those "natural" things you are taking are medicine. Willow Bark = Aspirin = Salicylic Acid (which is used for many things, like acne). You can go without anything? Well, brava. I personally would be incapacitated if I wasn't taking things for my allergies. And I've moved several times to accommodate my allergies. America today has been changed since the pilgrims came and introduced their animals, plants and worms. America has been unnatural for 400 years.

One of my best friends would have been dead if not for that c-section, which is named after Caesar, who was born in that manner over 2000 years ago. Today, a woman gets to survive the operation, due to modern medicine.

What is living naturally exactly? You obviously are using the internet. I had an art teacher who thought batteries were unnatural because they stored energy. A candle stores energy. Food is energy. Matter is converted - natural laws are at work. Science is not unnatural.

Natural, today, has nothing to do with nature and everything to do with perceptions and customs. It used to be the rally for pastoral living versus urban living, then moved on to the industrial age.

Medicine is not a panacea. It is not miraculous. It is a tool. I'm sorry that you've lost loved ones who didn't make it through modern medicine. You are right to question your doctors and practices: they are people, not gods. However, to say that all medicine is unnatural is to not understand the topic of medicine or what is natural.
Penny H:

"I think the real point of any ultra-challenging activity such as childbirth"

Childbirth is not an extreme sport. It isn't a sport at all. Just ask the hundreds of thousands of women in third world nations who die in childbirth each year.

Childbirth, in EVERY time, place and culture is and has always been one of the leading causes of death of young women.

The relentless emphasis on competition in first world societies and the cultural construction of faux "achievements" like unmedicated childbirth has been made possible by the spectacular advances of modern obstetrics, which allow contemporary women to pretend that they have "accomplished" something by refusing pain medication. The rest of the women in the world, and the rest of the women who ever existed, are and were aware that the only accomplishment associated with childbirth is to live through it.
Anjali Nelson:

"I believe that, while there are certainly medical situations we cannot control that just plain hurt, knowledge and confidence can make a huge difference in the experience of childbirth sensations in many cases."

Every study ever done on the subject, and there have been quite a few, show that an epidural is much better at relieving pain than any psychological preparation.

According to the Listening to Mothers Survey II, produced by the Childbirth Connection, a natural childbirth lobbying group:

81% of women choosing epidural said it provided very effective pain relief, whereas only 28% of women choosing mental strategies found them very effective.
marcelleqb:

"Natural, today, has nothing to do with nature and everything to do with perceptions and customs."

Absolutely!!!
Amy, while I didn't personally have success with mental preparation (at least not after the first 8-10 hours when the pain became excruciating by my perception), I do know women who were able to use self-hypnosis for effective pain relief, particularly in spontaneous, non-pitocin augmented labor. I don't know how one could predict success or failure on an individual level without going through it, since the labor experience is so variable. I also can't see any drawbacks to mental preparation, so long as women are accepting that "s@#t happens" at times and not to feel bad if unforseen circumstances arise.

I'm not sure what we are arguing for or against with respect to childbirth as inherently dangerous or not. I see that the maternal death rate was historically about 1 in 100, and I wouldn't be surprised if it was still be something like that in a completely non-medical society (no prenatal care, no clean conditions for delivery, no skilled assistants, no detection of hypertension or placenta abruptia or malpresentation for surgical intervention, etc.). However, I don't think anyone is arguing in favor of a completely non-medical pregnancy and childbirth. Even if we're talking natural childbirth or home birth, we are not excluding prenatal care or having a skilled assistant or having interventions when interventions are required. We're talking about normally progressing labors with healthy moms and babies, right? Thus, aren't we punching a straw man here?
My wife and I have a 5-month old girl. My wife, who has never been a hero when it comes to physical pain or discomfort, somehow managed, with the encouragement of a natural childbirth class and her own awe-inspiring strength, to deliver her without numbing pain medications. She was the fortunate beneficiary of a labor without unusual complications or the need for medical intervention to save her life or the life of our daughter. She did not, by the way, have an orgasm during the experience, not to my knowledge, anyway. Had it become necessary, or had she not been able to take the pain any longer, I would not have hesitated to assist in granting her request for an epidural. But I have never once asked skeptically why she would ever do such a thing as unmedicated birth when we have all these fabulous pharmaceuticals that could render her entirely free of the experience. She hasn't asked that either, nor ever questioned her decision or process. Neither of us would assert that we are superior people, nor our daughter a superior or more blessed human, because of her unmedicated birth (a subtle assertion that, sadly, is all-too-common among the activist set, much like the "breastfeeding mafia" implies that breastfed babies and mothers exist on a higher and more favored plane). But I wonder why we must accept all medical technology as a given good, and all unmedicated processes as outdated, silly, or dangerous. There are enough revered medical advances later shown to have been less than perfect, and in the arena of childbirth - an arena which one cannot deny has "worked" for thousands of years - I do not think that modern medicine need automatically intervene unless a health crisis during the birth precipitates or requires its use. There are certain human rites of passage, and although I will never personally experience this one, I have seen it close at hand, and seen that even a woman with a relatively low tolerance for pain is able to do this - again assuming no other crises - without being scarred for life or permanently damaged.
Honestly, I'm trying to understand the point of this article. Are you advocating medicalized birth? Are you making a blanket attempt at discrediting the goals of the natural childbirth community?

Whatever your point, the US healthcare system has really failed birthing mothers and their newborns. With an infant mortality rate at the 2nd lowest amongst industrialized countries (UN statistics), and US healthcare costs really running unchecked, rather than tackling issues behind access, cost and education, do we really need to advocate for MORE medicalization which increases the cost of birth?

Pain relief measures should be offered to birthing women when needed, but with the understanding that these measures do come with the risk of increasing the chance that interventions will be required. These interventions include the use of pitocin, episiotomy and C-section (especially if epidurals are given prior to 4cm dilation). Additionally, interventions on the birth side may lead difficulties in establishing early breast feeding (which, by the way, is not pain-free either!)
I suggest you check the facts, dr. Amy, before publishing fabrications to advance your point. But one factual error in your writings: heart disease, not breast cancer, is the #1 killer of women. Breast cancer is not even the top cancer killer of women; LUNG cancer is. False information is a grave disservice to the public from a health care professional.
"The relentless emphasis on competition in first world societies and the cultural construction of faux "achievements" like unmedicated childbirth has been made possible by the spectacular advances of modern obstetrics, which allow contemporary women to pretend that they have "accomplished" something by refusing pain medication. The rest of the women in the world, and the rest of the women who ever existed, are and were aware that the only accomplishment associated with childbirth is to live through it."

Okay. I thought the point of your post was to say that pain is unnecessary, some sort of evolutionary relic. My retort was, "yes, it may be unnecessary but we do it, and continue to get something from it, so don't dismiss it as unnecessary. The implicit assumption is that medical care is available, that we're not trying to stare death in the face by feeling pain we shouldn't. Comparing our experiences with populations that have no medical assistance is a bit like comparing apples and oranges.
Sara:

I'm going without the Epi, I would like to be able to pee on my own and stay on my feet. Being OUT of bed is much more important than having pain relief.

If a woman wants pain relief, great, she should have it. But I hate this assumption that those of us who wish to forgo it are doing so "just to gain the approval of other women" Complete BS in my view.

Sure, there are some women who actually care what others think but I sincerely doubt they represent EVERY woman who wants a natural birth.
marcellebg,

Have you tried holistic chiropractic to rid yourself of your allergies, rather than drinking the traditional med. kool-aid of thinking you have to take allergy pills forever??? I used to have EXTREME allergies, and getting regular chiropractic and massage therapy works for me!

I was told that I'd have to take allergy meds for the rest of my life... but instead of listening to the doc, I threw the samples she gave me in the garbage and began using holistic therapies... which WORK!!!

Also, I take herbs... unadultered, unprocessed (other than being chopped up or steeped in a tea), unmutiliated herbs that do wonders. I don't take MAN-MADE traditional meds that are toxic and cause more harm than good.

I get my info from EXPERIENCE... NOT from the internet. The whole concept behind traditional medicine is nothing but a FRAUD. It's not intended to heal... rather, it's only purpose is for EMERGENCIES that can't be helped in other ways. I could start a whole discussion about how herbal and natural healing was the way of this country until the 1800's, when the American Medical Assoc. was started to ABOLISH natural forms of healing.

Other cultures have been using natural/holistic forms of healing for THOUSANDS of years, and it works. This country is so brainwashed into thinking that natural things... things that the universe gives us... are a fraud and don't work... but that man-made chemicals and toxins work and are good for us. What a bunch of BS! It's greed and the almighty dollar that forces this thought.

I think the U.S's record for being the sickest and fattest country on the planet should be enough evidence of how traditional medicine DOESN'T work, other than for emergencies which have no other available solution.

Let's see... I used to use bleach and other toxic chemicals for cleaning, and I'd feel nauseus, dizzy, and like I was going to pass out. I switched to using NATURAL (organic plant-based and water-based) cleaners for EVERYTHING... and guess what??? I NO LONGER feel that way when I clean.

Willow bark is a natural med. (when used without bastardizing it)... a natural plant that works with the body to get it back into balance... unlike MAN-MADE meds that are toxic and DON'T work with our bodies to get them back into balance.

The whole philosophy behind traditional med. is to KILL the microbe that *is causing* illness... and in a lot of cases, to cut out body parts that are infected, inflamed, are hurting, etc. This is the most ludicrous thing I've ever heard of.

Is is THAT amazing that I don't use traditional meds and I'm not sick????? The U.S. culture has been brainwashed into thinking that getting sick is a natural part of aging and that is will happen to everyone. What BS!!!

To Amy, maybe you should try yoga and meditation to see how good it makes you feel... not just in the moment... but for days to come. A 1.5 hour session of Bikram yoga energizes me for at least 3 days, and it makes me feel great. I experience terrific relaxation and feelings of pleasure (not sexual pleasure, but pleasure because I feel so good) while doing it. This has EXPONENTIAL benefits for MIND, BODY, AND SPIRIT!
The thesis that pain is always an important signaling mechanism seems very fallacious. Clearly, pain has persisted in humans *because* it is an evolutionarily beneficial signaling mechanism, but it does not follow that every instance of pain is serving that function. Once the structures are in place to provide this information to the brain, they can be activated in ways that are not beneficial to survival. The majority of migraines and headaches are not indicative of any sort of problem or illness. Phantom limb pain, and other pains with psychiatric roots serve no purpose.

Likewise child birth pains are obviously attributable to the fact that nerves exist to signal damage or danger, and birthing a child is a physically traumatic event. We didn't evolve to have pain in labor, but rather it is an unavoidable consequence of birth due to the preexisting structure of pain receptors. While I would agree that women with assistance have lower rates of mortality, there seems to be no evidence here whatsoever that there ever were women who *didn't* feel pain in childbirth, and therefore died out because they didn't seek assistance.
marcelleqb,

I didn't say that ALL C-sections should be avoided. I stated that C-sections have been a TREND amongst the traditional med. community, just like yanking one's tonsils once was, and pulling one's wisdom teeth was, and so on. Please pay attention to the details that one posts rather than responding based on one person's experience.

Rather than finding the root cause of a health issue (like holistic/natural healing does) and fixing that, traditional medicine only focuses on the symptons and getting rid of them. Traditional medicine is REACTIONARY medicine... react to the symptom to get rid of it, rather than finding the REAL cause and taking care of that. Symptoms are signs/mechanisms of info that our bodies give us to tell us something isn't quite right. Silencing those mechanisms does WAY MORE harm.

It's the same philosophy that some have stated here that being *with* their childbirthing pain and discomfort was WAY MORE rewarding than silencing that pain and discomfort with meds follows.

Our society isn't taught to tolerate and experience pain and discomfort. Rather, it's taught to silence everything our bodies, minds, and spirit tell us in relation to our experiences.
marcelleqb, you stated...

"Natural, today, has nothing to do with nature and everything to do with perceptions and customs. It used to be the rally for pastoral living versus urban living, then moved on to the industrial age."

That's merely your OWN opinion. If you followed a natural way, then maybe you'd know a bit about it.

Dictionary.com's definitions of natural...

nat·u·ral /ˈnætʃərəl, ˈnætʃrəl/ Pronunciation Key - Show Spelled Pronunciation[nach-er-uhl, nach-ruhl] Pronunciation Key - Show IPA Pronunciation
–adjective 1. existing in or formed by nature (opposed to artificial): a natural bridge.
2. based on the state of things in nature; constituted by nature: Growth is a natural process.
3. of or pertaining to nature or the universe: natural beauty.
4. of, pertaining to, or occupied with the study of natural science: conducting natural experiments.
5. in a state of nature; uncultivated, as land.
6. growing spontaneously, without being planted or tended by human hand, as vegetation.
7. having undergone little or no processing and containing no chemical additives: natural food; natural ingredients. Compare organic (def. 11).
8. having a real or physical existence, as opposed to one that is spiritual, intellectual, fictitious, etc.
9. of, pertaining to, or proper to the nature or essential constitution: natural ability.
10. proper to the circumstances of the case: a natural result of his greed.
11. free from affectation or constraint: a natural manner.
12. arising easily or spontaneously: a natural courtesy to strangers.
13. consonant with the nature or character of.
14. in accordance with the nature of things: It was natural that he should hit back.
15. based upon the innate moral feeling of humankind: natural justice.
16. in conformity with the ordinary course of nature; not unusual or exceptional.
17. happening in the ordinary or usual course of things, without the intervention of accident, violence, etc.
18. related only by birth; of no legal relationship; illegitimate: a natural son.
19. related by blood rather than by adoption.
20. based on what is learned from nature rather than on revelation.
21. true to or closely imitating nature: a natural representation.
22. unenlightened or unregenerate: the natural man.
23. being such by nature; born such: a natural fool.
24. Music. a. neither sharp nor flat.
b. changed in pitch by the sign ♮.

25. not treated, tanned, refined, etc.; in its original or raw state: natural wood; natural cowhide.
26. (of a horn or trumpet) having neither side holes nor valves.
27. not tinted or colored; undyed.
28. having a pale tannish or grayish-yellow color, as many woods and untreated animal skins.
29. Cards. a. being a card other than a wild card or joker.
b. (of a set or sequence of cards) containing no wild cards.

30. having or showing feelings, as affection, gratitude, or kindness, considered part of basic human nature.
31. Afro (def. 1).
–noun 32. any person or thing that is or is likely or certain to be very suitable to and successful in an endeavor without much training or difficulty.
33. Music. a. a white key on a piano, organ, or the like.
b. the sign ♮, placed before a note, canceling the effect of a previous sharp or flat.
c. a note affected by a ♮, or a tone thus represented.

34. an idiot.
35. Cards. blackjack (def. 2b).
36. Afro (def. 2).
37. (in craps) a winning combination of seven or eleven made on the first cast.
38. a natural substance or a product made with such a substance: an ointment containing mink oil and other naturals.

Saying that *natural* is a matter of custom and perception is being completely misguided. Natural means things in their purest, most unadultered form. That is the way I choose. That has NOTHING to do with culture or perception.

That is what I work on following... using things that are in their purest form. I don't follow historical trends or the status quo. Doing that is a very closed-minded approach.
Why does kidding (giving birth to a baby goat) hurt? The pain of kidding is not needed to trigger good things, it is vital to prevent maternal and neonatal death, and is a vestigial response that is no longer needed.

I have raised dairy goats for 10 years now and seen more than 100 births. Guess what? The goats feel pain during kidding! Does this mean they are in danger? No, they are actually seeking a birth attendant!

All you have to do is apply Dr Amy's reasoning to any other mammal and it's clear how ludicrous it is. A contracting uterus is painful, plain and simple. The chemicals that are released to counter this also help the moms to bond with the babies. The real issue behind this is her obsession with pushing the use of pharmaceuticals and surgical procedures. Not surprisingly, she also has issues with breastfeeding.
Cheryl - you bring up an interesting point. I am guessing that your goats seek solitude during labor, at least if they are out in the field when delivering and are able to get away from others. Hiding is common behavior for laboring mammals, plus laboring quietly and delivering at night, presumably because of the risk of attracting predators during a vulnerable time. Apparently, some laboring nonhuman primates hang out at the edge of their group, thus being alone but still under the protection of others in the group in case a predator comes around. When I was in veterinary practice, we sometimes set up cameras to monitor laboring horses because our presence would literally inhibit the progress of labor. I've read that even in humans, laboring/delivering at night and being inhibited by the presence of strangers during labor are relatively common.
Sorry, "With an infant mortality rate at the 2nd lowest amongst industrialized countries..." should have read "2nd HIGHEST"!
Cats and dogs and other more domesticated pets also seek hiding when they are giving birth. Our cats used to find any place to hide... underneath the TV console, for example. I'm sure they also go through pain, but they are able to give birth without needing someone else.
"The central fact about the philosophy of natural childbirth is that it was created by men, in order to control women's reproductive choices. Now it is being used by some women as a way of feeling superior to other women. It has no basis in the scientific evidence."

Amy, have you by any chance read "Pushed" by Jennifer Block? It might change some of your views in regards to who is responsible for the natural birth movement.

What about fetal heart monitors? What about the fact that women in hospitals are not allowed to move around freely during labor? What about doctors inducing labor at their convenience? What about forced c sections? You are not addressing the fact that people are opting out of hospital birth for a multitude of reasons that have absolutely nothing to do with women "wanting to feel superior" to one another. But hey, you know, way to jump on the women blaming women bandwagon!
buckeyedoc:

"I'm not sure what we are arguing for or against with respect to childbirth as inherently dangerous or not. "

I'm not arguing for or against anything. I'm providing information that women can use to make informed decisions.
Great points, cocconino.

Amy... how do you think our ancestors... from millions and thousands of years ago... coped with the pain of childbirth? They didn't have pharmaceuticals, so what did they do? Did they NOT give birth NATURALLY???

What did our relatives from the more modern eras do? Traditional medicine didn't become big in this country until the last 100 years or so. How did they cope?

I guess they were a bunch of elitists, too.
"The central fact about the philosophy of natural childbirth is that it was created by men, in order to control women's reproductive choices."

I think you've got that wrong and perhaps a little research in the history of Obstetrics would shed a light. I can certainly recommend some books if you're interested or articles written by some well known anthropologists.

Women were doing just fine before Men took over their reproductive choices and began killing them in hospitals. First hospital with an Obstetric wing? I'll give you a hint; it was in Philadelphia. Look it up and take a peek at how many women were killed by the Men who convinced them they were safer having their babies there.

Our numbers for infant mortality and maternal morbidity are not impressive. You may want to look that up as well.
Bill Whitney:

"My wife, who has never been a hero when it comes to physical pain or discomfort, somehow managed, with the encouragement of a natural childbirth class and her own awe-inspiring strength, to deliver her without numbing pain medications."

It does not take awe-inspiring strength to have unmedicated labor. It is the default mode. Any woman can do it, and most women who have ever existed already have done it (myself included).

"But I wonder why we must accept all medical technology as a given good, and all unmedicated processes as outdated, silly, or dangerous."

No one is saying that. The point of my article is that bio-anthropological evidence suggests that labor pain used to serve a valuable purpose (causing women to seek aid that often turned out to be lifesaving), but is no longer necessary for that purpose.

Women's pain is an extraordinarily political issue, which has long been used to oppress women or to justify oppressing women. The idea that labor pain is punishment for women goes back thousands of years. The founders of the natural childbirth movement played on that deeply held cultural belief, and modified it to claim, essentially, that childbirth pain is punishment for women who do not "prepare properly" for childbirth.

There is a long and unfortunate history of minimizing women's pain or insisting that it is all in their heads, and the natural childbirth movement merely continues that history. Supposedly, childbirth does not have to be agonizing if women are simply in the right frame of mind; conversely, if women do feel agonizing pain, it is ascribed to the failure of women to psychologically conquer the pain. In other words, the pain is all in the woman's head.

The natural childbirth movement is not introspective. Natural childbirth advocates simply assume that what they think is correct. They do not see how they are caught in a web of cultural assumptions about women, pain and punishment.

There is nothing inherently good about labor pain. There is no benefit to the baby from forgoing pain medication. It is not an achievement to give birth without pain medication. Those are scientific facts. To the extent that natural childbirth advocates disagree, they are deeply influenced by their own cultural assumptions.
sara gonzales:

"With an infant mortality rate at the 2nd lowest amongst industrialized countries "

Infant mortality (death from birth to 1 year) is not a measure of obstetric care; it is a measure of pediatric care. The measure of obstetric care is perinatal mortality (death from 28 weeks of pregnancy to 1 month after birth). According to the World Health Organization 2006 report on perinatal mortality, the US has one of the lowest rates in the world, lower than Denmark, the UK and the Netherlands.

Professional natural childbirth advocates deliberately try to mislead women by citing infant mortality statistics. That's because the correct statistic, perinatal mortality, does not support their claims.
Nurse PhD:

"I suggest you check the facts, dr. Amy, before publishing fabrications to advance your point. But one factual error in your writings: heart disease, not breast cancer, is the #1 killer of women."

I suggest you read a little more carefully before flinging accusations.

I said:

"That would make it a leading killer of American women, slightly behind breast cancer. "

I did not say that breast cancer is the #1 killer of women, since it isn't. I compared maternal mortality to breast cancer mortality because the toll in lives/year is similar, and it is an all too familiar cause of death. If not for modern obstetrics, maternal mortality would also be an all too familiar cause of death.
Penny H:

"we do it, and continue to get something from it"

If you want to "get" something from it, no one is trying to stop you. Just don't tell the rest of us that we should "get" something from it, because that is a culturally constructed claim with no basis in medical fact.
Kathryn,
Thank you! The idea that natural childbirth is a male driven "trend" is laughable. It is a reaction to negative hospital experiences. And thank you for mentioning morbidity rates. They happen to increase with hospital intervention in non high-risk births.
This problem has little to do with gender issues. It has to do with hospitals-as-businesses and with doctors both male and female telling women they are not capable of birthing with out intervention (i.e. fetal heart monitor, epidurals, c sections, inductions). The option for women to have a natural birth, with medical guidance , and support in an emergency situation is right now being threatened. This is an issue worthy of attention.
LadyMiko:

"Being OUT of bed is much more important than having pain relief."

To whom? You? That's your personal opinion, nothing more. It does not tell us what the rest of us should believe, since it has no basis in science.
E S:

"there seems to be no evidence here whatsoever that there ever were women who *didn't* feel pain in childbirth, and therefore died out because they didn't seek assistance."

Exactly what evidence would you expect to see of a phenomenon that occurred hundreds of thousands to millions of years ago?

Obviously, there would be no evidence accessible to us today.
gee, I thought childbirth hurt because you're trying to pass a bowling ball through a shot glass.

but that's just me
Cheryl Smith:

"Not surprisingly, she also has issues with breastfeeding."

It's the same issue. I find it deeply disturbing that some women fabricate scientific "facts" in order to denigrate and demean other women. I'm not telling women that they shouldn't have unmedicated childbirth; I've done it myself. I'm telling women who choose unmedicated childbirth that they should stop telling the rest of us that it was better for their babies, better for themselves, better for bonding or an achievement, because it is none of those things.

The reason natural childbirth advocates push back so hard on this issue, and this comment thread is a perfect illustration, is that the desire to feel superior to other women is a main motivator for choosing unmedicated birth. Women who subscribe to the natural childbirth philosophy simply cannot accept that it is their personal preference; they continue to insist, in the absence of any scientific evidence, that it is the "better" choice.
Amy, I believe you are mixing different theories here, out of your misunderstanding of some women's reasons for natural childbirth.
Perhaps some people do believe (ridiculously) that women's pain from childbirth is a punishment for not being prepared. And maybe that was the basis for the natural childbirth movement (I am not educated on this, so I don't know anything about it).

But, I highly doubt that most women who choose natural childbirth think this way. It is a very ridiculous concept, as you are suggesting. Many women choose natural childbirth, because they choose to do things as naturally as possible... being inline with nature... rather than to intervene too much. The basis of that thought comes from the desire to do things the way they were designed by natural law.

The same holds true for breastfeeding. It is natural design to breadfeast one's baby, and there are umpteen reasons for this. To think that a man-made formula, especially ones that are animal milk-based, is better for the baby than its mother's natural breast milk is completely ludicrous and ridiculous. There's a reason mothers who've just given birth produce milk in their breasts. It's not something that simply happens for no reason.

To lump all women together and say that all who choose natural childbirth are doing so to follow a fad and to think they are superior to other women is completely inaccurate and biased. As I've already stated, you don't know the reasons behind all women's positions in choosing natural childbirth. Your opinion is very stereotyping.

On top of that, women who practice yoga and meditation and other forms of exercise and mind/body/spirit connection exercises and who use it as a way to cope with the pains of childbirth are not doing so, because they think that experiencing pain is a punishment. They are doing so in order to experience less pain and an easier labor, for baby and for mother... period.
cocconino:

"Amy, have you by any chance read "Pushed" by Jennifer Block? It might change some of your views in regards to who is responsible for the natural birth movement."

Hardly.

I read the book before I was interviewed by Jennifer Block. She said she wanted to write about me, and to challenge my claims. She interviewed me for 2 hours. We disagreed about pretty much everything. I had marked up my copy of the book, and went point by point through the various mistruths, half truths and deceptions in the book, and I provided scientific evidence for all my claims. She never wrote about me, and I have not heard from her since.
ConnieMack:

"gee, I thought childbirth hurt because you're trying to pass a bowling ball through a shot glass."

I used to tell my friends (not my patients), "Did you find using tampons uncomfortable? Now extrapolate."
How do you know that thousands and millions of years ago, the infant mortality rate was a lot higher than it is now? Do you have records to prove it? You are chiding someone for what they wrote about natural childbirth in relation to this, yet your claims can be put under the exact same scrutiny.
"There is a long and unfortunate history of minimizing women's pain or insisting that it is all in their heads, and the natural childbirth movement merely continues that history. Supposedly, childbirth does not have to be agonizing if women are simply in the right frame of mind; conversely, if women do feel agonizing pain, it is ascribed to the failure of women to psychologically conquer the pain. In other words, the pain is all in the woman's head."

I agree with this. However, I do not believe that has been the case in the history of obstetrics.Twilight sleep which was introduced at the turn of the century delt with a woman's pain during labor...this was the effect:

"Scopolamine + morphine provided childbirth without pain (or without the memory of pain), once a much sought-after objective. However, there were serious problems with twilight sleep. It completely removed the mother from the birth experience and it gravely depressed the baby's central nervous system. This sometimes made for a drowsy depressed baby with poor breathing capacity. Twilight sleep therefore has fallen entirely out of favor and is now a chapter in the history of obstetrics."

The medical profession did argue that the post partum depression was all in the woman's head.
And we *know* that other medical claims, said to be backed by scientific research, has NEVER been wrong.
Amy:

"Just don't tell the rest of us that we should "get" something from it, because that is a culturally constructed claim with no basis in medical fact. "

No, we shouldn't judge others based on the choices WE make.

But I'd like to know how many women are actually "telling other women THEY SHOULD get something from it"

Seriously.

How many women (who have had or want a natural birth) are "bragging" about how "surperior" NCB is? Amy, do you really believe that people like Laura Shanley and websites like MDC truly represent ALL women who want a natural delivery?

IRL I have NEVER heard a woman say " Oh I feel sorry for you, you had the Epidural." or "Oh, you went natural, are you crazy?"

I have several friends that have had kids and we talk about this kind of stuff alot and no one really cares what other people think, but it is fun to talk about.

Maybe its just where I live, but there are no "Epidural Protests" at our local hospitals. :) I really don't see this "mean, vile and nasty Natural Birth Movement" of which you speak.

What I DO see, however, both in RL and Online is a push for more options to be availble to women during their births: be it better prenatal care, pain relief, more access to CNM's or Vbac's. Choice is not a bad thing and there is no "one size, fits all"
cocconino:

"Twilight sleep which was introduced at the turn of the century delt with a woman's pain during labor...this was the effect:"

Twilight sleep was implemented because of demands from women!

On the history of twilight sleep from a midwifery text, Pain in Childbearing, key issues in management:

"In the early years of the twentieth century, experimentation in obstetric anesthesia took place. In 1902, Von Steinbuchel of Germany introduced the combination of scopolamine hydrobromide and morthine sulphate. The former blunts the memory and the latter is a powerful hypnotic and pain reliever. Together, they induce continuous sleep with lack of memory so that women were unable to recall the events of labor. They cause respiratory depression in their babies however. The use of 'Twilight Sleep' spread rapidly, although it was limited by the fact that a doctor had to be in attendance...

Twilight Sleep initiated some of the first organized social movements of women. In the USA, the National Twilight Sleep Association (TWA) was formed to combat the predominantly male obstetric profession. Their mission was to inform women that 'modern science has abolished that primal sentence of the scriptures upon womankind'. Interestingly, this group of women changed obstetric practice and its relationship to pharmacological methods of pain relief profoundly..."

Repeatedly over the history of obstetric anesthesia, developments were implemented because women demanded them over the objection of doctors. The overwhelming majority of women want, and have always wanted, pain relief in labor. It is only a cultural subgroup of women, influenced by the natural childbirth movement, who insist that childbirth is inherently painless or that there is value to the pain.
Amy:

"To whom? You? That's your personal opinion, nothing more. It does not tell us what the rest of us should believe, since it has no basis in science. "

Yes, I was sharing my opinion and never implied that it was more than that.

Please quote where I implied that all women should share my views.

Also, there is research that shows being mobile during labor does have its benefits.
Amy,
Good to know that you were interviewed by Jennifer Block. I am surprised to hear you say that there were mistruths, half truths and deceptions in her book, as I found that her facts were easily researched and confirmed. But I am not a doctor so I could very well be wrong.
I think that the core point of her book, and the point of many natural birth advocates is paramount; non- high risk pregnancies should not be treated as emergencies. And women should have choices as to what kind of birth experience they want.
cocconino:

"non- high risk pregnancies should not be treated as emergencies."

But ALL pregnancies, both low risk and high risk, are potential emergencies. That's the reality of childbirth.

Fundamentally, obstetrics is preventive medicine. It is much better to prevent an emergency than to treat it. It is much better to be fully prepared for an emergency than to pretend that it won't happen. Natural childbirth advocates are flat out wrong when they suggest that emergencies are rare among low risk women.
AmyT: Gee, your friends must have loved whispering ex-trap-o-late between clinched teeth while they tried to do their Breathing.

I can see this subject is not only not going away (which I don't mean to imply it should, I just cannot believe the amount of words present here so quickly), but needs my two cents' worth.

I have had three pregnancies go to term. One while I was 17 years old. I'd trained in Lamaze with a "progressive" nurse, delivered him naturally, and only found out 18 years later that his delivery was "normal" for me.

I'm lucky. In all three, I have labor, which I was totally able to cope with, i.e, not too much pain, for about 12 - 14 hours. In this labor I can walk and talk, don't eat much, pace a Lot, and fight off basically heavy cramps like pain.

During the last hour or two, I'm stuck at 2 - 3 centimeters.

Then, in approximately 45 minutes, I dilate from 3 - 10, toots-sweet, let me tell you! During that 45, I feel like I'm going to die, I fight off panic, I fight off panic, I fight off panic (so as not to make it worse), I breathe a lot, regularly, and then, against all belief, the baby comes out. I will never say it's easy. I will say it hurt. I will say it hurt less each time, and I don't think it's 'cause I got "stretched out". (I had a doctor, between the Irish twins' births in '95 and '96 tell me I had the uterus of a 25 year old!) It's because each time I knew more and breathed better and didn't panic and tighten up.

And face it, it's okay to go through pain when you're doing this amazing physical contortion. And it's okay to feel superior to men when you do so. I remember what the word hystero means, and I do not like it.
oops, should have been: I know what the word "hystero" means, and I do not like it.
I mean, Lookit what they've done:

Hysterical personality disorder
Hysterical pregnancy
Hysterical pregnancy
Hysterical pregnancy
hysterical psychosis
Hysterical raisins
Hysterical raisins
Hysterical realism
hysterical reasons
Hysterical Stars
Hysterical strength
hysterically
hysterically
Hysterically Laughing Out Loud (IRC)
hysterics
hysterics
hysterics
hysterics
hysterics
Hysterisis
Hysterisis
Hysterisis
Hysterisis
Hysterisis
hystero-
Hystero-epilepsy
Hystero-epilepsy
hystero-oophorectomy
Hysterocarpus
Hysterocarpus traskii
hysterocatalepsy
hysterocatalepsy
hysterocele
hysterocleisis
hysterodynia
hysterodynia
hysteroepilepsy
hysteroepilepsy
hysteroepilepsy
hysterogenic
hysterogenic
hysterogeny
hysterogram
hysterograph
hysterography
hysteroid
hysteroid
Hysteroid dysphoria
hysterolith

~~~~~~~~~~~~~~~

Ils ont change ma chanson ma
Ils ont change ma chanson
C'est la seule chose que je peuz faire
Et ce n'est pas bon ma
Ils ont change ma chanson.

~~~~~~~~~~~~~~~~~~~~~~~~~
... picked it like a chicken bone, indeed.
Amy, your claim that women who say that they've been able to cope with the pain of childbirth better through breathing techniques and meditative techniques are claiming that childbirth pain is all in the head is grossly inaccurate. You're not understanding what they are doing and why they are doing it.

Through my massage therapy sessions, I've learned that there are areas of the body that are far more sensitive than others, and therefore, one experiences a lot more pain when being massaged in these areas. Sometimes, I experience so much pain that it nearly brings tears to my eyes and makes me want to scream.

In order to be able to tolerate this pain more, I engage in focusing on my breathing, specifically deep breathing. The focus on the breathing helps to take focus off the pain I am experiencing. Also, deep breathing works in a way that calms one and somehow diverts the pain away from one's awareness to an extent. When I don't focus on the deep breathing, the muscles of my body remain very stiff and tense, causing me to experience the pain to the fullest, and it creates yet more pain in areas that aren't being worked on, because of the tenseness of my muscles.

I imagine (I've never given birth) that women who use deep breathing techniques and meditative techniques during childbirth do it for the same reasons I've mentioned.

This is COMPLETELY DIFFERENT from what you are claiming... that women who use these means to alleviate pain during childbirth are supporting claims that pain is all in the head. First of all, pain IS perceived by the brain and one's awareness (spirit), so one could say that it IS in the head. Also, I'm guessing that your position of *in the head* means that one is imagining pain that really isn't there.

That is completely untrue of why people use deep breathing techniques and meditation as ways to alleviate their experiences of pain.
I'm guessing that you've never tried using deep breathing and meditative techniques to alleviate pain.
When I was pregnant with my daughter, most everyone I spoke to had had the epidural and highly recommended it. But I had seen my sister's birth at a hospital, pitocin, epidural, and it really struck me wrong. I had a co-worker who had used a midwife and only because I had seen my sister's birth did I even consider another option.

The midwife I had would work with you in the local hospital, and at first that seemed perfect to me, the best of both worlds. Then I took a childbirth class with a nurse from the local hospital and, again, it just struck me as so wrong with the emphasis all on the needles and drugs and very little on much else. I toured the hospital and again, it just made me feel almost sick to be there.

The only thing that felt right to me was the yoga class I was taking, with the very nurturing teacher and close community. So, in the last month, having read about a birthing center not too far away, I investigated it and found it was much more to my innate idea of what I wanted for my birth.

All of this was a real journey for me. I went against what I was reading in every book, what I was being told by neighbors. For me, the journey through my pregnancy was a profound time of change and growing up, much of it because of the inner work I did in my yoga class.

I later went on to teach prenatal yoga and work with childbirth community in my neighborhood.

I find myself so reacting to your contention that the reason I chose an unmedicated birth had to do with wanting to feel superior to others, because it was through the process of making the decision to have an unmedicated birth and all that that process involved that I gained a since of self that had been entirely lacking up until then. That sense of self didn't come from feeling superior. It came from being true to myself.

I did a lot of research on pregnancy as a yoga teacher and though I read a lot, I realized that unless I were a doctor or midwife attending many births and up to date on research, I never could understand the real risks and benefits of various medications. I am really glad you are sharing your knowledge with us here.

However, please don't contend that women who choose not to use medication are doing it because it makes them feel superior or because they read a book that makes them feel that it is the correct way to do it. At least in my case, not using medication was all about not doing things the " correct" way. It was about doing it my way.
Amen, the Buzz. As I've stated, I haven't had any children yet, but I plan to use natural means... yoga, meditation, deep breathing exercises, guided imagery, a midwife, etc when I do have children... because for me, being as natural as possible works for me and is being true to myself and to nature, as you stated. I also don't like the ways of hospitals and traditional births. Like some have stated, they are designed for the convenience and laziness of the doctors... and not for the health and care of the baby and mother. Hospitals are institutions, and money-making businesses. Birthing centers and having midwives deliver babies in the homes of mothers is much more personal and nurturing. I don't see anything that is nurturing about having a baby in a hospital.
Shawna,

You presume too much about me, but I will tell you this: I am allergic to most tree/bush based herbs - willow bark, cinnamon, rooibos, juniper, sage, rosemary, etc. There’s more I’m allergic to, but it’s not important for the post. I’ve never had to go from a “chemical” life to an organic one because my parents raised me organic. We grew our own food. We’ve always cleaned with vinegar. I drink raw milk and eat most of my food raw. I haven't always lived in the traditional or Western world. I also take two pills daily - ones that are made in a lab. I bless modern medicine daily.

The fact that you list nearly 40 definitions of the word “natural” proves that it is a concept. The concept of nature versus the urban or the artificial world has been discussed since language existed. It’s in Gilgamesh. Natural today implies the lack of artificiality. What is artificial? Anything made by humans. What is unadulterated? It means not diluted – not even with water (goodbye tea.) “Natural” and "pure" are concepts.

No creature seeks pain. Not one, so how can it be unnatural for humans to try to avoid it? Animals have been known to seek plants that relieve pain or make them feel good. Why shouldn’t the human animal do so? Many mothers chose an epidural because it does not harm the child. Natural medicines, e.g., cannabis, opium, would.
The Buzz:

"However, please don't contend that women who choose not to use medication are doing it because it makes them feel superior or because they read a book that makes them feel that it is the correct way to do it. At least in my case, not using medication was all about not doing things the " correct" way. It was about doing it my way."

That's great. You should do things "your way." Therefore, it should be easy for you to understand that your way is simply your personal preference, just like you might prefer vanilla ice cream to chocolate. For most women, "their way" is to have pain relief in childbirth because there is no reason not to, and it is not an achievement to have unmedicated childbirth.

However, this thread has over 120 comments on it because natural childbirth advocate insist, indeed feel compelled to insist, that "their way" is objectively better. It's not, and they don't like to hear that.
FYI, in response to some the study you mentioned above about use of medication and breathing not being as effective as pain medication, in my experience as a yoga practitioner for over 15 years, very few people have enough practice with these techniques to use them effectively during childbirth.

Taking a short class on meditation or breathing techniques cannot substitute for a long standing practice. I'd be very surprised if that study were done on people who had a real grasp of breathing and meditation techniques.

As a teacher, I have observed that for people to new to yoga tend to use too much effort in their bodies when they are new to yoga. Yoga takes years of practice before it becomes incorporated into your way of moving, before the unnatural breathing rhythms become effortless, and before meditation becomes truly meditative.
marcelleqb,

You haven't answered my question about whether you've tried other forms of natural healing... such as chiropractic... as a cure for your allergy problems. No one should have allergies, and when one does, it suggests that the body is out of balance in some way. So, when one takes man-made meds... toxic meds... they serve no purpose other than coping with the allergies. They DO NOT go to the source to take care of what is causing the allergies.

When I'm speaking of natural meds, I'm speaking of meds that haven't been man-made in a lab from synthetic sources and that haven't been bastardized beyond their original recognition. You are so wrong about the concept of tea. A tea is an extraction... heated water extracts the healing, nutritional, flavor, and other properties of the plant. It's NOT a diluted substance. In many cases, a plants properties need to be extracted to be able to digest them. This is WAY different than a man-made pill made of synthetic materials in a lab.

Chewing and digesting food is a form of processing. If we didn't do it, we wouldn't be able to provide our bodies with nutrition, and we'd die. When eating raw foods and minimally processed food (meaning cut up food or food that is very minimally heated in order to digest it or something similar), it can be said that it's natural. It wasn't created in a lab with synthetic materials. We have to minimally process them in order to digest them. But, they aren't some man-made invention that came out of a lab. That is what is meant by *natural*.

Whatever you want to call it, I don't agree with traditional meds... man-made substances made in labs... things that don't exist in nature without human intervention. We can safely say that plants are *natural*, as they are made by the natural world... and not by man in a lab.

Also, I never said that ALL natural substances are beneficial for humans. I simply said that I don't agree with taking meds, and I rely on holistic/natural healing, and it does wonders for me.

You should try the holistic chiropractic approach to see if it helps. It helped one of my cousins and has helped me tremendously. I'd be interested to know if it helps to alleviate you from your allergies.
The Buzz:

"in response to some the study you mentioned above about use of medication and breathing not being as effective as pain medication, in my experience as a yoga practitioner for over 15 years, very few people have enough practice with these techniques to use them effectively during childbirth."

Don't you see what you are doing? This is exactly what I am talking about: blaming women in pain for their own pain. Your unstated assumption, the one I am trying to get you to question, is that if a woman feels pain it must be her fault!

It is not a "lack of practice" that makes relaxation and yoga useless for childbirth pain, it the fact that childbirth pain is excruciating, agonizing, the most pain that most people will ever experience.

Please, stop blaming women for their own pain, and please, stop implying that childbirth pain is the punishment for women who haven't learned to do it "right."
marcelleqb,

Where have I assumed too much about you? I responded to your comments about my comments, and then I stated my opinions about our society that relate... nothing that is personal to you.


Amy,

Where are the 120 posts claiming that the natural way is the superior way and where women are pushing others to choose natural childbirth? The posts I've been reading advocating natural childbirth are stating that many of these women have tried it, and they've explained their experiences... without stating whether they think it's superior or not. They are stating that it's their choice and then follow up with details about their experiences... period. That, in no way, states anything about feeling superior. Also, you keep accusing ALL women who choose natural childbirth of choosing it SOLELY for the reasons of following a fad and to feel superior to others.

If that's your take on the personal experiences of women who've used natural childbirth... without them stating that they feel superior because of it... then I think there is some insecurity and are biased thoughts within you that should be addressed. Perhaps you are sensitive to the issue, since you are an OBGYN and work in the traditional medicine arena. This does not back up your claims about why some women choose natural childbirth. Your claim is the one that infers feelings of superiority.

Perhaps you are conjuring up your claim because of being close-minded to the notion of natural childbirth.
Amy,

I think you are COMPLETELY misconstruing statements made by women (most recently, The Buzz) talking about natural childbirth. Where do you get that anyone is blaming women for their own pain... regardless of WHAT technique they try... whether it be meds, yoga, meditation, whatever??? You are completely off the mark here.

It's a biological fact that women experience pain during childbirth. Where is there any fault in that, and how does supporting natural childbirth say that women are at fault for their own pain?

The Buzz stated that it takes a long time to really grasp practicing yoga. I've practiced different forms of yoga, so I know this is true. Also, The Buzz stated that if some women didn't experience some pain relief from yoga, then she bets that they were new to it and hadn't grasped it yet. How is THAT saying that women are at fault for their pain during childbirth??? I absolutely don't get your argument. It seems so ludicrous to me. The Buzz is simply stating that one can receive reduced childbirth pain if they've really grasped yoga and meditation techniques... but if they haven't, then they probably will experience some sort of pain.

This has to do with different ways of alleviating pain during childbirth and whether they are effective or not or whether a woman has really learned how to use them effectively. It has NOTHING to do with saying that women are at fault for their pain during childbirth.

I find your position to be a crazy one.
I don't think I'll ever be on board with the idea that childbirth is so inherently dangerous that every delivery is a potential emergency and should be treated that way. It is factually true that anything can result in an emergency, but the risk of death during a routine, uncomplicated delivery is just not very big. Driving a car could fit into that category, and so can showering (lots of slips and falls). I'm aware that modern obstetrics operates from a defensive perspective, but it's not always the right perspective. Studies of some interventions, like continuous fetal monitoring, have not shown improved outcomes. And how often do women aspirate because they ate something during labor? How often is a 41-weeker baby truly too large to deliver? Such rare complications, yet so many women are pressured to conform their delivery to a really medicalized, stark model that is, frankly, overkill. I used to blame malpractice lawsuits, but maybe the training itself is partially to blame by skewing perspective toward worst-case scenarios. It's no different than police officers starting to feel like everyone is a criminal. It's based on experience but not statistical reality.
"However, this thread has over 120 comments on it because natural childbirth advocate insist, indeed feel compelled to insist, that "their way" is objectively better. It's not, and they don't like to hear that. "

Assume much?

So now if someone supports natural birth as an option, they're suddenly a "Natural Birth Advocate"

Oh snap!

Please qoute (ie provide proof) anyone here that has implied that "natural birth" is better and ALL women should aspire to it.

This is beyond redundant and is hardly useful in helping women make informed choices, which is what you "claim" to do (or try to do)
buckeyedoc:

"Driving a car could fit into that category, and so can showering (lots of slips and falls)."

That's simply not true. Childbirth is much more dangerous than either one.

Overall US perinatal mortality across all risk groups, for births after 28 weeks, is 7/1000.

In the US in 2004, there were 42,884 deaths, out of a population of about 300 million. That's a death rate of 1.4 per 10,000.

The death rate drops even farther if you calculate the risk per car trip. Let's say you take 100 trips per year, which is almost certainly extremely low -- that's just two trips a week, after all. Now, your rate for the whole year is 1.4/10,000, but that is spread out over all 100 trips, your risk of dying on any given trip is 1.4 per million.

In other words, it is 50 times more likely that your baby will die in childbirth than that you will die in a car accident in a given year. Your baby is five thousand times more likely to die in childbirth than in any given car trip.

"Studies of some interventions, like continuous fetal monitoring, have not shown improved outcomes."

No, that's not what the studies have shows. The studies you are referencing show that continuous electronic fetal monitoring is no better than monitoring my intermittent auscultation by a nurse following a very strict protocol.

"It's no different than police officers starting to feel like everyone is a criminal. It's based on experience but not statistical reality."

The reality is that American obstetrics saves approximately 40,000 women and 200,000 babies each and every year. That's a lot of lives saved. Pregnancy complications and emergencies are not rare; they are common.
LadyMiko,

I've agreed from the very beginning that every woman should use or not use medication according to her personal preference. So why are people arguing with me? What are people complaining about, if they are not complaining about their belief that unmedicated childbirth is not merely a preference, but a superior option?
Dear Dr. Amy,

I appreciate how you are advocating for a woman's right to choose a less painful childbirth.

Is it true that when you have an epidural, a common side effect is that labor slows down and you are more likely to need other forms of medical intervention such as pitocin, c-section, forceps, etc?

If the answer to this question is yes, and an epidural is the first step in a potentially escalating set of interventions, this provides a clear reason, other than ego, why educated mothers (by experience or the academy) may choose to eschew the medical approach to childbirth that you advocate for.

I have not yet had children, but am considering the option of having a natural childbirth. My own mother had an epidural with me, and she ended up delivering with forceps after an excruciatingly painful labor that seemed to go on forever.

To me, it seems natural (heh) to want to avoid an escalating set of procedures during childbirth for the sake of pain treatment that may or may not do the trick. This is from a girl who needs vicodin after dental work - I am not thinking I will just be able to "relax" into the pain with some nice breathing. I can say that I would like to avoid interventions that would introduce a whole host of risky complications.

Thank you for your response to this non-emotive, fact based opposition to having an epidural. And, thank you for being willing to give me that epidural if I get to the place where I decide I really need one. When the time comes, I would like to be respected for my decision, whatever it may be.
Amy, you keep saying... OVER AND OVER... that there are so many examples in this post of women who think their way is superior to all over ways, and that they choose natural childbirth ONLY because they are following a fad and because they think they are superior compared to other women and other humans.

THAT is what people are arguing with you about... because you are SO off the mark.
AmyT: As my post indicated, I agree with your fundamental premise that there is a natural-birth advocacy community in this country which has become rather strident and self-righteous in its views, dangerous attitudes when the health of women (or anyone) is at issue. As my post also implied, I feel much the same way about the pro-breastfeeding community, which my wife and I ran up against head-first when a myriad of problems made it ultimately impossible for my wife to breastfeed our daughter, which was not an option that we had previously considered (thanks, in part, to our natural-birth training, although that was not the only type of education we sought prior to birth). I had no idea of the obstinance and lack of pragmatism that many (not all) breastfeeding advocates and consultants share. The idea of not breastfeeding is so odious and wrong to these people, most of them simply end up insisting that it will work, must work, even in spite of strong evidence to the contrary. In the meantime we had to figure out feeding our daughter through other means (ultimately doable, but still a daunting task in the face of a days-old first child and total sleep deprivation).

But I digress.

My point here is - I agree that there are indeed deep-seated cultural assumptions, especially in the Western world, which deny women a place to authentically experience pain, and to have options within that place for them to choose without judgment. However - how does this fully account for the fact that the United States has such a vastly different overall childbirth/labor/obstetrics system than much of the rest of the Western industrialized world? And how can you responsibly dismiss significantly higher U.S. infant and mother mortality statistics as unrepresentative of differences in our childbirth system? And how can you in one breath dismiss my assessment of my wife's unmedicated birth as "awe-inspiring," since childbirth is such a relatively simple task for women to do, and in the next propose alarmingly that childbirth is an inherently dangerous activity which flirts with death at every moment (not your words, but certainly your sentiments)?

Folks may never see eye-to-eye on this; my wife has very close friends whose births were assisted by planned and desired epidurals, and no judgments (verbalized, at least) have ever been exchanged between them. I don't believe that my admiration and respect for my wife's strength in labor and birth is due to some deep-rooted cultural minimization of her and all women as inherently incapable of properly processing pain, and I sort of resent your implication that it is. I prefer to see it as proper veneration for her role in bringing our daughter to the world, in bringing any child into the world, all of whom, whether medicated at birth or not, whether brought through a medicated birth canal or not, are awe-inspiring. Whether or not the natural-birth community tells you that an unmedicated birth is worth an extra 4 IQ points (unbelievable, I know).
"So why are people arguing with me? What are people complaining about, if they are not complaining about their belief that unmedicated childbirth is not merely a preference, but a superior option? "

I can't speak for others here, but my choice has nothing to do with feeling better (simply because of said choice :)) than other women.
I would prefer an unmed labor because as I stated earlier, mobility (to me) is more important than pain relief. I completely respect that other women may not make the same choice I will, so for me, its just a preference: best for "me" and that's it.

Its like this, I wear sandals almost all year, my husband wears sneakers. One is not better or worse than the other, they're just choices.
Emme Renee:

"Is it true that when you have an epidural, a common side effect is that labor slows down and you are more likely to need other forms of medical intervention such as pitocin, c-section, forceps, etc?"

No, it's not true. An epidural in active labor does not lead to a "cascade of interventions" as natural childbirth advocates like to claim. There's no scientific evidence that women who have unmedicated childbirth have better outcomes than women who have epidurals.

"I have not yet had children, but am considering the option of having a natural childbirth."

I tell my patients to investigate all options, but not commit to any specific plan until they feel the pain. One of the things I find most distressing about the natural childbirth literature is that it encourages women to make decisions without information. No one would suggest that you decide before the fact to choose between codeine or tylenol for the hours after a tooth extraction. Why encourage a woman to commit to a specific form of pain relief (psychological methods) before she has any idea what her labor is going to be like or how long it is going to last?

Some women don't need any pain medication, and they aren't necessarily the ones who planned on unmedicated birth. When the time came, they simply did not need it. On the other hand, many women are encouraged to commit to unmedicated birth without any idea of what the pain is like. Then they feel like failures when the reality is utterly overwhelming. No philosophy should make a woman feel like a failure because she wanted pain relief. The point of childbirth is a healthy baby and a healthy mother, not a competition on who can get by without pain relief.
Bill Whitney:

"The idea of not breastfeeding is so odious and wrong to these people, most of them simply end up insisting that it will work, must work, even in spite of strong evidence to the contrary."

Unfortunately, lactivists, like some natural childbirth advocates, value process over outcome. They insist that there is one and only one way to have a baby and to feed a baby, regardless of evidence to the contrary. For most people, it is the outcome that matters more: a healthy baby is more important than a vaginal delivery, a thriving child is more important that the act of breastfeeding. I wish that some of the process obsessed women would questions their assumptions a bit more.

"And how can you responsibly dismiss significantly higher U.S. infant and mother mortality statistics as unrepresentative of differences in our childbirth system?"

As I mentioned above, infant mortality (death from birth to 1 year) is not a measure of obstetric care; it is a measure of pediatric care. The correct measure of obstetric care is perinatal mortality (death from 28 weeks of pregnancy to 1 month after birth). According to the World Health Organization, the US has one of the lowest perinatal mortality rates in the world, lower than Denmark, the UK and the Netherlands.

Second, unfortunately, race is a risk factor for both perinatal and maternal mortality. African descent (independent of economic and social class) is a risk factor for perinatal and maternal mortality. It is not a coincidence that the countries that have better perinatal and maternal mortality rates than the US are "whiter" than the US.

If find it extraordinarily disingenuous for professional natural childbirth advocates to deliberately exploit the tragedy of excess Black perinatal and maternal mortality (since that accounts almost entirely for the difference between the US and other industrialized countries) as an endorsement for natural childbirth. Nothing could be further from the truth.

The primary causes of perinatal mortality are prematurity and congenital anomalies. Natural childbirth would not have any impact on either of those problems. Most of the causes of maternal mortality --- pre-eclampsia, hemorrhage, and pre-existing medical conditions --- are not going to be affected by natural childbirth, either.

It is wrong, morally wrong, to claim that differences in the care systems are responsible for differences in outcomes, when all the existing evidence shows that this is not the case. And it certainly does not help the victims of these tragedies, particularly black infants and mothers, to pretend that natural childbirth could have averted their tragedies. If we want to solve these problems, we must approach them truthfully, not make up claims to serve pre-determined interests.

"I prefer to see it as proper veneration for her role in bringing our daughter to the world, in bringing any child into the world, all of whom, whether medicated at birth or not, whether brought through a medicated birth canal or not, are awe-inspiring."

On that we definitely agree.

I'm curious, though. If that is what you really think, why didn't you mention it in your original post? Why did you feel it was important to point out that your wife " somehow managed, with the encouragement of a natural childbirth class and her own awe-inspiring strength, to deliver her without numbing pain medications." That statement leaves the impression that the awe was inspired by forgoing pain medication, not by the birth itself.
LadyMiko:

"Its like this, I wear sandals almost all year, my husband wears sneakers. One is not better or worse than the other, they're just choices."

Something tells me that if I had written a post declaring that there was no scientific reason to prefer sandals over sneakers, it would not have resulted in more than 130 comments arguing the point.
If it ever happens to me (probably won't magically do so, since I'm 37 and partnered with a woman) I want to be drugged to my eyeballs before, during and after the process.
My sis scheduled her C section in the 4th month- the ob fought her on that, but she pressed until she got her way. For her, not having resentment at my nephew for the pain was her way of bonding with her baby.
You all are free to 'go natural' if you want, as long as me and mine have the right to have nothing to do with it. Dr. Amy might want to save ya, but all I can think is good luck and god speed.
Shawna,

Yes, I have tried every type of therapy you have suggested and more. I still have allergies. There isn't anything that you are going to suggest that is natural that is going to work. The 2 pills I take daily aren’t for allergies nor are they for killing anything. Nor are they for pain.

As my allergies have been explained to me: Many cities plant only male trees, causing excessive pollen production. Plants have been forced to evolve faster than humans. I eat many foods that are originally from many sources and I’m not of one culture, i.e, if I were Irish and living in Ireland, I might be well adapted, I’m not. Sometimes the “root cause” is genetic, e.g. celiac, and there is no cure. Sometimes all you can do is treat the symptoms.

My allergies are completely natural and due to nature at large. Those plants you deem harmless can kill me as easily as Sulfa Drugs, to which I am also allergic.

When I have an allergic headache, it goes on for days and it begins to affect my ability to sleep, play well with others, etc. It is not a migraine - I know the difference. I have an extremely high tolerance for pain, so I tend to ignore my pain until it becomes overwhelming. At that point, I take what I need to take to feel better. I don't take anything natural.
I couldn't put my finger on what was "bugging" me about Amy's assertions regarding the medicalization of childbirth and risk management, but I think I figured it out. There is a obvious "medical = good and natural = bad" bias from Amy here, but then statistics about risk management are being used to argue in favor of medicalization of childbirth.

However, in order to operate from a position of lowest risk to mother and child, we would have to argue AGAINST epidurals (and elective C-sections, for that matter). After all, weighing the mother's wishes and her suffering against the real risk of complications from these procedures (I remember signing off on that epidural consent form) would force us to err on the side of not intervening and making her "deal with it." So, we're not really talking about doing what has the absolute lowest risk. We're talking about doing whatever is "medical" regardless of risk and rejecting whatever is "natural" even if it has lower or equivalent risk.
hyblaean,

I don't ever remember ANY woman or man who's posted in this thread telling someone else the way they should go through childbirth. Rather, people are stating how they FEEL about it and what their experiences have been, if they have had children.

Amy is the one pointing the finger at people, telling them that they think they are superior to others for choosing natural childbirth and that they are simply doing it to follow a fad. She also continues to say that women who choose natural childbirth are looking for rewards because they've done so.

In NO post have I read ANY of that here. It's all fabricated, from her mind, because she is completely biased about her opinion. It seems that she doesn't like talk of natural childbirth, so she wants to make things up about people who are posting here. It's completely crazy.

She's saying that she's all for women choosing their own way, yet she continues to point out that using meds while going through childbirth IS the way to go, and scientific research tells us that. It's set in her mind that meds are the way to go no matter what.

WHO'S the one who's acting superior and following a fad???
buckeyedoc:

"However, in order to operate from a position of lowest risk to mother and child, we would have to argue AGAINST epidurals (and elective C-sections, for that matter). After all, weighing the mother's wishes and her suffering against the real risk of complications from these procedures (I remember signing off on that epidural consent form) would force us to err on the side of not intervening and making her "deal with it." So, we're not really talking about doing what has the absolute lowest risk. We're talking about doing whatever is "medical" regardless of risk and rejecting whatever is "natural" even if it has lower or equivalent risk."

Absolutely not!

This is one of the most irritating arguments of the natural childbirth movement: we really have the best interests of mothers and babies at heart. That's pious baloney. The last thing that natural childbirth advocates care about the is the well being of other women and their babies. They are focused single-mindedly on demeaning those other women simply for making different choices.

Why is that natural childbirth advocates are only "concerned" about the "risks" of pain medication for women and babies? Why aren't they worried about the risks of pain medication for men? Why should men "give in" and have local anesthesia for a vasectomy? Think about the (minuscule) "risks" of novocaine. Surely they could psychologically master the pain, right?

The fact is that the risk of dying from a labor epidural is less than the risk of dying from a lightning strike. I don't notice natural childbirth advocates counseling that everyone should stay inside on a rainy day. The risk of dying from a labor epidural is less than the risk of getting killed in a car accident on the way home from the hospital. I don't notice natural childbirth advocates counseling that everyone should therefore walk home.

Natural childbirth advocates should spare the rest of us their pious concern about the "risks." That's just a back door attempt to claim that unmedicated childbirth is "better."
Just for the record, I'm for using natural means of reducing and eliminating pain for surgeries and other procedures (acupuncture, for example)... instead of using meds. My insurance company even covers acupuncture when it's use in place of anethesia for pain management.

I went to a dermatologist about 10 years ago, because I had problems with acne. She wanted me to take 2 different antibiotics to get rid of the acne. She told me that there were very slight (yeah, right) chances that the antibiotics could damage my kidneys and liver. When I asked her if there were any alternatives to helping my acne besides taking these antibiotics, she point-blank told me no. I wasn't willing to take any risks with the antibiotics.

That's when I walked out of her office and never went back. I knew she was lying, and I was ticked off because of it. So, I started to research alternative methods and talked with holistic practitioners about it. I started to change my diet to eat healthier and cleansed my body and got colonic treatments for a while... and guess what? My acne disappeared! I haven't had ANY problems with it since.

In fact, I think it was antibiotics that caused the acne in the first place. I never had it when I was a kid but started developing it when I was in college. I had bronchitis way back then (before I knew what holistic healing was) and took antibiotics for it. It was shortly after that that I started developing acne (antibiotics kill off the good bacteria in your digestive system and can cause a multitude of other problems).

There ARE other alternatives out there beyond MAN-MADE, LAB-MADE MEDS (of which you may not be aware)!

Also, the reason we're talking about women and childbirth here is because that's what the post is about! It's not about men and what methods they have available for managing pain, so why should we talk about them? You're the one who started the post, Amy.
"Natural childbirth advocates should spare the rest of us their pious concern about the "risks." That's just a back door attempt to claim that unmedicated childbirth is "better." "

How about the risk of an epidural vs. the risk of eating crackers and aspirating during labor? My hospital allowed an epidural but no food or drinks at all. You are completely missing the point that we accept some policies out of a pro-medical bias that has nothing to do with risk. I could easily pick out some of your statements and use them to accuse you of a backdoor attempt to prove that medical interventions are inherently better regardless of risk.

Amy, the reason you are pissing people off on here is because of your narrow-minded idea that anyone who is in favor of anything natural is some kind of Nazi forcing their own beliefs on others. Your posts about breastfeeding, circumcision and natural childbirth always go like this: "I'm not against X, but here's why people should not be in favor of X." "People who are in favor of X are privileged white Western women just trying to force their beliefs on others." "People who are in favor of X are disingenuous, because what about unrelated conditions Y and Z?" Maybe you've had some bad experiences with women who are far to the radical fringe of some kind of movement that they ignored solid medical advice, but that's no excuse to condemn every woman who dares to empower herself in the smallest and most logical way. I'm not even an NCB-er, and I find some of your statements shockingly off target.
Amy,

I read your post "Why is natural childbirth advocacy so mean?" You took the same tone in that post with people who are in favor of UNMEDICATED, UNHOSPITALIZED childbirth as you have here.

From reading these 2 posts of yours, it's very evident to me that you have some emotional issues going on inside you that need to be worked out. You seem to be emotionally tied to using meds, even though you claim to be for women's choices to have their babies how they choose to. I have come to the conclusion that you need some help in ridding yourself of your negative emotions that you've internalized in relation to your thoughts of birthing WITHOUT MEDS AND WITHOUT BEING IN A HOSPITAL (notice how I didn't use the phrase "natural childbirth", since you seem to be so angered by it).

The things you accuse proponents of UNMEDICATED childbirth of, you are committing.
The idea that white western women are the only ones who want natural childbirth and that's it's all just a trend is both false and insulting. I wanted to go without meds because the idea of being confined to a bed and not being able to move around as I pleased made me crazy just to think about it. Oddly, I never left the bed once my contractions started - I slept like a log in between contractions because I was so tired.

I gave birth at a wonderful hospital in Portland, Oregon. The nurse who was on duty when I got to the hospital was only there for about 15 minutes and then her shift was over. She came in to see me the next morning and asked if I got through the birth without meds, as was my hope. When I told her I had she said that she used to work at a hospital in one of the suburbs where most of her patients were Hispanic. She said the vast majority of them never used meds during birth. It was just a part of their culture that you dealt with it on your own. Now, I'm not about to deny any woman the childbirth experience she wants. It's extremely personal and everyone needs to do what's right for them. This nurse said that since coming to the hospital where I gave birth, the vast majority of her patients are upper middle class white women who are all about medication. Some asked to have the epidural started before they were induced! In the 4 months she had worked at this hospital she had seen only 5 natural births.

The fact is that for some women, meds just aren't necessary. We're fine dealing with the pain on our own. I would never tell another woman that she needs to do things the way I did them. Please, Amy, don't insult those of us who went natural by saying we're only following a trend or that we're only of a certain demographic.

Also, I believe it was in ethnopediatrician Meredith Small's "Our Babies, Ourselves" that she mentions living with a tribe of people where women gave birth alone as a matter of custom and a point of pride.
Angie Lawless:

"The idea that white western women are the only ones who want natural childbirth and that's it's all just a trend is both false and insulting."

You might consider it insulting, but that doesn't change the fact that the philosophy of natural childbirth is popular only among Western white women and it was invented in large part by Western white men.
"Far from being beneficial, labor pain may turn out to have only harmful effects. "

Yes, and all the research the indicates mothers who did not have an epidural or other pain-relieving drug have reduced post-partum depression, and a better breastfeeding relationship is so harmful. I suggest you go have a heart to heart discussion with people like Ina May Gaskin or Marie Mongan, and any woman who's ever had a planned natural birth and compare it to the women who have drugged births. See who is happier, and who is more satisfied with their birth.
S M:

"Yes, and all the research the indicates mothers who did not have an epidural or other pain-relieving drug have reduced post-partum depression, and a better breastfeeding relationship is so harmful."

No, that's not what the research shows, and if you were to read the scientific papers, you would see that. You are simply parroting what Gaskin says, and she is spinning mistruths, half truths and outright deceptions. Don't take my word for it and don't take her word for it. Check the actual scientific literature, not the "bibliography salad" that professional natural childbirth advocates add to their writings without ever having read the papers.

There has only been one paper published about Ina May Gaskin's "Farm" and it showed an appallingly high neonatal mortality rate, which they tried to hide by comparing to a group of high risk women recruited for another study. The neonatal mortality rate at the Farm was 10/1000, more than 3 times higher than the neonatal mortality rate for a comparable risk group delivering in the hospital in the same years.

The claims about the effects of epidurals on postpartum depression, and the effects of epidurals on breastfeeding are MADE UP, just like the claims about the value of labor pain. If people learn nothing else from this post, I hope they learn this: Most of what natural childbirth advocates think they "know" about childbirth is factually false, your claims included.
Amy:

LOL, No, I don't think you would have had nearly as many hits.
Wow, Just been training in OB/GYN for my EMT-B certification. Was present at the birthings of two of my children and thought I knew something. But, this section is the most-failed on the National Registry exam.

Am bringing this up because I am currently fascinated personally, professionally and politically about the Sarah Palin narrative of her recent delivery of Trig. I just cannot believe it, although two of my neighbor ladies with extensive birthing and some medical experience tell me that it is possible to deliver a baby thirteen hours after the breaking of the water.

This includes aircraft travel at some 30K+feet and some sort of vehicle travel to an Alaskan outback hospital with no NICU facilities, by a family doctor, return to work two days later [without the baby?].

Found a fascinating discussion of this issue, which I will return with link to, and a very similar argument about whether childbirth is a crisis or an ecstatic experience. The discussion there had definite political overtones.

I look forward to reading all of this and trying to figure it out, as a male.

Just remembering what Robin Williams said about us guys sharing the experience: "Not unless you've passed a bowling ball. Not unless you've opened an umbrella up your ass."

Have described arthritis pain to women as "like childbirth." Can't described the looks on their faces. The mother of my children, and she had perfect birthings, one at home: "It's like your whole bottom is falling out."

There seems to be a consensus of opinion that we, maybe women, remember pleasure much more than pain, or else there would be only one go round.
Double Wow. Everybody run out and get Spiritual Midwifery and understand the Gaskin context, with photos and stories of birthings, tragic and otherwise, all beautiful.

What they mean as sexual is Freudian, a greater term, indicating a greater connection with all creation, all animals who give birth.

I think we all agree that childbirth diminishes the desire for physical sex, at least for a time, maybe for all time. I honestly believe that, as a male, we get the benefit of a subconscious attitude, however expressed: "See what you did to my body."

Hope y'all don't mind a bit of male perspective on this. Mostly, I am still trying to understand it. Just know that my kids are the only real thing that matters, all that matter.
Wow, I am so glad I stumbled onto this. "Dr. Amy," has a long list of canned answers and responses. She makes the rounds everywhere she can to denigrate proponents of natural and/or homebirth, or really proponents of the midwifery model of care. I wonder so much why this is so personal to her--there is speculation that she is associated with ACOG (the doctors trade union) to try to stop the movement away from the obstetrical model of care to the midwifery model.

I haven't heard alot of discussion of the climbing c-section rate. I don’t think she can argue with the numbers that c-section is 4 times more dangerous for a woman than vaginal birth, yet it continues to increase. ACOG recommends that hospitals actually ban VBAC (vaginal birth after c-section) unless certain requirements are met (24 hour anesthesiologist and pediatrician, I believe). But honestly, I don’t know what the advantage of birthing in a hospital is if they are not prepared to handle an emergency, so this should be a huge red flag to any woman.

Dr. Amy states that she just wants women to have the facts, but natural childbirths are very few compared with the medicated ones, so why does medicated birth need such protecting? And her statement that the natural childbirth proponents simply want to shame women for using drugs or wanting pain relief is nonsense. Most of these women are devoted to women, children and families. These women only want what is best for women and babies.

As for childbirth being a potential emergency--yes, of course, as is getting in a car and driving across town, or crossing the street, or getting a cavity filled (or running a marathon). This is a fact of life. But this is also wonderful and exciting and brings into the world a person we end up loving more than we ever thought we could. So we try to prepare and protect ourselves as best we can. When I was lying on a metal slab being sliced open because my body and my baby did not agree with the Pitocin, CYTOTEC and epidural, I did not feel as though I did everything I could to protect him and me. I found out later that this was true.

Why do we treat every labor as though it were going to be an emergency when only 10% need intervention? Shouldn’t we treat them all as normal, and deal with the 10% then? I wish every woman could have had my second experience over my first. Then maybe women have such negative views. See this article by Dr.Wagner:
http://www.mothering.com/articles/pregnancy_birth/birth_preparation/risks.html

Why, Dr. Amy, do doctors still use Cytotec? Do you think my OB told me anything about it when he put it on my cervix? He said "this is a cervix ripener to get you all ready for the Pit." He failed to mention that Searle had just sent out a letter stating they did not endorse or recommend it for labor induction. See http://www.ican-online.org/pregnancy/misoprostol-cytotec-labor-induction-a-cautionary-tale

OK, I have gone on way too long here, because I resent how you try to divide women. I know you will deny it and say it is we who are doing that but it simply isn’t true. Let me end by saying the reason for so-called natural childbirth isn’t to feel pain for pains sake--it is to safely have a baby--what we all want. I know that my epidural let to my c-section, which was very unsafe, so to say it is safe is BS. I also know that my baby did not start having decels until after I had one as well.

see www.ican-online.org for more information on c-sections.
Heather Deatrick:

Your comment is filled with the mistruths and half truths of "natural" childbirth advocacy. I don't have enough time to address them all, so I'll just use one for purposes of illustration.

" I don’t think she can argue with the numbers that c-section is 4 times more dangerous for a woman than vaginal birth, yet it continues to increase."

C-section is NOT 4 times more dangerous than vaginal birth. Women who die in childbirth are 4 times more likely to have had a C-section than women who did not die, but that does not mean that the C-section caused the death. The most common causes of maternal death include pre-eclampsia, serious pregnancy complications and pre-existing medical conditions. Often the C-section is the last ditch effort to save the life of baby or mother or both.

Your claim is the equivalent of saying that brain surgery causes deaths from brain tumors because people who require brain surgery are more likely to die than people who don't need brain surgery.
Here are some abstracts. Amy, I know you don't accept abstracts as proof, even though abstracts include the conclusion, but these conclusions can be a nice discussion point for everyone else.

And to state my own position very, very clearly: I believe a pregnant woman should choose what is best for her and her child. A statistic can only tell you so much. It can't inform you fully about your situation. Anyone who tries to make you feel bad about yourself for not having your child in the way that you and your doctor are comfortable doing is a jerk. Any doctor who does fully inform you of all of your choices is also a jerk.

Source: Obstet Gynecol Volume: 109 Issue: 3 Pages: 669-77 Published: 2007 Mar

Abstract: OBJECTIVE: To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal). METHODS: Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries-3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal-240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay. RESULTS: Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74-2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000) (P or =4500 g. The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section.

And from a journalist's point of view:

You'd need to check out the original to get the bibliography and check her sources, but it's provocative.

Brink, Susan, U.S. News & World Report, 00415537, 09/04/2000, Vol. 129, Issue 9

(this is only a small part of the article--it's too long to publish all of it here)

Alarming technology. "The No. 1 factor is fear of litigation," says Anthony Scialli, professor of obstetrics and gynecology at Georgetown University. Doctors resort to a C-section at the first sign of trouble, and these days, technology provides plenty of early alarms. Electronic fetal monitoring, designed for high-risk births, is now routine. "The monitor tracings are overread. Physicians see trouble that isn't there," says Scialli. They're especially likely to see signs of trouble when the delivery has been induced, or when the mother got an epidural pain blocker very early in delivery. This month the American College of Obstetricians and Gynecologists introduced recommendations that could help stem the tide of C-sections--and that give a pregnant woman wanting to head off unnecessary surgery a guide for talking to her doctor.
The rate of C-sections edged downward from 1989 to 1995 as an increasing number of women who had given birth by cesarean tried for a normal birth with their next child--a so-called VBAC, or vaginal birth after cesarean. Some insurers, quick to recognize the cost savings, began to require that a woman go through a trial labor before a second cesarean. But physicians began recording a slight increase in complications from VBACs. "There were inappropriate candidates forced to have a trial labor," says Anita Showalter, an obstetrician/gynecologist in Kidron, Ohio. The increase in VBAC complications led to fewer physicians willing to risk it, raising the overall c-section rate.
And that rate was already too high, say many doctors. There are good reasons to avoid the procedure if possible. The maternal mortality rate, while still low with cesarean section, is three to seven times higher than with vaginal delivery. Even in the vast majority of cases where all goes well, a woman's recovery is long and painful. Six weeks after Jacob's birth, Woods still struggles to nurse him in a football hold under her arm, rather than the more natural hold across her belly. In bed, she piles blankets between her and the baby to avoid the painful kicks of his tiny feet.
oops. Some sort of crazy posting accident (probably me) messed up some of that post. There are several separate abstracts. Let's try that again:

Source: Obstet Gynecol Volume: 109 Issue: 3 Pages: 669-77 Published: 2007 Mar

Abstract: OBJECTIVE: To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal). METHODS: Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries-3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal-240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay. RESULTS: Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74-2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000)

On the other hand, here's a study attesting to the fact that your pelvic floor is better protected with caesarean, which you know, yeah, probably:

The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section.

Then there's:

Author(s): Renz-Polster, H; David, M R; Buist, A S; Vollmer, W M; O'Connor, E A; Frazier, E A; Wall, M A
Source: Clin Exp Allergy Volume: 35 Issue: 11 Pages: 1466-72 Published: 2005 Nov
[ PubMed Related Articles ]
Abstract: BACKGROUND: The composition of the intestinal flora in young children, if unfavourable, may increase the susceptibility to allergic disorders. Beneficial intestinal microbes originate from the maternal vaginal tract and thus are more likely to be transferred during vaginal births than during Caesarean sections (C-sections). OBJECTIVE: To determine whether children born by C-section have a different risk of allergic disorders compared with those delivered vaginally. We also tested the hypothesis that the risk of allergic disorders is highest for children born after 'repeat C-sections'. METHODS: A retrospective cohort study of 8,953 children aged 3-10 years. Children diagnosed with allergic rhinoconjunctivitis (AR), asthma, atopic dermatitis (AD), or food allergies were identified from the Kaiser Permanente Northwest Region electronic records. The children's sex, birth weight, birth order, postnatal exposure to antibiotics as well as the mothers' age, ethnicity, education, marital status, smoking status during pregnancy, and use of asthma or hayfever medications were identified through the mothers' medical records or through the Oregon Birth Registry. RESULTS: The risk of being diagnosed with AR was significantly higher in the children born by C-section than in those delivered vaginally: adjusted odds ratio (OR)=1.37%, 95% confidence interval (CI)=1.14-1.63. Delivery by C-section was also associated with the subsequent diagnosis of asthma (OR=1.24%, 95% CI=1.01-1.53); this association was gender specific, with a positive association restricted to girls (OR for asthma in girls: OR=1.53%, 95% CI=1.11-2.10; in boys: OR=1.08%, 95% CI=0.81-1.43). There was no significant association between mode of delivery and AD. If children born in a 'repeat C-section' were considered separately the risk of being diagnosed with AR increased further (OR=1.78%, 95% CI=1.34-2.37). The same increase was noted for asthma in girls (OR=1.83%, 95% CI=1.13-2.97) but not in boys. CONCLUSION: Caesarean sections may be associated with an increased risk of developing AR in childhood.

Just a few. Sorry for the mess up before.

That posted: CHOICE! That's the ticket, and as far as I can tell, we all agree about that, right?
odetteroulette:

" A statistic can only tell you so much. It can't inform you fully about your situation"

Statistics are the aggregated experience of hundred, or thousands, or even millions of women. They can tell you the probability of various outcomes, but, of course, they cannot tell you what is going to happen in your particular situation. That cuts both ways, though. Statistics tell us, for example, that breech vaginal delivery increases the risk of neonatal death approximately 6/1000 compared to C-section. You could reason that since the odds are low, you can assume your breech vaginal delivery will be fine. Of course, it is equally likely that you will be one of the 6 whose baby will die. You can't know.

"CHOICE! That's the ticket, and as far as I can tell, we all agree about that, right?"

In medicine, it's always about INFORMED choice, not simply choice. You must have accurate information in order to make an informed decision and a lot of the information propounded by natural childbirth advocates is not remotely accurate, because they made it up.

Regarding the study you cited: it contains a glaring assumption for which no justification is provided. The authors studied planned C-sections with no DOCUMENTED prenatal risk and assumed that these were "elective" C-section. However, it is well known from other studies that birth certificates are notoriously unreliable for failing to record existing prenatal risks. A recent study noted, for example, that more than 50% of patients with significant heart disease did not have this fact recorded on the birth certificate. Therefore, unless the authors can demonstrate that the women in the planned C-section group had no RISKS, no merely no documented risks, we are not free to assume that the C-sections were purely elective, and that calls the results of the entire study into question.

Natural childbirth advocates love to claim that obstetricians don't follow the medical evidence. The real problem is that natural childbirth advocates are not familiar with ALL the evidence. They find one paper that they like and they assume that is the only paper on the topic worth considering. Medical professionals are required to review all the evidence in order to give the patient the best possible recommendation.

Sure, the choice always belongs to the mother, but if it is not an informed choice, it may not be the choice she really wanted to make.
The authors studied planned C-sections with no DOCUMENTED prenatal risk and assumed that these were "elective" C-section. However, it is well known from other studies that birth certificates are notoriously unreliable for failing to record existing prenatal risks.

Wouldn't the same error of undocumented prenatal risks exist for the vaginal birth cohort? Do you honestly believe that an elective C-section offers no additional risk (morbidity and mortality) over a vaginal birth? Surgery vs. no surgery for a routine delivery? That seems like an impossible position to defend using any statistics or logic.
I know I didn't want to go to the hospital when I went into labor, but the pain after a while became excruciating enough that I was unable to resist being loaded in the car and driven to the hospital. Once there, I was determined to be left alone. Would you believe they don't put locks on the bathroom doors in the maternity ward? Once extracted from the bathroom, I was put back on the bed. After a while, I was up on all fours and I think I wet the bed, but I can't be sure because I couldn't see straight from the pain. A nurse got me to sit down so she could check something or other and I latched onto her in a bear hug because I felt like that was the only way to keep my innards from being ripped apart. She hollered for someone and they pried me off, and then decided to attempt an epidural on me. By that time, it was too late to do one, so I gave birth naturally. I seriously thought I was going to die. I have no idea what the point of feeling like I was being drawn and quartered for two hours was all about, but it sure got me to a hospital.

Good post.
buckeyedoc:

"Wouldn't the same error of undocumented prenatal risks exist for the vaginal birth cohort?"

No. Studies on the reliability of birth certificates show that doctors and midwives tend to leave out risk factors; they don't make up risk factors for women who do not have any.

Here are two papers that address this issue directly.

How Well Do Birth Certificates Describe the Pregnancies They Report? The Washington State Experience with Low-Risk Pregnancies, Dobie, Baldwin, et al., Maternal Child Health Journal, 2:3, September 1998.

Conclusions: Because birth certificates significantly underestimated the complications of pregnancies, number of interventions, number of procedures, and prenatal visits, use of these data for health policy development or resource allocation should be tempered with caution.

The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data, American Journal of Obstetrics and Gynecology, Volume 193, Issue 1, 125-134, July 2005, M. Lydon-Rochelle, V. Holt, et al.

Results Birth certificate and hospital discharge data combined had substantially higher true-positive fractions than did birth certificate data alone for cardiac disease (54% vs 29%), acute or chronic lung disease (24% vs 10%), gestational diabetes mellitus (93% vs 64%), established diabetes mellitus (97% vs 52%), active genital herpes (77% vs 38%), chronic hypertension (70% vs 47%), pregnancy-induced hypertension (74% vs 49%), renal disease (13% vs 2%), and placenta previa (70% vs 33%)... Conclusion In Washington, most medical conditions and complications of pregnancy that affect mothers are substantially underreported on birth certificates,...

Look at the results of the second study. For virtually every serious pregnancy complication, more than half the cases appeared on the birth certificate as having no risk factors. It seems pretty clear that there is a serious problem with relying on birth certificate data to determine pregnancy complications.

"Do you honestly believe that an elective C-section offers no additional risk (morbidity and mortality) over a vaginal birth?"

But we are not talking about purely elective C-sections; the authors looked at non-emergency C-sections with no documented risks. Just because risks were not documented, does not mean that there were not medically sound reasons for the C-sections.

There has not yet been a study done of purely elective C-sections.
Some reports indicate that cannabis helps relieve labor pains. Such uses are reported among native tribes in South Africa and Southern Rhodesia: "The Suto tribe fumigates the parturient woman to relieve pain;"the Sotho women of Basutoland "are reported as smoking cannabis to stupefy themselves during childbirth," and have also been known to "administer the ground-up achene with bread or mealiepap to a child during weaning" (Watt, 1962:13).

So, I'm all for using this natural painkiller during childbirth.
Your honor, the witness is being non-responsive!

It just ain't that hard to compare a cohort of healthy primiparous women with normal pregnancies who want a C-section to avoid labor/delivery or vaginal trauma to a matched cohort going through a vaginal delivery. The risks of elective C-section are right out there in the medical literature (risks to mom and baby) with confounding variables controlled. I see a bunch of relevant articles in Clinics in Perinatology even with a brief PubMed search. I think you're dancing on the ACOG line of not really taking a stance.

And once again, the medical ethics literature argues in favor of C-section minimization... "Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication."

I've been through both delivery routes, and common sense is overwhelming me.
buckeyedoc:

"It just ain't that hard to compare a cohort of healthy primiparous women with normal pregnancies who want a C-section to avoid labor/delivery or vaginal trauma to a matched cohort going through a vaginal delivery."

You may not think so, but it hasn't been done because there simply are not that many women who choose purely elective C-sections.
Amy, you're completely reaching here. The point of that first set of studies clearly show the c-section, whether it had higher unreported risks or not ( and really, that's, you know, kind of a crapshoot--we'd have to guess), was more likely to have complications. Period. It was a big sample. This just makes sense. It's surgery. Surgery is more likely to lead to surgical complications than when you don't have surgery. See what I'm saying here?

My own doctor was very clear. The vaginal birth was slightly safer under most circumstances, but it was a small difference. The c-section was slightly riskier because of the possibility of complications, especially regarding the wound itself, but also because, after surgery, there are regular possibly complications. Like blood clots and such. This is not very complicated.

And I agree with you about informed choices. So much so that I anticipated you and talked about it in previous posts. Here. Recently.

Okay, we're not going to have a meeting of the minds. We never do. That's okay. But those were my thoughts.
buckeyedoc:

"The point of that first set of studies clearly show the c-section, whether it had higher unreported risks or not ( and really, that's, you know, kind of a crapshoot--we'd have to guess), was more likely to have complications. Period."

Whether it had unreported risks is not a trivial point. You want to make a claim about C-sections on maternal request. You must be sure that those C-sections are purely maternal request C-sections.

There is internal evidence, from the paper itself, that many of the supposed "planned" primary C-sections were NOT planned, primary C-sections. The classic case of planned primary C-sections is that they are chosen by older, middle to upper middle class white women with private insurance having their first baby. Indeed the majority of women having "planned" primary C-sections were white women with private insurance having their first baby. However, a surprisingly large number of women did not fit that profile. Out of the 3334 "planned" C-sections, there were 205 in women under age 20; 811 were having their 2nd, 3rd or more child; and 742 were on Medicaid. It is stretching credulity to believe that these were really "planned" C-sections with no medical indication.

Moreover, the paper itself does not offer a particularly strong case against elective C-section. Only 64 women were rehospitalized in the first 30 days after surgery and the most common complication was wound infection, occurring in 22 women. There were no serious post-operative complications.

Within the paper itself, as opposed to the abstract, the authors are honest about the limitations of the study:

"Our use of the term “no documented prior risk,” reflects the reality that there may be medical indications for cesareans not recorded or captured by the variables reported on the birth certificate and hospital discharge data studied here. Two recent studies have examined the reliability of birth certificate and hospital discharge data and find underreporting of some medical risk factors...

Applying the term “maternal request” to these planned primary cesareans is problematic, because none of the population-based studies, including ours, measure maternal request. Studies from other countries have cast doubt on a simple characterization
of medically elective cesareans as involving maternal request."

It is possible, indeed it is quite likely, that this paper does not tell us anything about purely elective C-sections because purely elective C-sections represented only a small fraction of the C-sections with no documented risk.
I had an orgasmic birth. In the hospital. Over forty years ago. With my feet up in stirrups. And the doctor even cut an episiotomy. I woke up in labor that morning. Not terribly painful or intense. The only weird thing was that my contractions never developed any sort of rhythm. Throughout the entire labor and delivery they were totally random. My doctor said not to come to the hospital until I was having contractions two minutes apart. So I spent the day walking around town, reading, knitting, eating lunch and occasionally timing my contractions, only to discover that they were still random. They gradually became more intense. At around 8 pm we decided to go to the hospital as the contractions were getting sort of close at least some of the time. The hospital was yucky. Everyone in their own little room, with nurses running in and out. There were six women in labor. Around 11 I went through transition and started pushing. The pain stopped and I began to feel intense pleasure. The baby's head became visible. At this point they hauled me out of the bed, loaded me on a cart, took me into the delivery room and put me on the delivery table. The entire procedure was a major nuisance since I was deeply engaged in trying to push out a baby. They put my feet up in stirrups and I continued pushing. The doctor told me he was going to have to cut an episiotomy and did. The baby came out. It was a moment of extreme physical pleasure. The doctor let me hold my daughter while he sewed up my episiotomy. Okay, now tell me that I made up the entire story! Thanks. I love to have people tell me that I am imagining things or telling lies to support a doctrine. So empowering...
On a side note - just about pain generally - there was an interesting item in the latest Economist about capsaicin, the chemical that gives chilies their spiciness.

Essentially, we love chilies despite the fact that they cause pain (including some pretty strong phyisical responses), and the reason is partly the high resulting from a rush of endorphins in response to that pain.

Completely separately from all this, there is interesting research out there about the way we humans (and probably other animals) form strong memories: highly traumatic events are burned in much more strongly than mild ones. I believe there has even been work done on drugs that block the chemical effects of trauma with a goal of keeping traumatic memories from being so intense (naturally enough the first practical use anyone could think of was giving it to soldiers so they wouldn't regret killing people so much.)

So, there are two plausible facts here: firstly, we do have an inherent capacity to enjoy pain after the fact because our natural pain relief chemicals give us a high. And secondly, our memories are far more intense when they relate to events that involve pain and trauma.

From this foundation, I would be prepared to believe that the "ecstatic event" idea, and also the "bonding with the baby" idea probably have some factual basis. Nor would I be surprised if these factors played at least a partial role in evolution in this area of life, although I certainly also buy the "seeking assistance" angle as well.

I want to stress, though, that this doesn't mean I am advocating painful births or anything! I just think that some of the peripheral issues are interesting.
Oops, I don't know how I managed to comment on this six weeks after everyone else! :)
I am the father of Heather Deatrick's child. She WAS informed of everything, and gave consent at every junction. The cause of the issue was that she had decided at the last week to to the "bradley method" and therefor thought she could deliver with no drugs, but lacking the training to pull it off. (personal opinion: thousands of women across the globe give birth each day with no drugs and no training, why cant "we"?)

As the father of Heather's child, and the parent who did the most work during his birth, I can say that her claims are false.
Birth in an empowering experience, Ina may Gaskin is a Qualified Midwife!
epidurals can cause severe allergic reactions and even anaphylaxis if incorrectly placed can cause paralysis and infection. Opioids cause Low APGAR scores and again people can be allergic to them.

as for Pelvic openings being Narrow, put anyone in the lithotomy position (lying on their back) and you will get a smaller pelvic opening and pushing up hill. Where as using gravity and having woman on their knees allows the pelvic cavity to open fully and the coccyx to move backwards to some degree allowing the ligaments to move freely.

Yes better nutrition does impact on a baby's size but so does smoking, drinking, Drugs.

allowing your body to do what in needs to do be that walk, sit or rock during birth is far better than being confined to bed with 2 belts while an electronic machine monitors a false state of being, woman are better mobile during labour than restricted in the same way as one would confine an animal. at the end of the day child birth is safer now due to hygiene and better skin to skin contact and we hope better breastfeeding rates to give baby a better immunological start to life.