When we labor in an environement where labor pain is accepted as part of
the process, and not as something we are bound to abolish, and also, where
the attitude toward birth as a normal process prevails, I think it makes a
substantial difference both in the woman's ability to give birth without
unnecessary intervention, and also, possibly in her perception of pain.

I attended 300+ home births over a 12 year period as a lay midwife prior
to going to nursing school, working in a hospital OB dept, and now
becoming a CNM. Over the years, I have been struck by how much more
painful labor seems to be for many women in the hospital environment than
it is for them at home, and how much more negatively these women seem to
perceive birth. As an OB nurse, I did my best to get women up and
walking, in the shower, and in the tub (once we finally had them) and to
keep the atmosphere light and relaxed.  Even when I had women who were
being induced, I tried to keep things as relaxed as possible, and it was a
strategy that generally worked well if not undermined by others.

Women in labor are very vulnerable to the influence of suggestion, both
positive and negative. One woman, I remember in particular, was being
induced but progressing and doing very well until her physician came in
and started complaining that she was "*only* at zero station and 8 cm
dilated" and verbalizing her concerns out loud that the woman had a "small
pelvis".  Once the seeds of doubt were planted in the labor room, the
entire atmosphere changed despite my best efforts to calm things down.
The woman's progress stopped immediately after those comments, she began
to request pain medication because she could no longer cope, and to
noone's surprise, she ended up with a C/section for failure to progress,
and grateful to be rescued after the birth because the doctor said "she
was just too small".

I think that fathers should be there to support the mom in labor, but I
think it is asking too much to expect someone who has never been at birth
before to assume primary responsiblity for providing support for the
laboring mom.  The fathers, themselves, often need support and reassurance
that things are okay in the face of intense labor.  Every woman deserves
one to one care with someone experienced in the ways of labor, who
believes in birth as a normal process, and who is skilled in keeping birth
normal, and in facilitating birth when things go awry. Some labor nurses
are good at this, but many have not been trained in this model of care.
Doulas are a good idea, but to be honest, doulas have limited power in the
hospital environment and are not making the key management decisions.  The
reality is that every woman deserves a midwife, and that in the midwifery,
or "with woman" model of care (which certainly can be and is practiced by
physicians) is much more successful at helping women have a positive birth
experience in which they feel empowered and which avoids unnecessary
interference than the pathology model of birth which is in common use in
most hospital settings.

Epidurals, intrathecals, even systemic pain meds are all tools with
specific indications and uses.  Each has benefits and drawbacks. When
women are able to labor in an environement which is relaxed, allows them
to eat and drink as they wish, allows them to move freely without
routinely being hooked up to monitors, and IV's, allows the use of
showers, bathing, and encourages the use of other effective
non-pharmacological approaches, then all the available research on this
topic seems to agree that those tools are employed much less frequently.

Off my soapbox for now (the air is getting thin)

Ione Sims, CNM, IBCLC (in rainy Shelton, Washington where it was reported
that there was 9 inches of rain in our area yesterday)