Description and Official Rationale
Epidurals and caudals are two similar types of regional anesthesia that free a laboring woman from pain without dulling her mental faculties. They are commonly used during Cesarean section when the woman wishes to be "awake and aware," and also, in lower doses, during normal labor and delivery for complete or near-complete pain relief. The administration process is complex. Briefly, a local anesthetic is injected into the lumbar region of the woman's back, and then a long needle is inserted into the epidural space "outside the last of the three membranes that cover the spinal cord, just inside the bone and ligament of the vertebral column" (Inch 1984:93). This needle makes a hole into the epidural space, and through it a soft catheter is threaded. The needle is then removed, the point of entry sealed, and the catheter is taped to the skin. At its end a small filter and stopper are attached, through which doses of anesthetic can periodically be administered. The whole process, during which the mother must hold herself as still as possible, takes about 20 minutes to complete.
Physiological Effects and Ritual Purposes
It is important to note the high degree of variation in the effects epidurals have on the mother's experience of birth: skillfully given, epidurals can eliminate the pain of contractions while reducing neither the urge to push nor the mother's ability to do so; applied with a heavy hand, epidurals can completely deaden the woman's sensations, severely reducing her ability to push and increasing the likelihood of forceps application (Pritchard et al. 1985:364) and Cesarean section (Thorp et al. 1989). At the same time, there is wide variation in the effect the epidural will actually have on the individual woman. Her body may not respond to the epidural as the anesthesiologist intends--some women find that they still experience pain in spite of their expectation that the pain will be gone, whereas others who may have wanted to feel some sensations so that they could push may find themselves completely deadened and unable to do so. Crawford (1979) finds that in the best of circumstances, about 85% of parturient women are free of pain, 12% experience partial relief, and 3% feel no relief. A 1985 study by Crawford and his colleagues of lumbar epidural analgesia given during labor to 26,490 women at Birmingham Maternity Hospital in England between 1968 and 1985 found no maternal deaths. The relatively rare dangers for the mother included loss of consciousness (1 in 3000); cardiac arrest (1 in 3000); severe hypertension and headache (1 in 2000), and numbness and weakness (1 in 2000).
There are several other potential disadvantages of epidural anesthesia to the mother. These include lowering of the blood pressure and paralysis of the breathing muscles if there is an accidental lumbar puncture (Inch 1984:95-98; Pritchard et al. 1985:363), as well as long-term backache (MacArthur et al. 1990). Dangers to the baby include oxygen deprivation, slowing of the heart rate, an increase in the acidity of its blood, and poor muscle tone, which affects the baby's ability to suck (Inch 1984:97-99). If an epidural is administered before the woman enters active labor (defined as beginning around 5-6 cm. dilation), marked slowing of labor can result. During second stage labor, epidurals are likely to decrease a mother's ability to push, leading to delay of the birth, to "failure of descent," and/or to spontaneous rotation to the proper position--all of which can lead to an increased incidence of midforceps deliveries and forceps rotations (Chestnut et al. 1987; Cox et al. 1987; Kaminski et al. 1987). If you're doing so well, why do they have to slap you with an epidural?...I was ready to push, and they gave me an epidural [and it slowed my labor] and I had the baby eight hours later. And on my next birth, I was determined to stay home so that they couldn't do that. I left home at 4:30, had the baby by 6:00. They gave me an epidural and it didn't take effect until after the baby came. Because I was only there a few minutes before-- they got me all set up and prepped and ready to go and then gave me an epidural and I wasn't numb until after the baby started coming. Why do they feel like they've got to give you an epidural? Is it something within them?
-Louellen Jones
While I was trying to do it naturally, I was nervous, tense, uptight, and scared. As soon as I had the epidural, I relaxed! The baby popped right out soon after that, and I was able to really relax and enjoy the birth.
-Caroline Freeman I definitely think that the epidural is the only way to go. Why would anyone want to go through all of that when there is a better way?
-Gretchen Lauderman So common is the use of epidurals today that many childbirth professionals are calling the 1990s the age of the "epidural epidemic." 60% of the women in my study, and 80% of the women in a recent study by Sargent and Stark (1987) received epidurals or their equivalent. To numb a woman about to give birth is to intensify the message that her body is a machine by adding to it the message that this machine can function without her. In particular, epidural anesthesia puts the final seal on this message, dramatically illustrating to the woman the "truth" of one of Western society's fundamental principles--the Cartesian maxim that mind and body are separate. (See Chapter 5 for a discussion of the many women who demand epidural anesthesia during labor and birth because they desire this separation.)
Yet to fully understand the symbolic significance of the epidural in hospital birth, we need to consider the meaning of its replacement of scopolamine and general anesthesia as routine procedures in most hospitals. Although "scope" did serve to reinforce the technocratic model of birth in that it told women that their machines did not need them to produce a baby, it did not make women act like machines but like wild animals--an uncomfortable metaphor because it undermined society's attempts to make birth appear to be mechanical enough to conform to the reality created by the technocratic model: When I was in medical school, the ward patients in labor received little or no pain relief, while the private patients were given scopolamine, a drug that wiped out the memory of the labor and birth. Many women loved it and would say, "My doctor was wonderful. He gave me a shot to put me out as soon as I came to the hospital. I never felt a thing." Those women weren't put out, but they didn't remember what had happened to them--at least not consciously. When these women thought they were "out" they were awake and screaming. Made crazy from the drug, they fought; they growled like animals. They had to be restrained, tied by hands and feet to the corners of the bed (with straps padded with lamb's wool so there would be no injury, no telltale marks), or they would run screaming down the halls. Screaming obscenities, they bit, they wept, behaving in ways that would have produced shame and humiliation had they been aware. Doctors and nurses, looking at such behavior induced by the drug they had administered, felt justified in treating the women as crazy wild animals to be tied, ordered, slapped, yelled at, gagged.
-Harrison 1982:87 Furthermore, any type of general anesthesia meant that the woman would miss many of the important messages she could have been receiving. The "awake and aware" Lamaze patient with the epidural fits the picture of birthing reality painted by the technocratic model much better than the "scoped out" or "gassed out" mother, as the epidural makes a physical reality out of the conceptual separation of mind and body, a reality that the woman will grasp precisely because of her awareness. (See Chapter 4 for a discussion of the conceptual mesh between the philosophy on which the Lamaze method was originally based and the technocratic model of birth.)
