Dear Lactnetters:
I have been reading with great interest the discussion on epidurals.  I'd
like to through in my 2 cents as a psychologist.
In Marsha Walker's post of 4/16, (which I liked enough to print out), she
described an article about why we should do epidurals to prevent
psychological problems in mothers and fathers. Because of the pain of labor,
mothers and father may experience psychological fallout--therefore all
mothers should have epidurals!!  I can understand Marsha balking at this and
her pointing out that many women experience births that are terrific and
empowering.

However, I think we must also acknowledge that there are frequently
psychological ramifications of difficult births for both mothers and fathers.
 What we fail to take into account is that the interventions and
medicalization of birth frequently create the very conditions that foster
epidural use.  For example, we all know that birth is frequently more painful
if a woman is flat on her back attached to a monitor.  We know that birth is
more painful if she has no one to talk her through each contraction.  Some
husbands/partners are overwhelmed by the hospital environment and cannot
help.  Others, let's just say it, are putzes and are of no help (and can make
matters worse).

The literature is full of references and stories of women describing their
births and also describing subsequent symptoms that are post-traumatic stress
reactions.  These include flashbacks, panic attacks, depression, numbing,
phobic reactions.  The author of that article is correct in indicating that
these reactions do occur.  However, it is ridiculous to assume that an
epidural would remedy this.  How about good old fashioned labor support??
 How about giving women power over their birth experience? I personally know
2 women who had c-secs with failed epidural anesthesia.  In this case, the
epidural caused the problem.

Even in cases where medical intervention was clearly necessary, there can be
psychological fallout.  Who can come that close to death or death of a loved
one and not have some reaction? Yet most of these women are sent home without
a word to indicated that they might feel badly following their experience.

I am presenting a paper this summer at the International Trauma and Memory
conference on some of the psychological implications of negative or
frightening births.  To my knowledge, it is the first time birth will be
discussed at a mainstream trauma conference.
I have a whole chapter on this topic in my book "Postpartum depression"

I'm afraid these types of negative births are on the rise. All of us who work
with postpartum women should be sensitive to these issues (as I know most of
you are), and offer information for helping women to heal and have a better
experience next time around.

Enough for now.  Can you tell that this is one of my favorite topics?
Kathy Kendall-Tackett