Epidurals: A Feminist Issue

In Epidurals: What Your Doctor May Not Know I highlighted that over 50% of Canadian obstetricians and over 35% of family doctors are unaware of many of the risks associated with epidurals, and that a significant number of Canadian women pregnant with their first baby are also not informed about epidurals. I concluded with the observation:

Would we tolerate this level of ‘expert’ uninformed opinion to guide our decisions anywhere else in our lives? Buying a car? A house? Planning a vacation? Planning a wedding? Making career decisions? None of these analogies come anywhere close to the enormity of making decisions about our health. And not just our health as women–the health of our babies too.

So where have the feminists been? Why is this not #1 priority on the women’s agenda? Addressing violence is important, yes. Yet we know that empowering birth can transform women, helping us to believe in our own strength and abilities, which I believe would enable more women to leave violent situations. Sexual issues are important, yes. Yet, birth is a sexual event, and with the right support can enable women to connect to a powerful and life-giving part of their sexuality, which may help with healing of prior trauma and learning to trust themselves and those around them.

At the risk of sounding outrageous, it is my belief that the way that we approach birth in our society–uninformed, relying on the experts, medicated, numbed, unable to walk, unable to feel our body’s urges and power, fearful, unsupported, and ultimately perhaps cut open–is a major contributor to the oppression of women today, and a powerful force in silencing our voices.

We are vulnerable in our hour of greatest pain and power. This vulnerability, with caring support that respects all that our bodies and minds and spirits can do, can lead us to a place of trusting ourselves in a deep, essential way. Or, this vulnerability can lead us to a place of feeling silenced, numbed, ignored, and deeply uncertain of our own power.

It is my belief that many of us are afraid of our vulnerability, and we are afraid of losing control. Unmedicated birth is unpredictable, powerful, raw, intense, and requires caring support. We are women who are used to being in control: of our education, of our careers, and of our reproduction. In order to mitigate our fears, of how we will respond to pain, or how we will cope with a force that is from within ourselves yet not under our cognitive control, we decide to get an epidural, some of us before we have even had our first contraction. For many, this is a blind decision, thinking only of the advantages (pain relief) and not of the risks.

While there are many physical risks associated with routine, and especially early, epidural use (increased malposition of the baby, increased forceps/vacuum delivery, increased episiotomy and/or severe perineal tears, longer labour often leading to augmentation, increased risk of fever, increased risks of cesarean under certain conditions) there are other risks that research doesn’t usually measure.

One of those risks is that we lose our voice and we lose caring support. While the epidural doesn’t paralyze the voice box, it makes it much easier for the birthing woman to be ignored. With an epidural, the birthing woman is practically in the same state as a woman who is not birthing: she is not moaning, she is not deep breathing, she is not focusing in on herself and her baby, she is not accessing deep resources of strength and ability to change. She is not moving in the birthing dance, she is not relaxing into the birthing trance. The birthing woman with an epidural is numb from the waist down and cannot move, and is further attached to the bed with continuous electronic fetal monitoring, IV lines, the epidural catheter, and most likely a urinary catheter. And because the birthing woman is not doing the normal birthing things and is not experiencing pain, it can seem that she does not need caring support.

And yet, the woman with an epidural is still birthing. She is still a birthing woman. She is still going through an enormous transformation, and bringing a baby into the world. It’s interesting to note that receiving caring, continuous support during the birthing process is the most important factor in women’s satisfaction with their childbirth experience. It’s also interesting that women who receive this type of support are less likely to get an epidural.

Of course, for the woman who is experiencing birthing pain as suffering, which depends on many different circumstances, the option of getting an epidural as a way to relieve suffering is also a feminist issue. Women who are experiencing unmanageable pain should not be forced to suffer, either by lack of availability of pain relief or by feelings of guilt. However, women should still be informed of the risks, so that we can weigh the information in light of our values and our current circumstances, to make the choice that is best for each of us.

And we should also ask ourselves: how can we help birthing women avoid suffering in childbirth? Because pain does not have to equal suffering. The best research indicates that caring, continuous support is the answer.

And above all, as women, as mothers, as rational people who have responsibility for our own health and the health of our children, we need to be informed; we need to inform ourselves and our sisters about the risks of epidurals, and be sure that our voices are not silenced by fear of change, fear of the unknown. When we make truly informed decisions, whether that choice is to get an epidural or not, then we are truly empowered.

Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186(5) S160-72.

Hodnett ED, Gates S, Hofmeyr G J, Sakala C, Weston J. Continuous support for women during childbirth [PDF]. Cochrane Database Syst Rev 2011, Issue 2.