For Jennifer Houston, a certified nurse-midwife from Catskill, these interventions are all part of a modern misconception that birth is a medical event. “Doctors are practicing a medical model—they’re selling services,” she said. “They’re keeping an eye out for danger and they’re looking through a filter of pathology. Medicine makes birth pathology, and it’s not pathology. It becomes pathology when it’s not supported.” While hospitals and medication certainly have roles to play in risky pregnancies and abnormal labor and delivery scenarios, they are simply not necessary for the average, normal birth.
These days, a common hospital delivery may play out something like this: First, an epidural may be administered to numb pain from the waist down via a spinal injection. But that can hinder natural contractions, so the doctor may give the mother pitocin, a drug that stimulates labor but also causes more pain. That may necessitate another epidural, which may necessitate more pitocin. All of these drugs and injections can cause the baby to go into stress, so a cesarean section may be performed. “A regular, normal hospital routine inhibits the natural physiology of birth happening normally on its own,” Houston said. “Unfortunately, I see a lot of women these days asking for and wanting epidurals and not being well informed. In some ways, they may be more humane-looking births, but in other ways we’re still overusing technology, overmedicating people, and definitely doing too many C-sections. One hospital intervention leads to the next, and there’s this whole cascading effect.”
When you trace these births backward from the moment of delivery, you’ll often see a procession of interventions that fell against one another like dominos—and it often starts with the painkillers.
According to the American Pregnancy Association (APA), more than 50 percent of women request an epidural during labor in a hospital, making it the most popular anesthesia for pain relief during labor. Epidurals are injected just adjacent to the spinal cord of the lower back, where a catheter is placed that typically administers a combination of local anesthetic and narcotics or opioids. More medications may be dispensed to steady the mother’s blood pressure or to extend the effects of the epidural. The APA notes on its website the benefits of the painkiller (like relieving discomfort and allowing rest in prolonged labor), but the catalog of possible drawbacks is longer and more striking, including rapid drops in blood pressure, severe headaches caused by leakage of spinal fluid, slowed or stopped labor, permanent nerve damage at the insertion site, shivering, nausea, and more. The list also warns that pushing may become more difficult, so that further interventions—pitocin, forceps, vacuum extraction, and cesarean—may become essential to delivery. The use of an epidural can also hold health implications for the baby, with studies suggesting infants may experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability during the delivery process, and may also have difficulty breastfeeding after birth. Though some of these side effects may be rare or need further documentation, an overwhelming complaint against the epidural is that women feel powerless and cheated out of the real childbirth experience.
Houston herself said she was medicated during the birth of her first child, and felt “scared and out of control” during the process. “A lot of women feel less control when they have narcotics,” she said. “Certainly epidurals could be useful if people are having very, very long, difficult labors and just have to have some relief, but midwives generally work on that need for relief through the skills required for an unmedicated birth.”
A Natural Birth
“I always looked at birth like most other women, with fear,” said Kate Murphy of Kingston. “I think we are conditioned as a culture to immediately picture a red-faced woman in excruciating pain screaming and cursing her way through the experience. When I found out I was pregnant, however, my feelings changed. I felt that I could birth my child gently and with confidence.”