Labor pains? They’re for your own good, dearie.

It takes a certain kind of chutzpah to say such a thing to a woman in labor. Doubly so when you happen to be male:

The pain involved in childbirth serves a purpose and more women should go through it in order to prepare themselves for the responsibility of bringing up a baby, according to Dr Denis Walsh.

Dr Walsh, a senior midwife and associate professor in midwifery at Nottingham University, said: “A large number of women want to avoid pain. Some just don’t fancy the pain [of childbirth]. More women should be prepared to withstand pain.

“Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.”

Celebrity births, TV programmes and films such as Knocked Up, give the impression that childbirth is a highly medical process, when in fact the pain is natural, healthy and temporary, according to Dr Walsh.

“In the west it has never been safer to have a baby, yet it appears that women have never been more frightened of the processes,” he said.

In an article for the journal Evidence Based Midwifery, published by the Royal College of Midwives, Dr Walsh argues that normal birth is in danger of being “effectively anaesthetised by the epidural epidemic.”

He says a widespread “antipathy to childbirth pain” has emerged in the past 20 years which has combined with increased patient rights and risk-averse doctors to create a situation where almost all hospitals now offer epidurals on demand.

Instead the NHS should take a “working with pain” approach which would encourage women to use yoga, hypnosis, massage, support from their partners, hydrotherapy and birthing pools as natural ways of alleviating their pain, he said.

“Over recent decades there has been a loss of ‘rites of passage’ meaning to childbirth, so that pain and stress are viewed negatively,” he added, arguing that patients should be told labour pain is a timeless component of the “rites of passage” transition to motherhood.

He says that said epidurals are also associated with medical risks such as a prolonged first and second stage of labour, a heightened chance of the baby’s head being in the wrong place and lower rates of breastfeeding.

In addition, an epidural makes a mother more likely to need help during the birth, for example by using forceps, which can be traumatic for both mother and child.

Official figures show that the number of mothers receiving an epidural has soared from 17 per cent in 1989 to 1990 to 33 per cent in 2007 to 2008.

Dr Walsh said 20 per cent of epidurals are given to women who do not need them and that “Emerging evidence [shows] that normal labour and birth primes the bonding areas of a mother’s brain better than caesarean or pain-free birth”.

Walsh’s paper has been submitted to the Royal College of Midwifery’s periodical, Evidence Based Midwivery, for peer review, but has not yet been published. Given the contents of the lecture given by Walsh upon which it’s based, however, it will probably be a hit with the RCM – as it discusses the same talking points as the NHS when promoting its Lamaze-inspired idea of ‘normal birth’.

Never mind that labor can be excruciatingly painful for some women, midwives often underestimate the severity of their charges’ pain, and that the methods of pain relief suggested by Walsh have been deemed inferior to epidural analgesia in a large American survey. That’s disturbing enough in its own right. But for a supposedly science-based organization, or any of its members, to promote the idea that women cannot become responsible or loving mothers if they don’t experience the pain of childbirth? Downright creepy, not to mention entirely lacking in anything resembling evidence.

In fact, the only evidence-based facts in the monologue above are that epidurals are associated with prolonged first and second stages of labor and increased incidence of instrumental delivery (though not CS). There is no evidence that epidural analgesia causes breastfeeding failure, though it may well be that mothers refusing pain meds in labor are also more motivated to breastfeed. In fact, despite studies which claim to show women who had epidurals have lower rates of initiating and sustaining breastfeeding, there is also evidence to the contrary. A recent review on the subject by anesthesiologists concluded:

breast-feeding is a multifactorial, complex phenomenon. Epidural analgesia is one factor that possibly can influence success, especially when high doses of epidural opioids are administered. However, many more social, economical and other medical factors influence success. The evidence is available that good postpartum lactation support is critical. At the moment there is no prospective, randomized evidence that epidural analgesia causes reduced breast-feeding success. Retrospective studies showed an association but failed to demonstrate causation. So, despite alarming messages, we should reassure our patients that epidural analgesia is the best form of analgesia available with the least effect on the newborn and the best guarantee for successful breastfeeding when patients request some form of analgesia.

I’m not sure Walsh’s assertion that “normal labour and birth primes the bonding areas of a mother’s brain better than caesarean or pain-free birth” really deserves a response, but I’ve touched upon the (very lousy) ‘evidence’ of this here.

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18 Responses

  1. I suggested tarring and feathering Doctor Walsh on another blog. Pain may have some benefit in labor. I just don’t happen to know what on earth that benifit would be unless you are the type who likes marathon running and feel achievement from such acivities. The rest of the world wants an epidural and a good epidural. 33% epidural rate seems miniscule. I think my hospital has a 98% epidural rate.

    If a woman values a natural childbirth, I am happy to help them achieve their goals. But if they do not, I am also happy to help them achieve their goals.

    There is the rare occasion with Hellp syndrome where we cannot insert an epidural. In that case, women do need to go without so I think it is a good idea to think about plan B just in case it happens. But if a woman cannot have a spinal or epidural, we can give them a fentanyl pca. Doesn’t work as well as the epidural but it is somewhat helpful.

    And it is forever pissing me off when folks suggest a monther needs “the love hormone” to bond with her baby. Adoptive mothers bond with their babies all the time. So WTF?

  2. Wow. I am sure glad that Dr. Walsh is not my doctor!

    Having had one child the painful way and two children with epidurals I will have to call bull-shat on the strange theory that child birth pain is helpful to bonding with a child.

    Love my kids! No pain needed to help me “Prepare” to be a mother. I say Dr. Walsh shoud experience giving birth without any sort of pain blocker. 😛

  3. First of all, “Dr.” Walsh isn’t a doctor. He’s got a PhD, not an MD. I’m not even sure if he’s a nurse, since direct entry midwifery seems to have taken over the profession since my time in the UK, when ALL midwives were also registered nurses.
    It is truly frightening that, more than 100 years after anesthetics were developed, the idea that women must “suffer” the pain of childbirth to fulfill their functions as women, is still being bandied about. And that women are buying it.
    And, lastly, Midwife Muse described three planned “homebirths” she recently attended. She is an advocate of home birth, yet she shows very well that hospital birth offers more modalities of treatment, and a safer environment for birth, if not as pleasant as being in the home. In two of her examples, part of the reason for transfer/hospital birth was to obtain analgesia that was impossible in the home.

  4. I believe the increase in labor duration with an epidural is on the order of 30-60 minutes, and the instrumentation incidence is not found to be increased.
    The problem is that a lot of studies are retrospective, so it is hard to tease out whether the women that requested epidurals had more dysfunctional labors to begin with (longer, persistent OP), or if the epidural itself was the cause. In addition, the epidural techniques have changed quite a bit since some of the older studies (It’s not my mother’s epidural anymore).
    Interestingly enough, there is a post at the Skeptical OB that lambastes the same attitude– different guy though. (Odent)

    • I saw that post of Dr. Amy’s and liked it. I’ve also ragged on Michel Odent once – here. And I agree the increase in labor time is not large, and if you’re under analgesia anyway, matters little. AFAIK there is an increase of forceps and vacuum births however. Again, the absolute increase in risk is the main issue.

  5. can’t wait for uteri transplants… every time my hubby or boss gets annoyed at me for being moody/irrational I just tell him to grow a uterus, or two.

    I was upset that the birth teacher had a phrase in her handouts about “accepting pain with happiness” that is nothing compared to this idiot.

  6. I have to admit I sort of agree with at least part of what this guy is saying. I chose to do a natural birth when I had my first baby about a year ago, partly because I was really curious to know just how bad it would hurt. And I thought if this process that is so fundamental to life hurts *so* much, maybe there is a reason for it. Maybe we *should* feel it. So, as it turned out, labor hurt really bad! After my daughter was born, I felt shaken and somewhat traumatized by the whole thing, wondering if maybe I should have gone with an epidural after all. But as days turned to weeks turned to months of me experiencing just how incredibly hard it is to be a new mother, I would often think back on my labor and the experience kind of took on new meaning for me. It was like it was some kind of harbinger, as in, WARNING: motherhood is really f-ing hard, but the painful parts are fleeting and they ultimately give way to joy.

    I want to add that I am not some kind of natural birth fanatic or anything–I would never, ever tell any woman how they should have their baby, because it’s a completely personal decision. I’m glad I did it once, but I might choose to have an epidural if I have another child. I certainly don’t think I bonded better with my daughter than women who have epidurals or c-sections. I guess I’m just saying that, for me personally, the incredible pain of labor was an apt beginning of a huge reality check about what it’s really like to care for a baby.

    • JillP: I think the problem isn’t with a woman holding this attitude about her *own* labour and what it means to her, but with someone deciding what *other people’s* labours should mean to *them*.

      • I know, sorry. The first quoted paragraph struck a chord with me and I wrote that comment in haste. After rereading the whole post, I realize it was a completely pointless comment. Please excuse!

  7. And it is forever pissing me off when folks suggest a monther needs “the love hormone” to bond with her baby. Adoptive mothers bond with their babies all the time. So WTF?

    Also, no one ever suggests than men have to experience excruciating pain in order to bond with their children. Grr.

    • Alas, in the AP/NFL world, the idea that daddies bond at all with their babies (or at least in any way resembling the bond Mom has) is sometimes ridiculed.

      • I have to say that was definitely my take away. I could be wrong, but nothing I’ve read leads me to conclude anything but that.

  8. And what about the women who naturally have “painless” labors? Are they not supposed to be the role models for the rest of the women kind b/c labor doesn’t hurt if you are doing it right? Turns out, if you are doing it right it will hurt..?

  9. If epidurals are so risky why would “risk-averse doctors be offering them on demand”? I also love the bit where he says that “antipathy to childbirth pain” is a recent phenomenon. Pain is pain, and it’s never been particularly popular.
    When I get time, I want to read the original paper, to see if it’s just as loopy as the way it has been reported.

    • The original paper isn’t yet published, but you can see the slides of the lecture it’s based on here (Under “The Zepherina Veitch Memorial Lecture” in red):

      http://www.rcm.org.uk/college/resources/events/rcm-annual-event/

      (I originally tried to link to the slides themselves in the blogpost, but for some reason it wouldn’t let me).

      If you look at his references – esp. regarding the utility of pain in labor, a lot of them are opinion pieces in midwifery periodicals, not actual studies.

  10. I also love the bit where he says that “antipathy to childbirth pain” is a recent phenomenon.

    Tell it to Queen Victoria.

    BTW, the entire site is worth checking out. Apparently there were people who objected to anesthesia being used in any context, including surgery.

  11. Every single study I’ve ever read has indicated that pain is counterproductive to healing. Why should labor pains be any different?

    Why don’t we push a bowling ball out said doctor’s backside and see how he feels afterwards?

  12. I agree with Stacy from NJ. And perhaps he should also be repeatedly kicked in the groin at the same time while someone tells him that it’s for his own good and that he really should embrace the pain.

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