EPIDURALS

 I have recently read 2 paeans of praise for epidurals on Kveller, one from Jordana Horn , who really has skin in the game, seeing as she is expecting her 6^th (kol haKavod, besha’ah tovah, or as someone told her, ‘G-d bless you!... G-d help you.’), and another from Renee Septimus, who gave birth around the time that I did, ie back in the day. So I, as mother of 7, felt I could make a comment or three.

Background: As a medical student in 1977 I did a 10 week obstetrics term in a major teaching hospital (different system in Australia) and I got to see all sorts of births and assist as well. And when I saw that epidural being introduced in (then) the minority of women, this enormous trochar and cannula (Medicalese for whopping big needle), inserted in the laboring woman’s back, I was agog and aghast, and I solemnly swore to myself that I would never have anyone do that to me. I nearly passed out just watching.

I am no good with procedures of any kind, neither doing them nor having them done to me; I wanted to be a psychiatrist after all. (Definition of Psychiatrist: Jewish doctor who hates the sight of blood. Hahaha. I digress.)

My first delivery was of twins at 36+ weeks, 34 years ago. My OB was an older guy, trained in London, who inserted a local anesthetic block (details available on request) and delivered the twins vaginally, the second twin breech, with 2 sets of forceps and the sort of skill that no longer exists. He was masterful; he only did stuff when he had to do it, and when he did, he did it well. I stuck with him for subsequent pregnancies despite the fact that he had the bedside manner of a fish, because I recognized and respected his awesome skill and cool head.

So yes, pain relief; but no epidural.

All my other babies were delivered vaginally with no instrumentation and no epidurals; I did have a shot of Pethidine (Demerol) on two occasions, but my last two, one babe of 11lbs and the last of 10.5lbs, with no pain relief at all, except prenatal yoga and what would now be called hypnobirthing. I’m not saying it was easy; it was hard work! That’s why they call it LABOR after all!

Big deal, good for you, I hear you say. Yes. There is a lot of Mazel (luck) in life, birth no exception. Yes, I was lucky, thank G-d. And I also prepared before each birth, with mental, more than physical, exercises; I had a lot of pelvic pain so all I could do was swim, and do very gentle antenatal yoga. The yoga teacher was more into the mental work than her title suggests and it was amazing.

Giving birth with full mental clarity and untethered to tubes and machines and monitors is incredibly empowering. The feeling of elation and triumph was indescribable. I felt like I had won 5 Olympic Gold medals.

Renee has stated that in 30 years she knows of no complication to mother or child from an epidural. As she knows and as we all know, anecdotes do not really mean anything in determining the safety of a medicine or a procedure. So what I am about to say also might not mean a great deal; but unfortunately, I have known personally 2 women who had dreadful results from routine epidurals. In one case, a 5^th pregnancy, the epidural site developed an abscess which nearly resulted in the woman becoming paraplegic; fortunately, she recovered after months in hospital and eventually regained the use of her legs. But because she had been so ill, her baby had to be fed formula, unlike her other children whom she breastfed for 2 years. Thank G-d the child is well, but my friend did mourn the loss of the breastfeeding and the early weeks getting to know her baby.

In the other case, the poor young woman delivering her first child had a lethal allergic reaction to the epidural and could not be saved.  The baby survived emergency C-section.

These are very very very rare outcomes. Far more common are the terrible headaches which prevent a new mother from sitting upright, and may not resolve until a procedure called a ‘blood patch’ is used to stop the leakage of the cerebro-spinal fluid from the epidural site.

And there is some evidence that babies are affected directly or indirectly because there are negative effects on breastfeeding early on.

So although I cannot quote you statistics and figures, I can tell you that no procedure is entirely risk-free, epidurals included, and I believe that they should not be used routinely.

Let’s consider giving birth without drugs and intervention as a sort of Personal Everest: It’s a hard climb, but the view and the pride in achievement are incomparable. There are some people who can summit without oxygen- well, not everyone can do that. Sometimes you need extra oxygen or extra Sherpas; and sometimes you need to be Medevaced from base camp. It doesn’t always go according to plan, even with good preparations. But to labor (sorry) the metaphor, I think it is not good to avoid even trying on the climbing boots because you are afraid that they will hurt your feet.

I have heard Sheila Kitzinger talk of giving birth as one of the last truly wild and natural things that we can do in our civilized lives; she said something like, it is standing on a mountaintop with the wind blowing through your hair, it is magnificent, and it is ours. And at the time I thought, well, that’s a load of tosh; tell that to a woman having a hard time. But there is something in that image of a strong woman, whipped by the elements, screaming in triumph. It does get to me a bit; but it’s not for everyone, I agree.

We live in a time and place where there are marvelous medical procedures available, and that is a good thing. We have choices, and that is also a good thing. But when we choose to make interventions routine and commonplace, we see that the harmful side-effects also become more commonplace. 

And I believe we lose something of ourselves when our fear makes us give ourselves into the hands of detached professionals, when perhaps we didn’t need to.