7.25.2006

A Loaded Opinion: Dr. Darshak Sanghavi and "The Mother Lode of Pain"

The Boston Globe’s Sunday Magazine (July 23, 2006) features an article titled “The Mother Lode of Pain” by Dr. Darshak Sanghavi that presents itself as an inquiry into medicated vs. unmedicated birth. While the article provides some reasons for foregoing drugs during childbirth and even cites an interview with Ina May Gaskin (who is likely the foremost authority on midwifery today), Dr. Sanghavi’s article quickly deteriorates. Ultimately, he champions the use of pain medication during labor as the only option for ‘thinking beings’. In the process, he manages to be condescending and insulting, curiously exemplifying one of the many reasons why women have stopped listening to this type of self-serving medical opinion.

From the outset, Dr. Sanghavi stresses the importance of education, beginning with the story of Fanny Appleton who in 1847 was the first woman in the U.S. to use ether as an aid in birthing her third child. From that point on, however, the issue of education gets twisted, as Dr. Sanghavi tries to explain why even educated women choose natural childbirth. Some are dismissed as being misinformed by outdated research on early epidurals and their side-effects (p. 6 and 7), and others as being misled by erroneous information provided by childbirth classes (p. 7). Then there are those that are compared to religious fanatics and suicide bombers (p. 5), and finally those for whom labor is an 'extreme sport' (p. 7). According to Dr. Sanghavi, truly educated women are those that agree with using medication during labor, for to choose any other option is to ‘rationalize the existence of labor pain’ (p. 7).

There are several clues within the article as to reasons why women choose to birth without medication that Dr. Sanghavi does not delve into. (Unsurprisingly, he discusses only the idea of ecstatic births and reduces Gaskin’s justification for labor pain to this, thus subtly denigrating her.) The fact that women feel empowered and in control (p. 7), the idea that labor pain is a ‘pain with a purpose’ and that it does not imply suffering but may be a ‘joyful pain’ that is part of a process (p. 3-4) are, by themselves, very powerful reasons. Not to mention the fact that not all research supports Dr. Sanghavi’s premise that modern labor medication has no effect on babies, labor or subsequent complications such as cesareans. (As a starting point, Henci Goer’s “The Thinking Woman’s Guide to Birth” provides ample medical research to the contrary.) But that is material for a different post.

In the interest of fairness, and lest it seem that I am exaggerating Dr. Sanghavi’s level of condescension, I have decided to quote the last section of his article:

As a pediatrician, I have been present at hundreds of births and spoken with dozens of women who passed up anesthesia during labor. One justification I've often heard is that labor pain "empowers" women or gives them a sense of "control." But many women accept pain for a more mundane reason: They are poorly educated about obstetrical anesthesia and don't have access to compassionate and technologically advanced medical care. In that sense, Fanny Longfellow's story is especially relevant; she overcame both ignorance about anesthesia (by teaching herself about ether) and the lack of access (by finding a willing dentist when no obstetrician would tend her). She didn't rationalize the existence of labor pain.

STILL, THERE WILL ALWAYS be people who want their pain. When I was a teenager in New Jersey, I endured an optional religious challenge called the atthai, an Indian Jain custom of fasting for eight straight days. The idea is that the people should dissociate from the material world, even from something as elemental as food. Accomplishing the painful challenge is something of an ego rush; the hunger artists are honored as members of a holy community. (I look back on this now with agnostic disbelief.)

Like prolonged fasting, enduring labor without anesthesia attracts notice. It casts the mother as a struggling heroine who - by sheer mental force - gracefully keeps her body under control. "Natural childbirth purists," author Margaret Talbot wrote in the New York Times after having children with and without anesthesia, "see labor as a kind of performance for which a woman can and should rehearse, and in which she can comport herself more or less admirably. [They] regard labor as an extreme sport."

In this setting, the pain of unmedicated labor offers up a formidable, if artificial, trial that precedes entry into a highly selective sorority. It creates drama. It captures attention.

Yet pain in the end is an utterly primitive thing, a vestige of insect and reptilian brains. It evolved primarily as a way to change behavior without need for thought - to force one's hand to pull away from fire or tend urgently to an injured limb. Thinking beings, in some sense, have evolved beyond pain. (Some pain reflexes continue even in brain-dead individuals.) If anything, reliance on pain to create meaning during childbirth indicates a constricted imagination. Surely there must be more innovative challenges than voluntarily refusing effective, safe, and available pain relief during labor. As the American College of Obstetrics and Gynecology states, "There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician's care."

Which is why choosing to feel pain during childbirth strikes me as odd. Eliminating pain won't create a sudden existential crisis among mothers, because parenting is too rich an experience. And after all, being born is ultimately the least distinguishing feature of being human; everyone's done it and, moreover, no one remembers it.



What, exactly, is compassionate about Dr. Sanghavi’s characterization of natural childbirth and the women who choose to birth without medication? There is no room for any opinion but his own informed, expert judgment, and women who think differently are negatively characterized as ignorant or not in their right mind. As someone who is so keen on education: How is it that he makes no distinction between Lamaze classes and the Bradley method? (I guess those ‘natural childbirth’ classes are all the same, and anyway, they are just “setting women up for failure”.)

In a few paragraphs, he manages to compare unmedicated childbirth to religious rituals or experiences (remember the suicide bombers?), then casts mothers who labor without anesthesia as struggling heroines who are seeking entrance into a highly selective sorority, thus creating drama and capturing attention. Not content to leave it at that, he goes on to suggest that women who choose not to be medicated are responding to their primitive, reptilian brain, and are suffering from a constricted imagination by relying on pain to give meaning to childbirth. We are not just childish and dramatic, but have turned into the snake itself.

Come to think of it, Dr. Sanghavi’s characterizations of women who labor without pain are more suitable to describe many in his own profession. They express an almost fanatical belief in medicine and rationalize their own shortcomings, often behave like an exclusive fraternity whose wisdom is not to be questioned, and they certainly love drama and attention. Their version of an extreme sport is to practice ever more ‘necessary’ cutting-edge interventions, and to create a need for things that are unnecessary and may even be harmful (think of some routine aspects of medicalized birth, such as episiotomies, fetal monitors, and being made to labor on your back, just to mention a few). Isn’t this really about a primitive type of envy at not having the chance to ‘deliver’ birthing women from their own bodies?

In the end, however, what is most disturbing about this article is the one-size-fits-all attitude towards women by advocating the use of medication by all, and its lack of respect for those who decide to trust their bodies -and themselves- during the process of childbirth. It may be true that no one remembers being born (and there are those who would disagree), but every woman remembers her labor and the birth of her child. Birth is not only about the outcome, as the medical profession may like to believe, but it is also about a physical, emotional and -dare I say- spiritual process in which you bring another being to life. To dismiss birth as being “the least distinguishing feature of being human” strikes me as truly unimaginative.

5 Comments:

Anonymous isabel said...

This doc's attitudes and "expert" opinion can be very misleading and damaging. Nice reflections and commentary on your part. It serves as an example on how to be critical yet avoid being disrespectful and closed minded/imposing. He could have been ripped to shreds!

9:46 AM  
Blogger Rose Connors said...

Camille,

Thanks for the post. I believe that women need to be taught their bodies' intrinsic ability to give birth, as women have done since the beginning of time. No wonder the conundrum exists, when men are trying to write rules about birth, which they have never experienced and never will.

Rose

5:20 PM  
Anonymous Anonymous said...

I think he makes alot of sense. On another board, one of the mothers is irate because other people don't acknowledge her "accomplishment" when she chose an unmedicated birth. I would think it is done as a personal choice, and what one believes is right--rather than for approval. But apparently, there are more than a few people who want a medal for it, and that's what makes it dumb.

10:58 PM  
Blogger eshana mama said...

Wow! That doctor is nuts! If we should avoid pain all our lives, let's just all sign up for morphine accounts and enter his Brave New World, shall we?

I gave birth with no pain medication. It was very spiritual for me and I believe my unborn daughter. I did zen meditation for most of the 20 hours (when I wasn't sleeping in the beginning and pushing at the end). I kept my daughter stress free even though the cord was around her neck.

We had a beautiful, quite, stress free, spiritual birth in a hospital. There was some pain, yes, especially with back labor, but my body was made for this job and my focused mind could see us through it and my husband and my doula were there for physical, emotional and spiritual support. The midwife and nurses in the hospital were so supportive and respectful of our choices. CHOICES being the operative word.

This male doctor has not the physical anatomy or mental capabilities to understand my choice. He will simply never know what a birthing woman is going through, and perhaps because of his inherent ignorance and inability he will seek to belittle the power and choices of the birthing woman. Maybe he does this to make her feel unable, inadequate, and powerless so he can take away her power under the guise of sympathy and simply "knowing what is best" which isn't far from sheer domination and abuse of not just one woman but an entire gender. Will he then seek to have us tried as witches?

Ha! Two can play your game, Dr. Sanghavi.

1:45 PM  
Blogger Liz said...

I'm just now googling Dr. Sanghavi after Parents magazine published his ridiculous speculation that the hundreds of medical studies documenting the nutritional benefits of breastmilk must all be flawed because there's probably really something socioeconomic at play affecting (equally) the breastfed child's respiratory, gastrointestinal, immunological, and otological health - and their IQ! And during National Breastfeeding Month no less. Anyway, just came across your post here and found it a very well-written critique. Nicely done.

7:28 PM  

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