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 terific, 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."
