Observations on Midwives and Epidural Anesthesia During Labor and Delivery

by Mara Merritt, third year medical student

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Two days ago I completed my four week long obstetrics/ and gynecology core rotation. The month was filled with the unexpected in many ways. One of the surprises was my response to epidural (spinal) anesthesia injections that are given to reduce pain during labor and delivery.

My mother started training to be a lay midwife (now called certified professional midwives) in 1984, shortly after the birth of my youngest sister, (who was born at home). By the late 80's my mother was knee-deeply involved in the Association of Texas Midwives and spent many weeks in Austin for many years working on the regulation of the practice of midwifery in the state of Texas. Until last week I thought of epidurals as purely evil. (It is not that all midwives oppose epidurals, but my mother taught natural childbirth classes for a decade before entering midwifery, so I never heard a positive word regarding epidurals leave her mouth). The experience of midwives has been that epidurals slow labor down and are unnecessary when other approaches are taken to the birthing experience and pain.

Four weeks ago I was part of participated in my first hospital births ever. There are so many differences between these hospital births and the home births I have been involved in are so many that the experiences do not even resemble one another. When I have attended births with my mother, she is welcomed into her patients’ homes as part of the family, as an invited and honored guest to a joyous celebration. Over the past month I have entered delivery rooms as a virtual stranger, piecing together the lives of families in cramped fragments of time. Having only between 15 minutes and to 12 hours with hospital patients;, I have felt myself to be an intruder. (tThe mask and gown definitely add to the sensation of being some sort of alien invading this most intimate of experiences).

My positive response to the use of epidurals in labor shocked me. I have spent the last decade of my life reading and hearing about how negative opinions about epidurals. epidurals slow labor down and are unnecessary when other approaches are taken to the birthing experience and pain. However, in the hospital delivery room I again and again saw uncomfortable, writhing women transformed into calm, smiling women as a result of an epidural. So, why not? Of course, I still have this sharp edge that insists that no one can fully experience something if the senses are blunted, and I personally would want to know the cliff of the pain as well as the full ecstasy of bringing a child into the world. I have never been in labor, and I have never experienced what these women are feeling; eEven if I had, if feel that the choice still belongs to these each individual womean.

I wonder how, as a doctor, a medical student, a counselor, or a friend, to support people as a doctor, a medical student, a counselor, or a friend in decisions I do not think are good decisions (or at least decisions I would definitely not make myself). It is the age old problem of not imposing one's your own values on others. I know it’s more complicated than this, though. The patient/doctor relationship is one with a definite power imbalance. , and I have seen many patients relinquishing agency their autonomy and decision-making responsibility and deferring to their doctor in making choices about their health and their lives. How do doctors take care to not impose their own values and judgements on patients, to not take advantage of their vulnerability of patients in oppressive and imposing ways? I live my life, for the most part, with great intentionality, and I make careful, deliberate decisions regarding my own health care. I think that if all my patients became vegetarian, gave birth at home, and embraced nonviolence in thought and action, as I do, I would be thrilled. I know, though, that this is my life path, and I want to be able to encourage others to pursuite of othertheir own paths that are different from mine.

I think that this openness should goes beyond an merely embracing of differences. It involves a creation of space for discussion and sharing, which demands that traditional walls between doctor and patient be dismantled. During my ethics course during in my second year of school, I was told that doctors should not share much of their personal life with their patients. Since doctors have more or less unlimited access to a patient’s past and present, this creates a one-sided relationship in which the patient is completely vulnerable and exposed, and the doctor is the knowledgeable expert. I believe the opposite is a much healthier way to manage health care. Patients simply have to be the ultimate experts in their own lives., since tThey are the ones living inside their skins; they are the ones who experience their life and their bodies firsthand. I have been told by many attending doctors to never trust what a patient says because patients lie frequently; . A common medical attitude is that patients are problems that must be overcome in the achievement of health.

My mother warned me in the years before I started medical school that there was no way I could escape the process of brainwashing that would leave me as a conventional, coldly competent and conventional physician. For once, thankfully, my mother was wrong. I am part of a growing number of medical students and physicians struggling to redefine the role of the doctor, to live wholly and openly as individuals and healers.

The above is adapted from a response to a listserve conversation among members of the Humanistic Medicine Interest Group of the American Medical Student Association (AMSA):

Mara Meritt is a third year medical student at Texas College of Osteopathic Medicine in Fort Worth.

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