I want my epidural!

Our angry, heavily pregnant writer doesn't buy the idea that natural childbirth is best.

Jennie Bristow

Topics Politics

UK health secretary Patricia Hewitt intends to ‘challenge the assumption’ that the safest place to give birth is in a hospital, and to encourage more women to have their babies at home (1). Now, why would she want to do that?

I have nothing against the idea of home births. I know they can be fine; I know women who had a better time of giving birth at home than others did in a hospital. As I await the imminent arrival of my second child, living some miles from the nearest labour ward and with a toddler in tow, I have even flirted with the idea of having a home birth myself.

But all this individual decision-making is very different from a policy push that actively encourages people to have their babies outside of hospital. As a political objective, home birth sucks.

As things currently stand, women whose pregnancies have gone to term (37 weeks) and whose antenatal care has shown no indication that the birth would be complicated can opt for a home birth. This means that a midwife is there with you all the time, but there are no doctors on hand; so far as pain relief goes you can puff a bit of gas and air but forget about anything that is consistently effective, like an epidural (an injection in the spine that relieves childbirth pain).

The relative safety of home births under these circumstances is quite difficult to judge. There is an argument that statistics lumping together the outcome of all home births, including those that happen by accident to women going into labour prematurely and women who did not know of their pregnancy, rather unfairly suggest that they are more dangerous than hospital births (2). On the other hand, statistics that show the outcome of planned home births only – low-risk, full-term spontaneous vaginal deliveries – would hardly give an accurate picture either, given that home-birthing women are whisked off to hospital at the first sign of complications, and only two per cent of all births happen at home in any case.

On safety, the bottom line is, as a spokesperson for the Royal College of Obstetricians and Gynaecologists put it, ‘If you have any complications then the safest place you can be by far is the hospital delivery suite’ (3). On pain relief, the bottom line is that you are better off in a hospital with an anaesthetist and an epidural. The health secretary’s bottom line, however, is politics.

‘A strategic shift towards more home births is part of the government’s move for more care to be provided in the community and in the home, and away from acute hospitals’, a health department source told the Independent on Sunday (4). In other words, it’s about saving money and making patients take more responsibility for their own care. If any other procedure were under discussion that involved risk, blood and high levels of prolonged pain, our risk-averse, cynical times would surely be expressing disquiet about hospitals, with all their equipment and skilled resources, offloading their work on to the low-tech ‘community’. But when talking about the small matter of having babies, Hewitt’s proposal is seen as quite acceptable: cuddly, even. Because it fits with the fashionable promotion of ‘natural’ childbirth.

Hewitt wants to ‘demedicalise’ pregnancy and ‘challenge the assumption’ that birth should take place under the supervision of a doctor. In this, she talks the talk of the natural childbirth movement, which campaigns against the ‘doctor knows best’ approach to pregnancy and birth. Pregnancy is not an illness, goes the argument, and birth is no big deal: women have been doing it throughout the ages without all the monitoring and machinery we have today, and the skills and experience held by midwives makes them much better at handling childbirth than those scalpel-happy doctors who make up with certificates what they lack in empathy.

The natural childbirth movement wants to see women embrace the pain of labour as they joyously push a baby out of their vagina and put it to the breast, all in the cosy surroundings of their own home. And when this vision is contrasted with a nightmare of a hospital labour ward with strip lighting, sharp implements and frowning obstetricians, it appears extremely attractive. Of course you’d want a birth like that. The trouble is that nature itself often has different ideas.

Proponents of ‘natural’ childbirth conveniently forget that the medicalisation of pregnancy and birth in the 1970s was due, in no small part, to the desire to stop women and infants dying out there in the community from one of several things that can go wrong in childbirth. ‘Natural’, yes, but as Dr Thomas Stuttaford has argued in The Times (London), ‘Nature is as cruel at the beginning of life as at its end’. He also reflected on his obstetrics experience in the 1950s, when more than 90 per cent of babies were delivered at home and ‘home deliveries were scary’ (5).

However much a woman might want an uncomplicated vaginal birth, we all know of women who have had inductions, emergency C-sections, forceps, ventouses, cuts and tears and other unpleasant interventions that may have stopped serious complications from arising. Nobody relishes the thought of these things – but they are usually better than the alternative, which is generally more risk of damage to the mother and child, and more pain.

Yes, pain. A universal feature of childbirth, and one that the ‘natural’ vision continually glosses over, is that it really really hurts. For some lucky women with speedy labours – like myself, at least the first time round – it doesn’t hurt for very long. For others, the pain can go on for a couple of days, becoming excruciating towards the end. Now you can get these marvellous mobile epidural units, available in half of hospital delivery units, which magic the woman’s pain away while allowing her to walk around and generally get on with the business of having her baby. Epidurals are today considered safer for the baby and more effective than other, more widely used forms of pain relief such as pethidine.

But the natural childbirth movement hates them. So much so that in February, it was reported that the Royal College of Midwives (RCM) was considering a proposal to charge women for the privilege of relieving the agony of labour through having a needle in their spine. ‘Epidurals have become a kind of norm for a lot of women’, said Sue Macdonald, chair of the RCM’s education and research committee which came up with the proposal. ‘Sometimes women think “I just want to get rid of the pain, how fantastic”.’ (6) Indeed they do. And what the hell is wrong with that?

One of the central prejudices of the natural childbirth movement – and the one that most sums up its weirdness – is the notion that pain in childbirth is a good thing, to be positively embraced. Let’s remind ourselves that we are not talking just a tickle of pain, but in many cases hours and hours of intense agony – the like of which no other kind of patient would be expected to tolerate. Can you imagine a movement that promoted the spiritual benefits of pain following an appendectomy, for example, or the removal of a tooth? But this is precisely the prejudice that surrounds pain in labour – that it is uplifting, character-building, and helps you to bond emotionally with the new life you are bringing into this world. Yeah, right. Like having some little creature put you through unnecessary agony for hours on end makes you feel more affectionate than if it were to slip out painlessly.

Thankfully, the epidural-charging scheme was roundly mocked in the press, rejected by the Department of Health, and even opposed by the queen of the natural childbirth movement, the National Childbirth Trust (NCT). But while charging women for pain relief may seem too draconian, the widespread suspicion that exists of the ‘unnatural’ epidural already means that women can have a battle on their hands when trying to get one administered in hospital, finding themselves discouraged and fobbed off until it is considered ‘too late’ to administer the anaesthetic. And at a home birth, of course, you can’t have an epidural at all.

I find it easy to accept that midwives know what they are doing when it comes to delivering babies, and that they are very good at their jobs. I can just about accept that, for some women for whom a low-risk labour seems probable, a home birth might work as well for the health of the mother and baby as a hospital birth (provided, of course, that this is the mother’s choice and not the health secretary’s).

What I cannot accept is the glib approach to pain in childbirth that goes alongside the promotion of home birth, midwife-led ‘birthing centres’, and all the other things that meet the approval of the natural childbirth movement. Some women may not want or need pain relief – but most women really, really do. A truly woman-centred approach to childbirth would be one that took away all that nasty ‘natural’ pain, and made labour as easy and safe as possible.

Jennie Bristow is former commissioning editor of spiked, and is now waiting for the birth of her second child.

(1) Childbirth revolution: Mummy State, Independent on Sunday, 14 May 2006

(2) See for example Home birth, an editorial in the British Medical Journal, 23 November 1996

(3) Home vs hospital: Where would you rather give birth to your baby?, Independent on Sunday, 14 May 2006

(4) Childbirth revolution: Mummy State, Independent on Sunday, 14 May 2006

(5) A woman’s right to a safe and painless delivery, The Times (London), 6 March 2006

(6) Midwives call for epidurals fee, BBC News, 23 February 2006

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Topics Politics


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