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Friday
Apr262013

Women Get High From Epidurals?

Really? This is what, in part, an article by Judy Slome Cohain, originally published in the Autumn 2010 Midwifery Today, says. From what I understand, Cohain is a Certified Nurse Midwife, making her comments/beliefs even more confounding.

“They get a little buzz and feel a bit tingly high from the relief of pain and the fentanyl and smile from the high. It seems a shame that they are unaware that they could get that high by learning how to find the place inside themselves that releases it naturally, or by surrounding themselves with other high people. Also, if the woman feels the fentanyl high, then the baby must be getting it also….”

Her interpretation of what women are feeling is bizarre. It isn’t that they are high, they are relieved! Is the baby relieved? Probably from the stress hormones’ minimization.

The really long article waxes poetic about unmedicated birth, saying,

“The biggest lesson I’ve learned from 25 years of assisting births is that there are no two people on earth alike. Each woman is a completely unique entity with different tastes, needs and desires. By enabling a woman to birth at home—or in any place she chooses—where she can find the position, place, smells, atmosphere and surroundings she needs to birth, she can birth practically without pain. I am not only referring to people who meditate and do hours of yoga every day. I’m talking about Mrs. Couch Potato, too. I could describe hundreds of women who did not feel much pain during birth.”

I haven’t been a midwife for 25 years, but I can surely tell you that there were plenty of women who felt a great deal of pain in their home births. Some so much, they transferred to the hospital for pain relief; not many, but a few. Pain is one major reason first time moms transfer to the hospital.

Cohain also says,

“The task of labor is to breathe and relax for 30 seconds of contraction. This can easily be accomplished by the most unimaginative person by walking slowly and counting 10 slow breathes. An imaginative person can connect to the place in her body where she can release her natural endorphins and get a natural high. She can surround herself with a few people who love her and get a contact group love surge. She can connect to her power or whatever power she wants to let flow through her—it’s much like the energy you get watching a great concert, or a shooting star, or a child take his first step. As this energy flows through her she can imagine herself powerful and giving life force to others, praying for the health of sick people she may know. She can kneel down in soft, green grass and suck in nature’s bounties. It can be tiring, but the longest it will last at significant strength is 12 hours.”

30-second long contractions are in early labor and that is typically the least uncomfortable time, but for some, it is still painful if the baby isn’t in a great position. And the longest hard labor lasts is twelve hours? She must have some speedy women giving birth around her.

I’ve been to births that sound like what Cohain describes above, but they were the unusual, not the typical. I’ve also been to hospital births that were just as ethereal as these home births she describes. Has she not?

“Watching a woman get an epidural reminds me of watching a teenager have a bad drug trip. Birth is not a terribly painful process in the comfort of home, although going to the hospital doubles it.”

It makes me very uncomfortable to read such statements. Sure, staying in the bed without movement can be more painful, but more and more hospitals are “allowing” women to move around in labor, even as they are tethered to monitors and an IV. Saying that birth isn’t a “terribly painful process” at home discounts all those women for whom birth is terribly painful.

Cohain even attacks the verbiage used around epidurals, although, as far as I know, she gets even that wrong. She says,

“Although the euphemism, ‘She took an epidural’ is universally used, no woman can take an epidural. She has to be given it.”

In my 30 years of experience with epidurals, the woman got an epidural, she didn’t take one. Have you all heard of taking one?

There is great detail about a woman in a hospital bed and getting an epidural, including the erroneous information that says,

“The anesthesiologist takes a large gauge needle on a 5 or 10 cc syringe and starts digging into the laboring woman’s back. The hole has to be large enough to fit the drug-bringing canula which goes in 4 inches, or 10 cm, in and up her spine. Blood flows down her back in a half-centimeter stream from the hole. It hurts to be stuck.”

First, the woman gets a shot of lidocaine so she doesn’t feel the needle going into her spine. The doctor also doesn’t “dig” into the woman’s back; he knows precisely where he’s going. While it does sting like a bee sting for the lidocaine poke, the insertion of the needle and then canula are typically felt as a lot of pressure, not pain.

At one point, she says that Bupivacaine is an opioid, which it is not.

And her belief that women get high from epidurals is laughable if she weren’t so serious. Accusing women of wanting to get high in birth is downright rude; women are wanting to have pain-free births and have that option in a free world.

It’s sad to me that Cohain doesn’t seem to have seen some beautiful hospital births, that the only lovely births she’s seen have been home births. I’ve seen some hospital births that were more wonderful than some home births.

I’m tempted to write a birth story where a woman starts out at home then transfers to the hospital for an epidural, words billowing melodiously. It could happen.

References (3)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Response: longchamp tasche
    - Navelgazing Midwife Blog - Women Get High From Epidurals?
  • Response
    Response: bit.ly
    - Navelgazing Midwife Blog - Women Get High From Epidurals?
  • Response
    Response: new year 2016
    hhhhhd

Reader Comments (13)

I think what overall is most disturbing about the original article, was the serious lack of respect she had for women who choose to birth differently than what she would desire. She is patronizing, disrespectful and yes, I agree rude. How does this make for anything empowering about birth? She is like a doctor from the 1950's, except pitching the opposite extreme. Makes me very thankful for my doctors, midwives and doula's who have attended my various births in hospital and at home. They treated me respectfully, though by the third child, a homebirth and back labour, I think anyone who tried to suggest that I was a poor brainwashed woman, or someone seeking a high if I opted to transfer to hospital for pain relief, might have found themselves educated about their beliefs and attitudes in a way, only an experienced mom with that level of pain can do.

April 26, 2013 | Unregistered CommenterJoy

Thank you Barb for another wonderfully balanced post!

April 26, 2013 | Unregistered CommenterFlorence

Lordy, lordy. Talk like this was what scared me off getting an epidural when I had to have my first labor augmented with Pit (at the suggestion of my midwives, after a day of excruciating back labor transferred to the hospital). What an extra hour of intense agony I did not need! I got the epidural and fell asleep, finally, after a day without much sleep.

Btw, the anesthesiologist was the most decent and kind medical personnel I met that day, bar none. We keep peppering him with questions and then apologized, but he said, "Please don't [apologize]. Questions are the sign of an intelligent mind." He made me feel safer and calmer than the OB or the nasty L&D nurse we had first.

April 26, 2013 | Unregistered CommenterKim

Sigh... I wish midwives would let go of ideology! How can we critisize OBs and then spout unsupported ideologies? Routine intervention is bad, evidence supports this for many interventions. But interventions are tools that when used appropriately and wisely can help women and babies. I have had many clients in the hospital who as survivors of sexual abuse or assault or as young teenagers simply did not tolerate the pain of contractions. An epidural allowed them to have a vaginal birth and to actually be more present to their labors and births because they were freed from the sensations that awakened memories of abuse/assault or released them from fear. I have also attended clients who were so exhausted that without the rest afforded by an epidural they would have needed a C-section. Other women make the choice to have an epidural and as midwives, isn't that what we stand for? Women's autonomy and right to choose. I have never seen a woman get a high from an epidural, most take a nap! There is no one right way to birth for everyone! Every woman who gives birth should be empowered to feel that she just accomplished the most amazing miracle. Please leave the rhetoric at the birth room door. BTW I am currently a home birth midwife and am loving it but home birth is not the right choice for every family, Vicky, CNM

April 26, 2013 | Unregistered CommenterMidwife Vicky

a few things that really annoyed me- "30 second contraction" and "starts digging into the laboring woman’s back" I am only a lowly doula, but I have never seen either of these scenarios. Back to back, 1.5 minute long or longer contractions, yes, and an epidural placed by inserting a needle, yes. I have great respect for home birth and hospital birth, (more for hospital birth, honestly) but it just seems here like the midwife is trying to frighten women away from birthing in the hospital. I agree with you, the relief some women feel from the epidural is just that, relief. I wonder if that midwife ever has had a child!

April 26, 2013 | Unregistered Commentersara

I have been reading your blog for years. I am so happy that you are here, acting as a voice of reason and operating from a truly woman-centered, rather than agenda pushing, perspective. You are an inspiration and embody the type of philosophy I hope guides my practice as a CNM (I just finished school :))

Thank you.

April 27, 2013 | Unregistered CommenterMelissa

If I hear ONE MORE TIME how the only good birth is a natural/homebirth I am going to FLIP TABLES. I had an induction and an epidural and a prolonged second stage, and I felt traumatized emotionally form everything that happened. Yet I got nothing but crap from the crunchy crowd for going to the hospital or agreeing to the induction or asking for the epidural. When I had my twins, I chose a hospital birth (partially because of your blog which said numerous times it doesn't matter how the babies are positioned, ANYTHING can change between Twin A and B and you don't have time, so thanks for that!) and I had a GREAT birth. Why? Because I was empowered in my choices, I knew what my limits were, and I had a fantastic doula. Guess what? Still had a hospital birth, still got an epidural, and had a safe breech extraction, two healthy boys, no pelvic floor injury, and I had a beautiful experience.

I am so tired of hearing people say they're sorry I had a hospital birth or an epidural or the extraction. I LIKED my hospital, I liked the nurses and the residents, and I loved the postpartum staff. I could have kissed the anesthesiologist for giving me the epidural even though I was 9+ (two hours after arriving at a stretchy 2). And my extraction was the only way besides a C-section for twin B to born, because even though he was head down at labor, he went transverse. It's so frustrating when no one will accept my story.

April 27, 2013 | Unregistered CommenterKatie

I was just discussing the homebirth of a friend of mine that was horribly traumatic because it was so painful and precipitous - so much so that she wants a hospital birth with an epidural next time. So to say that birth at home "isn't terribly painful" is an obnoxious generalization.

In regards to epidurals, I'd like to offer my own experiences:

I have had epidurals placed, or attempted on five separate occasions. I say attempted because two of those five times they were not successful and they ended up using general anaesthesia. I can tell you that sometimes there is a hell of a lot of "digging" going on with that needle and the lidocane be damned - it isn't that effective I certainly felt the attempts and the placement as a lot more than pressure. I have a very small epidural space in my spine apparently, and it's quite challenging to place an epidural. I have to get cerclages placed in my pregnancies, and they insert and remove them after placing and epidural. For one of the placements and one of the removals they had to give up trying because it was so painful for me and they had tried so many times, and they put me under GA. Each epidural placement or attempt necessitated at least three and up to six tries. There was certainly blood running down my back after multiple tries, and I had extremely painful bruising at the site that lasted for a couple weeks.

And about the "high" feeling: I have felt "high" for a while after the first bolus goes in. I hate the feeling. I feel light headed and silly and out of control and well, I know what feeling high feels like, and after getting the epidurals, I felt high. It was fairly short-lived, but I certainly experienced it. In regards to fentanyl, I have a recollection of discussing it with a midwifery student about her pharmacology studies, and I recall that some passes through to the baby, but it has a fairly short half-life, and they don't want the mother to take it if delivery is expected to be within an hour or something like that, as it it can affect the baby's respiration after birth, but it's a good pain-relief option for labour if birth isn't imminent.

Getting epidurals has been so incredibly traumatic that I had PTSD flashbacks about them (and the rest of my very traumatic first birth) for a long time. However, I know that I am an anomaly and this article is making unqualified generalizations that are totally ridiculous. I do know that I have another child, I will insist on getting GA for the placement and removal of the cerclage because I can't handle the trauma of another epidural placement - even though the hospital I would go to now uses portable ultrasound to guide the placement, so there probably wouldn't be failed attempts, I feel like the whole process would be too triggering for me.

April 28, 2013 | Unregistered Commentera. k.

It has happened....A dear friend transfered to the hospital after 36 hours of laboring at home, had an epidural, slept for an hour, turned off the epidural and had a vaginal birth.

A month later, I had a nearly pain-free home birth. I didn't realize that my waves were more than Braxton Hicks until I was ready to push.

Is one birth better or more "right" than the other? Not at all, just different. I wish more people could see both sides of the coin.

April 30, 2013 | Unregistered Commenterkaren

Thank you so much for this post! I'd like to share some of my own experience and thoughts on this.
I am soon to give birth to my second son and it is a huge security factor to know I can always fall back on an epidural. Though I live abroad in East Africa, I am birthing my children in my home country of Germany. I consider it an incredible privilege to have access to one of the best healthcare systems worldwide - if any of my African friends had the options (epidurals among others, but especially neonatal care!) that I have, they would gladly take it.
Now, German hospitals today offer a lot of freedom to mothers. They can take any position they want and birthing rooms usually come equipped with stools, swings and bathtubs - you can even play your own music and burn your own incense. There is a lot less pressure now to speed things up, less inducements, less cesarians etc.
This is in response to a very healthy and important movement that started back when things were still different and hospital births could indeed be less than respectful of women's needs and wishes. We have home births, birthing houses, and an amazing amount of literature, websites and institutions that promote "natural births". When pregnant with my first child, the language and messages used really made me insecure: Was there something wrong with me for wanting to give birth in a hospital? Would it be a failure if I had pain, or could not bear that pain? If something would go "wrong" during birth and I or the baby would need assistance, would that be a sign that somehow I had not prepared my mind and body in the right way? Shouldn't I do everything I can so that this birth will indeed be a wonderful, transcendental and connecting experience for me and my child?
I finally decided to stick with a hospital birth, but wasn't sure about an epidural, hormones etc. I will forever be grateful for the advice of an (American!) friend of mine who said this: "If you wish to try, by all means, try. But if you can honestly say that it is too much, don't force yourself and suffer for 30 hours the way I have. It is not necessary. To me, the pain was traumatizing. I wish I had taken relief".
So, not to get into my birthing story too much: For all my yoga and meditation and preparation, I indeed was not able to have an easy birth. I had no breaks in between the hot phase of labour pain for 10 hours. I stayed on my feet that entire time, walking, squatting, because I could not lie down. I tried the bathtub. My midwife checked me and I was still only 1 cm open. We both could tell that my strength was waning. We decided on an epidural + labour hormones together.
It wasn't a nice experience to set the epidural, as I had to curb my back, keep down my urge to move, and talk to the anesthetist at the same time - but it wasn't painful. What followed were possibly the three most wonderful hours of my life because all that pain left, and my husband and I were both free to focus on the beauty of bringing our son into this world. Yes I had a high and it came from total relief! My birth had needles and tubes and bedpans in it, but it was more wonderful, transcendental and connecting than anything I could have imagined. I now believe that no matter what degree of "unnatural" environment or methods you bring into the process: YOUR BIRTH REMAINS A MIRACLE and YOUR BIRTH IS PERFECT JUST THE WAY IT IS.
I am proud that I did what was good for me and my child and I am grateful I was able to savor these few hours of bliss. I am thankful there was discourse and literature out there that forced me to weigh my options. But I am glad I did not let myself be directed by fear or guilt. This was my reality, my pain, my decision, my state, my body, my child.
My advice to women anywhere, including Mrs Judy Slome, is to let each other be, to respect each of their own realities, and to not let ideology of any kind mess with their birthing decisions.
Thank you for reading.

May 12, 2013 | Unregistered CommenterDesiree

I have had two HBs. I've never taken an epidural. I have a plethora of drug allergies and do not feel safe getting one. My births were both beautiful. However, they were both painful. My first was a persistent OP with a 36 hour labor. The natural "momnesia" managed to fail a few times, as a decade on I can distinctly recall some of the most painful contractions. My second was a precipitous 3 hour labor (one push! She flew out of that birth canal like a baby panda!), and though I had no back labor, I had to cope with the pain. Which I did. But neither of my babies entered the world on a cloudy cushion of love-high.

As a doula, I have seen cases where epidurals have been godsends. More frequently, I've seen them send things awry. Yet in no case have I seen a mother get high from an epidural. This woman's rhetoric smacks of disrespect. It's as if she cannot abide the fact that women actually have a choice and resorts to soft-focus statements and outright disinformation in order to scare them. I've seen this same tactic used by people who relentlessly push women to have epidurals, and it infuriates me both ways. Women do have prefrontal cortices. We are capable of making good decisions for our particular situations. We most certainly do not deserve to be lied to or guilted into following someone else's cock and bull propaganda, be it some drug-pushing L&D personnel (they exist, though thankfully not universally) or some flowery-headed, self-righteous "birthy" person with a woefully inchoate understanding of pharmaceuticals.

June 15, 2013 | Unregistered CommenterC'helle

I have quite a few women in my social circle who home birth, I have had 4 babies in the hospital and am now expecting our 5th. I get very frustrated with the way some of the home birth moms and the way they talk about epidural pain relief. With my first my contractions started with a bang 4 days past my due date, 5 minutes apart right away and a minute long. I labored at home for about 7 hours before going in. I was 5 cm when they checked me. 10 hours later I had made no change, with contractions that were back to back and 3 minutes apart for several of those hours. I was totally exhausted . I had a wonderful CNM in the hospital who was very supportive of whatever choices I wanted to make. I decided to have an epidural and some pit. It was so relieving and worked beautifully. In just 2 short hours I couldn't believe it was time to push! I had no trouble pushing and our daughter was born in just 2 pushes. It was lovely to have had a nap, my husband got some much needed rest. I felt totally at ease and ready to snuggle our daughter. She was bright eyed and calm when she came out and just stared at us with her big open eyes. I had been really set on a natural birth and felt a little like a failure at the time. I had read so much about natural child birth that I set myself up for feeling like i had made an awful choice by having a "medicalized" birth. In hind sight I'm so thankful for the experience that we had. We were all healthy and happy. My next baby I had an epidural and the two after were natural unmediated births that were quick and more manageable than my first two. I can't recommend one over the other really, there were things in each birth that I enjoyed and things I could have done without. You never know what your birth will bring you, being open to that reality I think would help women to feel like they can embrace what happens during birth without feelings of unmet expectations. For a woman who has had less painful, fairly quick labors to pass judgment on other women who have the opposite is frustrating. I no longer expect to gain empowerment from a birth experience, but rather I stand in awe of the miracle of a new person being brought into the world. And it is shameful that NCB advocates would make a woman feel as if she has somehow not experienced "real birth" if she has had any sort of intervention.

June 4, 2014 | Unregistered CommenterChef holly

Holy cow. Birth isn't painful, but the sting of a local is? I am very very glad this woman was not my midwife. Birth is agonizingly painful, and to be poo-poohed instead of reassured would have been traumatic.

August 13, 2014 | Unregistered CommenterC

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