Why do North American women give birth in bed?
—offered an appealing alternative. Administered at the level of the spine, epidurals effectively bypass the brain, allowing mothers to stay awake and alert during labour, to relay their symptoms and participate in care decisions. But they also require a different trade-off. The medicine spreads out to block all nerves that relay and receive signals to and from the pelvis and thighs.
Women with epidurals are unable to urinate on their own. A catheter must be placed to help them. Otherwise, their bladder will simply distend like a balloon. They are also unable to effectively move their legs and must remain in bed, usually for many hours. Epidurals require more intensive monitoring, a multitude of wires that act as tethers.
At birthing centres, epidurals are not available, and as a result, labour looks remarkably different from the hospital equivalent. While the mother may not necessarily look comfortable, her movements and her mindset more closely resemble an athlete accomplishing a feat than a patient undergoing an ordeal. Throughout, midwives are in attendance toOccasionally, complications develop during labour that make it necessary for these mothers to be transferred to the hospital.
But the expectation of these mothers is not absolute control any more than it is absolute comfort. Most recognize that labour is neither completely controllable nor completely comfortable. They, perhaps like all people giving birth, simply seek to understand these trade-offs and have the opportunity to cede control—or comfort—on their own terms.
Neel Shah is an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.
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