Monday, 22nd September 2014

Momdoc’s blog: Achieving Natural Childbirth in the Hospital

Posted on 30. Jan, 2011 by in Pregnancy and Birth

The rate of epidurals in my hospital is around 80 percent. This week, I was caring for a patient who’d delivered her first baby without an epidural and was now in labor with her second. I pro-actively told her nurse not to give her an epidural even if she asked for it—just to call me and I would come and talk to her. The nurse seemed appalled that I wouldn’t respond immediately to a request for an epidural. But I knew what was going to happen—my patient would get to the transition phase of labor (in which women feel panicky) and she’d say she didn’t feel she could do it, and before I’d hear about it, the nurse would call the anesthesiologist who would gladly come in and place an epidural for labor pain relief.

Generally (but not always) if you can do your first labor without drugs, the others are easier. This one wasn’t so easy. The baby was facing up, and the pushing was painful and took longer than expected. I know she had second thoughts about natural childbirth as the labor wore on. If I hadn’t been there, I have no doubt the nurse would have “felt sorry” for her and encouraged her to get an epidural. But the next day, I asked this patient if she was sorry that she didn’t end up getting an epidural; she said no, she was glad, because she felt so great afterwards, and the baby was so alert and nursed so well. Her husband was awfully proud of her too.

 You don’t run a marathon with the goal of avoiding discomfort, and some mothers-to-be want to experience childbirth as women have experienced it for millennia. Natural childbirth isn’t for everyone, but I wish the healthcare team, in our wisdom, could individualize care, and rather than responding reflexively that epidural anesthesia is the answer to everyone’s labor pain, target our support measures to the desires of the laboring woman.

What does this mean for a mother-to-be? Talk to your doctor or midwife, take a tour of your labor unit, talk to your support team, and try to set the scene for the sort of labor you hope to have. Labor is unpredictable, and will probably not go exactly as expected. But preparation: educational, psychological, and logistical, can help shift the odds towards whatever you consider ideal.

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53 Responses to “Momdoc’s blog: Achieving Natural Childbirth in the Hospital”

  1. Tessa Hermes 15 January 2012 at 5:08 am #

    Appreciate you sharing, great blog.Really thank you! Really Cool.

  2. Pipeloentje 5 February 2012 at 12:34 pm #

    this is all very nice, but comparing childbirth and running a marathon is a bit unfair. I gave birth in December, baby was a bit late, so needed to break the water and also some oxytocin to accelerate labour, made the 2-minute contractions and transition unbearable. So I asked for epidural, I got a very small dose, still felt everything, even pain, but it was not unbearable. Then when my little angel baby girl shot out like a rocket, I tore very severely, so instead of having to put me to sleep to stitch me up, they could just top up the epidural, and I could be with my baby for an hour after birth. So please do not paint epidural so negatively, it can also come in handy, when used properly, and women do not get overdosed to become completely numb…

  3. Stephanie Briggs 12 April 2012 at 1:31 pm #

    Unconscionable. It seems you have no clue (or perhaps don’t care) how painful childbirth can be, and the toll that sustained, untreated severe pain can take on the mother in both mind and body. Pain increases heart rate and blood pressure. These things can harm both mother and baby. In the developed world, rejecting pain medication out of hand when it is readily available (barring any medical reasons that they might not be in the best interests of the patient, such as an allergy to narcotics) makes no sense.

  4. Alenushka 12 April 2012 at 4:36 pm #

    I am appalled by you. Denying patient pain control to confirm to you own ideology is disgusting. I doubt you would deny pain control a man with kidney stones. Or perhaps your would. Pain is great, right?
    Your perpetuating misogynist myth that labor pain is good thing. Epidurals do not increase rate of c-sections, do not reduce alertness in the baby and do not interfere with breastfeeding. Study after study showed that. Epidurals are safe and effective methods of pain control. If your were my doctor and denied me an epidural in that manner, I would report you to the hospital management.

  5. tara 12 April 2012 at 8:31 pm #

    It’s horrible that you choose your own agenda over the patient’s wishes. A laboring mother should have the right to change her mind regardless of your ideology. It’s not your place to decide for her. I don’t care if afterward she was okay with it, after labor is finally over a woman is delirious with her new baby and forgets the pain, that doesn’t mean it’s right to withhold pain relief. This is not okay. And how misogynistic to add how proud her husband was of her. I daresay he would be proud of her even if she got the pain relief that she requested. This sounds like a serious breech of ethics.

  6. Sara 12 April 2012 at 8:34 pm #

    This is appalling. How dare you undermine this woman’s choices? Disgusting.

  7. Lisa 12 April 2012 at 9:39 pm #

    I was someone who wanted a natural labor and it was so painful and awful that I suffered from PTSD after– which then triggered a serious, life-long chronic pain syndrome that has no cure. Untreated pain can cause long term damage, as many studies have shown. It is one thing for a woman to choose natural childbirth and another thing to force a woman to birth naturally. Had you done that to me, I’d have your medical license!

  8. Lisa 12 April 2012 at 9:43 pm #

    As someone who is suffering from a life long chronic pain disorder that was triggered after a traumatic natural labor, I am appalled at you denying someone pain medicine. Untreated pain can do lasting damage to the body as many studies have shown. It is one thing if a woman chooses to have a natural labor, and another thing to deny her access to drugs she requests. If you were my doctor and had asked me how I felt the next day, you’d have to go through my lawyer to speak to me.

  9. Laura 12 April 2012 at 10:33 pm #

    There is no scientific evidence that epidurals interfere with the baby’s health, breastfeeding, or alertness, and in fact there have been peer-reviewed studies that have proven no link. How unethical for you, a medical professional, to deny a woman pain relief that has been proven safe and effective? I have to seriously question your ethics and professional development if you think this is a good way to practice medicine. Not to mention that you have not experienced the pain of childbirth yourself, so you have no idea the pain these women are experiencing, or how much “easier” it is with subsequent births. Every birth is different, every baby is different, you should know that better than most. This is a disgusting show of hubris, that you should be ashamed and formally reprimanded for.

  10. Martha Reilly 13 April 2012 at 10:36 am #

    As a physician, I wish to remind you that this approach is COMPLETELY unethical. You do not have the right to deny your patients medically appropriate treatment because of your ideologies surrounding birth.

  11. Jenny 13 April 2012 at 1:00 pm #

    The doc says at the beginning that she was prepared to discuss the situation with the patient if she said she wanted an epidural. That doesn’t equate to denying the patient the epidural, only creating a cushion between what the mom originally wanted to what the mom may potentially want during the labor. The surprise factor came from the nurse, who obviously held that there should be no such cushion, only that the mom should get medicinal pain relief if that is what the mom expresses in labor. The article doesn’t say if the mom actually ended up requesting the epidural at all, so it sounds like she didn’t. If she had, and the doc came in to discuss things with the patient, and the patient still maintained that she wanted one, and was still refused, YES, this would certainly be a big, even a legal, issue.

  12. LovleAnjel 13 April 2012 at 1:01 pm #

    This is paternalistic nonsense. The nurses are not responding reflexively. They are individualizing care – an individual asked them for an epidural. Just because you disagreed with the mother’s choice does not make it okay for you to order a nurse to not give your patient their requested pain medicine! This is the opposite of individualized care. It took away your patients bodily autonomy in favor of paternalistic control by her physician.

  13. Miriam 13 April 2012 at 1:45 pm #

    I’m surprised at how different labors can be. My first was 18 hours–12.5 before pushing. That gave me time to deal with the intensity. I honestly don’t remember it being painful. This time (six days ago!), I dilated so quickly, and I went from a short period of deep, “gentle” contractions to rapid freight train contractions that were so intense and painful I saw no benefit to experiencing them! I would not have been present at all if I continued on that way. The epidural was the greatest thing I could have chosen. I am SO HAPPY I had medical staff that respected my wishes, even though I began labor with a desire to “go natural”. My child was born healthy, and I experienced minimal vaginal trauma because I was able to relax and focus on slow and controlled pushes. My anesthesiologist was simply wonderful. If a woman enters labor saying “no matter what I say, do not give me pain relief”, that is one thing. For a doctor or anyone to make that decision for her, however, is simply paternalism disguised as a pro-woman, natural approach.

  14. Sara 13 April 2012 at 2:31 pm #

    The more I think about this the angrier I get. I delivered my first 5 children without pain relief. By the time I was pregnant with my 6th I was over it. I wanted the epidural as early as I could have it. I knew I ‘could’ do it, but why should I have to when there is safe and effective pain relief available. My OB ordered the epi and the anesthesiologist never showed. I endured the most horrific pain for the next 3-4 hours. I was in a complete panic, the pain was so overwhelming I really don’t remember much of the experience. I remember the agonizing pain and the deep sense of betrayal. From what I have been told I was also doing quite a bit of screaming and crying. But hey, I did it so it’s all good right?

  15. Lisa 13 April 2012 at 3:34 pm #

    Your husband must have been so proud of you!^^^

  16. Sara 13 April 2012 at 3:38 pm #

    I don’t think that proud would be the word he would use. He was furious that they would allow me to be in pain for so long. He said it was terrible to watch and be completely helpless. I’ll have to inform him that he was looking at it all wrong.

  17. Juliet 13 April 2012 at 5:56 pm #

    If only there were more doctors like you!! The sad, influx of opposing opinions came from here: https://www.facebook.com/groups/199827500028384/
    A facebook group called *fed up with natural childbirth*.
    I think you can understand why all these people think you should give epidurals out, they are strongly opposed to natural birth. If we had more doctors like you, we would have less women giving birth at home. Thank you.

  18. Marjorie Greenfield MD 13 April 2012 at 6:11 pm #

    Thanks! I was wondering where these reactions came from.

    I am so sorry that people misinterpreted what I was describing. This was a situation where the mother had told me what she wanted from her birth experience and I helped her to get it. And she was happy. Most of my patients want epidurals, and I support them. I am sorry if the description could have been interpreted as being about me–it was about the mom and what she wanted, and how she could have gotten undermined by well-intentioned caregivers.

    Birth is very personal and unpredictable. No one knows exactly what it will feel like, and what she will want in the moment. Of course a mom can change her mind, even if she said she didn’t want an epidural ahead of time. The point of this post was just to say that the people around you need to understand what you are hoping for, and know how to support you when the going gets tough. This is true for moms who feel strongly (as my own mother did) that they want pain relief in labor as well as moms who want to avoid medical procedures. Ah well.

    Thanks Juliet for your support.
    Marge Greenfield

  19. Sara 13 April 2012 at 7:37 pm #

    I am in no way opposed to natural birth. I’ve done it, time and time again. I support a woman’s choice. And I can tell you there was nothing more degrading than being denied a choice in my labor. And I sure as heck think an epidural should be given to a woman asking for one.

  20. Marjorie Greenfield MD 13 April 2012 at 9:06 pm #

    Yes I agree. The problem is some women express the distress of transition by saying “I can’t do this” or “I need drugs.” If we always interpret that as a change of heart, we will provide epidurals for women in the transition phase of labor, just before they are going to give birth. My analogy is that we are running alongside a woman running a marathon and at mile 24 she says “I can’t do this.” Is it better to encourage her and ask if she is sure she wants to stop? or to say–sure, just stop now! The point is the goals she set for herself. One option I recommend to my patients who are seeking natural childbirth is to have a code word with their doula or other support person that means, REALLY I AM DONE. Some doulas make a plan with their clients that they will help them get an epidural if they ask three times. This helps us avoid getting confused between a cry for support and a real change of heart. Everyone is allowed to change her mind. Let’s just support women towards what they are seeking rather than undermining them. That’s all I was trying to say! I am not preventing moms from getting desired epidurals!

  21. holly 13 April 2012 at 9:08 pm #

    Sounds like bad practice to not give pain relief if is requested. Did she come in and say, “hey, I’m probably going to ask you for pain relief, but please don’t let me, unless it’s absolute necessary?’ If not, it sounds like quite a shame. If this happened at the dentist, more people would probably be appalled.

  22. Pam 13 April 2012 at 11:43 pm #

    Dr. Greenfield’s caring approach to a laboring woman who has expressed a strong desire to birth unmedicated is admirable. More Docs should follow her example! The mom she was referring to had expressed her desire to birth unmedicated and was highly supported in that desire. Nothing was withheld from her, but instead she was offered a different kind of support that helped her birth in a way that was safest for herself and her baby. It is not easy to birth unmedicated in hospitals today… assumptions and pressures to get the epidural abound. Kudos to Dr. Greenfield for helping this momma achieve the birth she wanted. It is a rare and magnificent careprovider who reflects back to a laboring woman the normalcy and purposeful sensations she is challenged with in labor. Offering understanding, a gentle touch and a true belief in a woman’s ability to birth is most often exactly what a woman needs to carry her through that difficult/short time in her labor. Birthing unmedicated gifts a woman with a flooding of amazing hormones that are the reward for a job well-done and that move the mother/baby couple into a more connected bonding/breastfeeding experience. It is worth it for the mom and and baby and every effort should be extended to support that state of well-being for them both.

  23. Christy 14 April 2012 at 1:03 am #

    I applaude Dr. Greenfield’s efforts in ensuring this mother’s wishes were carried out. I am a doula and have heard the cry of “I can’t do it!” so many times, even at homebirths. It is a perfectly natural response during a very intense time of labor and should be expected. Dr. Greenfield supported her patient by being there and listening. That can hardly be said for many Dr’s and Anesthesiologists. I personally have had her as my doctor for prenatal care and can honestly say she would never deny a patient requested pain medication and is very willing to help her patients deliver healthy babies the way they want to.

  24. Amy 14 April 2012 at 8:38 am #

    Thanking heavens above you’re not my doctor. By mentioning your hospitals 80% epidural rate, you’ve made it clear where your little ideology is. So are 80% of women forced into an epidural? More likely 80% of the women choose it. Some of them probably want it but dont have time. I don’t see someone refusing an epidural as a ‘hero’ – it’s just their preference. Their preference, NOT yours. Oh and just so you know, I didn’t find this on your fb group linked above.

  25. Jax 14 April 2012 at 9:29 am #

    I also applaud dr. Greenfield for providing personalized care. How many practitioners even remember what their patients specialized wishes are? Dr. Greenfield took the time to be there and provide support during her patient’s toughest moment when the most common and accepted method of dealing with the panic that sets in at transition is get that epidural going and check back later. I wish I would have had someone With experience to support me through that difficult time rather than send some one in to ask about an epidural.

  26. Erin Randel 14 April 2012 at 10:58 am #

    There is a Facebook page of people opposed to natural childbirth?! Wow. Will they segue into organized opposition to natural haircolor in old age? I’ve never met Dr. Greenfield, but am delighted and (unfortunately) astonished to learn there’s an OB out there who considers it her business to encourage laboring women to hold fast and dig deep to find their inner strength. Over three pregnancies,and after a lot of research, I went from a stressful in-hospital NCB to an unassisted homebirth, and the depth of strength I discovered within myself has been a gift.
    If more professionals–from the OBs to the floor nurses–had her YOU CAN DO THIS attitude, I might have chosen the hospital right along.

  27. Ann 14 April 2012 at 11:19 am #

    As a physician who in the past delivered babies and as a woman who had 2 natural deliveries I applaud your ability to provide appropriate care for your patient by being present and nurturing during the difficult phases of labor. Some OBs rush in at the last moment to get credit for delivering the baby without really managing the labor. Sitting with a woman and individualizing the care to her needs is completely ethical!

  28. tlsegall 14 April 2012 at 1:23 pm #

    I greatly appreciate your blog post. I have two daughters which I gave birth to naturally. For the first birth my husband and I did the tours and classes recommended by the hospital and doctors. I was the overly organized first time expectant mother. I naively had my birthing plan all typed up and ready. I think the only thing that went really truly to plan was the pain meds portion. My husband was my advocate and partner during the whole process. I told him that I do not want meds at all. If I asked for them, he was to request them for me. The anesthesiologist came in my room asked if I wanted an epidural to which I gave an enthusiastic NO. He left and was never needed again. If you have the kind of relationship with your doctor and your partner, your needs will be met. If not, get a new doctor. I didn’t see this post as you denying your patient her request for meds. You were following her lucid request and plan set in advance. We have all made snap decisions when under duress that we later regret. There are other issues at stake here. Good for the new mother and her child!

  29. Chelsea 14 April 2012 at 3:09 pm #

    I also applaud Dr Greenfield. As a Labor and Delivery nurse, I have OFTEN witnessed other nurses who DO NOT respect the wishes of their patients in regard to pain medicine. In essense, ALL care providers, Doctors, nurses, midwifes, anesthesia staff, have and EQUAL RESPONSIBILITY to deliver excellent care, timely care and COMPASSIONATE care. As a healthcare provider, we are supposed to be there to deliver excellent care—which in the case of childbirth is very subjective to the patient. One woman’s dream birth may be another woman’s nightmare….and that can vary birth to birth even for the same woman. For instance, say you have another family stressor or tragedy occurring simultaneously…that woman may not have the stamina to have a natural birth….there are thousands of reasons birth plans can change course during labor…so the bottom line is that any care provider for childbirth needs to have a STONG line of communication going with the patient to ensure a satisfying birth. I think that in this case, Dr. Greenfield was trying her best to honor her patient’s wishes. THERE CERTAINLY are nurses who choose to undermine the patient’s agenda as soon as that “transition panic ” sets in. Let’s not attack Dr. Greenfield here….she is a wonderful doctor with a wonderful heart.

  30. Melissa Gonzalez 14 April 2012 at 3:18 pm #

    As a doula and childbirth educator, I tell my students that 99% of women will get to a point in labor where they’ll say, “I give up, I want an epidural.” It’s important to know beforehand what she *really* wants — for some women (women who are interested in natural childbirth, for example) “I want an epidural” can be another way of saying, “I’m scared, I’m tired, I need more support.” In that case, it’s better for them to have a open and clear communication with their care provider so that she can get what she really wants and needs. The goal of the care provider is to have a healthy mom and baby, and some go above and beyond and try to make sure they have a satisfactory birth experience as well. Kudos to Dr. Greenfield for not only being open to natural birth, but encouraging it!

  31. Rachel 14 April 2012 at 3:22 pm #

    Oh please. My mother had all three of us naturally (only one in the hospital because I managed to literally get her ovary in a twist in her first trimester) and she had maybe half an hour between when she walked in and when she had me. People whining about it—guess what? Not that long ago, you didn’t get these drugs. And they can have seriously bad side effects. If you can do anything without pumping chemicals into your body because ‘oh no, it hurts!’ you should. I get it, child birth sucks, but guess what? First of all, if you go in expecting a ton of pain, you’re going to get it—mirror neurons in your frontal lobe. If you go in thinking it’s going to be fine, it will hurt much, much less. In addition, child birth has been happening a lot longer than these drugs, and you know what? Yeah, I do have less respect for women who demand the drugs, because they are putting their momentary comfort ahead of their safety and the baby’s safety.

  32. Rachel 14 April 2012 at 3:33 pm #

    And not only that, but I actually saw one woman on that facebook group claiming that the ‘hippy ways’ of wanting natural childbirth will actually cause the death of infants? I’m sorry, what?
    Epidurals carry huge risks, including sudden drop of blood pressure (which would mean less blood to the baby). Also, the mother can no longer assist in the birth, because the entire lower half of her body is NUMB. In the case of the anaesthesia being administered spinally, the leakage of spinal fluid is a risk as well, which can lead to later discomfort and pain experienced by the mother. Also, “Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries and episiotomies. ” I don’t know about you, but I don’t want a cesarean unless it’s necessary. They aren’t healthy, and studies have just surfaced showing that they may have negative side effects on the baby. As may epidurals:
    “most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties.”
    Since when would having a baby the way you are supposed to cause death of the infant? Please, learn what you’re talking about before you say it. A woman’s pelvis is designed to have a baby.

  33. Katy 14 April 2012 at 3:50 pm #

    Kudos to Dr. Greenfield for supporting this woman during labor. Labor gets to that point where most women feel they need an epidural. I’ve had three natural births and it ran through my head each time. But with caring support providers I was able to push through. Dr. Greenfield is providing another method of relief – support and encouragement.

  34. DanieS 14 April 2012 at 6:31 pm #

    I find the reactions above quite sad. We as mothers should be supportive of each other regardless of how we delivered our children. It is a painful, messy AND a beautiful thing. I certainly didn’t see the beauty of it at the time and did receive an epidural. Other women can, and perhaps these are the ones who garner the strength to carry on. I am not dissappointed in how I delivered, it was how it was to happen at that time and place for me. Folks should take a moment and re read Dr. Greenfield’s post and subsequent comments, she is merely proposing healthcare professional understand, support and customize their care based on the patient’s desire for how they want to approach childbirth. Don’t we want that out of our doc’s?

  35. Sarit CNM 14 April 2012 at 6:42 pm #

    This type of care obviously cannot be used by all doctors and midwives. It could be considered “unconscionable” and “paternalistic” for providers who don’t actually have personal relationships with their patients to deny them pain relief, because what do they know of their patients’ wishes? But when there is a good relationship, knowledge of the patient’s history and values, and plenty of discussions about birth during prenatal care, providers can encourage patients through pain, rather than immediately yielding to requests for epidurals.
    Patients routinely make requests out of pain that we know are not their true desires. I’ve had people ask me for C-sections when their first contractions began, for inductions at 30 weeks because they’re “sick of being pregnant” or for me to “just pull the baby out” to stop the pain. These requests shouldn’t be ignored, they are cries for help that require out encouragement, support, and compassion; but not our acquiescence.

  36. Rachel 15 April 2012 at 12:44 am #

    As to the response I gained on the facebook group, I will keep talking. You are judgmental women who don’t recognize the danger of the choices you make.
    Natural birth causes child death? Please. Do your research.

  37. Rachel 15 April 2012 at 12:47 am #

    I do like being called “unhinged and judgemental,” though, by people who refer to me as a hippy, loud, obnoxious, and insane…How does it make me unhinged to have an opinion, exactly? I agree, my respect comment was inflammatory. It’s a personal opinion that I don’t believe other people should have, but it is my gut reaction.
    I have plenty of respect for all mothers, no matter how they claim that title. It is the people who demand drugs without looking into the side effects, who do so against their doctor’s reccomendations, and who assume that without the drugs it ‘can not be done’ that I have slightly less respect for, if only because they are acting like a fourteen year old girl getting a tetanus booster.

  38. Merrill Lewen 15 April 2012 at 8:35 am #

    Wait a minute everyone!! Dr. Greenfield said this patient wanted natural childbirth and that she wanted to support those wishes. She did not say that she did not say that she did not support the wishes of her 80% of patients that want an epidural! The concern she expresses is how to help the individual woman through the momentous event of childbirth without the system simply doing what it seems to be norm. Thank you Dr. Greenfield for listening and educating your patients during pregnancy, helping them through the wild event of labor, and aiding in their healing, both emotionally and physically, postpartum.

  39. Angie 15 April 2012 at 9:54 am #

    Dr. Greenfield,

    Thank you for following your heart and common senses when it comes to caring for your patients. You are a breath of fresh air in the obstetrical community.

    A woman’s care provider is the person a woman has built a relationship with over the course of her pregnancy. When labor gets tough sometimes a women needs to hear that her care provider believes in her.

    I applaud Dr. Greenfield listening to the wishes of her patients and believing in them.

    Keep up the excellent work!
    Angie

  40. Kiki 15 April 2012 at 10:53 am #

    Awesome!! Good for you doc!! I love this. If I would have had half of your support I would have birthed in the hospital. I saw six OBs in a quest for an ounce of support for a drug free birth and was told at 7 mo pg to just stay home if that’s what I wanted. So I did. And three babies later, all birthed at home, it’s still rare to find a dr like you. Stay true to yourself!!

  41. Kathi Rosen 15 April 2012 at 12:16 pm #

    Wow! Amazing how some here twisted the doctor’s comments to suit their agenda. She did NOT tell the nurse to refuse pain meds, she told the nurse to call her so she and the patient could discuss the decision. That is called giving your patient top-notch, individualized, supportive health care. I am past my child-bearing, but I wish there had been more docs like Dr. Greenfield when I was birthing my babies.

  42. Joanna 15 April 2012 at 2:01 pm #

    “Wait a minute everyone!! Dr. Greenfield said this patient wanted natural childbirth and that she wanted to support those wishes”.

    No, she never explained that in the original post. The original post made the following points in the following sequence:

    1. The hospital in question has an epidural rate of 80%.
    2. The doctor ordered the nurse to refuse the patient an epidural if she asked for one.
    3. The patient was having a difficult, painful labor and was refused an epidural
    4. The next day, when prompted, the patient said she was happy with being refused an epidural.

    Later on, in the comments, the author clarified that the patient had wanted a natural birth and the author was intent on supporting that goal. None of the was explained or included in the original post.

    Without the missing information, the original post did come across as paternalistic, ideological and cruel. The commenters responded to that. It’s not that complicated.

    And yes, Rachel, DO keep talking. Thanks for telling the truth and letting us all know how natural childbirth advocates really feel!

  43. Joanna 15 April 2012 at 2:12 pm #

    “Wait a minute everyone!! Dr. Greenfield said this patient wanted natural childbirth and that she wanted to support those wishes”.

    No, she never explained that in the original post. The original post made the following points in the following sequence:

    1. The hospital in question has an epidural rate of 80%.
    2. The doctor ordered the nurse to refuse the patient an epidural if she asked for one and come get the doctor instead.
    3. The patient was having a difficult, painful labor.
    4. ??? Doctor doesn’t explain what happened (did she discuss with patient? What was the discussion? How was decision reached?)
    5. Doctor congratulates herself for refusing epidural to patient and everyone is “proud” of patient who was in pain.

    Later on, in the comments, the author clarified that the patient had wanted a natural birth and the author was intent on supporting that goal. None of the was explained or included in the original post.

    Without the missing information, the original post did come across as paternalistic, ideological and cruel. The commenters responded to that. It’s not that complicated.

    And yes, Rachel, DO keep talking. Thanks for letting us all know how natural childbirth advocates really feel about their fellow mothers; though for those of us familiar with them this isn’t a surprise.

  44. Susan Greene 15 April 2012 at 2:16 pm #

    Interesting the passions evident on this subject! As I read it, neither Dr. Greenfield nor the birthing woman she describes were naïve – this woman already had a labor and delivery without epidural, she knew the challenge. Labor support by a “known” individual (not the nurse who just came on shift) is proven to correlate with shorter labors, use of less epidurals and narcotics, reporting of higher maternal feelings of satisfaction with her birth, less depression for moms after birth and better breastfeeding experiences (earlier onset, longer overall nursing time, etc). There are definitely physiologic reasons why having support helps – women in labor have access to more of their own endorphins and the other hormones that empower them and help them deal with pain. Contrary to the comments of the pro-epidural faction, epidurals do not guarantee a pain free labor or birth – some epidurals are very spotty, some work on half the body , some don’t work at all! Women go their whole pregnancies, avoiding that small drink at a party to protect their baby BUT, expose themselves and their babies to heavy and sometimes large drugs through epidurals. I, for one, am grateful epidurals exist – but I know that not all women need them. Most women are more powerful than they know and with support (preferably continuous support) and encouragement ( AND access to doulas, water therapy such as tubs/showers, advice about position changes, quiet, dark, warmth, uninterrupted space etc) can birth their babies. Thank you Margie Greenfield for supporting women’s choice and low intervention birth

  45. Rachel 15 April 2012 at 6:06 pm #

    “And yes, Rachel, DO keep talking. Thanks for letting us all know how natural childbirth advocates really feel about their fellow mothers; though for those of us familiar with them this isn’t a surprise.”
    It isn’t how I feel about you. It’s how I feel about the way you attack other mothers as being ‘sanctimommies’ and ‘hippies’ just because they choose a different path than you. It’s disgusting. I retracted my statement about less respect because, I admit, it was inflammatory and brought on in a bout of anger.
    But the way you people act…it frightens me. Since when has the choices made between a doctor and her parent been your business? At all?

  46. Heather Young 15 April 2012 at 7:24 pm #

    Truly amazing. It is so unheard of these days that pregnant/laboring women get personalized care. I applaud you and your efforts. It’s all too often that you hear women are DISCOURAGED to give birth naturally and unmedicated. I wish more doctors were “cheerleaders” as you are.

    As for the above statement of “unfounded” evidence against epidurals, it could be further from the ruth. There are plenty, they are just not often discussed due to the ease and convenience of a quietly, numbed, bed ridden patient.

    To each his own, and to Dr. Greenfield, BRAVA!!

  47. lisa 16 April 2012 at 10:51 am #

    I applaud Dr. Greenfield’s respect for her patient. There is far too little of this in most hospitals.
    Caring, compassionate, individualized care is what a woman deserves when bringing her baby into the world.

  48. Sunday Tortelli 16 April 2012 at 3:23 pm #

    While it is true that the original blog post may not have provided extensive details of the backstory regarding the expressed wishes and goals of this laboring woman and the trusting relationship she had forged with her doctor prior to being in labor, I find the responses that presumed a misdoing on Dr. Greenfield’s part quite unfortunate. Regardless of personal viewpoints regarding labor pain management, what I appreciate about this story is that Dr. Greenfield cares enough about her patients that she prefers to offer personal guidance while they are making important decisions about their labor care plan. How often do women complain about the impersonal (and sometimes even dismissive) care they receive from their doctors? How often do women complain that they were not offered enough accurate information to exercise their right of informed choice or informed refusal during their birth experiences? Over 20 years of working as an advocate for birthing women allows me to state with total confidence that such complaints are commonplace. This is not a debate about epidurals. This is a testament to what can happen when a woman and her doctor forge a relationship of mutual trust and respect. That type of relationship can carry a woman in her most difficult hours and can also help the family and other members of her support team to minister to her needs in the most effective manner. It allows for elimination of fear and acceptance of the hard work of labor. Brava Dr. Greenfield! This is but one more example of the type of caring, objective and open-minded doctor that I have known you to be over many years of association.

  49. DanieS 17 April 2012 at 10:30 am #

    Sunday Tortelli – love your post!

  50. Carrie 17 April 2012 at 11:01 am #

    Deep, calming breaths everyone! If you read carefully, at no point did Dr Greenfield say she would deny her patient an epidural. She only requested the opportunity to come to the bedside to provide emotional support and help her make an informed decision. Any of you who have spent a significant amount of time in hospitals should recognize this as a rare event. I applaud Dr Greenfield’s dedication to her patient. I believe her only intent in this article was to encourage education and awareness of one’s options in labor.


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