AmyTuteurMD

AmyTuteurMD
Bio
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.

MAY 3, 2010 8:27AM

An industry devoted to ignoring and demeaning women's pain

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  woman screaming

There's something perverse about an entire industry predicated on the concept that excruciating pain is good for women. I'm talking, of course, about the "natural" childbirth industry, and the books, blogs, courses, videos and celebrities that comprise it. The "natural" childbirth industry isn't always sure that the pain of labor exists, but they are sure that if it does, it's desirable that women feel it.

The unalterable bedrock of "natural" childbirth advocacy is that women should refuse effective pain relief in labor. The "ideal" situation is for women to embrace their pain and pretend that it is "good pain." Of course, there is no such thing as "good pain": they just made that up. The pain of contractions and the pain of vaginal distention do not differ in any way from any other kind of pain. It is not carried by different nerves, it is not conducted through the action of different neurotransmitters, it is not routed to different areas in the brain. It is exactly the same as any other kind of pain. So the take home message of NCB is that the excruciating pain of childbirth should be ignored.

And not merely ignored. What's worse is that the NCB movement pretends that women are improved by experiencing the agonizing pain of childbirth, although they cannot think of any other instance in which human beings are improved by agonizing pain. The irony is that "natural" childbirth advocates have beliefs that are strikingly similar to the Victorian clergymen who opposed anesthesia in childbirth when it was first introduced in the second half of the nineteenth century. The clergymen believed that is was wrong to abolish labor pain with anesthesia because God intended for women to feel the pain. NCB advocates appear to believe that it is wrong to abolish labor pain because "Nature" intended for women to feel the pain. There is precisely zero concern for the effect of that pain on a woman herself.

The "natural" childbirth movement routinely demeans women who do not want to tolerate the pain. They are portrayed as weak, as "giving in," as uneducated and uncaring because they don't understand the "risks." Or worse. The ultimate insult, implied, but not always stated is that "authentic" women can and should accept the pain, and that, therefore, women who opt for an epidural are somehow less womanly.

There is one strain of "natural" childbirth advocacy that simply denies the reality of the pain. In this view, the pain of childbirth is psychosomatic in the true sense of the word. It does not reflect actual neurologic signals, but rather the social conditioning of women by a medical, technocratic culture. Pain is a manifestation of the fact that the woman has not "educated" herself that the pain doesn't exist, doesn't "trust" birth, and, once again, is not an "authentic" woman.

There is another strain of "natural" childbirth advocacy that acknowledges that the pain exists but that it can and should be "managed" in ways that are "natural" and inherently ineffective. The goal is not to abolish the pain; that would be wrong. The goal is to tolerate the pain so that the incentive to abolish it will be reduced. Hence the emphasis on hypnosis, water, and labor support. The pain is real, the pain is severe, and it is acceptable to reduce the pain. But it is only acceptable to reduce the pain in ways that involve no technology, and it is never acceptable to actually abolish the pain.

The "support" people in the "natural" childbirth movement exist primarily for indoctrination. The childbirth educator exists to convince women that pain is good for her, and pain relief is bad. The primary function of a doula is to interfere with a woman's desire for pain relief. At every point, the doula counsels the laboring mother that she does not "need" pain relief, that she's doing "great" and she "can do it," with "it" being enduring labor without an epidural.

At the fringes of the "natural" childbirth movement is a group that not only denies the existence of the pain, but inverts it. Childbirth is not painful, it is pleasurable. At the moment of birth, "authentic" women have an orgasm! No remotely plausible physiologic explanation is advanced for this claim, beyond the inane observation that the tissues that produce the pain of childbirth could, in different circumstances produce sexual pleasure. The explanation makes as much sense as the claim that kicking a man in the groin could induce orgasm because sexual pleasure can be produced by contact in the same area.

Why are "natural" childbirth advocates so invested in the idea that women "should" experience excruciating pain in labor? Why are they invested in the idea that women benefit from experiencing labor pain? Why do they direct the bulk of their efforts, both before and during labor, to pressuring women to forgo effective pain relief? Why do these efforts include misinformation about the "risks" of epidurals, and insinuations about the fitness of the laboring women as a mother, and even insinuations about her fitness as a woman?

I don't know all the answers to these questions, but I do know this: it is inherently wrong to ignore the pain of women and to pretend that agonizing pain is good for them.

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Thank you, Dr. Amy, for bringing this idea to the fore. We should not have to make excuses for ourselves when requesting pain management when giving birth. It hurts! I'd like to see one of those Victorian guys pass a kidney stone with no laudnum and see how much "God intended" for them to feel pain.
I used an epidural with my first child and fully plan on one for the next. I wish that I had read this article a couple of years ago, it would have made brushing off negative comments a little easier. Thank you.
This article is predicated on a false assumption right from the start that all deliveries are inherently “excruciatingly” painful. I've had 3 children, one with an epidural and two with no pain medication whatsoever, and each birth was different in terms of level of pain. Because I was not allowed to move enough to get comfortable in the hospital after they strapped the fetal monitors on, I had an epidural with my first child; the epidural was a NIGHTMARE. I hated it. I hated the pins and needles sensation during delivery and I really hated the severe back ache I was left with for days afterward. With my second child I refused the epidural and I DID NOT HAVE PAIN beyond a level similar to period cramps during contractions only; that delivery was a breeze. With my third child I had "back labor" and I will freely admit that there was a lot of pain during contractions. There were a couple of times when it got bad enough that I was thinking of asking for the epidural but the intensity passed almost as quickly as I had the thought, and I had great support in the form of a student midwife who also practiced acu-pressure. She dug her thumbs in my back where it was hurting and once she started doing that it controlled the pain for me as well as an epidural without the side effects. In retrospect, for me, I was thankful I didn't have the epidural after all because of a few minutes that were tough during the labor. I mean, I REALLY hated the epidural that much that the discomfort of back labor was the better option for me. I know not everyone will react to epidurals the same way, but isn't it better for all options to be on the table, so that women can make their own informed choices? The natural childbirth movement went radical because they are fighting the entrenched medical establishment that tells a woman not to trust herself, that it's OK, dear, we doctors know better than you do how to handle things. The natural childbirth movement empowered me to make the right choices for my birth. No one held me captive and "forced" me to deliver without medications, but they did give me the power and knowledge to fight the established medical system and do things my way, with the safety of modern medicine as a back up if anything went wrong. I have absolutely no regrets, and if I were to have a fourth child I would do things the same way- no meds for me. Bring on the “pain” and keep your epidurals. (Because it really isn’t excruciating to deliver a child, as I know from personal experience.) If other women decide they want the fully medicated delivery, that’s their choice, too, and I’m glad it’s out there for them, which must be said lest I sound judgmental. What a wonderful world it would be if we were all educated in every option and entitled to make our own best choices without anyone, the medical establishment or the natural childbirth movement, or anyone else for that matter, sneering at us for it. Even, dare I say it, supporting us in what is best for each individual and the choices we make! Wow, what a concept!
RamblingFamilyManager:

"The natural childbirth movement empowered me to make the right choices for my birth. "

Why would you need to be "empowered" to refuse pain medication?

Labor pain is like any other form of pain; there will be a range of patient experiences. Some people need a lot of narcotics after surgery, some need very little, and some can get by with Motrin. Some people need a lot of narcotics after breaking a bone, some need very little, and some need none at all. No one needs to be empowered to refuse pain medication after surgery or after breaking a bone. They just refuse it and they don't get it.

Natural childbirth doesn't empower you to refuse pain medication; you can always do that. It attempts to convince you to refuse pain medication and insists that refusing pain medication is "better" than accepting it.
The empowerment wasn’t only to refuse pain medication, although that was a part of it, the empowerment was to do things my way thus reducing the need for pain medication in the first place. I didn’t need the medication for my second and third deliveries because I had other ways of handling pain management. That’s how the medical community refers to it, isn’t it? Pain management? Medication isn’t always the answer for managing pain, and sometimes makes the problem worse. During my unmedicated labors the discomfort lasted only as long as the delivery itself. For the delivery with the epidural I had the pins and needles sensation while the medication was working, which I hated, then the severe back pain for days afterward. “Just a side effect”, you know. There were other things that I did my way during the unmedicated deliveries, thanks to the things I learned in my natural childbirth class. (And I didn’t go with Lamaze, which is useless and only teaches you to be a good, compliant patient, at least the way it was taught in my hospital.) I knew from the first delivery that the fetal monitors made me really uncomfortable and added to my pain, so I labored at home as long as possible with my second. (And just try to labor in a hospital without those things slapped on you the second you get in a bed.) By the time I finally went in I was far enough along that I didn’t want to move around much anymore anyway, so that worked out well for me. I also didn’t let them give me Pitocin again, which increases the pain of labor. (My first OB needed to get to his golf game, thus the need for the Pitocin that time. There was certainly no medical reason for it.) Hospital procedures are designed for hospital convenience and liability reduction, not the comfort of the patient, and all too frequently result in increased pain to the point that yes, medication becomes necessary. That’s what happened with my first delivery and natural childbirth classes gave me the information I needed to not let it happen again. I stayed home and avoided the fetal monitors and Pitocin in early labor. I had a doula, which you’ve sneered at but I found to be very helpful, (the nurses told me she was exceptionally good compared to others they met, so I know the quality of their help varies), and I had relaxation techniques under my belt that helped significantly. With my third child I had the student midwife, her blessed thumbs, and her knowledge of acu-pressure techniques. I did have pain but it was managed quite well without medication. There are other ways, and the sooner the medical establishment opens up to that idea the better off we’ll all be. Standard medications and standard hospital procedures have their place and I am thankful for them, but there are other ways of doing things, including other ways to manage the discomfort of labor. Some people want the medication right away, others of us want to avoid putting those chemicals in our bodies and the bodies of our babies unless it becomes absolutely necessary, so we try another way. The option to have the medicine is out there, of course, but the decision to try to avoid it should also be supported by both doctors and hospitals, which it all too frequently isn’t.
"others of us want to avoid putting those chemicals in our bodies and the bodies of our babies unless it becomes absolutely necessary"

Yes, that's part of the effort of NCB advocates to scare women into refusing pain medication. It is far more dangerous to your baby's health and well being to put it in the car to drive home from the hospital than to have an epidural. So if NCB advocates are so concerned about avoiding risks to babies why aren't they counseling mothers to walk home?

The medication in an epidural is similar to the medication used for dental work. Do you avoid putting chemicals in your body during dental work? Should other women try to avoid chemicals during dental work? Would you be empowered by refusing novocaine for dental work? Why is labor pain any different?

It isn't any different. NCB advocates simply like to pretend that it is, because they think women OUGHT to experience labor pain and that they will BENEFIT from the experience. It's an astoundingly misogynistic viewpoint and it is wrong.
First of all, I am speaking from personal experience here. The experience of having delivered three babies, each delivery different from the others. I am also speaking from the personal experience of dealing with a full on traditional medical delivery and how I was treated then (talk about misogynistic!) as versus how I was treated during two non-traditional midwife deliveries that were influenced by the “NCB” community. I took a Bradley class before my second child was born. There was no attempt to deny that there would be pain and discomfort during childbirth; rather the emphasis was on how best to manage that pain through movement, finding a comfortable position in which to labor, and relaxation techniques. There was never any implication that a woman would be somehow unfulfilled or less of a woman if she chose to take pain medication. There was no pressure to do it “the Bradley way”, rather we were given an education about what childbirth involved, the work our bodies do during labor and delivery, and what our options would be. I am confused by the statements in the article that the NCB movement “pretends that women are improved by experiencing the agonizing pain of childbirth” when this is so far from what I encountered when I was involved with this same movement. It was all about pain management, just not with medication. Again I will state there are many ways to manage pain; it may be shocking, but the medical community doesn’t have all the answers. Some women have bad reactions to epidurals. I was one of those women so I sought out a different way that worked for me. As to the example of dentistry, it doesn’t hold up. If I had to have dental work done during pregnancy I would do my best to put it off until after the delivery so as not to expose my baby to those medications. By the same token I would also avoid routine X-rays during pregnancy. There are things we don’t do when we are pregnant unless absolutely necessary, all in an effort to protect the developing fetus. Now, when I have to have dental work while not pregnant, bring on the nitrous oxide. I’ve had considerable dental work done and that pain is so different from labor that there’s no comparison. (It’s not like you can massage your teeth while the drill is running.) No, not all pain is the same, so I completely disagree with you there. The pain of a muscle cramp is different from a knife wound is different from a bump on the head is different from a root canal. The pain of childbirth comes from muscle contractions and the work of our bodies. (I don’t know what you are talking about regarding vaginal distension; I never experienced any pain in that area. Once dilated, the actual pushing and delivery are not at all uncomfortable.) Thus the methods of pain management differ. You wouldn’t manage the pain of terminal cancer the same way as the aforementioned dental work, for instance.

I would ask the doctor- have you personally experienced a non-medicated birth? Have you taken a Bradley class? What is your personal experience in this area beyond supervising fully medicated deliveries for other women? Are you only advocating for the medical and pharmaceutical communities without giving proper consideration and study in an open minded fashion to other options? Yes, I am sure there are radicals on both sides out there, as in every area of life, but to paint the entire natural childbirth movement with that same radical brush is wrong. The opening statement, “There's something perverse about an entire industry predicated on the concept that excruciating pain is good for women” sets up a false argument. Using the term “an entire industry” is the first flaw. Saying childbirth equals “excruciating pain” is your second flaw (some births are painful, some are not, and it’s the individual woman’s perception as to whether or not the pain is excruciating, as you’ve already conceded). Finally, nowhere in my experience has any natural childbirth professional EVER said pain is good for women.

I hope, with my comments, to share a different experience with the natural childbirth community than the one depicted in the article. The Bradley Method was a blessing to me and allowed me to deliver my second and third children without suffering through the prolonged side effects of an epidural, the method claimed to “actually abolish the pain”. Epidurals do not “abolish the pain” for every woman; for me they only changed it and delayed it, because the back ache I got as a result was much worse, and far longer lasting, than labor itself.
“An Industry devoted to sedating women so they cannot interfere, because men know what’s best for them”
While your blog heading was certainly chosen to elicit a passionate response, it is no more completely true than mine is. The reality lies somewhere in the middle I would guess. The fact that you’ve written and presented a 10 paragraph post about childbirth without ever mentioning a child is somewhat worrying to me. (They’re what come from childbirth –they are the often slimy, screamy end product!)
If what you presented were an accurate depiction of NCB, then you'd be correct: the depiction which you base your post upon is offensive. I don't share the same understanding of NCB as you do, or I would not ever consider NCB as an option.
My loose understanding is that NCB acknowledges a woman's conscious choice to bring a child into the world in the best way possible, to celebrate the creation of and closeness with that child which only woman are blessed with in this way. And, while medication, or medicinal pain management, can play a role in the childbirth process, the reality is that it is not always used only when needed, sometimes to the detriment of that closeness, awareness of a woman’s own body and risk to the child. In the eyes of some people, our medical system occasionally runs like a factory farm when it comes to birthing. NCB simply acknowledges that, as a species, we'd given birth for a very long time without medication, as most other mammals still do.
To me you’ve come across as an OB/GYN who is seething because NCB moms, doulas, etc. are getting in the way of how you want to deliver their babies, asserting that you know best. Therein lies the problem.
The NCB myth of the One True Way to give birth is intense and unfortunate. All the hand-waving about empowerment and OBs pushing women into interventions they don't want seems bizarre to me. Is it, perhaps, a handy excuse new mothers use against the militant faction of the NCB movement?

Anecdotally, in both my hospital births, there was no pressure. My OB and the nurses were absolutely lovely. I could do whatever I wanted: eat, walk, shower, wear my own clothes, etc etc. I just had to mention it. It probably helped that my general demeanor tends to be calm--even during childbirth, and I had the expectation that they would be reasonable. Interestingly, the second time I could not have the epidural I asked for (in advance) because I dilated extremely fast. (My OB almost didn't make it in time, and the nurses were prepping to deliver.)

Let me restate that: I asked for an epidural and it was not available to me. This calls into question the assertion that OBs force/coerce women into having epidurals.

Since the outcome was both of us surviving in good health, I do not feel like my "experience" was ruined by the preventable trauma of extreme agony.
Pain is pain. Women no longer die of childbed fever and there is no reason for a woman to suffer in pain in childbirth when an epidural can be given. We are not in the 19th century. We don't do surgery by giving a shot of whisky and pinning a person down, why does childbirth have to remain in the darkages?
Thank you for the informative post Dr. Amy.
rated
"First of all, I am speaking from personal experience here."

As opposed to whom?

I have a lot more personal experience than you do, both delivering babies and giving birth to them. Does that mean I must be right?
muse2r:

"The fact that you’ve written and presented a 10 paragraph post about childbirth without ever mentioning a child is somewhat worrying to me."

That's because NCB has nothing to do with babies, and not much to do with birth, either. It's about what is "good" for women and what they "should" do. In the NCB world, labor pain is good, women should feel it, they are "improved" by it, and they should never abolish it.
In my experience, it is the OB and hospital staff that denied me information. I have short labors. I walked into the hospital with my first labor, already dilated 8 cm. I was in pain. I asked for painkillers, and was denied. The nurse told me it was my first labor and I had another 8 hours or more to go. I learned later that out in the hall, the doc told my husband it was almost over. I started screaming that I couldn't take 8 hours of this. The nurse gave me a tranquilizer. That made the pain worse. I could only scream incoherently after that. Then, when I was done pushing, and the pain was over, the OB gave me a spinal to stop the pain of the episiotomy. I had no idea what was going on. I think a spinal is overmuch when a local could have done it, and I'm not even sure episiotomies are necessary. Plus, since I'd had the spinal, they wouldn't let me hold my newborn child. They said I might drop her. They wouldn't even put her on my tummy. And trying to sit on that cut hurt for weeks.

My 2nd labor was only an hour. I didn't get out of the bathroom. Natural delivery feels like extreme stretching, but it's not a pain level that I would medicate. And I did not need an episiotomy. I wish hospitals were as nice a place to give birth as my bathroom. I got to hold and nurse my second daughter right away.
To Dr. Tuteur:
I noted that I am speaking from personal experience in order to give specific examples to counteract the generalities in the article. I am sure you have significantly more personal experience with highly medicated traditional deliveries. I am wondering, however, about your experience with moms who have received natural childbirth education from a reputable source. Have you taken a Bradley course, for instance? Have you had a child yourself using natural childbirth techniques for pain management? Having a child without an epidural because you were too far along is very different from having a child without an epidural because you are prepared for a natural delivery and have other ways of dealing with labor pain.

As I know from the three very different births I experienced, each one is different. I learned the very important lesson from those experiences that I should not generalize. If I went by my second birth, with a labor that was no worse than having period cramps, even easier in fact since the discomfort stopped between contractions, then I would think anyone who says childbirth is painful is crazy. If I went only by my son’s birth, which was very uncomfortable with bad back labor, then I would say yes, childbirth is extremely painful. (But also manageable since I still say I prefer dealing with unmedicated labor to the pain I got with my one epidural.) By the same token, I can acknowledge that many women will not react to the epidurals the way I did with my first birth and will prefer that to natural childbirth. I do not judge them; it is their choice and more power to them and I am glad the option is out there for them. I am simply stating that for some women natural childbirth methods of pain management are preferable to epidurals. I am also stating that I disagree with your stance that the natural childbirth movement is “an industry devoted to ignoring and demeaning women’s pain” since my personal experience was so very different from that.
"I am sure you have significantly more personal experience with highly medicated traditional deliveries. I am wondering, however, about your experience with moms who have received natural childbirth education from a reputable source."

I have delivered hundreds of babies to women who had no anesthesia and no interventions. Most made that choice NOT because they had bought into a particular philosophy, but because they didn't need those things.

And, I have had two unmedicated births myself. I didn't find them the least bit "empowering" compared to my other births. The only difference was that they were much more painful.
But you still haven't answered the question- have you taken a Bradley class?
"Having a child without an epidural because you were too far along is very different from having a child without an epidural because you are prepared for a natural delivery and have other ways of dealing with labor pain."

Really? In what ways do they differ? Does this mean that because I wanted an epidural and it was unavailable, I don't get to brag about a birth free from medical pain management?
It suddenly occurred to me that we are probably talking about apples and oranges here, or night and day, because that is the difference between Lamaze and Bradley. Dr. Tuteur, if you took out "natural childbirth movement" and inserted "Lamaze" in its place in this article, then I would be cheering you on, but there is more to the “movement” than Lamaze. I’ve taken a Lamaze class and it was absolutely useless; huffing and puffing does nothing for pain. When I took the hospital sponsored class all they taught was how to be a good, compliant patient and do exactly as you are told without question. They even used the class to get informed consent forms signed for epidurals.

Bradley, on the other hand, is worlds different. It was not taught through the hospital but rather by a well trained private instructor. We learned about the birth process and what is going on in our bodies during labor and delivery. We learned exercises to condition our bodies for the work of labor. I mean, it’s called “labor” for a reason. You wouldn’t run the Boston Marathon without training, would you? Well, birth is the same way. We also learned very effective deep relaxation techniques so we would be able to calmly let our bodies do the work they know how to do. There was a lot more to it; we met weekly for a few months so I can’t begin to cover the course content here. No one was made to feel like they would be a “failure” if they decided to get pain medication, or told they would be less of a woman somehow. (Although I will give you this- Dr. Bradley, who came up with this method, was very old fashioned in his views about women. His work has been updated by Susan McCutcheon so if you are planning on doing any reading about this I would advise her book over his.)

To Anthropologist Underground:
You can brag about anything you choose; you don’t need my approval. I will offer you my sympathies, however, since a birth without pain medication when you were unprepared for it with truly effective alternative pain management strategies must have been horrible.

It’s the same Boston Marathon comparison. Would you run the Boston Marathon without training for it? If you found yourself in a situation where you HAD to run the Boston Marathon but you weren’t ready you’d be screaming for pain killers by the second mile. (But I don’t think the doctors would be following you around with an epidural for it, either.) Having a baby is hard, physical work and if you aren’t ready for it, it will hurt a lot more than it has to. When I said having a child without an epidural because you were too far along is very different from having a child without an epidural because you are prepared for a natural delivery and have other ways of dealing with labor pain this is what I meant. I prepared, using Bradley exercises, for months for my second and third deliveries and it made all the difference. My second child was so easy; she just popped right out without any fuss. The nurses couldn’t believe it; they kept looking in on me and were astounded that I wasn’t asking for any pain medication. For what? I wasn’t in any significant pain at all; I’ve had period cramps that were worse. My third, well, he was a different story, but I was also prepared for him and was very happy I didn’t get an epidural since I reacted so badly to my first one. That labor HURT when I lost focus a couple of times, but with the Bradley relaxation techniques and acu-pressure I pulled it together and the pain was controlled better than any epidural could have done.

Here are a few thoughts I wish I could share with every pregnant woman. First, just because you are planning to have pain medication doesn’t mean you will get it. (As other comments have noted, sometimes, for whatever medical reason, the doctors won’t give it to you.) Secondly, some women react badly to epidurals and pain medication. I didn’t like the way the epidural made me feel and the back ache I had for days afterward; I’ve had friends who told me they got migraines from hell from their epidurals. I HATED my epidural so much I turned away from it completely for my second and third children. Pain medication HAS SIDE EFFECTS, sometimes they are nasty side effects, and they don’t take away 100% of the pain anyway. Finally, Lamaze is useless. If you want to be prepared for childbirth find a Bradley class. It doesn’t matter if you are planning on getting all the drugs in the hospital because you may not be able to have them, so you’d better have some other ways of dealing with pain under your belt. It never hurts to be prepared.
Sigh.... Thanks for the condescension RFM. It strikes me that this is exactly the type of competitive, dismissively arrogant attitude that colors the NCB proponents with the taint of extremism.

Most women in our society who enter childbirth are aware that a variety of pain management techniques exist. Many of us have taken a variety of classes and have lots of "tools" in our toolbox. Many of us have exercised, either read Bradley or taken classes, done yoga, practiced calming techniques etc, and bring these to bear during childbirth. This is how I got trough a delivery with pitocin, but without an epidural with calm and focus. I never said my experience was horrific or I was unprepared for the agony--just that I had asked for an epidural and it was unavailable.
I guess what I'm doing such a bad job trying to articulate is that there is no reason for NCB proponents to pressure women to give birth a certain way. Or to make them feel badly for giving birth in a hospital, or with an epidural, or for not eating the placenta, or whatever the latest NCB protocol-du-jour is. IMO childbirth method is one marker of status/inclusion among a certain subset of mothers. Instead of celebrating the birth of a healthy baby, the conversation turns to "what if... you were educated, or took Bradley classes, or hired a different doula, or did it my way... " It's unfortunate that new mothers have to develop methods to brush off these types of comments.
To AU:
I apologize if you perceived any condescension in my comment; it was not intended that way at all. I was wrong to make assumptions that your experience was horrible. I am not up on what “most women” know about childbirth these days; my first pregnancy was way back in the dark ages. (She’s almost 17 now.) I certainly didn’t know about Bradley at that point, although I learned before my second came along out of desperation to avoid another epidural. (My second child is 9, my youngest is 7.) All I have done here is speak from personal experience, stating that I believe the good doctor was wrong in her statements that the “entire” natural childbirth industry wants women to suffer, and that women are judged as somehow lacking if they don’t tow the line. I also refute the implication that medication is always the answer and takes away all the pain. I’m not judging anyone. If you want a highly medicated birth and that works for you, great, go for it. Many, many, many healthy babies were born that way and went on to bond with their moms and have happy, healthy, successful, wonderful lives.

I can also see your point that there are certain groups of women who will be snotty about it, but that’s competitive human nature and not the fault of the methodology itself. Why would you even want to be friends with women like that? I mean, who needs it? There will also be women who will judge you for not going to the “right” doctor or putting your child in the “right” pre-school, or buying the “right” outfits or stroller or whatever. Jerks are out there, but it isn’t fair to say the entire natural childbirth movement advocates that kind of behavior. As your kids get older and you get past that “Mommy and Me” phase, you’ll find it matters less and less. No one asks about how I delivered my babies at soccer practice or Girl Scouts or in the waiting room at dance, for instance. It feels like everything when they are little but it ceases to matter once you get past that stage. Don’t worry, though- those judgmental types will find some other way to deem the rest of us as unworthy. ;)
I've been following your posts for about a year now, and I finally had to chip in.

I just don't think there is one right way to have a baby. I'm a mom of two kids (one born at home, one born in the hospital). I'm also a practicing doula. I had my first baby in the hospital, I had an elective induction, I had an epidural, I had all of the "interventions"... and I had a GREAT experience. I had my second baby at home, totally "naturally", with a midwife and I had a GREAT experience.

As a doula I support everything from drug-free home births to elective surgical births. What is right for me, my body and my baby isn't necessarily what is right for the next woman, her body and her baby.

All to often I meet other doulas that are really pushy about the wonders of "natural birth". And I used to be too. What changed? A few things... last year I had a home birth mom look up at me after her "natural" home birth and ask, "Where's my big rush of endorphins?". I was speechless. It never occurred to me that not every woman would get that great rush that I experienced after my home birth. I've also seen very difficult attempts at natural/vaginal deliveries that have turned into unwanted surgical births... causing trauma to the mother. It wasn't the surgery itself (in my opinion) that traumatizes the woman... it's the expectation (usually from NCB books or classes) that if she does XYZ she'll get this "empowering, beautiful, pain-free" natural birth. And that is a bunch of BS.

Penny Simkin talks about the difference between pain and suffering. When you go on a long hike your muscles may ache... but most people wouldn't want to take pain meds to relieve a healthy muscle ache. The pain from childbirth is interpreted differently by each woman. If it's tolerable for one woman and she wants a natural birth - go for it! But for someone else, getting an epidural as soon as possible is the most appropriate solution for her discomfort.

I believe the most important thing we can do in our society is to educate women about their options (and I mean unbiased - not pushing towards "natural" birth or the other side making elective c/s sound like a day at a beauty spa-which it most definitely isn't), helping them find supportive and well qualified caregivers, then making sure that they are able to birth in an environment that is safe and supportive. I never want ANY woman to look back on her experience and feel badly about it, whether it goes exactly as she had hoped or it was the complete opposite of what she expected.

Can you meet me half way on this Amy? Do you think NCB is always inappropriate? I'm curious about your opinion...
"Do you think NCB is always inappropriate?"

There's nothing wrong with unmedicated childbirth. It's a choice, and I agree completely that women should make the choices that are right for them.

The philosophy of natural childbirth is something different. It does not acknowledge that different women will want different things. It starts with the principle that unmedicated birth is superior and that anything else is inferior. Moreover, there is an effort to tie unmedicated childbirth to notions of "authentic" motherhood or even "authentic" womanhood. At the heart of the philosophy of natural childbirth is the belief that women ought to suffer pain in labor and that women are improved by the experience. That's what I object to.
Very good article, Dr. Amy. My only criticism-- the photo is a woman with eye shadow, mascara, flawless eyebrows with no sweat on them, and clean hands pulling back her hair as she screams. Typically screaming women with intact eye shadow are engaged in something other than labor.

Just saying.

Another thought-provoking piece.
I've had two children and two successful homebirths...so you know from where I'm coming. Why so venomous towards homebirth? Worried you'll lose your job? LOL. Birth is SERIOUS BUSINESS, eh?

Really, for me the pain was worst when I was in any position other than leaning forward, on my knees, or leaning forward, standing up (pressing my arms against a countertop or something). My husband even commented on it; he said, "You know, all the birth stories we hear from women who went to the hospital talk about all the pain, and how the women were always in bed, either sitting up or actually reclined. You NEVER put yourself into that position. And you were never in bed!"

It's true, Ladies. Read the above paragraph again. I never PUT MYSELF into a painful position. I'd like to see you choose your position at a hospital.

That's what homebirth is all about--CHOICE. At home, the midwife was on MY turf. I was relaxed and comfortable and did whatever I needed to do--for example, like I said above, leaning against the counter during a contraction. With my second child I walked around the house--stark naked--to keep labor going, stopping every minute or so to deal with the contraction, then going right back to walking. Again, you can't do that in a hospital.

My midwife--the best and greatest woman in the world, other than my mother--ALWAYS allowed me the option to transfer to a hospital, for any reason I chose, including pain. She also had VERY STRICT rules about certain medial conditions that she would never attempt to assist a homebirth--ie, breech, etc.

Like I said before, at home I was able to put myself in the least painful position possible--so my pain wasn't that bad. There was one time when I was in the pool (called an "aqualdoula"--a really big portable pool for labor) relaxing, leaning my back up against the side. A contraction came on and it was the worst pain I'd ever felt! I quickly scrambled up onto my knees (it must've looked hilarious with my big belly) and instantly the pain was cut in half, and quite bearable. Also, when my midwife checked me (she did so only at my request, by the way) it was really painful.

So if you're going to a hospital, be forewarned: they check you a lot and they don't let you get into the most pain-free position possible. (My theory is that they WANT you to be in enough pain that you'll take the epidural, because once they've got that in you you're stuck in bed and they can more easily control you.)

That's right. This is not a debate about which method, homebirth or hospital, is safer: it's a debate about CONTROL. CONTROL of women, CONTROL of babies, and most importantly, CONTROL OF MONEY.

I resent your phrase "quack" when in reference to anyone other than an OB/GYN who decries a woman's prerogative to CHOOSE her method of birth. It's fine if you want to propel your own beliefs, but do so in a positive (affirming) manner, rather than trying to knock down others. What are you so afraid of? Afraid women reading your blog have already searched the Internet and found gobs of positive homebirth information out there, and you'll lose business? It's doubtful that would happen: the media's got you covered when it comes to negative imagery about birth.

Ladies, don't listen to "Dr" Tuteur! She's full of it--"it" being her own pecuniary self-interest!
Pt 1 of 2
Many moons ago, after “accidentally” learning of the Bradley Method® of natural childbirth in nursing college while researching the role of the father in labor for a report, I decided I would attempt natural birth with the father at my side as my doula. I had 4 hospital births. I did not want or have any pain meds for the labors or births for the health of the baby and because I wanted to be totally me, awake, alert and actively participating and in control, not a drugged body giving birth to a drugged baby as was the case in my own birth.

1st baby, due to pressure from an impatient OB, I was administered pitocin 12 hours after pre-labor rupture of membranes and insignificant progress. In spite of the feeling that my cervix was repeatedly being rammed by a telephone pole by these unnaturally strong contractions, a healthy, otherwise drug-free 6 lb 6 oz baby boy was born only 2 hours & 9 minutes after induction Apgar 9/10.

The only pain med I ever had in childbirth was for an episiotomy repair with the 1st baby.

Dr. Amy, with all due respect, I really don't see why you chose to present such a harsh and erroneous depiction of “the” philosophy of natural childbirth.

There is no single philosophy of natural childbirth.

Women choose natural birth for a variety of reasons. Some are selfish, and some are self-less. You can say the same thing for women who choose to have a medicated birth, and those who choose to have an elective cesarean birth. Also, there are doctors who will choose to sell a mom on a medicated birth or cesarean birth procedure for selfish reasons; it’s not always for the sake of the mom or the baby!

After parenting for 27 years, my husband and I now prepare expectant couples for natural birth as certified Bradley® natural childbirth instructors. These couples come to us; I have not advertised locally yet (though I plan to soon, so potential couples will realize they need 3 months to train rather than 4-8 weeks as with other classes.)

These couples not only choose the path less taken today, but they also spend 12 or more weeks following an excellent pregnancy diet, exercise to prepare for birth and postpartum, and deep relaxation and natural breathing which is very effective for pain management. They are very committed to their goal. They want to be in control of their bodies and take responsibility for how their baby comes into the world.

In our classes the couples are reminded that the ultimate goal is for a healthy outcome: healthy baby, healthy mother. They know there are times intervention is necessary. They are prepared for normal birth but should expect that there are times that medical and surgical techniques are necessary. They prepare for decision making and communications with their health care providers regarding options and necessities. They are smart health care consumers. They expect their doctor or midwife to serve as a lifeguard, should a problem arise.

All potential parents should evaluate all options with an open mind just as they would research a major purchase. There should be a well-thought out plan and practice and rehearsal for this major life event.

Birth pain is pain with a purpose. Labor is hard work. For many of us who prepare for natural birth that is all it is. Hard work. Very hard work. Pregnancy is not an illness or medical condition; it is a normal life process. Uterine contractions naturally cause sensations just as other natural body functions such as peristalsis or hunger or a full bladder typically cause characteristic sensations that cue us as to our needs and progress.

One of our moms hates needles and on the surface, this seemed to be her primary motivation for wanting a natural childbirth—to avoid needles. She actually was very health-minded and took good care of herself even before her pregnancy. Another mom we had is quite fitness and health oriented. She had a hip replacement and was petrified that under the influence of an epidural, someone might cause hyperextension of her hip, damaging the 2 year old repair.

Both of these prima gravid women who seemed to have fear of interventions, successfully relaxed and performed magnificently, succeeding at medically uneventful natural birth.

There are plenty of women who fear the pain of childbirth or who don’t have the time to prepare adequately for a natural birth, so I'm sure you and like-minded OBs will never run out of clients happy to have epidurals and cesareans. These women are free to make that choice, at least today. God forbid the cesarean becomes the only acceptable way to give birth in a hospital!
Pt 2
Natural birth prep can not be learned in a one day seminar. One can learn about it by reading a book but achieving it takes a lot of preparation and readiness for the unexpected. A significant though not lengthy part of training for natural childbirth is to learn about the average birth today in order to avoid getting on the conveyor belt that leads to an experience laden with interventions unnecessary for natural vaginal birth.

Doesn’t it make sense to encourage others be as prepared as possible for success when aiming for a drug-free birth? The analogy about preparing for a marathon is an excellent one to compare natural childbirth prep to. Mocking the natural birth movement draws attention away from the many valuable things taught for a healthy outcome, useful even should a cesarean end up necessary. Applied lessons help with relaxation whenever needed for pain (for a lifetime) and the nutrition and exercise help with healing and recovery.

Also, most of our moms choose to breastfeed, even though most of them will go back to work. Unnatural (drugged and surgical) births often hinder the initial early bonding and nursing experience crucial to a good start. These moms have learned that breastmilk is best for baby, and that’s what they want, in spite of the challenges that can pose. They are women who are up to the task or who at least are willing to give it a try, from their perspective that it is in the best interest of the baby to do so.

It is inappropriate and unprofessional to berate those who choose natural childbirth. To imply that (many or all) natural birth mothers judge medicated birth mothers is outrageous! NCB moms can not be held responsible for the feelings and regrets of those who have not tried or succeeded at natural childbirth themselves.

I've seen the same phenomena regarding women who are friends with women who have home schooled their children. Some of these women who have stated they "can't do that" also verbally or non-verbally express a sense of guilt that they don't or can't do it.

If a woman does what she believes is right for her, she should feel good about it regardless of what others are doing or saying. If she doesn't, rather than blame "the movement" whatever that movement might be, she should get to the bottom of her feelings and move on.

If a woman doesn’t feel good about choices she’s made in birth, as in life, it’s up to her to figure out why and come to terms with that. To project blame on a narrow philosophy of an ever growing movement toward natural birth is presumptuous and diversionary. It is not healing or empowering.

There is no shortcut to helping women feel good about themselves and their decisions. That’s a matter of maturity of the individual. Some women get it; some are slow to grow; others never will get it and will choose to blame others for their guilt whether or not it’s justifiable.

I would encourage all women to aim to keep growing. Rejoice in your accomplishments and learn from your mistakes. But don’t judge others or feel you are judged for the way you have had your births or the way you educated your children or fed them… Do your best and be happy with that. Get help if/when you need it. Enjoy parenthood. It doesn’t last long!

I commend all women who choose to have babies and children, both birth mothers and adoptive mothers. Motherhood itself is on the decline. The world needs a few good moms. If you can’t be one, encourage the rest of those who are tackling this demanding but very rewarding job!

Thank-you Dr. Amy, for your thought-provoking opinion article and the opportunity to respond to it.
"An industry devoted to ignoring and demeaning women's pain"

This title does not describe the Bradley Method®! Certified Bradley instructors teach what pain is and how to work with it, not to mask it or ignore it. Natural childbirth instruction is not an industry. It is both a calling and a labor of love. It's not the right job if you are in it for the money.

One takes pain medication to ignore the pain of childbirth. Another takes natural childbirth training to ignore the offer of pain killers. (Nancy Berntsen, AAHCC, 2010)
I've had two vaginal deliveries and I feel that I educated myself on various birthing options before having my children. Before I gave birth I came to the realization that 100 women will tell you 100 different stories about their labors and deliveries. Therefore, I decided that once I was actually in labor I would see how I felt and then decide whether or not I wanted pain medication. Choosing to have pain medication is an option that I want whether it's giving birth, having dental work or doing anything else. I have a chronic medical condition and I have to have regular sigmoidoscopies. I am always offered pain medication for this procedure but I don't accept. I don't find the procedure painful. It's slightly uncomfortable and I'd rather put up with feeling slightly uncomfrtable than feeling the after effects of pain medication. I also dont' like the idea that I can't drive home by myself after the procedure if I have pain medication. Maybe I am particularly sensitive to pain medication, but I hate feeling groggy and out of control. This is how pain medication makes me feel. I can't speak for others. Getting back to giving birth. I was more frightened by the idea of an epidural than natural childbirth. Again, maybe that's just me. I've never liked needles. However, I went into it thinking that I would have to evaluate the situation once in it and then make a decision about pain medication. I had a quick labor and delivery with my first child and I had her without any medication. The benefit of this was that I felt really great afterwards. I walked out of the delivery room and I was able to squat/move while in labor, which is something that I think helped move things along, which brings me to another point. It was my understanding that epidurals slow down labor. I wanted to get my labor over and done with as quickly as possible, so the thought of slowing it down even to be more comfortable was not appealing to me. Overall I was pleased with the after effects of my medication free labor and delivery. WIth my second child I had no choice but to be induced due to excessive amniotic fluid, so I had Pitocin. Even though my son was moments away from being born I was told that I had several hours ahead of me so I asked for a Narcotic, which didn't help my pain at all. All it did was make me groggy. So I asked for an epidural, but by the time I asked they realized that the baby was minutes away from being born and they had no time for an epidural. I felt much worse after having my second child. Maybe this had nothing to do with medication, but it took a lot longer before I felt normal again. As I said earlier, maybe I'm just sensitive to pain medication. The bottom line is that I was glad that I had choices available to me. I'm an individual. What's right for one person isn't necessarily right for another. Women should absolutely have pain medication avaialble to them in childbirth, but they shouldn't be forced into it if they don't want it. Not everyone wants pain medication and not everyone tolerates it well. They shouldn't be forced to have no pain medication or to have pain medication, that's a personal choice and pain is subjective. The bottom line is that women should be well informed about their options and they should be looked at as individuals who are capable of participating in their plans of care with their obstetricians. They should be able to have some sort of control over the things in child birth that are optional, like pain medication because there are so many things that we have no control over as the patient, whether we are giving birth or having our tonsils out. Please keep that in mind when dealing with your patients.
I love this comment from one of the natural birthers:

"It is inappropriate and unprofessional to berate those who choose natural childbirth. To imply that (many or all) natural birth mothers judge medicated birth mothers is outrageous! NCB moms can not be held responsible for the feelings and regrets of those who have not tried or succeeded at natural childbirth themselves."

I think she just proved your point. Natural birthers assume that there is some sort of guilt women harbor who haven't birthed "naturally." They also claim that they are "empowered" by natural birth. To me, empowerment doesn't equal pushing a baby out of my vagina without drugs.

I feel empowered each day that I raise my child. I felt empowered when I received my doctorate. I feel empowered when I am kind to other people. But I don't feel empowered because I did what so many other women in the history of womankind have done: give birth.
I would argue that gynecology as a whole is an industry devoted to ignoring and demeaning women's pain. If it weren't so, why is it that every time I consult with an ob-gyn about my excruciating menstrual pain, I am told condescendingly that it's all in my head, that I'm exaggerating, or that I'm not taking my Advil correctly?

Besides getting that condescending lecture from eleven separate doctors (majority female, by the way), every single one has pushed the pill on me, which would be dangerous under the best of circumstances, and fatal otherwise, since I am a migraine-with-aura patient. The industry favorite seems to be Yaz, a pill known for KILLING even the youngest teen girls, including those asymptomatic of migraine, thanks to its high propensity to induce fatal DVT and other clots.

Finally, I've yet to find an ob-gyn who respects my interest in permanent, non-hormonal birth control, because I am not viewed as a decisive, mature married woman in her 30s who has never wanted and will never want a family. Instead, I am informed, like a petulant 8-year-old might, that I don't know what is best for me, that I could always change my mind, that someday, my husband might want me to have kids (inherent assumption: I will obey him at all costs), and it's "crazy" that I can't make myself satisfied with hormonal solutions that make me suicidally depressed and have a high likelihood of inducing fatal strokes because of my migraines.

Thanks to the arrogance of eleven separate ob-gyns, I now medicate my own periods with the help of friends who have surplus prescription painkillers. Patient, heal thyself.