Abstract
This chapter presents a historical introduction to birth analgesia and the influence of scientific and medical discourse on understandings of women’s bodies, influencing the ways in which women themselves can frame their own corporeal knowledge. Here, the process of birth, and how it is understood within Western cultural discourses, is investigated more thoroughly. We highlight the influence of biomedicine as a dominant birth discourse and explore current medical knowledge about epidural analgesia, exposing some of the assumptions behind evidence-based medicine and technology use.
JUNO
I was just really active, trying to get it progressing
And then when they kind of started getting painful
I started squatting and moving
Just through the contractions
And in the intense part, just powered through.
I don’t know—got impatient and I yelled a lot.
It’s a good release
Think I almost bit him at one point.
He was like ‘Do you remember trying to bite me?’
And I was like ‘Yeah I think I do’
And he was amazed at how—
Cause I think the other two labours I have been very, like
‘I don’t need any support’, like
‘Don’t touch me’ kind of thing
But with this one,
Near the end
It was like ‘I need you’
I was like ‘You need to be here’.
But it was a little bit longer than that this time,
So he had to put in some harder yards,
But he was like ‘Wow the strength!’
He goes ‘That was the first time I’ve ever felt that you were actually stronger than me!’
But no pain relief and no pain relief after actually either,
So I didn’t tear or anything like that.
Yeah, so no water but I like feeling really grounded,
Like, attached to the ground.
I was on all fours, because
I really wanted to be on the ground.
I was on all fours on the bed because,
Obviously it’s more comfortable.
It’s a very hard floor in there,
Even then I was like ‘I want to be on the floor’,
Just letting gravity do all that.
Yeah no water,
I didn’t even have a shower or anything,
Just kept moving around.
Yeah it’s been interesting reflecting,
Near the end I was getting really impatient.
I was like ‘Just get out!’
You know, I was just over it.
And I was like ‘Wow, some women do this for a lot longer’
And so I can understand why you would reach for those things.
I think I felt a little bit more of that,
Just that intensity, and that pain and just wanting it to all be over.
Whereas with the others,
Because that last stage was quite quick,
You just don’t have any time to even contemplate it.
Whereas this time I felt like, you know,
I didn’t contemplate it but I definitely got impatient.
I was like ‘Come on I have had enough!’
And yeah, because every contraction was a bit more painful
And it didn’t feel like there was an outcome coming in the near future
I think I could relate to that a little bit more.
I was still going ‘Yes this is all good and it’s coming’.
I knew it was coming
It just felt a lot longer.
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Notes
- 1.
Technically an anaesthetic, in that they entail anaesthetic drugs and are administered by anaesthetists; the terms ‘epidural analgesia’ and ‘epidural anaesthesia’ are often used interchangeably. Usually, it is the purpose of the drug that denotes whether it is described as analgesia (pain relief) or anaesthesia (surgical anaesthetic), and it is for this reason that we use the term analgesia throughout this book, as we are primarily interested in the use of epidural as an analgesic agent.
- 2.
What we mean by the term ‘routine’ is that epidural analgesia is readily available in most hospital labour wards; that is, its use is not restricted or limited.
- 3.
Although this was written almost 20 years ago, as a physiological event, birth could remain fairly unchanged, arguments about increasing maternal age or obesity notwithstanding.
- 4.
By ‘intuition’ Descartes did not mean ‘either perception or imagination’, but ‘the clear vision of the intellect’: that is, reason (Lindsay 1937, p. xiv).
- 5.
Translated in this volume as ‘I am thinking, therefore I exist’.
- 6.
Lindsay (1937, p. xiii) sees the cause of this dualism as the discord between Descartes’ search for reason and his absolute faith in God: a dichotomy that resulted in the contemplation of ‘two entirely disparate worlds’.
- 7.
Martin (1989) also cites Laqueur here.
- 8.
Although menstruation may have been thought of as unclean and impure, it was still considered a normal physiological process (Martin 1989, p. 31).
- 9.
- 10.
- 11.
Ehrenreich and English (1979, p. 34) cite a petition by doctors to the English Parliament ‘asking the imposition of fines and “long imprisonment” on any woman who attempted to “use the practyse of Fisyk [medicine]”’.
- 12.
Reading original source material (cited in secondary sources) is particularly eye opening in its misogynist detail. For example, the authors of The Malleus Maleficarum also state: ‘What else is a woman but a foe to friendship, an unescapable punishment, a necessary evil, a natural temptation, a desirable calamity, a domestic danger, a delectable detriment, an evil of nature, painted with fair colours!’ (Kramer and Sprenger, in Chauhan 2005, p. 2). How can we focus clearly on current issues for midwifery and birthing women if this history, and its impact on birth knowledge and practice, is not acknowledged?
- 13.
The 2011 edition contains a new finding—increased risk of caesarean section for foetal distress—although there is still no significant increased risk for caesarean section overall. Of the 38 studies included in the review, 33 compared epidural with opiates.
- 14.
Little is known about the subtle hormonal interplays that occur in the mother–newborn dyad, in part because this has not been a priority in medical research (evidenced by its non-appearance in the biomedical literature). However, the research that is being done suggests that these hormonal responses are essential for the wellbeing of human beings, and of society in general (Odent 1999; Uvnäs-Moberg 2003). It is imperative, therefore, that those working in the area of maternity care are aware of, and can support these processes where possible.
- 15.
Many of the studies on epidural analgesia are undertaken by anaesthetists and compare either the analgesic properties and effects on motor block of various combinations of medications to be used in epidurals or compare epidural with parenteral opioids. The plethora of studies concerning anaesthetic intricacies of epidural medications and dosages are beyond the scope of our review.
- 16.
For example, Leap and Anderson (2008, p. 41) give examples of the ‘purpose of pain’ in labour, which include that it: marks the occasion, summons support, heightens joy, is a transition to motherhood, reinforces triumph, and triggers neurohormonal cascades.
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Newnham, E., McKellar, L., Pincombe, J. (2018). The Epidural in Context. In: Towards the Humanisation of Birth. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-69962-2_2
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