Monday, April 2, 2012

Is avoidance of labour pain a reason to opt for an elective cesarean?

In most of the literature on choosing an elective cesarean, the avoidance of labour pain is considered to be an inadequate reason to choose to have an elective cesarean section. It certainly wasn't THE reason I was lobbying for an elective cesarean during my last pregnancy - after all I had no idea what the pain of labour and delivery would be like. I had people assume that it was the reason for my choice, with my own step-mother-in-law greeting the news of our birth plan with "oh honey, just get the epidural". I'd typically responded with "my choice isn't just about the pain of childbirth.". In truth, the first time around, I anticipated that choosing cesarean wouldn't mean less pain overall, just different pain. I was anticipating trading the pain of labour and birth for the longer recovery and a longer duration of pain. I anticipated a qualitatively different kind of pain that on the whole would be roughly equivalent.

The thing is, I never imagined a circumstance in a major urban area in Canada where access to effective pain management (ie. an epidural) would be a problem. I had no reason to believe at that point in time that I would not have access to an epidural should I have decided to proceed with a vaginal birth.

Now, knowing what I know - I feel very differently about this. I think that the avoidance of being in a situation where the pain is not in control and is extreme, is a valid and reasonable reason to elect for a cesarean. It shouldn't be the only reason - but it certainly ranks a heck of lot higher this time around than it did the last time around. If the health system cannot guarantee access to effective pain management when it is known to be available, why should it expect women to just chance it with a natural delivery? If spontaneous labour comes with a risk of unmanaged and insufficiently mitigated pain that is off-the-scales, why should we expect women to willingly submit to that?

Why is pain in childbirth considered to be 'okay' - when pain in any other medical arena is seen to be something that should be managed and mitigated?

I believe part of the reason I found giving birth to my first child was traumatic (apart from a complete violation of my right to determine what happens to my body) - was the insufficiently mitigated pain I experienced during the process.

If access to effective pain relief (epidurals) during labour and delivery was guaranteed to occur on demand, then it likely isn't a valid reason to elect for a c-section. In the absence of that situation - I personally, think its very logical for a woman to choose a cesarean - particularly now that I know what I know about access to epidurals during labour in most of British Columbia.


  1. I have to say, avoidance of pain-- vaginal, anal, and pelvic floor pain-- was a big reason behind my c-section. My experience of being treated for pain in our system, in BC, was so poor that I had nightmares about healing at home from birth and not being given adequate pain medication because I birthed vaginally. I would have rather have had surgery, despite how painful c-section is (and it IS painful, I'm not going to lie there-- I joked and said, it's just like vaginal, the labour pain is just AFTER...) and have better managed pain. Even then, I had an OB yell at me in hospital (on rounds) that if I was HIS patient, he would've sent me home with Advil. (I had a post-op hematoma that looked like a car accident... thanks...) Luckily, my OB kept me well medicated and he was NOT my OB. I shudder to think of women who have him as theirs.

    Anyway, I did not have any faith whatsoever that post vaginal birth pain would be managed, and given our rural hospital and the experience of my friends, I knew that an epidural was vaguely possible, but difficult to get if you were in hospital at the wrong time. I don't actually know anyone who has had one, so that should tell you something.

    There were many other reasons, too, but this was one of the top five. Now knowing my OB and the trust we've developed, I think she would've adequately managed any pain I'd had, either way, provided she could.

    Uncontrolled vaginal pain = uncontrollable PTSD flashbacks to being raped for me. I was not about to spend the first weeks of my baby's life, reliving the most horrible times of my life. Needless to say, the surgical pain did not do this, although my milk coming in triggered a slew of things I had forgotten and that was difficult enough. But that was short-lived.

    I can't say that avoidance of pain was the main reason I had a maternally-requested c-section-- protecting myself from further sexual trauma and it's consequences (physically AND emotionally) was number one, followed closely by being able to control the birth and all elements around the birth as much as humanly possible (knowing who would be there, especially), but it certainly factored highly.

    Good luck.

  2. I didn't have a history prior to the first birth of sexual abuse/PTSD. I very much so worry that being put in a similar position would be traumatic, and could worsen whatever psychological damage that may exist from the first birth experience.