Thursday, 28th August 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. Julie 17 April 2012 at 12:24 pm #

    What a beautiful story, showing how Dr. Greenfield listened to and understood her patient, and then took on the role of a supporter to help the patient achieve the birth experience she wanted. She doesn’t have an “agenda” here, she’s just showing how one patient was able to labor and deliver outside the mold of what we typically see at this hospital. Every patient, no matter what their beliefs or desires regarding pain control in labor, should be respected and supported in such a way. Thank you Dr. Greenfield, for sharing this story.

  2. Hasan Abdessamad, MD FRCSC 17 April 2012 at 8:39 pm #

    I arrived late to this discussion but after I read Dr. Greenfield’s original post and scanned through the comments underneath I came to realize that all of you are on the same page. We all want to make sure we are providing patient-centered care, we are compassionate and we ultimately provide the mom with an experience that is well-informed, individualized, safe and gratifying. I salute you all for thriving for that and I admire Dr. Greenfield for sharing with us her insightful and inspiring approach on doing that. I like how Dr. Greenfield asked the nurse to call her when the patient asks for pain management so that she allows her patient to discuss this important decision with her personally. I also want to thank Dr. Greenfield for the tip about the “code word”. I will definitely start using that with my patients.

  3. Toby Frazier 24 October 2013 at 7:08 am #

    The main argument women make for openly discussing birth practices and explaining (over and over and over again) what a woman’s body is capable of is that it’s supportive. The general thinking is that the discussions are necessary for women to feel better about themselves and their choices. But, sometimes I think the “sanctimamas” are actually doing a disservice by making women feel like they have to have a certain kind of birth to feel proud of themselves. If they wanted a home birth and had a hospital birth, they lose cool points. If they planned on a natural birth and wound up with an epidural and a C-section, they can’t share in the same joy or wax poetic about the “beautiful pain” of their contractions before pushing. It’s this type of mentality that leads to a person literally having nightmares about having a hospital birth with meds. Maybe if the education these sanctimamas (and documentaries) provided didn’t come with such harsh judgment, we’d all be better off. At the very least, it’d help women like Elise catch a few extra hours of much-needed sleep.


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