If you were my woman

When doctors tell birthing women, “if you were my wife or daughter, this is what I would recommend,” it doesn’t necessarily mean that the procedure is the safest or even evidence-based research.      -- Janel Martin-Miranda, MA

Physicians are our trusted caregivers and references to information about our health and wellness. We are lead to believe that medicine is always scientific and physicians always follow the evidence-based science, and that they have our best interest in mind (and heart). Dr. Mayer Eisenstein, MD, JD, MPH, medical doctor of Homefirst in Chicago, IL, now the largest physician- and midwife-attended homebirth practice in the nation says that, “homebirth is safer than hospital birth for those 90 percent of mothers who are low risk. The problem is that obstetricians treat all women as high risk.”

He continues,
"Obstetrics, which is really a combined philosophy, business, and religion, does not have science as its base,"

And,
"Obstetricians practice much more philosophy than science. Pregnant women are tested, medicated, and operated on to excess every day by this profession in an unethical and dangerous way. This unscientific medicine is dangerous to us as a nation. Our maternal and infant mortality rate is unacceptable for a society as sophisticated as ours. We produce more premature infants than any other country with our interventionist technology and then praise ourselves for saving some of their lives."

Nowhere is the truth of this more blatant than with the routine inducing and use of epidural anesthesia. The increasing use coincides with increasing poor birth outcomes and poor infant mortality rates. Women are still lead to believe, and do believe, that it is safe and that it has no physical or psychological consequences to their child. The incidence of ADHC and asthma among children has also increased with the use of epidural.

Scientific evidence that shows us that epidural anesthesia is extremely dangerous and the doctors are not practicing according to the evidenced- based science. Inducing a baby’s labor and using epidural anesthesia have become increasingly acceptable by women and doctors. Inducing drugs create such painful contractions that pain relief such as epidural anesthesia (narcotics) is almost always necessary and the statistics show a cascade of medical interventions is likely to result. In the research on safety of fetal monitoring it was shown that the only thing fetal monitoring did consistently was result in c-sections.

The drugs used in epidural anesthesia are from the “caine” family of drugs. An alarming number of our babies are being born with these drugs in their bodies. Drug effects stay in the body so that it is not surprising to have the epidemic cocaine and crack addiction problem that we do. Obstetric medicine must not be aware of their own research and the body of Pre and Perinatal Psychology showing traumatic effects of the hospital environment and medical interventions on the laboring woman and birthing baby. If they are aware, how is that they are allowed to continue? How is it that women continue to demand it? How could they do this to their own wives and children?

Physicians and women and their babies are caught in no win situations. Everyone is being harmed. Increasing malpractice suits and rising malpractice insurance has many obstetricians in crisis. The main reason for use of medical interventions is to minimize and to eliminate their own risk of lawsuits, to increase revenues, and to manage their schedules. The crisis and panic is passed along, literally, to the birthing mother and baby.

The scientific fact emerging in the midst of tort reform (because of malpractice COSTS not because of poor care and loss of life) is that obstetrics is not practicing evidence-based science and this is a great disservice to women and babies. Women are discouraged from water births, from natural labor, from waiting for the baby to start labor, and are restricted to bed with monitors with non-scientific based reasons. It is a vicious cycle. To avoid this, women are choosing homebirth.

Homebirths are attacked with a vengeance by obstetrics groups on the misinformation and non-scientific backing because of the potential loss of revenue. What is safest for babies and women is ignored. The statistics and research known for thirty plus years is ignored and manipulated. The media does not present the true scientific data on the medical model of obstetrics. Movies and television present the perspective of birth as frightening and a medical crisis to be managed. Homebirth is presented as wacky and unsafe even though the statistics show it is safer.

Often homebirth is the only way a woman can have birth her way and take full responsibility for her body and birth. It is not because of what she or her baby needs but to give the physicians and hospitals control. The emotional, physical, and psychological health of women and babies is not the driving force behind what insurance companies and hospital policy makers and lawyers pass along to physicians.

Obstetricians in training are taught two main things: 1) that every birth is a potential medical crisis waiting to happen, so that it must be managed; and 2) that pain relief is a huge life-saving service to woman and babies, in spite of the effect on babies. Ironically, both of these are the biggest contributors to unscientific practices in obstetrics such as the increased inducement rates and of epidural anesthesia. Both of these interventions are a result of their training beliefs, not science. Malpractice avoidance is what the interventions are really about. Medical interventions contribute to the United States being twenty-eighth in infant mortality. Birth trauma for babies, the violation of their body and soul for women, and further malpractice claims and insurance for physicians are entwined in a morbid cycle of violence.



I personally have learned that when doctors tell their patient, “If my wife or daughter were in this situation, this is what I would advise them to do,” it doesn’t necessarily mean that it is the safest method or that it is even researched based. I chose to have the epidural anesthesia after two natural births because I believed it was safe, not damaging certainly; why would I choose something that with so much potential medical risks and that is so traumatic for my baby? Because I believed, as I was told, by physicians, that it was perhaps even best and that it would make birth easier for both of us.

Even though I’d had two natural births previously, I was certainly interested in an “easier” way that was promoted as harmless and the “best technology.” My husband was a medical student and he believed what he was taught…that this new epidural anesthesia was safe and the most advanced technology. I trusted him because I believed he wouldn’t harm our baby or me. Ten years later, in the midst of my study of pre and perinatal psychology and healing the deep wounding from mine and my childrens’ births, and promoting the reform of medicalized birth, this tells me that either physicians totally ignore the scientific literature, don’t read it, or don’t care.

Preventing malpractice is often given as the reason I know now after my daughter's father went through obstetric residency. THIS makes no sense to me…..that obstetricians are allowed to get by with doing interventions and procedures that are scientifically known to be damaging and traumatic. Women who arrive at hospital in labor are routinely given inducing drugs known to create horrific pain, cause uterine rupture, and lead to the use of drugs and c-section. A client who was five cm dilated at her regular visit three weeks early was sent immediately to the hospital. She was not even aware of being in labor yet; however, she was put on epidural anesthesia. Her baby came to me at one year of age because of severe asthma and she was not able to crawl. The child was rolling and dragging herself very much like a paraplegic would. Both asthma and the “army crawl” are known “complications” of epidural. There was not a single medical reason for the epidural, not even maternal request. This use is malpractice and must be stopped. Why do doctors continue to do this? It is well known that they are motivated by controlling their income, schedules, and liability and ignore scientific literature. They are permitted by law, the Federal Drug Administration, the Center for Disease Control, liability insurance companies, and their own professional group, ACOG to continue under the guise of safety, and THIS is not grounds for malpractice?

The following is a listing of the research about epidural anesthesia from before 1992. Thirteen years later is considering safe, normal, and natural. From http://www.fensende.com/Users/swnymph/Epidural.html

-Epidural substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization. (21 studies cited)

-In first-time mothers, epidurals substantially increase the cesarean rate for dystocia. This effect may depend on management. (12 studies cited)

-Epidurals decrease the probability that a posterior or transverse baby will rotate. Oxytocin does not help. (7 studies)

-Having an epidural at 5cm dilation or more eliminates both excess posterior/transverse and excess cesarean for dystocia. (2 studies)

-Epidurals may not relieve any pain or may not relieve all pain. (3 studies)

-Innovations in procedure - lower dosages, continuous infusion, adding a narcotic - have not decreased epidural related problems. (13 studies)

-Delaying pushing until the head has descended to the perineum increases the chances of spontaneous birth. (a time delay of 1 hour is not really delaying - it needs to be a positional not timed thing...) Evidence is divided as to whether letting the epidural wear off before pushing increases spontaneous delivery. (4 studies)

-Maternal complications of epidurals include: [Uitvlugt, A. "Managing complications of Epidural Analgesia" International Anesthesia Clin. 1990;28(1):11-16]

-Maternal hypotension(5 studies). This reduces uteroplacental blood supply and can cause fetal distress. (8 studies)

-Convulsions (4 studies)

-Respiratory paralysis (3 studies).

-Cardiac Arrest (6 studies)

-Allergic Shock (2 studies)

-Maternal nerve injury due to needle injury, poor positioning, forceps injury, infection, hematoma, or subarachnoid injection of chloroprocaine. The last three usually cause permanent injury. (9 studies)

-Spinal headache (3 studies)

-Increased maternal core temperature. (2 studies)

-Temporary urinary incontinence. (1 study)

-Long-term backache (weeks to years), headache, migranes, numbness, or tingling. (2 studies)

-Serious complications occur despite proper procedure and precautions. The epinephrine test dose can cause complications. (12 studies)

-Epidural anesthetics "get" to the baby. (5 studies)

My favorite:

-Epidurals do not protect the fetus from distress. In fact, they cause abnormal fetal heart rate, sometimes severe, which may occur with or independant of maternal blood pressure (11% - 43% depending on the study and type of medication used - the 43% was found with Bupivacaine, the most common drug for epidural.) (15 studies) Stavrou


-Epidurals may cause neonatal jaundice. (2 studies) [Clark, DA & Landaw, SA.

-Epidurals may cause adverse neonatal behavioral and physical effects. (these are both direct effects and indirect effects from the increased rate of labor complications and interventions.) The importance of this is debated. (4 studies)

-Epidural anesthesia may relieve hypertension, but hypertensive women are at particular risk of epidural-induced hypotension, which reduces placental blood supply. (2 studies)

The research since 1992 has been quite clear about the detrimental impacts of inducing drugs and epidural anesthesia. This is evidence of the tendency of doctor’s to not practice evidence-based medicine. Perhaps, they do not have time to read their own journals. It’s unlikely they would recommend such high risk, unnecessary interventions for their own loved ones, if they really believed this information and the Pre and Perinatal Psychology findings they could not continue to practice with such disregard.

State-by-state, hospital-to-hospital, and doctor-to-doctor there is wide variations in protocols. With consistent research indicating the long-term physical consequences how is that hospital and obstetricians are allowed to continue to use these drugs? How is that they are allowed to be “self-monitored”? How is that there is not a consistent protocol established at the national level that insures safe use of these interventions? How is that our courts and systems do not allow lawsuits to address these blatant misuse of technology and drugs? And, that only a parent of a severely handicapped child can MAYBE bring suit for compensation and years later have the money to care for their child?

Remember that this research is prior to 1992 and since then the use of epidural anesthesia has doubled. Some estimates are that between 80-88% of births include epidural anesthesia. This is good news for the anesthesiologists. What other issues with children is doubling? Are they connected? Pre and Perinatal Psychologists and trauma therapists, and brain researchers think so. Asthma, learning difficulties, behavioral problems are being linked to induced and epidural birth. Something is seriously wrong that physicians are continuing to promote epidural anesthesia even for their own family members with this ongoing scientific information available. Our society promotes the current medical care system that focuses on drugs because of the expectation of taking away the pain at any cost is one explanation. The media is full of information presented by professionals and experts and they influence women’s decisions.

In general, medicine today is focused from the outside-in (surgery, drugs). Looking for an outside force to take away the pain. This is known in the Castellino Prenatal and Birth Therapy to be birth dynamic imprint. Because most of us (in the last hundred years plus) experienced birth with interventions and control from the outside-in, we are a society dependent on doctors and drugs. Most of us were born with our mother’s forced on her back with legs in the air, drugs, we experienced blocking of our own biological impulse for living and separation from our mothers during the most important hours of our existence.

So strong and ingrained is this belief in providing women painless birth, that a woman wishing to have a natural birth (no drugs) will often have to spend much energy and effort resisting repeated suggestions for an epidural. A significant consequence that goes unrecognized is the impact on attachment and bonding between mother and baby. This is known in Pre and Perinatal Psychology to contribute to significant life long relationship issues.

I watched an episode of maternity ward where a woman who had been induced did not want an epidural. She was in extraordinary pain, which is always the case with induced labor. The nursing staff and in particular, the doctor, continued to come to her telling her epidural would be best. She resisted and fought for hours. Finally, she gave in. The obstetrician, smiling big in a close-up with the camera, says something to the effect, “We’re really glad SHE finally DECIDED to have the epidural because it’s going to be better for her and her baby.” Really!?!? Not according to the scientific data. Doctors really don’t get it. And, dude, that is not "maternal choice" or an "informed decision."