Book Review: Epidural Without Guilt

When I was offered a review copy of the recent book, Epidural Without Guilt: Childbirth Without Pain, I jumped at the chance to read it.

The book is by Gilbert Grant, MD (Director of Obstetric Anesthesia, NYU Langone Medical Center) and came out this winter.

If there is anything more contentious it would be the divide between natural birthers and those who want medical help. Dare you mention to other moms that you *gasp* had an epidural during labor and you get treated like a bad case of head lice is jumping off you. But what is so sad about that is everyone involved still had to go through labor to get the baby. I had some bad experiences after having baby 2 – it is quite shocking how it seems OK to ask a woman how she birthed. And then to start ‘task-tsk’ing’ right to their face. And god forbid you dare bottle feed. The Seattle Freeze settles over. You are not one of them. Oh no. You used a hospital, you used pain medication, you bottle feed, you OH MY GOD! You use disposable diapers? Fast way to get shunted from mom groups here. At my age I just roll my eyes.

When I had my first son I was young and of the crunchy granola type. I was scared of hospital births, of OB’s, of needles and had my head filled full of interventions that would “snowball and before I knew it I would have a C-section” – or that is at least what was drilled into my head by the labor classes I took. What had made it worse is the OB I went to upon my suspicions I was pregnant. They gave me a pregnancy test, but to see them as a patient I had to sign a bunch of paperwork including ones that gave them the right to give me blood transfusions without further consent. When I declined – after all I was only 5 weeks along! – the OB’s nurse gave me a scathing lecture how I would end up bleeding to death and leaving an orphaned baby at birth. Yikes. I was out of there….I was living on an island at the time and instead found a midwife who had her birthing center in the woods along with a many weeks long class on how labor pains were part of being special. Well, that hippy fantasy changed when I was 7 months pregnant and ended up with Pre-eclampsia and on bed-rest for a month, in and out of the hospital. My blood pressure wouldn’t stay down, I was back in the hospital, so they delivered him early, at 36 weeks. He was a tiny baby, just over 5 lbs. And I delivered him naturally, my labor was quick overall. I had mostly back labor – he was sunny side up. That was more painful than the real labor pains. Again, he was a small baby. And I delivered in a rural country hospital. It could take a long time to get an epidural if the anesthesiologist wasn’t on or was in surgery. The quick labor (a shy 5 hours) helped a lot (though it took 2 days to get into real labor). I of course was proud I had delivered naturally.

I figured when we found I was pregnant nearly 13 years later that I would go the same route. Add in a lower back injury a few years ago and a bigger baby and by 38 weeks I was pretty miserable.

3 days before I had him:

I walked around the last couple weeks in pre-labor. Finally at 38 weeks my OB decided she wanted me to deliver, she wanted him out before he got much bigger and my blood pressure was starting to creep up. But no Pre-eclampsia at least. I had a good pregnancy, mellow. I had given up the hippy concepts by then and had accepted I had to see an OB the whole pregnancy for both mine and the babies safety. I was watched carefully, many ultrasounds, many times the appointments as normal, we saw a fetal maternal OB as well. I had an amniocentesis test the Friday before to check his lungs were ready and then monitored over the weekend. I was induced on a Tuesday evening and it took about 24 hours for real labor to start – that is where my water broke and the real contractions started. Like with my oldest the baby wasn’t reacting well to being induced. His heart rate was plummeting when it shouldn’t have been. A big difference is I knew what was going on this time. With my oldest the OB told my mom updates but never me. They kept me in the dark to keep me calm, hence I didn’t freak out. But this time I knew, I could see the monitors going up and down. Babies don’t deal well with being induced and it causes stress. The medication used to induce me was much harder on my body than what was used for baby 1 and more so the Preeclampsia helped me – the baby is seen as an invader to push out.

Finally maybe an hour after my water broke I gave in. I knew I had lost control of the pain. I couldn’t breathe deep enough, his weight was causing the pain to radiate down my legs, through my back injury. I couldn’t cope anymore and I needed to rest so the baby could as well. The nurse working with us asked me many times if that was what I really wanted, no pressuring me. She called for it when she knew that was what I wanted. The anesthesiologist got there quickly and got me in position and was done in a blink. Within seconds I could feel the pain ebbing. Suddenly I was pain free. I could breathe. I was able to lay there and NAP, which I desperately needed (the problem with inducing is that you are in mini-labor for so long before, you barely sleep). I woke up and I knew the baby was ready and coming quickly. I had no problems pushing, I knew what to do. No tearing. And we had a 9 lb baby with a labor that was even shorter than baby 1, around 4 hours long from when my water broke (baby 1 was a shy 5 hours).The biggest help with the epidural is it allowed me to get where I needed to be. To relax and let nature takes its course.

After everything settled down, the baby was taken care of, I recuperated a bit and as soon as my legs started coming back online and had some feeling the nurse got me a walker. I started walking around the room (we had a lovely all in one suite that was quite big) until I was steady enough to stand alone. By a couple hours out all effects of the epidural were gone. The anesthesiologist who performed it was professional, quick and very good at what he did.

Having gone through childbirth both ways I can say this: don’t be rigid. An epidural CAN be a good thing. It can mean the difference between relaxing through the pain so you don’t end up in an emergency C-section. It can mean a healthy Mom and Baby. Don’t let fear and guilt color your decision. If it is so painful you cannot take it anymore then accept that you cannot!

After reading Epidural Without Guilt it was like seeing my thoughts before having had one. He answers questions and urban myths about anesthesia. I like his comments on that childbirth is the only thing performed without pain medication. While I am not one to take a ton of pain killers (even with oral surgery I take only shots) I wouldn’t sit there with no medication. I wouldn’t consider it. So why did I feel so guilty that I took it for childbirth which was countless times more painful? Mostly because in the US the concept of a “natural childbirth” has become the prize for women to attain, even at the expense of them and the babies safety. That somehow even a natural hospital birth is not as good as a homebirth or better a waterbirth or an unattended birth in your home.

I don’t criticize either side anymore after my experiences. What I realized is it doesn’t matter how you birth as long as you and the baby are safe and healthy in the end. You get those things as your prize. What you don’t get is a certificate that says you sucked it up and took the pain. Once you take that out of the mix, then why do we willingly suffer pain? The pain doesn’t make birth any better.

You might not agree with my points but at least read what the other side has to say. The book is an excellent start to separate fear mongering from truth. Being educated is important, especially knowing your options.

~Sarah