The epidural catheter threaded into the epidural space in mom’s back.
As a working doula, what can I say about epidurals today? I have three things to say about them. First, if you are giving birth in a non-rural part of the U.S., you should decide what you think about having an epidural prior to your birth. You should read about them and discuss them with your care provider (doctor or midwife) and also your doula.
Second, please realize that most mothers can give birth without an epidural and that there are distinct advantages to not having an epidural. All the mothers who have spoken to me about giving birth without pain medication have been glad that they did it! Not just some of them, all of them! That is significant. They may have different reasons, but moms who have a pain-med-free birth are proud of themselves. They have conquered their rite of passage into motherhood. They have accomplished something that no one can ever take away from them. Ever.
That isn’t to say that moms who have an epidural (or other pain medications in labor) won’t have a lovely birth. They can also be proud of themselves and their births. It isn’t the same sort of birth, though. When a mom chooses to have an epidural, she really becomes a patient. That makes the flow of the birth more medical. She has to follow the safety protocols for epidural labor, which usually include continuous fetal & contraction monitoring, continuous IV, staying in bed for the rest of labor, catheterization for urinating, and more.
Finally, epidurals are big medicine. That is, they produce a big effect and they can have some big side-effects as well. Here is one side-effect people don’t usually talk about (luckily, your doula will talk about anything!): having an epidural in labor often makes moms feel more vulnerable. The labor is being guided by doctors and medicine instead of mom. There is a catheter in her back that is there to stay until after birth. Mom feels like she couldn’t do it without outside help. Mom feels tied down to the bed.
So when you are thinking in advance how you feel about epidurals, think of how this will affect you, because it is your birth!
Ina May Gaskin talks about your cervix as a sphincter that opens with privacy and relaxation. Birthology recently quoted Ina May and also added a short video of her speaking about the benefits of kissing during labor and the benefits of privacy for your cervical sphincter. A woman’s cervix should be respected. The more privacy and relaxation a woman is given, the easier and more painless her birth can be.
During labor, we doulas often gently remind a mother to relax her jaw and open her mouth. Birth is about her opening her body to ease her baby out.
In the news, two of Norway’s prime minister’s male cabinet members are on paternity leave. The Reuters article then goes on to let us know that in Norway both parents get an automatic two weeks off after a birth. Then they are offered a combined 46 weeks of fully paid leave or 56 weeks at 80 percent of their normal pay.
Ten weeks are reserved for the father and are lost if he remains on the job (So, the other 36 of 46 weeks are for the mother. These can be taken concurrently with the father’s leave, or divided up between the 2 of them). Many fathers take more for themselves as their wives head back to work.
Later this year the maximum leave in Norway will expand to 57 weeks, with 12 weeks to the father, and the government intends to expand the father quota to 14 weeks later.
What do U.S. parents get? According to the Wikipedia article on parental leave, we provide no paid leave at all for mothers or fathers, but parents can have 12 weeks of unpaid leave. “The United States is the only Western country that does not mandate paid parental leave, although the Family and Medical Leave Act of 1993 mandates unpaid parental leave for the majority of American workers.” This also puts us behind almost all of the countries in the world, including Trinidad and Tobago where moms get 13 weeks paid leave. In Guatemala, the mother gets 84 paid days leave and the dad gets two paid days off for the birth of his child.
So here I am screaming, “Why should we be so far behind in this“? We are better off economically than Guatemala and they can afford it. Therefore, we should be able to!
We need to step it up, for mothers, fathers and baby’s sakes!
Here is a video of Dr. Nicholas Fogelson, OB-GYN, discussing the benefits of delaying cord clamping until after at least one minute. He is doing a lecture to other OB-GYNs at the USC School of Medicine in what are called “Grand Rounds”. The video is about 50 minutes long and is very interesting. He discusses research which shows infants who have had a delay of at least a minute before their umbilical cord is clamped have more iron and more blood (about 40 % more blood) than babies whose cords are clamped immediately. This increase in iron helps a baby have more iron for six months!
If you are interested in having your doctor or midwife wait before clamping your baby’s cord, give them the URL for this video. Doctors are always having to learn new things (as are doulas). Dr. Nicholas Fogelson believes that the routine cord clamping we do is like the blood-letting practice doctors used to do for patients. When we observe other mammals give birth (like cats, horses, orangutans, etc.) they do not cut the cord quickly. They lick off the amniotic fluid and bring the baby close, but are in no hurry to cut the cord. Perhaps routine cord clamping has been doing our babies out of some necessary blood they would have had normally. After all, if there is no emergency, why should we been in a hurry to clamp the cord?
Beyond the physiologic reasons, you might also have emotional reasons for delaying cord cutting. If your baby is still attached to you, they can’t take him away from you off to a warmer. They have to do Apgar scores on your belly while you gaze at your long-awaited child. Sometimes if a puff of oxygen is needed, the baby can have a puff right on your belly. Isn’t that nicer than routine separation?
For years I have seen women’s membranes artificially ruptured. Most of the time, I suggest before labor that moms try to avoid it. Rupturing the membranes doesn’t hurt, directly. But it does take away the cushion of water that usually helps make the birth more comfortable. The question is: why do care-providers suggest artificial rupture of membranes (AROM)?
Some care providers suggest that it will make the labor go faster. Studies show only a 30-60 minute decrease in labor length. Sometimes, when a labor medically needs to be managed (because the mother is ill or during an induction which could overwhelm the mother’s resources if it goes too long) AROM is the next logical step to getting a mom into active labor. The idea is, if rupturing the membranes is the only intervention needed to put the mom into fully active labor, it isn’t a big intervention. Keep in mind that once the membranes are ruptured, the clock is ticking on the birth. The longer the membranes are ruptured, the greater the chance of the baby being born with an infection.
I still find mothers tend to enjoy their labors more if their membranes stay intact or rupture on their own. Navelgazing midwife talks about the joys of the baby being born in the caul (with membranes intact at birth). I haven’t yet seen a baby born in the caul, but I would love to!