Tuesday, 12 June 2012

Living in a civilised society

I sometimes wonder if we know what we say when we trot out ye olde 'civilised society' line.  Now you're probably wondering why on earth I'm thinking about that.  Of course you may just be thinking about the colour to paint the spare room.  Anyhoo... the reason I'm thinking about it, is my having just read another throw away line about epidurals.

What I read was a mini 'debate' about how crazy women are not to have epidurals in a civilised society.  It was asserted that midwives had no place telling women about the side effects or spreading 'horror stories'.  Now I'm all for civilised society, I'm sure that most of you are, but what is our definition of such a place?  Is it that as long as things are done the way that I think that they should be done?  Might it be a place of informed consent?  

I'm not sure why we treat pregnant women as though their brains are absent.  We talk through the risks (by we I kinda mean the Health Care Professionals) and then we tell them again, and again...  When, however, it's a procedure that we want them to have, well then a quick whistle stop tour of the risks will do.  It's why you want to say 'Mars, enough already.  We know we need to be informed'.  

So, I'm not anti-epidural but nor am I pro-epidural.  I think that they have their place.  We need life saving measures to... um... save lives.  Perhaps what we need to inform ourselves about epidural anaesthesia and how a body responds physiologically during labour and birth.  

An epidural anesthesia may be presented as a substitute for the natural opiates (endorphins) a woman is supposed to release when giving birth. The need for epidurals is a symptom of an inappropriate hormonal balance. It is therefore highly dependent on environmental factors. It is related to the degree of privacy.

Lieberman E, Davidson K, Lee-Paritz A, Shearer E. Changes in fetal positioning during labor and their association with epidural anesthesia. Obstet Gynecol 2005; 105: 974-82

So what about these endorphins?  What do we know about them?  They are naturally produced by our bodies in response to pain.  Endorphins are neurotransmitters produced in the brain that reduce pain.

In my view, a civilised society is one which views birth as a natural and normal part of life.  Not an illness.  Not a disease.  Sometimes, just sometimes, birth needs a helping hand.  The words of Michel Odent 'we are at the bottom of the abyss' still haunt me from the MAMA Conference.  Let's give birth a helping hand when it is needed, not block our bodies and their natural responses just because we're 'civilised' and just because we can.

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