Dr. Gilbert J. Grant, author of Epidural Without Guilt: Childbirth Without Pain, recognizes that pain relief during childbirth is an incredibly emotionally-charged issue. After we discussed his new book and the guilt some women feel about getting an epidural, Dr. Grant contacted us to respond to some of the comments. He strongly feels that each woman should be able to decide for herself on whether or not to get an epidural and he's worried about the inaccurate information that is out there. This is what motivated him to write the book.
For 25 years, Dr. Grant has been providing pain relief to women during childbirth. He is an anesthesiologist at NYU Langone Medical Center. He says it never ceases to amaze him how many myths and rumors there are about epidurals and how people cling to old-fashioned notions that have long since been proven to be false. This is his response ....
From Dr. Grant:
Epidurals and spinals aren't for everyone. Some women want the "full experience" of labor and delivery. Good for them! But, [we] judge women harshly if they choose pain relief. And if you choose an epidural, don't feel guilty about it. There are a whole lot of reasons why having pain relief for childbirth makes sense -- and is safer for the mother and baby than suffering unrelieved pain.
The reason I chose the title Epidural Without Guilt for my book is that I have found it is quite a common feeling of women who end up using epidurals. Not all but many do feel a need to justify their decision, to rationalize it. I tell the story in my book of a woman who was in horrific labor pain until I relieved it by giving her an epidural. But her reaction was intense sadness. Guilt over having “caved in” and taken the pain relief.
It’s my impression that this feeling of guilt that many -- not all -- women feel is foisted upon them by society that has this crazy double-standard. What man would be told that it’s wrong to take a pain medication?
The other part of the problem -- and a major part -- is that there is a huge amount of ignorance about what epidurals are all about, and about the potential serious effects of unrelieved pain on the health of the mother and the baby. In an effort to combat this ignorance and to inform women about these facts, I decided to write the book.
Here’s an example: how many people know that experiencing unrelieved pain during labor and delivery (and even after the delivery) may increase the mother’s risk of developing postpartum depression or maybe even post-traumatic stress disorder (PTSD)? These are serious problems that have serious implications for the new mom, the baby, and the entire family. But does anyone ever consider this when they are thinking about getting an epidural? How can they consider this when they’ve never heard of it?
Unless you read the scientific journals on this subject, chances are you would never come across it -- because it is seldom, if ever discussed. When’s the last time someone’s childbirth education instructor told the class that if you have a traumatic delivery in which you suffer excruciating pain and have no control over the process, you’re more likely to develop PTSD? The fact is that a state-of-the-art “walking epidural” can provide complete pain relief throughout labor and delivery, and with patient-controlled epidural analgesia (PCEA), you can control how much or how little pain medication is given into your epidural.
Let's take a look at one of the myths: "Epidurals slow labor." In fact, epidurals don't slow labor. Three of the last four good scientific studies of this issue (published from 2005 to 2009) showed that epidurals and spinals, if given early (before four centimeters cervical dilation), may speed up labor. The fourth study showed that epidurals had no effect on the length of labor. We can speak about one person's experience or another person's experience, but to really figure out the truth, we have to look at the issue scientifically. When this has been done, when well-designed scientific studies have been conducted, it has become clear that today's "walking" epidurals and spinals don't slow down labor. End of story.
Every woman needs to decide for herself what type of pain relief, if any, she wants when she delivers her baby. There is not necessarily a right answer or a wrong answer. The answer is different for each woman. And each woman should decide for herself. But to make an informed decision, she needs to know the facts.