Medical Examiner

Of Elks and Epidurals

The glories of Birthing From Within.

The first of many choices you make when you have a baby is how to deliver it. Whether or not to take painkillers or have epidural anesthesia during labor is a practical question, but for women who’ve never been through labor before (and for their partners who never will), it also takes on symbolic and aesthetic meaning. Are you the kind of person who reaches for the iceberg lettuce, or for the organic mesclun? Would you rather run a marathon, or hop a cab to the finish line? Do you cast your lot with modern technology, or with the primitive past? Are you determined to experience what generations of women who came before you did, or relieved that you don’t need to?

My wife had never been admitted to a hospital before, doesn’t like needles, and wasn’t sure she could make it through labor without painkillers. Her obstetrician was open to a drug-free delivery—but she was also planning a vacation around Rachel’s due date. At the birth class we took at the doctor’s office, a nurse advised us that the vast majority of women she works with get epidurals, and added that it makes no sense to suffer needlessly. Then a friend invited us to take a course she was teaching called Birthing From Within. The class discussed how to get through labor without pain medication, but purported to be open to either approach. The more I learned, however, the more this open-mindedness felt like a passive-aggressive tug toward natural childbirth. Birthing From Within aims to make women “powerful in birth”; it may instead undermine them.

Birthing From Within classes are taught around the country by a network of “birth warriors” trained by Pam England, an artistically inclined Albuquerque midwife. In 1998, England self-published a book with the same name that has sold 70,000 copies and carries an endorsement from Lamaze International. In it, she puts a New Age twist on the movement to take childbirth away from medical technology, which she says “has left three generations of women spiritually and psychologically wounded.” In a Birthing From Within class, parents make “birth art” with tempera paints and modeling clay in an effort to explore their subconscious emotions and fears about having a child. There’s also foot massage, play-acting, sprinkles of Zen Buddhism, and frequent references to the ancient and primitive. England spins an elaborate fantasy about Lucy, the human ancestor who lived more than 3 million years ago and whose skeleton was found in 1974. Lucy “automatically responded to her body’s messages” when she went into labor, England says, without the aid of any medical intervention. Women today would do well to do the same—to get in touch with their animal selves rather than submit to epidurals, Caesareans, and other, potentially unnecessary, procedures.

Concerned that women will be rendered helpless when faced with the details of every possible birth complication, however unlikely, England generally errs on the side of offering too little detail about the nuts and bolts of labor. But she has a lot to say about epidurals. Her chapter on the “compassionate” use of epidurals slips into eight pages of clinical detail about risks and dangers, with capital letters to highlight phrases like “DEEP VAGINAL TEARS THAT EXTEND INTO THE RECTUM.” Then there is The Elk and the Epidural, a 15-minute video slideshow (think Bullwinkle goes holistic) in which Mother Elk hesitates at the brink of Epidural Cascading Falls—an unsubtle metaphor if ever there was one.

All of this grows out of England’s sense of responsibility for her own rocky birth experience. Her first pregnancy progressed normally until she had a Caesarean delivery that she saw as a failure. “I was eating whole foods, I was a home-birth midwife, I was in the best environment I could be in, so where did that Caesarean come from?” she said when I called her in Albuquerque. “There was some fear that I would have a Caesarean.” England worked through postpartum depression using the activities that are now at the core of her method—keeping a journal, drawing with pastels, reading up on the maternity rituals of the Cuna Indians of Panama—and by “learning to embrace the unknowable and unplannable nature of birth,” as she puts it. Her second child arrived quickly and smoothly, through the birth canal.

On the surface, England’s story shows that labor is unpredictable and beyond the mother’s control, no matter how much she has prepared. England smartly points out that birth plans set women up for disappointment. You imagine burning incense in the comfort of your own bedroom only to find when the time comes that you can’t stand the smell. Or you set your heart on giving birth without an epidural and then beg for one when the pain gets intense.

England doesn’t cut you out if you succumb. A woman’s decision to have an epidural “should not diminish her ability to birth from within,” she writes. But if you’re having a normal childbirth, she urges you to “hang tough.” And if you don’t, the implicit judgment is that your emotions got in the way. After describing how her own journey of self-discovery culminated in an easy second home birth, she trots out the example of Annie, who, when asked to depict her first pregnancy, drew a dark cloud—and went on to give birth again by Caesarean. “I believe that, in the absence of therapy, the unresolved issues symbolized by Annie’s ‘black cloud’ contributed to her second cesarean birth,” England writes. If you have a Caesarean, then you’ve come up short, and it’s at least in part your fault for letting your unresolved fears prevent you from attaining the natural ideal.

The debate over anesthesia during labor is an old one. When J.Y. Simpson, an Edinburgh obstetrician, first used chloroform to deliver a baby in 1847, critics cited the passage in Genesis in which God instructs Eve “in sorrow thou shalt bring forth children.” Perhaps more women would find labor fulfilling if they didn’t reach for pain relief so quickly, or if doctors and nurses weren’t so ready to offer it. But the expectation that the ordeal of giving birth should be fulfilling is itself a source of pressure. And who needs more of that when you’re about to have a baby? When Rachel went into labor, she didn’t ask for an epidural right away. But by the time she got one she was grateful for it—and if anything, it helped her enjoy the birth more. Medicine doesn’t have to be the opposite of nature, or scientific progress the antagonist of wisdom.