Having an epidural doesn’t mean you’re any less of a mom

Reports that Mila Kunis, the actress, plans on a “natural” delivery is all over the Internet. As a celebrity  she is clearly a medical expert and somehow it is relevant to hear how an actress with no financial concerns, doesn’t need to work on her feet until she goes into labor, has a BMI of 19 (OK, that’s a guess) who has never delivered before is planning to have her baby. Mila Kunis obviously represents the average American woman’s pregnancy experience.

But the distaste of asking celebrities their medical opinions and prying into the intimate details of their personal life aside, this is an opportunity to discuss the implications of what Ms. Kunis said.

For starters, the term “natural” as it applies to delivering a baby would be unassisted by anyone with any training, without electricity, and without medications to stem hemorrhage or treat infection from obstructed labor. In Africa, where most women have “natural” deliveries there is a 1 in 40 chance of dying during pregnancy and childbirth.

But it wasn’t this misuse of “natural” that got me peeved, it was this specific comment about not planning on an epidural …

“I’m crazy. I mean, I did this to myself — I might as well do it right.”

Having an epidural or needing pain medications isn’t doing it wrong. Asking for all the help that modern medicine has to offer isn’t wrong, it’s a choice. There is no prize for pain and it certainly doesn’t make you a better person if you sweat it out for 24 hours or more without help from pharmaceuticals. I despise the idea that if you need, or God forbid desire, analgesia during your labor and delivery that somehow you just aren’t mom enough.

I don’t think Ms. Kunis meant to be judgmental and she was asked this information, she didn’t volunteer it or send out press releases. However, I think it is a great example of a cultural bias that the only good delivery is unmedicated. I specifically blame the press because they ask about it, report it, and perpetuate it. Making women feel bad about their choices is a time-honored way to sell copy. If it were not no magazine cover would ever be photoshopped and Cosmo would have been out of business years ago.

Epidurals are not a great evil that looms over innocent mothers-to-be waiting to drag them down a path of certain destruction. An epidural is a safe, effective way for a woman to have pain relief during her pregnancy and delivery should she choose that option.

If you want an unmedicated delivery, have one. If you want an epidural, have one. Neither can be right because neither is wrong.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • JR

    There should be more options than epidural OR no pain relief. It appears alternative methods of pain relief aren’t even being considered or researched anymore.

  • EmilyAnon

    I didn’t read the article on the actress, but I thought in this day and age, “natural” birth meant not cesarean.

  • Suzi Q 38

    “Back in the day,” it was popular to deliver our babies without an epidural. Apparently, that was the ultimate goal….to personally feel every contraction. I tried.
    When I first got to the hospital, a woman was delivering “natural” next door.
    She was screaming at the top of her lungs and calling her husband every bad word she could think of. I could tell she was experiencing intense pain.

    I got a “taste” of what it would feel like when I dilated from 1 to 3.
    I felt a little pinch of pain, and that was enough for me.

    I asked the OB for the epidural. I seem to recall that my OB gave me my epidural, Is that possible?
    I never met the anesthesiologist, as I don’t think that there was one. Ignorance is bliss.
    The thought of allowing my OB do an epidural himself on me, kind of scares me. Back then, I thought that was O.K.

    In no time, I had fallen asleep.
    Anyway, I liked that epidural. I woke up to a slight discomfort.
    The doctor took a look and said I could push.
    Easy.
    Everyone is different. I didn’t mind not feeling the pain.

  • guest

    “…they can probably handle the birth without pain medication.”

    A man could probably handle having his arm amputated without pain medication (that’s how it used to be done, after all). But why should he? I think we could ask a similar question about women and childbirth…

    I find it interesting that in an age where it is automatically assumed that any patient having surgery will have anesthesia, we still see pain management for laboring women as being the choice of last resort because “they can probably handle the birth without pain medication.”

    • Lisa

      The difference between labor and surgery is that the side effects of anesthesia effect not only the mother but the baby.

      Women need to be fully informed about side effects of anesthesia on themselves and on the baby so they can make a decision. Anesthesia during labor is not necessarily safe; there can be side effects, just as anesthesia during surgery can also have side effects.

  • Karen Sibert MD

    Dr. Gunter is 100% on target. Every labor and delivery is a bit different, just as people are different. The position of the baby’s head as it descends–whether it’s facing forward or backward–can make the difference between a relatively normal amount of labor pain and excruciating back labor. Ms. Kunis isn’t at fault here–there’s nothing wrong with wanting an unmedicated delivery if that works out. But the mother who wants pain relief is entitled to it without guilt. Let’s keep an eye on the real goal here: to have a healthy baby, not to earn bragging rights about labor.

    • JR

      I really hope that you have a typo here:

      “The real goal here: to have a healthy baby”

      I’d hope that a healthy mom, which includes both mental and physical health, would be more important than a healthy baby.

  • querywoman

    I am critical of modern interventions, but since I never had a baby, I really wouldn’t know what I’d want.
    Mila Kunis hasn’t got there yet. We’ll see how she makes it through.

  • PrimaryCareDoc

    It’s so cute when people who haven’t even given birth yet are all judgmental about how other people do it.

    It reminds me of how I was the perfect parent before I had kids.

  • SBornfeld

    Ah, memories…
    My wife and I went to childbirth classes at the lamented St. Vincent’s Hospital in NYC. The couples sat through videos of unmedicated childbirth–mostly screaming women while the soundtrack played tinkling piano music. I raised my hand.
    “Hey,”, I said…”I’m a dentist, and in my office nobody gets any brownie points for doing without anesthesia.”
    The guys there mostly looked at me with questioning approval. Some things we guys never will understand.
    “Well,” the midwife said, YOU are dealing with PATHOLOGIC PAIN. We are dealing here with PHYSIOLOGIC PAIN.”
    To me this wasn’t much of an explanation, so I shrugged and said “SO???”
    She replied that there was a somewhat greater incidence of perinatal respiratory problems with anesthesia. I thanked her–that was a real, concrete reason. (During my wife’s labor, I also found out that the epidural required an internal monitor for the child. This is also a concrete reason, though we were assured it was no big deal).
    What WAS a big deal (to me) is that after all this (and 12 hours of induced labor–our daughter was 2 weeks post-term and the placenta didn’t look too good) my wife on one level thought somehow that she was a failure. Eventually there was an episode of distress and our daughter was delivered healthy after an emergency c-section.
    Everyone came out healthy and tired but happy. Sounds like a success to me!

    • PrimaryCareDoc

      Epidurals don’t require an internal monitor. Your baby was in distress, that’s why there was a fetal scalp monitor placed.

    • buzzkillerjsmith

      Dr. B,

      You really need to comment more, even though you are a dentist. Compared with most of the commenters here, you are not that much of a chucklehead. You and I will agree on the following:

      1. Moms who use epidurals are not bad moms. They are bad women. The Bible says something about in pain ye shall have kids. I disremember the exact wording.

      2. Men have a higher pain threshold than women do. You know this from dental practice, which, I am sure, involves large amounts of almost unbelievable pain.

      3. If you weren’t afraid that your wife might see this, you would agree with me 100% instead of dismissing me as a nut, which I might or might not be.

      • SBornfeld

        She’ll never see this. That’s why I agree with you 100%, buzzkiller! I am reminded (more often than I have to) that we will never understand the pangs of childbirth. True enough. Why then am I dismissed so cavalierly as a crybaby when I get hit in the nuts? (and why does this happen so often to me?)

    • JR

      In many countries outside the US, Nitrous Oxide has been approved for child birth.

      If the doctors decide you’re “too far along” for an epidural in the US… too bad! No pain relief at all! Suffer! (Ok, a few might offer alternatives but not all hospitals will).

      Having read the pros and cons… I’d prefer not to have a needle in my back. But I’d be ok with Nitrous Oxide.

      • SBornfeld

        I doubt that nitrous oxide could be an effective substitute for an epidural in childbirth. In dentistry we refer to nitrous “analgesia”, but really it’s more for anxiolysis. Plus, it does suppress respiration somewhat–something I’d guess the OBs wouldn’t be inclined to approve.

        • JR

          Patients say it doesn’t so much block the pain but rather help them handle it, so it’s not an equvalent to an epidural but it is an alternative. Its currently used in labor “by 60% of laboring women in the United Kingdom, 50% of laboring women in Australia, and almost 50% of women who deliver in Finland and Canada.”

          More info:
          http://www.asahq.org/For-Members/Clinical-Information/Nitrous-Oxide.aspx

          • SBornfeld

            The review states that there are no recent studies of efficacy. The 2002 review quoted included N20 concentrations up to 70%–far higher than would be used in dental offices. Although there would presumably be anesthesiologists present, I very much doubt that anything like this concentration would be used.
            Still, it’s either effective or it isn’t; and if there is a need (it certainly seems there may be) it should be evaluated and used if determined to be safe.) If you know what concentrations are used in the UK and Finland etc. I’d be interested to know.

          • JR

            Here’s a bit more, seems that it’s 50/50 and it isn’t administered in the same way that it is in the dentists office. In fact, that’s been one of the barriers to it’s use in the US, the lack of proper equipment.

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594866/

          • SBornfeld

            Interesting–chicken-and-the-egg situation. Obviously if there is FDA approval and institutions that wish to use it the equipment CAN be available.
            Yes, dental N2O machines can vary the concentration, and are not self-administered.

  • PrimaryCareDoc

    Interesting. I felt a huge sense of accomplishment and achievement after delivering my kids with an epidural. And I felt and could move my lower limbs the whole time.

  • Suzi Q 38

    I also wanted to point out that not all of us have easy pregnancies and deliveries.

    I had pre-eclamsia with both babies, and each birth was a huge deal and stressful situation. Having had to be on bed rest after month 3.5 with both babies, it was far from easy. The last month of both pregnancies warranted daily non-stress tests.

    My second was even worse, as I delivered by C-section earlier because he was breech and my labor started early without warning.

    Anyway, I was happy for the epidural the first time around. Our baby and I didn’t need any more stress.

    I felt like I had more than the “whole experience.”

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