Thursday, March 20, 2008

Epidurals in the Czech Republic

Will and I still remember the screaming. It was the woman in the next room in the hospital and she screamed to hoarse silence as she gave birth. I hadn’t gotten tired yet and was still in a chatty mood, but the screaming made us scared.

"Will it get that bad?" I asked. "Is this usual?" The doctor shook her head. "No, that lady didn’t want an epidural, and now she is regretting it. Don’t worry, pain like that isn’t common with an epidural."

The doctor was at least partially right - I never felt like screaming. I did sing Beethoven very loudly when they cut off the analgesia for the last stage of labor (apparently music is my dinosaur brain’s way of coping with pain), but labor hormones combined with the epidural helped me remember C’s birth as a challenge rather than a trauma. I'm guessing, though, that the doctor was wrong about why the woman didn’t have an epidural. When epidurals are provided to far less than 10% of women giving birth in a community, your next door neighbor's drug-free delivery most likely isn’t about a real choice.

Less than 10%. In 2002, MedLine reported that over 60% of women in labor in the United States used epidurals (65% in California). In Western Europe and Scandinavia, the average seems to hover around 30%, depending on location (women in the countryside have a lower epidural rate than women in cities). Availability of an anesthesiologist, cost, hospital willingness, and the education of families are the key contributing factors to women receiving epidurals.

How do I know this? Besides a MedLine/Google addiction, I am in the middle of reading through a worksheet on epidurals, provided by my obstetrician. It is actually part of a packet of documents that I have to sign and hand back to the clinic next week. Most of these papers are related to the birth certificate or to reserving a space in the hospital and I’ve read through the lot, but the epidural pamphlet, that kept my attention. Eight pages long, it not only asks for my approval and sign off on all risks (which I expected), it also presents a history of epidural analgesia, a list of frequently asked questions, and anecdotal stories from doctors and patients.

One doctor’s story: "I personally recommended delivery with the help of an epidural to one of my my surprise the anesthesiologist informed her that her legs could become paralysed as a result of the epidural."

The doctor had three possible explanations for this. "Either this anesthesiologist had little experience with epidurals and was afraid to apply them, or he didn’t want to spend the night monitoring his patient, or he wanted to save his hospital money, as the insurance companies reimburse clinics only for a small amount of the actual cost."

Sounds like an honest appraisal to me, and I’m guessing the lady next door to us had a similar story to tell. Or maybe, based on one of the FAQs in the brochure, her husband talked her out of it. See below. I liked the answer, though I would have been more blunt.

Q. My husband calls me a coward for wanting pain relief.
A. That is a somewhat old-fashioned and incorrect opinion, especially since men will never have to go through such pain.

Based on Will’s still remembered fears from listening to the lady next door, I’d bet that husband called his wife a coward before her water broke. At least she got the birth hormones.


tuckova said...

It bothers me how much the rates of things maternal (C-sections in the States or forgoing epidurals here) have to do with medical suspicions (often held by male doctors) rather than facts. In once case, they don't want the lawsuit and the unpredictability of waiting for the labor to progress; in the other case they may not want to bother with the injection or whatever, but it seems so rarely to boil down to "majority medical opinion is that this is what is best for the mother and the baby."

I think it's great if people want to have a birth without using any intervention and I think they should be able to do so. I personally don't let the dentist drill near my mouth without a needle full of novocaine first, and I sure wouldn't want any major activity in my, ah, more delicate parts without an epidural. That it should be anybody's decision other than mine makes me furious.

Julia said...

I absolutely agree with you. It should be a true choice for a woman. What I also suspect happens here is that there might be all sorts of reasons given for not doing an epi, but in the end those reasons are often provided as a way of avoiding saying that it wasn't "chosen" because of cost.

I can only speak from my experience (and what I've recently read) but for example, mothers have to pay completely out of pocket for an epidural if they want one at the hospital I am scheduled for. Luckily our private health insurance will reimburse me for at least a bit of this, but that's not an option for lots of women.

lizardek said...

What boggling statistics!! I can't imagine giving birth without an epidural, or at least the OPTION. I'm SO glad I wasn't born 100 years ago.

Karla said...

Not having given birth, I don't really know which I would prefer, but given my poor reaction to novocaine on any part of my anatomy (I will never let anyone use that on me again, it's a pain-inducer for me), and my basic feeling that mammals weren't designed to require painkillers to get through labor, I'd be demanding as natural a childbirth as possible. ... BUT with other options at hand! I wouldn't want to find I couldn't handle the pain.

Make sure they give you what you want.

Anonymous said...

Hi Julia! You do not know me but we have a great deal in common. I am actually from North Carolina but my husband and I live in CZ but about an hour from Prague in Pardubice. I think it is the 5th largest city in the country. Anyway, I stumbled across your blog because we are thinking of having another baby and more than likely I will be here for the birth because my husband plays basketball here and we are here from August to May or June. I would really love to talk more with you about giving birth here and having an epidural because I have heard both good and bad, and I would really like to have another but a little worried about giving birth here because my first was born in the US. Is there some way to contact you through email or you may email me. Also if you and your family would ever like to see some great basketball games let us know and we can get you tickets!
Lauren (