Tuesday, July 25, 2006

The Agony and the Ecstasy

Let me start by saying that I have had three of my babies with drugs (and of course my c-section baby I was anesthetized, but I didn't "have" her. She was cut from me). The first I had an epidural. I never felt his head come out. My second birth I had Demerol, which did absolutely nothing except make me pass out between contractions and be awake for the worst of the pain. My third baby was born before the epidural had a chance to take effect. That's when I knew I could give birth naturally. When my second son was born and I felt his head coming out in all it's burning glory, I had two thoughts: "I hate this! Quick blast that baby out!" and "Wow. I missed something important the first time when I didn't feel this."

There was an article printed in the Boston Globe recently about labor pain. The article is by a pediatrician, Dr. Darshak Sanghavi. He questions why women would want a natural childbirth when it is possible for us all to have better living through chemistry.

This doctor even interviews Ina May Gaskin and writes:
Gaskin believes the nerve fibers that richly populate the birth canal can give pleasure as well as pain. In fact, she reports that about a quarter of her patients tell her they experienced the first or the most intense orgasm of their lives during childbirth. And here, at last, I understand Gaskin's modern justification for labor pain. In her opinion, women should experience the greatest pain of their lives in the hopes they might find the greatest pleasure.
But later in the article he states:
"The vaginal canal is so richly supplied with nerve endings and pain fibers that it's almost uniquely suited to create agony."
Huh? I guess his wife never has an orgasm then. The same organs and hormones are in use during childbirth as are used in making love. Often times, if you turn the picture off a natural birth video and just listen to the sound, you would think an entirely different sort of video were playing!

He goes on rapturously (and falsely) about epidural anesthesia. He says a "hair-thin flexible catheter" is inserted into the mother's spine -- um, yeah, through a 16 gauge needle!! He also says
The mother is numb only below her waist - the drugs don't course through her entire body and don't enter the baby.
Yet, the PDR (Physician's Desk Reference) states:
Local anesthetics are bound to plasma proteins in varying degrees. Generally, the lower the plasma concentration of drug the higher the percentage of drug bound to plasma proteins. Local anesthetics appear to cross the placenta by passive diffusion. The rate and degree of diffusion is governed by (1) the degree of plasma protein binding, (2) the degree of ionization, and (3) the degree of lipid solubility. Fetal/maternal ratios of local anesthetics appear to be inversely related to the degree of plasma protein binding, because only the free, unbound drug is available for placental transfer. MARCAINE with a high protein binding capacity (95%) has a low fetal/maternal ratio (0.2 to 0.4). The extent of placental transfer is also determined by the degree of ionization and lipid solubility of the drug. Lipid soluble, nonionized drugs readily enter the fetal blood from the maternal circulation.

Depending upon the route of administration, local anesthetics are distributed to some extent to all body tissues, with high concentrations found in highly perfused organs such as the liver, lungs, heart, and brain. Pharmacokinetic studies on the plasma profile of MARCAINE after direct intravenous injection suggest a three-compartment open model. The first compartment is represented by the rapid intravascular distribution of the drug. The second compartment represents the equilibration of the drug throughout the highly perfused organs such as the brain, myocardium, lungs, kidneys, and liver. The third compartment represents an equilibration of the drug with poorly perfused tissues, such as muscle and fat. The elimination of drug from tissue distribution depends largely upon the ability of binding sites in the circulation to carry it to the liver where it is metabolized.

Hmmm... guess it does go through the mother's body. He then says:
In this setting, the pain of unmedicated labor offers up a formidable, if artificial, trial that precedes entry into a highly selective sorority. It creates drama. It captures attention.
This may be true in a hospital setting, where (in my area) up to 98% of women get "their" epidural, but in a homebirth? Who is there to "perform" for? Whose attention is being grabbed besides the people who are loving and supporting the woman in the most transformative experience of her life?

If you are denying the pain and trying to find a way out of it or under it or around it, you will hurt more. That I can guarantee you. If you welcome it as positive pain (pain with a purpose) and just dive into the middle and do what you need to do to come out the other side, you will minimize it as much as possible. NO ONE ever died from the pain of normal childbirth. It is not the pain of illness or injury. It is not constant. You have one minute -- maybe 2 -- of pain and then you get a little break. You can do anything for 1-2 minutes!

If you welcome each contraction and tell yourself, it needs to get stronger before my baby comes, you will lessen the pain. If you welcome the strength and power and realize it is YOUR strength and power -- you will lessen the pain. If you surrender to the pain -- you will lessen the pain.

There is such a thing as compassionate use of an epidural. When women truly can not take even one more contraction, or when they are so tense that we start thinking about c-section because they can't let their babies out, an epidural can mean the difference between a vaginal birth and a c-section. There is a time and place. But the time and place is certainly not in every normal childbirth!

The final paragraph of the article says:
Which is why choosing to feel pain during childbirth strikes me as odd. Eliminating pain won't create a sudden existential crisis among mothers, because parenting is too rich an experience. And after all, being born is ultimately the least distinguishing feature of being human; everyone's done it and, moreover, no one remembers it.
And again, he is wrong. I do believe that our births matter. That how we are born imprints on our brains and affects our lives forever. I was pulled out by forceps. I can't stand to have my face touched. Coincidence? Maybe. But I have heard too many convincing stories of people who were able to recall events of their birth under hypnosis that they had no way of knowing unless it was truly a memory.

People choose all the time to do things that are painful but that they feel offer a benefit: Mountain climbing, weight training, tattoos, piercing, marathon running. Truthfully, getting my lower back tattoo hurt more than having a baby but was in many ways a very similar sort of pain. My preceptor has a matching tattoo, except hers is further up her back and the writing at the bottom is different because it contains her name, not mine. She got hers first, and when I anxiously asked her how it felt, she said it wasn't bad. That it felt like "scratching a sunburn". She watched a movie and talked to us throughout. One week later, it was my turn. I sat in the chair, expecting a slightly painful scratching. The first line made on my back I thought, "Oh, my God, I've made a huge mistake. I can't do this." It felt like he was carving the tattoo in my back with a hot knife. But, I had a permanent black line on my back. There was no turning back at that point. I could only press forward. The more I anticipated the needle on my back and tensed up, the more it hurt. When I'd relax my back muscles and moan softly into a pillow, it was easier to take. Just when I'd think I couldn't take one more second of the pain, he would lift the needle and wipe with that blissfully cool, wet paper towel. Just like labor. Just when you think you can't take one more second of the contraction, it ends, and you get just a little break. Enough to catch your breath and gather yourself for the next one. And at the end you have something beautiful that will last forever.

When it was all done, I said, "I am so glad that is over. I will never do that again!". And just like you forget and decide to have another baby after all, I got my second tattoo six months later.

I believe women's bodies are made to birth babies. Our vaginas are miraculously stretchy with lots of little folds that open to allow the baby through. It is NOT like pushing a watermelon through a straw. It is NOT like hitting your thumb repeatedly with a hammer. When I gave birth to my fourth child, standing on my own two feet, I was King of the World! It was the single most empowering thing I've ever done in my life. After that, I could climb mountains, leap tall buildings in a single bound, and yes, mother 7 children at once.


DollyMama said...

Three things:

1. Finally got to poke around over here and love it.

2. I am amazed that you got a tatoo! Wow! Cool.

3. In response to that doctor, apparently he does not understand the concept for working for something that is important to you or having a sense of accomplishment. Why would anyone run a marathon when they could just ride in their car to get to the finish line? He doesn't get it, does he?

I don't know. In all my births for kids 2-6 I don't remember dreading the pain or even minding it that much. I was running the race that brought me to my baby. Seemed like a worthy thing to me......

Sage Femme said...

I feel like tattoos are alot like childbirth, too. I love yours! :)