Unmedicated Birth?

Although my mother and mother-in-law both gave birth without the assistance of epidural analgesia, this does not appear to be the norm for most women, at least in the current times. I do not go around broadcasting that I plan to have an unmedicated birth, because I really have no clue how it will ultimately all play out, and it could very well be the case that medical interventions become necessary… but hopefully not.

Some of the sentiments I’ve heard about an unmedicated birth are quite snide, and I get these from all kinds of people, including those who are professional healthcare providers (not my own, fortunately). No, I don’t want a gold star or a pat on the back for needlessly suffering through pain, nor do I believe that “natural suffering” should be part of the grand experience of labor and birth. Believe me, if I could literally snap my fingers and have a pain-free birth, I’d do it. However, the fact remains that no medication or medical procedure is without attendant risks and potential complications.

Some studies suggest epidural use causes increased labor time and increases the need for instrumentation use in the form of forceps and/or vacuum, which in turn leads to increased risk of severe tearing (here). I have no strong opinions on what other people should or should not do, except that I believe every woman should have enough information on data and risks to come to whatever conclusions based on her personal preferences. But just as to myself – as a person who has never undergone any sort of surgery, medical procedures frighten me. I have not so much as had tonsils removed, had a mole biopsied, or ever needed stitches. No joke, the most invasive medical procedure I have undergone is probably a pap smear. So the mere idea of having a needle in my spine that pumps drugs continuously in my body, along with a catheter up my urethra, or potentially having someone stitch my vagina or slice my belly open, causes just as much if not more anxiety than the fear of labor pain.

Further, having worked in the medical field, I have a selective awareness of all the things that can and do go wrong with medical interventions. I’ve had a case where a patient experienced a severe spinal infection from spinal analgesia and have also had a case in which a woman permanently and completely lost bladder control after a catheter mishap during birth. Granted, these complications are extremely rare, but at least with an unmedicated birth, I know what the worst complication is – pain. Pain sucks, but if you can tolerate it, it’s a lot less scary than complete loss of bladder control, paralysis, or a c-section.

All this being said, I dread pain and am not about to go into this without the right resources and tools, which is why we decided to take a Hynobirthing class. My clients are almost exclusively composed of healthcare providers, and being a person who very much appreciates medical technology, embracing alternative measures was not easy for me. This is particularly the case because the alternative measures inevitably involve a certain degree of what I describe as Hippie crap, for lack of a better term.

I own more than a handful of boho skirts and love Bob Dylan. I don’t wear deodorant because I don’t need it but that does not mean I want to give birth while dancing in a naked circle in the ocean or that I will ever be sold on the spiritual/emotional benefit of candles, incense, or aromatherapy [NOOOOO]. I am not one of those “spiritual not religious people.” I am not searching for cosmic truth or seeking to be one with nature.

I previously had no interest in meditation, spirituality, and certainly no interest in hypnosis, because I liked my life at a certain pace, and I liked to be in control. On my high school graduation night, a hypnotist performed a demonstration, and of about 40 people, I and one of my friends were the only two skeptical individuals who were not able to succumb to the hypnotist’s antics, despite following directions.

So how did I get over this?

First, I told myself I had to. I did some light research and found that plenty of women can and do experience bearable births without epidural use, and told myself that if I wanted to take this path, I would have to consider, accept, and follow the advice of the practitioners who specialized in this area. I’m not one to follow anything blindly, but I did make a commitment to this particular path. I bought Ina May’s Guide to Childbirth, my friend gave me Mindful Birthing, and I signed up for prenatal yoga.

During my first couple of yoga classes, I internally cringed at instructions to “send loving thoughts” to my baby and affirmation cards about beautiful birth goddesses. When told to “let go,” my instant thought was Let go of what? No, I don’t want to. But then the Asian mom in me said Listen to the teacher! What do you know? Plus, you paid for this, so pay attention and just do it! While yoga was not life-altering, it did bring a sort of calm and balance into my life.

In turn, the breathing techniques and general culture involved in prenatal yoga primed me for the Hypnobirthing class, which was taught by an experienced and knowledgeable midwife. The course featured much informative material about the stages of labor and delivery, the relevant anatomy, and exercises for managing pain. Don’t get me wrong; I still engaged in internal eyerolling at some of the videos, particularly the one where the narrator spoke like she was trying to get me to join a cult, and proclaimed nonsense about the spirals of the nautilus shell having some relation to the order of the universe and pain relief [please, just don’t]. However, I do strongly believe the meditation, breathing, and relaxation practices and visualization techniques were on point, useful, and will be immensely helpful during labor and birth.

In the end, as with all things in my life, I settled on a mishmash of what worked for me. I fully embraced Ina May’s perspective on dispelling the fear associated with birth, but ignored her implicit calls for further socializing medicine; I incorporated the benefits of prenatal yoga without resorting to paganism; and I fully engaged in meditation/relaxation exercises without committing to birthing in a tub at home and eating my placenta.

Thoughts on Ignorance as a Cause of Post-Partum Depression

I am not a psychiatrist, a medical specialist, or even a scientist, but I have a sneaking suspicion that post-partum depression, while obviously a complex condition, is rooted at least in part in one phenomenon: distorted expectations from lack of sufficient and accurate information.

Likely owing to society’s desire to increase the population of humans, and general squeamishness and avoidance of gross subjects, most women are exposed to only a very topical and rosy view of pregnancy, birth, and motherhood throughout their lives leading up to the decision to reproduce. Everyone’s heard of “pregnancy glow.” On the other hand, things like pregnancy constipation, pregnancy constant flatulence, pregnancy insomnia, pregnancy leaking of urine, and pregnancy leaking of amniotic fluid are less frequently mentioned, if at all. After labor, everyone knows about the “bundle of joy,” but probably not the bundle of shit on the delivery table.

Unless a woman happens to keep company with a horde of brutally honest women who don’t mind sharing things like a desire to literally die during childbirth because of the horrible pain (thanks mom!); how badly their vaginas tore, got infected, then tore again; among other horrifying stories not fit for dinner conversation, a woman may find herself pregnant and learning these very real possibilities for the first time. Society wants you to think of the glow, not the farting, leaking, pain, tearing, and shitting, because if women carefully considered all these downsides, some undoubtedly would have second thoughts. It is true the more women know and contemplate the implications of these realities, the more careful they are going to be about their decision to reproduce, but this should not be a bad thing.

Again, I’m not a medical professional, but I speculate jumping into pregnancy imagining the glow and the rewards of motherhood, then being subsequently ambushed by a slew of physical ailments, followed by serious physical compromise or injury during labor, topped off with the reality of becoming responsible for a squirming, screaming, crying, shitting bundle of mess all while suffering sleep deprivation and possible problems with breastfeeding, is an easy recipe for depression.

This is exactly why all women should seek out all the relevant information, both positive and negative before deciding to have children. Having worked in the field of healthcare law for many years, I know the detailed and precise description of risks and complications, both common and rare, discussed with women before they have so much as an appendix removal, brow lift, or boob job. For almost all surgeries, no matter how minor, physicians will review risks, benefits, and alternatives, providing an overview of common complications, expected outcomes, and even some remote risks, such as death. They are required to do this for every procedure, even life-saving surgeries most people in their right mind would never refuse. The basic rationale behind this practice is that people should know what they are getting into, and that includes not only common and expected risks and outcomes, but at least an idea of remote and unlikely complications as well.

Yet, as it relates to reproduction, a completely elective choice in this day and age, women hear merely about “pregnancy glow,” “bundle of joy,” and perhaps vague references to fatigue and morning sickness before committing to something of significant medical, physical, and emotional impact not only for the next 9 months, but indeed, possibly for the next 18 years. With this in mind, it’s actually amazing more women do not suffer post-partum depression.

Of course, while society has a tendency to give women inaccurate impressions, women need to take responsibility for their own decisions. I doubt many women look into the full panoply of risks, complications, and outcomes associated with pregnancy, labor, and the post-partum period in great detail before deciding to become pregnant; I know I didn’t, and I am actually someone who really took my sweet time deciding to have children at all. I had cataloged in the back of my mind a collection of horror stories from honest women over the years, and went into this with an understanding of a lot of worst case scenarios, because that’s my personality. I figured if I could accept the possibility of these worst case scenarios, then I would not have any regrets, but as far as being actually informed, this is totally not sufficient, and I met with plenty of surprises upon finding myself pregnant.

As with most things in life, preparation is key, and I surmise the more women know, the more they can do to prepare emotionally and physically, and the less shock and disappointment they will experience, which in turn would reduce the likelihood of post-partum depression.

The Beach

June 27, 2004 sober for 7 days I was lucid and smug

The sand told tales of tan lines, gold and shade taking turns on bodies resting on graininess

In the city with the highest concentration of fake beautiful people second only to Hollywood

Smooth young skins vie for afternoon bronze with books in hand, then dance in the garrulous waves

This is the glory and the glow

Their mothers, ghostly creators, are broken with leather and haunted by crows, purposeless, but

Can find solace in plastic salvation on every corner in this neighborhood

She tells me we are more than halfway dead and I believe her

I cannot help but think our friend who will be a man and a doctor, has more time

A lifeguard angrily shouts to us that no dogs are allowed

Texas Abortion Laws Force Abortion Clinics to Close, Liberals and Conservatives Both to Blame

By definition, freedom is the is the power to determine action without restraint; alternatively, it is the exemption from external control, interference, or regulation. The definition itself is straightforward, yet its application in politics is anything but. Conservatives want to protect people with oppressive laws and militaristic police from “the illegals,” “the terrorists,” the Muslims, drugs, and other various bogeymen, but feign a concern for “freedom” when it comes to economic issues. Liberals might not be quite as rabid about immigrants, Muslims, or drugs, but want to protect people nanny-state style, with equally burdensome laws from banning cigarettes/sodas/fatty foods, to forcing people to buy health insurance, while paying lip service to social freedoms.

In other words, everyone wants to pick and choose the freedoms they support, which is ultimately an untenable position.

Conservatives, who cheer on laws regulating sodomy, gay marriage, drugs, among other things that are no one else’s damn business, should not be surprised (yet for some reason, always are) when they find the government has inflated to an unmanageable size, and has continually extended its reaches into healthcare, private businesses, and other aspects of peoples’ private lives.

Liberals, who cheer on high rates of taxation, ostensibly for the purpose of the “greater good” and “general welfare,” should not be surprised (yet for some reason, always are), when they find their taxes have been spent on endless war, the most bloated military on the face of the planet, militarized police, and a growing police state.

The most recent example would be the 5th Circuit Court of Appeals’ ruling on a Texas law, which severely restricts abortion clinics. One key provision of the law requires that physicians performing abortions have hospital admitting privileges. This aspect of the law was upheld by the 5th Circuit last week (see here). This undoubtedly will limit access and availability of abortions across Texas. But wait, there’s more!

Another provision of the law, already in effect, mandates that abortions be performed in facilities equivalent to an ambulatory surgical center (see here and here). This has resulted in the closing of about half of the abortion clinics across the state of Texas, which should be unsurprising (see here).

Obviously, one motivation for the law was to limit abortions. However, that was not the stated intent. Lauren Bean, of the Texas Attorney General’s Office, explained, “This decision is a vindication of the careful deliberation by the Texas Legislature to craft a law to protect the health and safety of Texas women” (see here). Sound familiar, liberals?

When one exchanges a few verbs and nouns, it becomes clear that this law, designed for “protecting the health and safety” of Texas women, is really identical to the countless other laws, regulations, and restrictions in existence in every other area of healthcare.

The law requires that every abortion (which is a surgical procedure) be performed in a facility licensed as an ambulatory surgical clinic. Every doctor performing an abortion should also have hospital admitting privileges. Arguably, the law sounds reasonable on its face. Why shouldn’t a doctor performing a surgical procedure do so in a licensed ambulatory surgical center (which isn’t even a full-fledged surgical facility)? And why shouldn’t such a doctor have hospital admitting privileges for performing surgery? Surely, this will be a reasonable form of quality control and protect women from “dangerous” abortions. In fact, it’s very similar to any of the following laws:

  • Every prescription for medication X must be written by a licensed physician
  • Every procedure X must be performed by a provider licensed to do X
  • Every procedure X must be performed at a hospital licensed to provide X
  • Every medication X must be purchased only at dispensary/facility with permissible licenses to do so
  • Every device X for disease Y must be tested by the FDA under A,B,C requirements before being made available to any member of the public

I doubt most liberals have a real problem with any of the above, because certainly, those laws were passed to “protect” the idiot populace from greedy doctors, Big Pharma, scheming hospitals, and other horrible capitalists, and are completely justified. In the absence of those regulations, doctors will be colluding with Big Pharma to prescribe cyanide for profit, and hospitals will be killing patients, because, profits and stuff!

It would behoove liberals to acknowledge that for the most part, protecting people from their own choices does far more harm than good. Just as Texas’ recent abortion laws are designed to “protect” women from from a host of imagined dangers, but severely limit access to abortion, and indisputably increase the costs thereof, so do the the myriad of healthcare regulations already in place similarly decrease access, and increase prices in every other field of healthcare.

Abortion clinics are closing their doors across Texas, which will create monumental obstacles for women seeking needed services. Conservatives are certainly to blame, but liberals are not entirely blameless either. After all, they usually support all kinds of government regulations and interventions in a wide range of other healthcare issues. This particular intervention and restriction upon abortion is just one of many logical consequences of such support.

I’m not about to limit my beef to liberals, though. Stay tuned for the inevitable circumstance wherein conservatives find that their love of big government similarly has come back to bite them in the ass.