Official recognition and celebration of the sesquicentennial of the first obstetric anesthetic are now memories. For those of us who provide anesthesia care to women during childbirth, however, it frequently seems that the difficulties that beset the pioneers of obstetric anesthesia 150 years ago are still with us today and the battles fought and thought to be won long ago are still problems seeking solutions. We can only hope that the bicentennial in 2047 celebrates a vastly different landscape for women bearing children.
Arguments against providing effective analgesia for women during childbirth tend to reflect the tenor of the times. One hundred fifty years ago, in a less secular era than now, religious opinion was influential and was frequently employed in social comment. Thus, literal interpretations of various biblical descriptions of parturition and apparent proscriptions against alleviating labor pain figured prominently in the campaign against effective analgesia as it became available. Antagonists often railed from pulpits. These days, religious arguments are unfashionable and, therefore, often ineffective, so the same misogynists who sought to prevent women from having control over this important aspect of their life 150 years ago use updated arguments more in concert with current thinking. "Loss of control" is one such thesis. Paradoxically, to those who spend their professional lives in labor suites, this theory contends that women suffering through a painful labor somehow have control over their life, and this control is forever lost when effective relief of pain is provided. As we all know, nothing could be further from the truth. Yet this argument continues to be promulgated and people continue to subscribe to it. Why? In my opinion the answer lies in the fact that preparation for childbirth classes are often conducted by the same misogynists who advance this and other equally specious theories. Options for analgesia in labor are frequently presented in those classes by the same people whose aim it is to reduce access to effective pain relief. Thus, we hear almost as a routine that the portion of the class devoted to a discussion of regional block consisted of an epidural needle being passed around to the collective "oohs" and "aahs" of the captivated (and captive!) audience. This is a well known, but only temporarily effective, scare tactic. The effectiveness of such a dishonest approach can be reduced markedly by the honest, reasoned, accurate approach of an anesthesiologist explaining options for analgesia during labor. How many of us play a role in childbirth education programs?
A more insidious but increasingly more common method of analgesic option restriction is the pseudoscience tactic. Here, opinions that portray labor analgesia as (choose one or more): more dangerous than anesthesiologists are willing to admit; being responsible for a vastly increased cesarean section rate; the cause of unnecessary forceps deliveries or episiotomies; the reason so many children have learning disabilities or attention-deficit disorder; interfering with the mother-infant bonding process; and the latest, disrupting normal breast-feeding. To support their claims, superselected literature, frequently from suspect, non-peer reviewed sources, is often misinterpreted and used as "evidence." As with all pseudoscience, any criticism by a scientist (anesthesiologist) is deflected by claiming that it is suspect because anesthesiologists have a financial incentive to provide pain relief. Thus, anesthesiologists' motives must be base. Have you priced a doula lately?
Yet, otherwise thinking people are often swayed by these and other arguments. How can this be? I believe the answer lies in the ability of many of these misogynists to cloak themselves in an aura of women's advocacy. In short, they do a very good job of "snowing" their clientele. When they use the "bully pulpit" of a childbirth education class, they portray themselves as ombudspersons for pregnant women, as the bulwark against avaricious anesthesiologists and scheming obstetricians. The implication is that anesthesiologists don't really care about the women for whom they provide obstetric anesthesia services, they just push their product for financial gain. Once a family embarks upon the labor process and they are able to assess our attitudes for themselves, their opinion changes. They are confronted by our honesty. We explain the pros and cons of all we do in concise and understandable terms. We support their decision making without engendering guilt if they choose one option over another. They recognize that we are committed to their well being, safety and enjoyment. It becomes obvious that we really do care.
I doubt that misogyny will be eradicated by the year 2047. My fervent desire is that at least it will have been eradicated from locations where women will be enjoying childbirth.
Gerard M. Bassell, M.D.