When my wife Dana and I found out we were expecting our first child in the final months of my anesthesia residency, we simultaneously became inundated with good wishes and overwhelmed with advice on how to prepare for the big day. For an event (and its inciting cause) that has been around for all of human history, one would think from the explosion of pregnancy books, and women’s magazine articles that the last generation or two has invented it. As an anesthesiologist, I can confidently say that over these same generations we certainly have made the process a lot more comfortable. Unfortunately, because some people just won't let others live their own lives, the topic of pain relief in labor is no stranger to controversy. No less a world-renowned obstetrical anesthesia expert than Miranda Kerr, the Victoria’s Secret supermodel and wife of erstwhile “Lord of the Rings" elf Orlando Bloom, has opined in the current issue of Harper’s Bazaar, U.K.
The Aussie who is on the cover of the August issue, told the magazine that she decided to have a natural birth without any pain medicine after watching baby-bonding videos. Kerr saw that babies without an epidural come out and go straight for the breast.
“Then they showed the ones (babies) right after the epidural, and that didn’t happen,” Kerr said. “The baby was a little drugged up, and I was like, ‘Well I don’t want that.’ I wanted to give him the best start in life I could.”
Undoubtedly, if I were fortunate enough to be in that genetically privileged baby’s booties, I would leap like Legolas, straight for Amanda Kerr’s perfect breasts, drugged up or not. And for the record, here is Victoria’s real secret. The famed and fecund Queen was a huge fan of pain medicine for labor. One of the world’s first anesthesiologists, John Snow was celebrated for his ability to safely gas Her Highness senseless with chloroform during the births of her last two children. For this skill, and perhaps his success in identifying and halting the source of a horrific cholera epidemic in 1854, he was named by a 2003 poll of British doctors as “the greatest physician of all time”. Is it a coincidence that we have the word “snowed” to describe the state of blissful lack of awareness? I think not.
One of our first tasks was to register for a childbirth education class. I must admit, as an anesthesia chief-resident with a fair amount of experience on the obstetric floor, I harbored doubts about the value of this undertaking. I had seen numerous ridiculously elaborate birth-plans crafted in these classes burst into flame at the unyielding onslaught of the dragon’s breath of labor pain. I looked at the glossy brochure brought back from Dana’s first OB appointment, with the misty cover picture of a doe-eyed mother gazing down at her preternaturally chubby baby nestled against her breasts, its inner copy filled with words like “holistic” and “toxin-free”, and began to laugh in my usual snarky and cynical way… and was immediately shot down with “the look”.
Here is some hard earned marital advice. Do not laugh at your pregnant wife. Even if in the past she has been a gleeful co-conspirator with you against the smarmy idiocy of modern new-age baby marketing, just don’t do it. To this day, one of the biggest arguments in the history of our twenty-two year marriage was about the exorbitant cost, and “real need” of designer crib linens and bumpers. Give up. Just buy them.
On the very threshold of the first day of birthing class, empathy pillow in hand, Dana paused and made me solemnly swear that I would not let the teacher or anyone else in the class know that I was a doctor, and even worse, an anesthesia resident. She made me promise that I would listen attentively, that I wouldn’t snort derisively, roll my eyes, or sigh heavily… no matter what. In order to cement this deal, she gave me “the look” once again, and I knew I had no choice. I even agreed to carry the empathy pillow and go "hee-hee-hee, hoo-hoo-hoo" when prompted. I reluctantly introduced myself to the Birkenstock-shod doula-educator who looked and smelled like someone straight from an Oregon commune. She seemed a little too sweet, and had an edge I immediately recognized as pure passive-aggressiveness. I surveyed the room and the ten or so other couples scattered about. Some were bewildered and dazed newbies, and a few were clearly repeat parents, bored and all been-there-done-that.
The first few classes were actually fine, nothing too controversial.
Most of the topics were blandly informational, about such fascinating things as the early changes of pregnancy, lactation, mood swings, and must-have baby equipment. The routine was to present paired related topics, like nutrition and exercise, stretch marks and skin-care: So far, so good. I was dutiful. I was attentive. I was respectful. I took pains never to wear my scrubs to class, or discuss my day in the operating room. When asked, I said I was a student, which was sort of true. It would be an exaggeration to say that I enjoyed the class, but all in all it wasn’t horrible. So we continued to attend. And then one week, late in the curriculum, things took a decided turn for the worse.
On that fateful evening, we arrived a little tardy to find our hippie pedagogue at the whiteboard busily scribbling away. Everyone seemed unusually hushed and serious. Her ample rear-end wiggled, and the dry-erase marker squeaked as she wrote. The two topics of the night were already delineated on either side of the board – doubly underlined in her flowery script:
"Unexpected Fetal Demise” and… "Risks of Epidural Anesthesia"
Dana shot me a warning glance as she could tell I was starting to get riled up. She painfully squeezed my hand after we sat down on the floor, no chairs allowed here, the empathy pillow accusingly thrust between us.
Under “Risks of Epidural Anesthesia” the woman had drawn an elaborate diagram. In the middle was a big circle with the word “Epidural” in it. Several spokes extended from the center like a wagon wheel. At the end of each spoke were other circles, some big, some small. And then she started to write in each of them… In the first big circle she wrote, “Nerve damage, Possible Paralysis!” in the next, “Chronic Back Pain!” and the next, “ Use of –caine Drugs and Narcotics = Toxic, May Cause Future Addiction in Baby!” and the next, “Interferes with Breast-Feeding and Attachment!” then, “C-Section nearly Guaranteed!” and then starkly, "Death!!" Undoubtedly she felt the ultimate catastrophe gleefully deserved two exclamation points. Finally, in the tiniest, loneliest, most distant circle attached to the growing wheel of anxiety she glumly wrote in small letters, “...you may get pain relief”. Clearly, no exclamation point granted here. And that was it for me. I lost it.
I imagined myself like Clark Kent ripping off my striped oxford button-down to reveal my scrubs with the crimson “S” beneath. Only in my case it was an “A” for Anesthesia-Man, M.D.! I leapt to the board, grabbed the marker from the startled hippie-doula, and drew my own wagon wheel. In the big central circle I wrote, “Trip to Grocery Store” and then the spokes: “Horrific Flaming Car Crash!” and, “Kidnapped by Aliens and Anally probed!” and, “Poisoned by Botulism!” and so on. Finally in a small circle I wrote, “... you may get groceries”.
Needless to say, we were invited not to come back to class after that.
I could tell Dana felt relieved. She even smiled at me. Later, in the hall, several of the dads clapped me on the back, and made me feel better. A few of the experienced moms mouthed, “Thank you!” Of course I knew they all had epidurals with their first pregnancy, and as far as I could tell, they were alive, they all walked just fine, and not one of them had cocaine-addled junkie toddlers in tow.
Jeffrey L. Swisher, M.D.