I am hesitant to write about epidurals. Because, honestly, I don’t want to armchair quarterback anyone’s birth, or leave anyone feeling like I am looking down on them. So I want to be clear that I am not here to judge you, or your birth, or your birth attendant, or your hospital. I am not the birth judge. I am the parenting judge.
(Just kidding! I’m not the parenting judge, either. Except for myself, and I often come up lacking.)
Epidurals and Me
I didn’t use epidural anesthesia in either of my births. In fairness, my births were really short. With Hannah, I was in active labour for about 4 hours, and with Jacob it was more like 2.5 hours. I am defining ‘active labour’ as being unable to sit still or talk during contractions, and feeling the need to engage in measures like vocalizing, swaying and so on. My birth records state that Hannah’s labour was 1.5 hours and Jacob’s was 45 minutes, based on confirmed dilation. Either way you slice it, there may be people out there who spent days in labour who would kind of like to draw a mustache on my photo. Feel free, but keep in mind that I am not responsible for resulting damage to your monitor.
Given my own birth experiences, I was very interested to learn that here in British Columbia, we have one of the lowest epidural rates in Canada for vaginal births. Approximately 30% of BC women had epidurals in BC, compared to 69% in Quebec, 60% in Ontario, 50% in Alberta and 39% in Manitoba. I actually thought this might be a good thing – perhaps it indicates that we are doing a better job of supporting women through labour and honouring their wishes.
Anesthesiologists Raise the Epidural Alarm
On Twitter, Chad Skelton linked to an article in the Vancouver Sun with the headline “Women who want epidurals not getting them in B.C.: report”. You can read some of Chad’s thoughts on his blog. My summary of the article is that the British Columbia Anesthesiologists’ Society believes the disparity in epidural use is related not to women’s choices, but to a shortage of anesthesiologists. While the article states that we don’t know why epidural rates are lower here in my home province, it conjectures that 11,000 women are being denied pain relief based on the difference between BC rates and the national average.
Let me be clear. If women are asking for epidurals and being denied them, or being made to wait 4 hours, that is a problem. I am not here to say that epidurals, or the mothers who use them, are bad. However, I took issue with this article on several fronts. The anesthesiologists may be somewhat biased in their call for more anesthesiologists, for one thing. For another, there are no actual, concrete examples of women being denied epidurals. And finally, I felt the article did a fair bit of fear-mongering. For example, here is a quote from Dr. Roland Orfaly, executive director of the Anesthesiologists’ Society:
If you have an anesthesiologist dealing with a life-and-death surgery and the women needs an emergency C-section to save the baby and just by chance the surgery finishes as the C-section is needed you have a near miss…An hour earlier and the baby could have died.
More Information is Needed
We need to do everything we can to protect the health of mothers and babies. But I would prefer to hear about actual birth outcomes, rather than stories of what could have happened. We hear a lot of scary stories about birth in our culture. It’s true that birth can be scary. But it can also be miraculous and empowering. Many women, like me, find labour manageable with good support. So I take issue with articles like this one that paint birth as horrible, and suggest that women are being left to suffer in agony, without unbiased information to support that claim.
I had a back and forth with Chad about this, and we both came to the conclusion that more information is needed. But I think we still stand in different positions on birth. Chad took the pro-pain relief stance, stating that “[he] had a front-row seat and [he's] pretty sure [labour] hurt — a lot”. And I took the stance that supporting women to have the birth they want is the most important thing, and that lower epidural rates are not necessarily a problem.
Factors Contributing to a Positive Birth Experience
Some research bears me out. In a review of 137 factors that affect women’s satisfaction with childbirth, 4 stood out: personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship and involvement in decision making. These factors overrode age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions and continuity of care. This comes from women evaluating their own childbirth experiences. So, epidural use alone does not indicate how most women feel about birth.
We know that women who have midwifery care, and women who use doulas, have lower epidural rates, as well as fewer C-sections and shorter labours. In my own high-risk labour with Hannah, having a midwife made a huge difference for me. She was an amazing advocate with the doctors and nurses, she helped me get into positions that I found comfortable and she helped me to avoid being strapped down to the bed with monitors. If I hadn’t had her, I don’t believe that I would have coped as well as I did. We had a good relationship, she provided me with quality support, she kept me informed and she listened to me. Like the study suggested, these things made all the difference for me. I feel very satisfied with my experience, overall, and I would wish the same thing for other women.
My position is not that women should not use epidurals, or that women should avoid all interventions. Epidurals, C-sections and induction all have their place. My position, rather, is that women deserve support through their birth experience, from people that they trust, who honour their wishes. And so, instead of saying that we should increase epidural rates in BC, I think instead that we should talk to mothers and hear their experiences. We should track outcomes for mothers and babies. Then we should act on that information, to help make birth better, and safer, for everyone.
What do you think makes for a positive birth experience? How important is epidural availability to you in birth? And can you believe I’m talking about epidurals, either?