First off, I am absolutely a homebirth oriented midwife, although my
thoughts on the subject of epidurals may cause many to believe otherwise. I
am sensitive about sharing my views for fear of misrepresentation. However;
my experience has led me to some basic conclusions that seem practical and
useful to the art of midwifery and more importantly, the art of using
technology appropriately, and I feel compelled to share them. In these
times when technology is overused in childbirth and we often have to muster
our reserves in order to protect women and babies from intervention, we may
become blind to the fact that appropriate use of technology can lead to
good outcomes.
Over the last many years I've encountered a good handful of births with
long tedious labors that lasted days on end. The women were stoic and
strong. We fed them, walked them, counseled them, slept them and tried and
tried again to get them past a certain centimeter of dilation, to no avail.
Once the mother reached a certain point her pain threshold dissolved and
maternal exhaustion set in. It has always been my standard to transfer to
the hospital at this crucial point. My families have also agreed,
instinctually knowing it was the right thing to do.
Here is the amazing part: We get to the hospital, check in, monitor the
baby, meet the doctor and so on. The least interventive thing to do at this
point is to get the woman an epidural and some Pitocin. The epidural will
take the pain away and let her sleep, and of course the Pitocin will
strengthen the contractions. This combination works beautifully--I've seen
babies born easily within two to six hours. To see epidurals used in this
fashion has given me new respect for them. Seeing moms happy and relieved
not to have a cesarean section, an intervention that is way over used,
makes me less resistant in situations like these.
This doesn't mean I would make this decision for all long labors. We are
there to make assessments based on the best care of mother and child. To
the best of our ability, we must inform and encourage our mothers to birth
naturally if that is their goal. But when it becomes risky and overly
discouraging, alternatives must sometimes be sought.
I have strong opinions about using interventions in pregnancy and birth. I
should! I am a lay midwife who attends homebirths. I don't take any
transport or intervention lightly simply because of what I have learned and
heard about cause and effect. But based on what I've seen, I also believe
that at times an intervention can help cause less effect. Does every woman
deserve an epidural, as Hillary Clinton is said to have remarked? No.
Epidurals were first developed as a tool to be used in an emergency and
were never intended for widespread use. So let's stick to the premise that
wise use is best use, and keep birth as natural as we can as often as we
can, but feel OK when we can't.
-- Jill Cohen, midwife
Reprinted from Midwifery Today E-News (Vol 1 Issue 9, Feb. 26, 1999)
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