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Informed Choices.

All during their pregnancies women are advised not to take drugs. Sometimes even before becoming pregnant healthcare providers will offer pre-conception counseling and warn women of the hazards of taking certain drugs. Warning labels abound on products telling of the unproven safety of taking certain preparations while pregnant or breastfeeding.

Even after the birth, pediatricians will not prescribe so much as a cold preparation to infants under a certain age. Most doctors are even hesitant about using anesthetics for circumcision. Yet, during the most crucial hours of a baby's life, women are offered the highest classification of drugs known--narcotics. They are told it is safe and okay and that the healthcare provider wouldn't offer it if it were harmful to the baby. But is it really safe? Do we really know?

As a labor assistant, postpartum doula, and childbirth educator I am perplexed. I truly believe that unmedicated birth is best for mother and baby. At the same time I am realistic enough to also know that at times intervention is necessary. Women having a cesarean birth truly need to be medicated so as to not feel the surgery. Or, the woman who has labored for three days and needs a break and some rest in order to be able to go on and birth her baby may need some anesthesia. But should it be necessary to give women narcotics and numbing agents during birth 85 percent of the time?

I am told I shouldn't scare women. I shouldn't make them feel guilty about their choices--that it is their birth and my voice or opinion shouldn't count. At times I believe that. When a woman truly has been given the opportunity for informed consent and still chooses to use a narcotic or epidural for her birth then yes, she should be supported. All women, no matter how they birth, deserve that.

But what I am talking about is not support or lack thereof. I am concerned with how many women really know the effects that these medications could potentially have on their child; and not just after the birth, but long term. Do we really know enough about the drugs we are using to say that children will reach adulthood with no long-term effects?

There are many brilliant physicians working in the field who say we just don't know, or have found evidence that side effects do exist long-term. They have even had their finding published in all the major medical journals. But we choose to ignore these people or write them off as fanatics. Anesthesiologists do studies proving that epidurals are safe and effective and provide no short- or long-term side effects for mother or baby. Many people in the medical world accept these reports even though they are researched by the profession that has everything to gain and nothing to lose by a woman having an epidural.

As a postpartum doula I do see the effects in the home after the birth--mothers with back pain for months or headaches for weeks, and babies who can't seem to figure out breastfeeding. But our findings are not significant because we don't have the proper initials after our name. Or, as labor assistants and postpartum doulas, we are so involved in caring for the family that we have no time to do the work a study involves. If we did, then who would care for these families? Or worse yet, who would listen?

As women we need to rally around our pregnant sisters and help them to understand the birth process and not fear it. We need to stop telling all the horror stories to young women, causing them to fear what their bodies were meant to do. They need to understand that women don't die from contractions and that when women did die in childbirth it had nothing to do with the process itself. Women died from ignorance, malnourishment, dirty instruments and hands, and disease. And yes, women died even because there were lack of interventions at the time to help. Women need to know that their bodies are capable, powerful, and meant to give birth.

As an experienced professional in birth I am dismayed when I hear an anesthesiologist tell a woman there are no side effects to epidurals. I have seen the effects. To some of my clients it doesn't matter--they are willing to take the risks and accept the consequences. But others truly don't know. They trust the doctor to tell them if there are side effects.

At the same time doctors are saying there are no side effects, I am accused of not presenting a balanced view in my childbirth classes when we come up with more negatives than positives while comparing medicated versus non-medicated births. How is it a medical doctor can get away with blatantly withholding the truth and I am accused of frightening women when I give a more balanced view?

As a labor assistant, postpartum doula, and childbirth educator I am tired of walking on eggshells because the medical profession will disapprove of me and my methods and strong beliefs in women and birth. I am tired of letting my sisters down when I hold information back because I am afraid of upsetting them or their healthcare provider with the truth.

There are no clear cut answers and I do not profess to hold the magic wand that can be waved so that women understand and become less fearful of the birth process. But I do know that I will do everything in my power in the year 2000 to point women to the findings that are out there. Let them see for themselves and, in seeing, make decisions that are educated and informed. And then I will support them in their decisions. As an advocate for the birth process this is the best I can do.

--Crystal Sada, CCE, CD, is a birth advocate, childbirth educator, and labor support and postpartum doula.
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Author:Sada, Crystal
Publication:Special Delivery
Date:Sep 22, 2000
Previous Article:ITVS Presents "Born in the USA": A Provocative Look at Having Babies in America.
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