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Pain or no pain - a mother's decision.

Once viewed as "a woman's lot," experiencing pain during childbirth has become a personal choice. For the 1990s, most seem to have decided that "Pain is out," according to Warren Crosby, professor of obstetrics and gynecology, University of Oklahoma Health Sciences Center.

"Natural," meaning medication-free, childbirth was a reaction to two events--the 1960-70s women's movement and the medical obstetrical practices of the 1950s, in which women were treated like children and drugged into unconsciousness during labor. The babies also were affected by strong anesthesia, many showing the effects of drugs for hours after birth.

However, recent improvements in anesthesia have made it possible for the mother's pain to be dulled and for her to remain alert and able to participate in the birth. Newer medications can be administered locally, in smaller doses, with much less impact on the baby, reports Thomas Tinker, director of obstetrical anesthesia, Oklahoma Memorial Hospital. "Hormonal changes occur in a woman's body during her pregnancy which prepare her for giving birth and leave her, in effect, already partly anesthetized. We also have discovered that these changes make the nerves more sensitive to anesthesia, so smaller doses are required during labor."

This natural pain-blocking system can collapse under the influence of fear. Because of this, Crosby indicates, natural childbirth classes are extremely helpful, especially to first-time mothers, because they teach breathing and relaxation techniques.

When no anesthesia is used, the outcome may go two ways. If the labor is uneventful and not overly long, the mother usually feels much more of a sense of accomplishment and is prouder of her role in the birth than if she had used anesthesia. If the labor is extended, however, hyperventilation and other stress reactions can reduce blood supply to the baby and possibly lead to fetal distress. "This is a major risk with home births," Crosby points out. "In the hospital, the baby is monitored. At home, if the baby is having problems, the mother won't know it.

"Also, the pain is not simply forgotten once the child arrives. Statistics show that women who have had long, difficult labors are four times more likely to never have another child. Many women also build up so many expectations about having a natural childbirth that, if they end up requiring pain medication, it is psychologically damaging."

When painkiller is used, the two most common choices are a narcotic (such as butorphanol or demerol) or an epidural. Narcotics do not completely remove the pain, but make the mother very groggy and less concerned about it. The mother does not remain alert, however, and may not be able to push during the delivery.

"An epidural is a local anesthetic placed into the area around the spine, which essentially numbs the mother from the waist down. She is still aware, however, and able to actively participate in the birth. With the epidural, also much less of the anesthetic reaches the baby," Tinker explains. "This procedure demands a great deal of expertise on the part of the anesthesiologist, but many women have come to expect it as a routine part of childbirth. Many institutions have switched away from narcotics to using epidurals. I anticipate that the use of the epidural will continue to climb. . . ."
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Title Annotation:childbirth
Publication:USA Today (Magazine)
Date:Feb 1, 1993
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