Don’t Pressure Expectant Moms

When I first moved to London from New York, I was blown away that I didn’t need medical insurance to see a doctor.  All I had to do was look up National Health Service clinics in my area and go to the nearest one.  Prescriptions cost me mere £7, and birth control didn’t even require that £7-prescription fee (in New York, I had to pay $50 every month out of my pocket because they were not covered by my insurance).  Whatever NHS’s troubles, it seemed to me that they were doing a fine job.

Two years and a pregnant friend later, I changed my mind.

Last September, the Royal College of Obstetricians and Gynecologists put out a guidance on maternity services, urging NHS to ramp up the rates of “normal birth,” which it defines as “not be caesarean section” and “without epidurals.”

It stipulates “avoiding unnecessary interventions” leads to “better outcomes for women, quicker recovery, improved satisfaction and saves NHS money” (about £200 for an epidural and £1,200 in tariff price alone for a caesarean).  Aside from the whimper of outrage from seven U.K. and Canadian maternity organizations in a joint statement six months ago, no one seems to care about this.

Since becoming pregnant for the first time last summer, my friend has tried to secure the option of having an epidural, the most common pain relief drug for women in labor, at her NHS hospital in London.  Like every other woman, she doesn’t want to spend her labor wrought in pain.  Unfortunately, the revolving doors of midwives and medical consultants throughout her pregnancy have discouraged use of any pain relief drugs.

Like a nagging doula, they preach natural birth is better.

If we can use anesthesia during a root canal, women should be able to use an epidural during labor.  And no one should imply that using an epidural is somehow not the right thing to do, especially if their ulterior motive may be to cut costs.

There has been an explosion of women speaking out on being “tricked out” of using epidurals.  Typically, they are not admitted until the last hours of their labor because of bed shortages (many are sent back home even after their water breaks).  When they ask for an epidural, they are told that it is too early or too late, or that other women are waiting for the sole anesthesiologist on call.

Evidence suggests that the guidance goes against a range of findings.  For example, a commonly cited risk of epidurals is difficulty pushing.  The International Anesthesia Research Society reported more than once that new formulations of the drug can block the pain nerves without affecting the ability to push.  The Lancet in 2001 published a study where women given low-dose epidural required less forceps or vacuum-assisted deliveries than those who gave birth naturally.  This directly contradicts the claims made in the guidance.

Medical arguments aside, it is wrong to call unassisted birth “normal.”  The correct term is “natural.”  By referring to “normal birth” eight times, while not making one reference to “natural birth,” the guidance is forcing a social norm that medically-assisted birth is abnormal.

The guidance document also urges doctors and midwives to exert “influence” on expectant mothers to make “good choices.”  It is disgraceful that today in a cosmopolitan city like London, medical authorities are implying that women cannot make good choices, and that they assume to know what good choices for women are.

On the other side of the Atlantic, where obstetricians have become the most sued physicians, it is all about interventions.  Surgeries are quicker and reimbursed at higher rates by insurance companies.  Unsurprisingly, women report being pressured into C-section without being given other options.

Advocates of natural birth emphasize the need to get back to basics. A quieter, less medicalized environment is more conducive to giving birth, the argument goes, and today’s high-tech labor has made women feel out of control.

The National Childbirth Trust in the U.K. was created in 1955 supposedly to put mothers back in control of how they give birth.  Today, the NCT lectures expectant parents in workshops about the superiority of un-medicated home birth over hospital birth at £278-per couple.

Ina May Gaskin, the American poster child of the natural birth movement, has made home birth chic for bobo moms.  And midwifery is making a comeback as the holistic choice.  In 2009, one in every eight births in the U.S. was assisted by midwives, according to the Centers for Disease Control and Prevention.

It must be possible to have a baby in an environment where no legal or financial incentives or birthing fads force unnecessary interventions or deprive necessary ones.

Raging hormones notwithstanding, women are capable of making their own choices. And it is not the role of doctors or midwives to narrow birth choices for them.  Between the truths about natural birth and epidural, there is no good or right choice; there is only a personal choice, and it’s a choice every woman, including my friend, should make for herself.

Women have fought long and hard to have equal rights as men; they do not need bureaucrats or nanny states to decide what’s best for them.  What they need is access to options and unbiased information.

© Katrin Park and Ex Nemo, 2013. Unauthorized use or duplication of this material without express and written permission from this blog’s author is strictly prohibited.

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