Excerpted from Birth as an American Rite of Passage
Description and Official Rationale
With cervical dilation and uterine contractions that cause discomfort, medication for pain relief with a narcotic such as meperidine [Demerol], plus one of the tranquilizer drugs such as promethazine, usually is indicated. The mother should rest quietly between contractions with a successful program of anesthesia and sedation. In this circumstance, discomfort usually is felt at the acme of an effective uterine contraction, but the pain is not unbearable. Finally, she should not recall labor as a horrifying experience. Appropriate drug selection and administration should accomplish these objectives for the great majority of women in labor, without risk to them or their infants. (Cunningham et al. 1989:328)
Nearly all American women delivering in the hospital receive some type of drug (Woodward et al. 1982). One study reports an average administration of seven different drugs during vaginal delivery and fifteen during Cesarean delivery (Deering and Stewart 1978). Many of these drugs are documented teratogens or toxins (Brackbill et al. 1984). A study by Woodward et al. (1982) found that 86% of women delivering in hospitals receive at least one teratogenic drug, and 64% receive at least two, whereas women giving birth by Cesarean receive even more. "Virtually all drugs given during labor tend to cross the placenta rapidly and alter the fetal environment as they enter the circulatory system of the unborn infant within minutes or seconds of being administered to the mother" (Inch 1984:84). When a baby is born with drugs in her bloodstream, her own liver, which is one of the last of her systems to mature, must detoxify those drugs; a drug like Demerol, for example, can remain in the baby's system for several days (Inch 1984). Studies of babies whose mothers have received obstetrical drugs during labor have repeatedly and consistently demonstrated the sort of adverse effects that are associated with central nervous system damage: impaired sensory and motor responses; reduced ability to process incoming stimuli and control responding to them; interference with feeding, sucking, and rooting responses; lower scores on tests of infant development, and increased irritability. Bonding may also be impaired....The most frequent ...physiological changes include respiratory depression, general sluggishness and fatigue, extremes of muscular tone (limpness or rigidity) skin discoloration (blue instead of pink)...jaundice, abnormal EEG and sleep/alertness patterns, and increased tremulousness. (Brackbill et al 1984:17-18)
There are few studies of the long-term effects of pain-relieving drugs on babies; most of those conducted have not tested babies beyond six weeks of age, and very few have tested beyond the first year. (One very recent study finds evidence of a statistically significant correlation between the use of analgesics during labor (primarily pethidine--aka Demerol), the administration of drugs (primarily Vitamin K) in the week after birth, and the development of childhood cancer before age 10 [Golding et al. 1990]). But a paucity of studies does not mean a lack of lasting effects. Available evidence indicates that when early drug-related damage occurs, it may be compensated to some extent. However, as Brackbill (1988:23) points out, organisms that have to compensate for such damage do not perform as well under stress as nondamaged organisms. Ucko (1965) found that children who had suffered oxygen deprivation at birth functioned as well as normal children in everyday situations but exhibited more behavioral disturbances in stressful situations. Relevant animal studies show impaired learning resulting from exposure to analgesics at birth (Iseroff 1980). Perhaps obstetrical drugs are generally safe for mothers and babies; perhaps they are not. The truth is that no one knows for sure, one way or the other.
For many laboring women, analgesics do provide welcome relief from pain and tension, and can make the difference between a positive and a traumatic labor experience. But there is no guarantee that such drugs will accomplish that purpose--a common source of confusion and disappointment for women who are expecting complete relief with the first shot of Demerol. It has been suggested that analgesics may result in a slowing of labor (which will then entail the administration of pitocin, if the woman has not already received it, or in an increased dosage, if she has); too few studies have been done on this subject for any definitive conclusions to be reached. As with the long-term effects of analgesics on babies, little is known about the effects of such drugs on the woman and her labor.
Some of the women in my study reported effective pain relief from the Demerol or Nisentil they were given:
I requested medication one time--I requested some Nisentil [which I had been told] was a good safe drug....I was doing pretty well, but then going into transition, it was just getting real hard....[the Nisentil] made all the difference....It didn't really help the pain as much as it--it was like when the dentist gives you gas, it makes you not care that much. And what it really did was help me relax in-between, you know, it just kind of took the edge off so that I could really relax in-between contractions, which was nice.
Others reported that the drugs had no effect on the pain, but only made them drowsy and less able to deal with their contractions. The women who felt that pain medication was forced upon them resented the interference in their experiences of labor and the lack of support for their desire to avoid medication:
I asked for pain medication, but I didn't really want it. What I really wanted was for someone to tell me that I could do it--to remind me that that I was just in transition and tell me I was terrific, doing great. But they were only too eager to get me to take it. For just a few minutes I thought I couldn't do it, and so I lost it and took the drugs, and then it was all over for my natural childbirth experience--I got too woozy after that to do my breathing right. I know I asked for the medication myself, and that my reaction is irrational, but I am so angry that it was given so quickly. I didn't really want medication--I really wanted support.
In contrast, the women who requested pain medication and meant it expressed firm beliefs in their right not to have to be in pain. Potential depressive effects of analgesia on the baby were not an issue for most of these women, as they assumed that their obstetrician would regulate their dosages appropriately. They strongly felt that the choice to use analgesia was relevant only to themselves and their labor experiences:
I read all this stuff that told me that I would be a complete asshole to have drugs, because "it's so much better for the baby" and "it's a natural experience," and there was just all this pressure, and I revolted. I mean, my attitude was that I had quit smoking, had been eating meat and drinking milk for months and months, had been such a good girl. A couple of hours of whatever the drugs were going to do to me, tough. You can put up with it, kid.
States physician Michelle Harrison (personal correspondence):
I've always maintained that what hospitals needed were soundproof labor rooms. A lot of medication is given because of crying or screaming and its effects on other laboring women. Women, always taking care of everyone else, will be persuaded to take medication to alleviate the pain on the faces of their partners, or to appease nurses, or because they've been told they are making too much noise.
It seems to be a fundamental assumption of Western culture that pain is bad. As our society's microcosm, the condensed world in which our cultural values stand out in high relief, our medical system is constantly engaged in demonstrating the high negative value we place on pain. Perhaps we devalue pain so much because it, like birth, reminds us of our human weaknesses--our naturalness, our dependence on nature. Machines don't feel pain, so if we are going to be like them, neither should we. The physical--and conceptual--experience of pain, like the physical and conceptual experience of birth, grounds us in our natural selves. The experiential and conceptual combination of pain and birth presents a double-whammy threat to the technocratic model; to birth without pain removes half of that threat, bringing us one step closer to our long-term goal of technological transcendence. The analgesia that most laboring women receive intensifies the message that their bodies are machines by adding to it the clear statement that their machines can function without them. The sending of such a message would not have been possible without our cultural notion of the separation of mind and body--a basic tenet of the technocratic model. At the same time, this procedure teaches and reinforces that concept.
This ritual, of course, also serves the purpose of intensifying the strange-making process and its accompanying breakdown of the initiate's category system. What the woman feels and what her body does become separate, disconnected. Sensory experience and bodily knowing can serve her no longer as guides; now she must rely totally on machines and medical attendants for guidance and direction. A clue to the service that analgesia for laboring women provides for hospital staff members may be found in their nickname for Nisentil--"nice n'still."
© Robbie Davis-Floyd PhD, Used with Permission
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