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.