Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital

by Cathy Daub,  PT

I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jersey and Florida have the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 

They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 

The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   

I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:

1. Where do you feel safe giving birth?
2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?

The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey¹ with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey

•         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.

•         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 

•         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.

•         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 

Few women used highly rated nonmedical methods of pain relief such as:

1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
2. Drinking or eating during labor,
3. Freedom of movement during labor,
4. Pushing and giving birth in non-supine positions, and
5. Supportive rather than directive bearing down. 

The Listening to Mother’s II survey concluded:

• Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
• The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.

These conclusions point to three concerns:

1. We need more childbirth educators.
2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.

Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.

Reference:

1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers