With respect to the epidural issue and the whole issue of pain during
childbirth, we need to remember that much (not all, but a whole lot) of the
pain that women in the US experience in childbirth is because of cultural
beliefs and practices surrounding childbirth here.  And I'm not talking
about psychosomatic pain or self-fulfilling prophecies.  I'm talking about
how such practices as (see list below) increase the difficulty and pain US
women face in childbirth, necessitating more pain relief:

-- lying flat on your back with your feet up in stirrups (makes the pelvic
opening its smallest, compared to squatting, which makes the pelvic opening
its largest), thus leading to more cephalo-pelvic disproportion and more
need for hours and hours of massive pushing, and therefore more need to pain
relief
-- not being able to move around during labor because of the "need" for
fetal monitoring, thus lengthening labor
-- not being able to eat and drink during labor, thus wearing the woman out,
and making it sound like a c-section, or an epidural, or vacuum or forceps
extraction is a good idea
-- inductions with pitocin, which make the contractions stronger and more
painful, thus leading to a need for more pain relief
-- additions of pitocin to the IV drip because the labor is "stalled" due to
the epidural itself, or to the lack of movement, or to fright from the
strange environment and strangers all around, or simply because it has been
more than 24 hours since the waters broke
-- breaking the waters before they rupture naturally, speeding things up
because the mother and doctor want the baby delivered by a certain time
-- women who are physically out of shape because of our sedentary lifestyle,
so they have no strength to push
-- women who are emotionally out of shape because of our cultural beliefs
about how ineffective and weak women's bodies are

For another awesome video -- which I doubt any hospital would let you show
to prenatal classes -- check out "A Clear Road to Birth" by independent film
maker Judy Seaman.  This video shows several women giving birth by
themselves.  Sometimes the husband or other children are around, but there
is no doctor, no nurse, no midwife.  Just the woman, dealing with it.  It is
an amazing thing to watch.  If the "Gentle Birth Choices" video made
hospital deliveries look brutal, this video makes "Gentle Birth Choices"
look primeval (all that loud cheerleading going on and all that suctioning
of newborn babies going on in GBC).

Finally, we all know that, really, epidurals are NOT about relieving women's
pain, or causing or not causing difficulties with breastfeeding where good
IBCLC support is unavailable.

Epidurals are about MONEY.  Pure and simple.  If insurance companies
reimbursed anesthesiologists for the drugs and equipment at cost, plus
minimum wage for their time -- you'd be amazed at how, all of a sudden,
hardly anyone needed an epidural!  Epidurals are money makers for the
hospitals and anesthesiologists, and women who have to go through L&D as it
is usually structured in the US today know that chances are they will have a
lot of pain -- laying on their backs, not able to move around, or eat or
drink, with pitocin inductions -- and so they demand pain relief.  Women in
the US would scream bloody murder if their insurance companies wouldn't pay
for epidurals.  Until we get to the root of the problem -- allowing women to
labor as they wish, using gravity and the squatting position, and only their
partner/children to be with them, and perhaps a calm quiet doula, and no
pitocin, and no limits on what they eat and drink, and on and on and on . .
. . we won't see any end to this discussion.

Kathy Dettwyler


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