WOMENS-HEALTH Messages for October, 1998: Re: Another queston on epidurals

Re: Another queston on epidurals

From: William D. McIntosh, MD (anonymous@obgyn.net)
Fri, 23 Oct 1998 17:13:49 -0500 (CDT)

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At Fri, 23 Oct 1998, Christine wrote: >
>This is in response to Mary Shoup's answer to my post on
>epidurals and episiotomies. So, have epidurals become popular AGAIN, or
>did they never go out of fashion in some areas of the country? I can see
>why they would help if they provide a pain free interval during a long
>labor, (in other words, allow the mother to rest but wear off before the
>actual delivery stage) but how could they possibly help if the mother is
>unable to feel anything and can't push? (I'm talking about uncomplicated
>delivery) Is the trend now AWAY from unmedicated childbirth? It was my
>impression that 20 years ago the trend was away from intervention in an
>umcomplicated childbirth. I feel out of the loop here!

One of the wonderful thing about living in our time are the choices that are available. If you don't want an epidural, you don't get one. You have to ask for it, endure the counseling from anesthesia, sign the permit, and put up with the insertion of the catheter before you have it. You can have it turned off, or even pulled at any time. Women get epidurals BECAUSE THEY WANT ONE! I derive no benefit from a patient with an epidural, except for their comfort. I don't get paid any better, the labor is usually a little longer, generally the patient has to push a bit more, so the only person who benefits is the patient.

In the 12 years since I delivered my first baby in medical school, the demand for epidurals has done nothing but gone up. They have never gone out of fashion in any region of the country. No one is forcing these women to do something against their will. It is their own choice. This is not the forced twilight sleep of 30-40 years ago, this is a response to a demand by women for pain control for birth that leaves the woman awake and able to participate in the birth.

The age when patients were helpless pawns of the medical system is long gone. Women make their own medical choices now, or should. The fact is that the overwhelming majority, regardless of how you or I feel about it, want effective pain control for labor, and the epidural is what they chose the overwhelming majority of the time. The only current brake on the use of epidurals is the occasional refusal of third party payors to pay the anesthetists.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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In reply to: Christine: "Another queston on epidurals"
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