New Moms

Pain-Med-Free Childbirth: Tough and Brave, or Unnecessary Suffering?

| by The Skeptical OB

I ought to sent a thank you letter to the folks at the Lamaze blog Science and Sensibility. No sooner do I make a claim, then they rush to confirm it.

Barely a month ago, I wrote about the natural childbirth project of ignoring women's need for pain relief in labor.

It is difficult to imagine any other situation in which ignoring a woman's severe pain would be socially and ethically acceptable. But for natural childbirth advocates, a woman's needs are invisible, and therefore merit no consideration.

Less than 2 weeks later, Science and Sensibility showed us just how it's done. They published a guest piece by a family practice physician, and darling of the NCB movement, that purported to discuss the risks and benefits of epidurals without mentioning the most important benefit, the ability to relieve the agonizing pain of childbirth.

Now Penny Simkin explains why it's okay to render women's need for pain relief in labor utterly invisible. Ms. Simkin is the doyenne of the doula movement. Indeed, Ms. Simkin is so famous within the NCB movement that there is a Simkin Center at the Seattle School of Midwifery:

The Simkin Center for Allied Birth Vocations at Bastyr University trains social, practical and clinical care providers for pregnant and new families, including: Birth doulas [and] Postpartum doulas ...

In other words, Ms. Simkin is a stalwart in the industry that has the most to lose from recognizing and abolishing labor pain. That's why it's more than a bit ironic that Ms. Simkin decries the epidural "industry."

An enormous industry exists in North America to manufacture and safely deliver pain relieving medications for labor.

Who faces the real economic threat, Ms. Simkin? There's no greater economic threat to doulas than an epidural; when women have effective pain relief, there's no reason to pay someone whose entire purpose is to keep them from getting effective pain relief.

How clever, then, of Ms. Simkin to explain precisely why it's okay to ignore women's pain: pain should be ignored because "suffering" is more important. In a completely unexpected, who would have imagined, can't make this stuff up coincidence, pain cannot be treated by doulas but suffering can.

Whom does Simkin reference for her astounding insight that women's labor pain is irrelevant. Another natural childbirth advocate, of course:

Lowe also points out that "suffering," can be distinguished from pain, in that by definition, it describes negative emotional reactions, and includes any of these: perceived threat to body and/or psyche; helplessness & loss of control; distress; inability to cope with the distressing situation; fear of death of mother or baby. If we think about it, one can have pain without suffering and suffering without pain.

Those silly medical people! They think that agonizing pain equals suffering. No, no, no. Those silly women in labor, they think that agonizing pain equals suffering. No, no, no. They're too stupid to know what's good for them. They "grasp" at the opportunity for relief of pain even when Penny Simkin knows that they are not suffering.

When staff believe that labor pain equals suffering, they convey that belief to the woman and her partner, and, instead of offering support and guidance for comfort, they offer pain medication. If that’s the only option, women will grasp for it.

The unmitigated gall of the woman! Who, exactly, is Penny Simkin to tell women they are not "suffering" when they are experiencing pain?

And what is suffering? I know you are going to be super duper shocked to find out that while agonizing pain is meaningless, "birth trauma" is the legitimate cause of suffering.

... the definition of trauma comes very close to the definition of suffering. "Trauma" involves experiencing or witnessing an event in which there is actual or perceived death or serious injury, or threat to the physical integrity of self or others, and/or the person’s response included fear, helplessness, or horror. (3) Neither suffering nor trauma necessarily includes actual physical damage, although it may do so.

One's perception of the event is what defines it as traumatic or not. As it pertains to childbirth, "Birth trauma is in the eye of the beholder"(4), and whether others would agree is irrelevant to the diagnosis.

Evidently women are smart enough to define trauma for themselves; it's in the eye of the beholder. Women are evidently too stupid to define suffering for themselves; that's in the eye of Penny Simkin.

But not all women are too stupid to define suffering for themselves. Only women in labor are too stupid to define suffering for themselves and need Penny Simkin to define it for them. A woman who has pain in ANY other situation, in ANY other area of the body, for ANY other reason can figure it out for herself. It's just women in labor who can't be trusted.

This "reasoning" is simply obnoxious, not to mention patently self-serving, and entirely unscientific. Pain is a neurological phenomenon. Pain is what the WOMAN says it is. Pain can and usually does cause suffering. Pain SHOULD be treated if a woman wants it treated; no other reason is necessary, and no possible excuse mitigates the ethical obligation to treat it.

We do owe Penny Simkin thanks for one thing, though. By offering this inane, convoluted and incredibly self serving justification for ignoring labor pain, she has made it crystal clear that to NCB advocates women's pain in labor is meaningless.