The Myths of Modern Anesthesiologists
By Danell Swim
April 2, 2008
How does a pain free labor and birth sound? If you’re like most women, it’s an appealing idea! And it’s something that’s being embraced by more and more women these days, with epidural rates as high as 90% in some hospitals.
Dr. Gilbert Grant, the Director in charge of the Department of Anesthesiology at NYU Medical Center has written a book that is gaining popular attention. In Enjoy Your Labor: A New Approach to Pain Relief for Childbirth he encourages women in labor to receive an epidural before they are in any serious amount of pain. He claims to discount many myths surrounding epidural use, and has some harsh things to say about the natural birth movement.
You Wouldn’t Ask a Man to Have Surgery Unmedicated
Grant asserts that natural birthing is misogynistic in practice. In essence, it is hateful to women. In a Times Online article he asks why women are made to undergo labor without pain relief, when “no man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.”
I wholeheartedly agree that men should not have to go through any surgery without pain medication, but to compare that to childbirth is just plain ridiculous. Natural childbirth advocates do not advocate that women have cesareans without any anesthesia. Instead, they believe that childbirth is a natural event that doesn’t necessitate medication or treatment.
A natural labor is not an experience with constant, agonizing pain. Instead, there are contractions that last for 30-90 seconds (typically) which are usually painful, and resting periods in between. This cannot be compared to surgery by anyone that knows anything about labor patterns. The two are entirely different.
I’ll get back to his assertions of misogyny.
The Booming Industry of Natural Childbirth
From the Times Online article:
“Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so.”
Maybe things are different in the hospital that Grant delivers at, or perhaps he’s just not familiar with midwifery care, but he seems to be confused.
Midwives who deliver in hospitals will typically advocate that their patients have a drug-free birth, but do not insist on it. They do not get paid any more or less based on whether or not the patient requests pain medication. In fact, it is always the anesthesiologist who is paid for the procedure.
Or maybe he’s referring to childbirth education classes, which commonly teach methods of coping with pain. But perhaps he’s forgetting that many of these classes also teach information on medications and other interventions.
Any childbirth educator can make just as much money including information about epidurals in their classes. Anesthesiologists cannot make a living by advocating that women refuse medication. So who is really lying in order to make money? Logic would seem to indicate that the anesthesiologists have everything to lose by advocating natural childbirth, whereas childbirth educators would simply have to change their curriculum slightly.
To actually accuse the natural birth movement of doing it for greed is laughable. He talks of millions of dollars that are made by natural birth advocates, but fails to mention the billions of dollars that are spent in the medical model of care.
Safe and Effective
Grant purports that epidurals are so safe that every woman should have them, and even the information page for the Department of Anesthesiology at NYU (where he is Director) says: “The fact is that today, epidurals and spinals are extremely safe and effective for the overwhelming majority of women.”
I’d be curious to see the consent form that he has women sign before getting the epidural. No doubt it lets the patient know that anything that goes “wrong” in the placement or duration of the procedure is not the fault of the doctor or facility, so that the patient cannot sue in the event of a personal injury. This is typical of procedures done in any medical facility. The reason these are done is because there is no safe procedure or intervention; all carry risks, and to say that it is “safe” is subjective and misleading.
If Grant truly believes that the epidurals he administers are safe, then he should back that up with a written guarantee that nothing will go wrong. Otherwise, he should own up to the possible complications that can accompany something like the placement of an epidural catheter near the spinal column.
Misogyny At Its Best
On the NYU website, the controversy of epidurals slowing labor is raised. As such, it is explained that epidurals do not slow the first part of labor, but may prolong the second stage (pushing) by a few minutes. It also states that epidurals do not increase the risk of cesareans. “Everyone is unique - some women are able to push well even without feeling any “pressure” - while others need intense pressure to push effectively.”
This seems to insinuate that it is the woman’s fault if she does not effectively push after an epidural. Because rather than coming out and saying that epidurals often cause longer pushing phases and increases the cesarean rate, it is much more beneficial to the industry if they instead blame it on women’s poor pushing skills.
The study that is used to back up these claims is talked about in this article, Early Epidurals Don’t Increase C-section Risk, by Dr. Wong. Yet the study is so flawed to make such a suggestion about such a broad topic. In it, they compare epidural use to IV opiates to see if it increases the cesarean risk. The IV opiate group is the ‘control group’ in the study, and yet anyone could tell you that trading one medication for another cannot get you an accurate depiction of the increased cesarean rate. Instead, the study should be entitled: No Difference in Cesarean Risk Between Pain Relief Medications.
Dr. Wong expresses the belief that it would be virtually impossible to perform a study evaluating epidural use against no pain relief whatsoever. Apparently, it is believed that women are so incapable of laboring naturally that studying it would be an impossibility.
So these anesthesiologists refer to the natural birth movement as misogynistic, yet alleges that women are at fault for not pushing effectively, and that they are incapable of coping with labor pains without an epidural or opiates. The natural birth movement endeavors to teach women that they are strong enough to withstand labor without any outside help, but Grant classifies that as ‘hateful.’ I would hesitate to refer to his statements as ‘hateful,’ but I do believe condescending would fit the bill.
I have no doubt that these anesthesiologists have no experience with natural labor. After all, it would be like an auto mechanic trying to become an expert on a car that never breaks down; if he never sees one in his shop, he can’t be expected to know anything about it. Instead, anesthesiologists know about medicated labor, as that is their specialty. And to suggest that laboring without medication be something sensational would be jeopardizing their livelihood. You can’t expect a mechanic to do that.
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4 Responses to “The Myths of Modern Anesthesiologists”
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Where do you get those pictures?! That picture is creepy! I never got an epidural simply because I cannot imagine having a needle stuck into my spine. I don’t care how popular it is, it is a bizarre concept. And in the middle of labor no less?
I’ve heard that appendectomy comparison before, and it just gets lamer every time.
I say this once again: “If natural childbirth feels like getting an appendectomy, you’re doing it WRONG!”
Don’t forget, natural birth advocates are not unbiased, either. It’s important to make the best decision for yourself.
Most information is biased. It is important that women read as much as the can from many sources before going into labor. Epidurals have many side-effects, some very subtle. Some are likely still unknown, as really long-term studies have not been done on their safety.
It is too bad more pain-relief options (like some offered in England) are not available here, for both home and hospital use. It is also too bad most US women seem to be so busy working before birth, they have little time to research decide how they might prepare to deal with labor with or without drugs.