A woman-centred approach to birth includes the right to choose drugs.
CHILDBIRTH was the most painful experience of my life. I did it both times without any pain relief beyond nitrous oxide gas, but only the first time was by choice. The second time, had I been able to choose, I would have had an epidural, or at least some pethidine or morphine.
I didn’t have a choice because I was cared for exclusively by midwives in a birth centre. I liked the birth centre, and I liked laboring under the care of midwives who had looked after me during my pregnancy. Because I didn’t regard either of my low-risk pregnancies as illnesses, I felt there was no reason for my labor to be overseen by doctors in a hospital ward.
But while the birth centre I attended, like most in Australia, had ``standing orders’’ to provide me with gas, I had to reconsider my options when I wanted more serious painkillers. I could remain at the birth centre under the care of the midwives I knew and trusted – and accept what I saw as unacceptable amounts of pain – or I could transfer to a hospital ward and into the primary care of doctors I didn’t know, in order to get the pain relief I wanted. Some choice!
While most Victorian women labor under the care of midwives, only a tiny percentage have midwives as their primary carers.
A recent national report has called for resources to be made available to address the unmet demand for birth centres in every state. In addition, doctors will face increasing pressure to allow midwives to assume the status of primary carer for all women having normal, low-risk births.
One of the reasons doctors are under pressure to cede more of the responsibility for normal births to midwives is because of what the World Health Organisation considers unacceptably high levels of intervention in births, where the doctor calls the shots.
WHO believes 85 per cent of women should give birth without any intervention, Australian women have a significantly higher intervention rate.
Opposition to intervention in normal births has come from a number of groups. One such group is a coalition of midwives and mothers and forms part of what is known as the ``natural childbirth movement’’.
Historically, this movement’s embrace of intervention-free birth and exclusive breastfeeding as ``natural" and ``best for baby’’ has been part of an overall belief in the natural capacity of women to give birth to, feed and care for children.
These beliefs support a view that in most cases pain relief, like most birth interventions, is unnatural and unnecessary, damaging for the baby and can possibly disrupt the natural bonding process that occurs at birth.
Feminists are longstanding – though strange – bedfellows of the natural childbirth movement. Feminists also seek less medical intervention in childbirth, but their objection to intervention is that it strips women of their ``control’’ of the birth process.
Many feminists are unsupportive of pharmacological pain relief because it deprives women of an ``active‘’ and ``conscious’’ birth and is the tool of the enemy – the medical profession that usurped the control female healers and midwives once had over birth.
Of course, both groups have practical and ideological reasons for their less than enthusiastic stance on pain-relief drugs. The reality is that the current range of pain-relief drugs can disrupt a woman’s labor, leading to a ``cascade’’ of unwanted interventions such as a drip to get things moving again, a baby suffering respiratory distress and/or a forceps or caesarean delivery.
But having defined a woman-centred/feminist birth as free from pharmacological pain relief, both natural childbirth advocates and feminists tend to minimise the pain of labor by employing euphemisms such as ``intensity’’, and exaggerate the efficacy of the non-pharmacological forms of pain relief such as baths and massages, or both.
While I can see how this happened, I can’t support it. Any group batting for women must accept that some of us want a less interventionist and more woman-centred birth, and the best pain-relieving drugs money can buy.
Not only should natural childbirth advocates and feminists fight for the right to dispense such drugs to informed and consenting women, they should put their considerable skills and energies into fighting for a better choice of pain relief than what is now available.
Although I would have taken what was on offer, my real choice would have been a drug that effectively managed my pain, but also had a negligible impact both on my foetus and the course of my labor.
Pain is not noble, and it is not ``intensity’’. It is pain, and it sucks. Women should be given a choice about the sort of pain relief they want.
If they decide to have drugs, they should have the right for the drugs to be delivered by the carer of their choice – be it a midwife or a doctor. Those who want to take the pharmacological option need a wider range of choices than those currently available.
A woman-centred approach to birth is about expanding women’s rights and choices, and having effective pain-relieving drugs during labor is as legitimate a choice as any other.