EDMONTON — Ma.Fe Jackson didn’t want to miss any part of the birthing experience, so she refused to have an epidural in hospital even when the pain was so intense she couldn’t speak.

“Childbirth is very, very painful, but that’s normal and it’s only for a short time,” says the new mom who gave birth in February to first baby, Angelique.

Jackson is Filipino and most Filipinos don’t have epidurals, she explains. Besides, she’s scared of needles, which is how an epidural is administered.

Pain may be a normal part of childbirth, but most North American women today don’t experience it.

In Edmonton in 2009, 57 per cent of the 11,782 women who gave birth in hospital asked for an epidural, the most common form of painkiller. The majority of those who didn’t have an epidural had some other form of pain relief, most commonly an injection of Demerol or morphine.

Thirty years ago only two to four per cent of women had epidurals.

“We only used them for longer, more complicated labours,” explains Dr. Nan Schuurmans, an Edmonton obstetrician-gynecologist who has been delivering babies for almost 30 years. “There was a general desire to have a natural childbirth because there was a feeling that birth had become medicalized.

“Now, I would say the majority of women are coming in and they’ve already decided that they will have an epidural as soon as they get into labour. It’s really swung the other way.”

Even women who plan to have an epidural only as a last resort, usually end up having one, Schuurmans says.

There are women who are hardcore about having non-medicated births, but not very many, maybe six to 10 per cent.

Dr. Michael Klein, a family physician, pediatrician and neonatologist from Vancouver, thinks the trend reflects the lack of knowledge that women having babies, especially first babies, have about labour and delivery.

His maternity research, which includes a survey of 5,000 Canadian women pregnant for the first time, shows one-third to one-half, even by the last trimester of their pregnancy, aren’t fully informed about childbirth, including the effects of an epidural.

That may have something to do with the fact that only one-third of first-time moms-to-be sign up for prenatal classes. The majority get their information, or misinformation, as Klein calls it, from highly questionable Internet websites.

A similar survey of 5,000 health providers who care for these women, found they too were similarly lacking in information, says Klein, professor emeritus of family practice and pediatrics at the University of British Columbia, and senior scientist emeritus at the Child and Family Research Institute in Vancouver.

Although the epidural is considered safe, there are risks, says Klein, who spoke at a conference of the Association for Safe Alternatives in Childbirth (780-425-7993) in Edmonton on the weekend.

“When you get an epidural, the anesthetist will say you could have an epidural headache, and in very rare cases you could have a significant neurological problem because of it,” Klein says.

“For medical, legal reasons they say all these bad things that could happen, but they’re surgical bad things, direct side-effects of the placing of the needle itself.

“What they don’t always tell you is that it will lengthen the first and second stages of your labour significantly, that you’re more likely to have an epidural fever, and that it increases the likelihood of forceps or vacuum (to pull the baby out) by 1- times. You’re more likely to have an episiotomy or perineal trauma, and the issue of caesarean sections tend to be avoided altogether because doctors actually believe that even an early epidural will not cause a problem.”

Doctors believe this, especially if they’re under age 40, because they weren’t practising when most women delivered their babies without painkillers, so they have no context, says the 73-year-old Klein.

A study he helped author found that, in general, younger obstetricians (under age 40), were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, than physicians over 40, and they were less appreciative of the role of women in their own birth. They also saw caesarean section as a solution to many perceived labour and birth problems.

“Our research shows this confusion and … I think women really need to know the full picture,” he adds. If they were fully informed he believes fewer women would ask for an epidural.

Klein is best known for his research that found routine episiotomies caused the very problems they’re supposed to prevent. This work led to a dramatic drop in episi-otomies.

Critics fault Klein for hyping what they say is the small percentage of things that can go wrong and ignoring the pain relief epidurals give women.

Klein acknowledges that birth is painful, but argues many women would be able to handle it without drugs if they had support.

“There is a difference between pain and suffering, and no one is in favour of suffering,” Klein says. “You suffer when you are abandoned, when people aren’t there to help you with your pain.

“Nobody is going to deny there is pain in labour nor that it is significant, but if you are cared for by somebody who understands the pain and tells you only have a contraction or two as intense as this until you’re fully dilated and you’ll be much more in control of the pain, if you had that kind of information, you might decide to hold off (having pain relief).”

That’s why women who deliver babies with the help of a doula are less likely to need painkillers, says Klein, who thinks all women should be assisted by one.

“Midwifery intervention has positive outcomes that no other intervention that we have to offer in medicine can even touch. If we all practised that way we wouldn’t be having this discussion,” Klein says.

“The doula movement arose because women were not getting adequate support in labour,” he explains.

“With epidural analgesia, the nurse moved from a hands-on role as supporter to a manager of equipment. There is a new generation of nurses that has lost the ability to look after a woman that doesn’t have an epidural.”

“If you need an epidural because of the position of the baby, the size of your pelvis, because of the character of your labour or you have a low pain threshold, it optimizes your outcome. But if you don’t need it ... if the person looking after you gives epidurals routinely and rather mindlessly, you’re left with the side-effects without the benefits.”

Does that mean women should have to suffer the pain of full labour?

“No, I don’t think that,” Schuurmans says. “If they can have something for pain, that’s safe, well why wouldn’t they have it if they want it?”

czdeb@edmontonjournal.com