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July 15, 2009

Man: Labor pain good for women

Midwifery professor Denis Walsh argues that labor pain is good for women:

In an article for Evidence Based Midwifery, published by the Royal College of Midwives, Dr Walsh said the NHS was too quick to give in to requests for pain-killing injections.

He said: ‘A large number of women want to avoid pain, but more should be prepared to withstand it. Pain in labour is a purposeful, useful thing which has a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.’ [...]

He said labour pain was a timeless component of motherhood, but warned: ‘There has been a loss of rites-of-passage meaning to childbirth, so pain and stress are viewed negatively.’ [Daily Mail--where else?)]

The guilt trip is part of Prof. Walsh's larger crusade against epidural anesthesia for laboring women in the National Health Service.

It's one thing to argue that the risks of a particular pain-relief strategy outweigh the benefits, or to point out that some technique is often used on people who don't need it. Those are empirical questions.

It's another thing entirely to assert that women ought to endure pain for their own good. That's a dubious value judgement based on an unsupported claim about the benefits of pain.

Does Walsh have studies supporting a link between labor pain and maternal responsibility? Or is that just his pet theory that he feels entitled to dispense as if it were a medical fact? If pain builds character, does he advocate torturing new dads to harden them up?

Even if it's true that labor pain confers some marginal psychological benefit, a responsible clinician would lay out the potential costs and benefits and let the patient decide. Of course, the principle applies for pain relief options. Every option from drug-free birth to general anesthesia has its own costs and benefits. It's pretty rare that any one strategy is medically necessary, so the decision should be left to the woman.

Dr. Amy Tuteur, The Skeptical OB, has a great post about the sexist roots of the anti-anesthesia evangelism. She argues that Walsh is carrying on a long and ignoble tradition of romanticizing labor pain and dismissing women's suffering.


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What can I say! He thinks it builds character and parental endurance. Mothers-to-be should be sent to Eton-style schools to experience cold showers and plain food as a daily regimen. By the way, this line of reasoning is very close to part of the Catholic Church's proscription of sexual pleasure outside of marriage and outside of the procreative purposes of sex. Sexual pleasure is a reward that compensates a married couple for the pain and costs of child rearing. I hesitate to be crude, but all of this translates to the following: If giving birth is painful, and raising kids is very hard, don't complain. Instead, go fuck your married selves and get back to the kids.

Oh, which gender do you think came up with this marvel of apologetics and theology? HINT: Not women.

For all the rest of you Majikthisers, how about a little fun and deliverately misspelling Dr. Walsh's first name substituting a 'P' for a 'D'.

I would love this guy to experience menstrual cramps, never mind labour pain.

He wouldn't endure labour, himself, for five seconds. And menstruating would be grounds for monthly paid sick leave.

Simply put, the man is a Dick.

(I'm leery of unsympathetic men who become specialists in ob/gyn. Have yet to meet one who isn't also bent.)

"If pain builds character, does he advocate torturing new dads to HARDEN [emphasis mine] them up?"

Depending on one's predilections, it might just do that.

I saw a report on "60 Minutes" about 15 years ago about how the DEA regards doctors who prescribe a lot of pain medication to men-or-women as drug dealers.

The problem is that some people have long-term pain which requires a lot of pain medication.

Your article's title should read "Doctor: Labor pain good for women," because these attitudes are not unusual in the medical profession towards everyone in pain, not just women in labor. In the Victorian Era, doctors campaigned against the use of anesthesia in childbirth to reduce pain because they believed it was God's will for women to suffer the pains of birth and, like Dr Walsh, that it built character. This had nothing to do with the dangers of chloroform, which were not understood at the time, but basic puritanical "morality."

There are modern doctors who argue against treating pain in children on the "builds character" theme as well:

In the 1990s, Yaster coined the term “clinical disregard” to describe the prevailing attitude that treating children with potent opioids should be practiced only as last resort. That belief, Yaster says, is rooted in myths that “pain builds character” and treating children with even the smallest therapeutic doses of opioids is drugging them up.

Personal values and beliefs of healthcare professionals about the meaning and value of pain in the development of the child (e.g., the belief that pain builds character), and about the treatment of pain, cannot stand in the way of the optimal recognition and treatment of pain for all children (Walco, Cassidy, & Schechter, 1994).

While I don't doubt there is a sexist dimension to this behavior, the refusal to treat pain aggressively or the belief that pain is somehow good for you is common in the medical profession and under-treated pain is a major problem for everyone who experiences pain, particularly on a chronic basis. These attitudes arise from puritanical thinking and the right-wing authoritarianism that pervades the medical profession. Then again, some doctors are simply sadistic jerks. Walsh sounds like one of these.

Though there are risks to epidurals and pain medications, the patient should be informed of these risks and allowed to make the decision herself.

Hmm. My wife tried to do a natural childbirth with a midwife. She was slow dilating and the baby was slow coming out. After more than 36 hours of pre-labour and labour and getting transferred to the hospital, they wound up giving her an epidural so she could rest. It was a few more hours after that before our son was born. That said, the reason why we tried to avoid the epidural is that it can actually slow down dilation and the final push. A lot of the changes are triggered by the production of oxytocin (also the reasons why sex is recommended as a natural inducement for triggering labour in women who are later than scheduled). Apparently the epidural opioids can suppress the natural production of oxytocin and prolong full dilation and labour.

Sure, they can also give the woman an injection of oxytocin to advance dilation and labour as well. However, since there's some indication that some of the opioids can sometimes cross the placental barrier, its better to avoid or minimize subjecting the baby to the opioids if possible since that may have developmental and addictive repercussions.

Having been told the above, I really was torn at seeing my wife in such pain. I'm amazed that she lasted as long without the epidural as she did, as were a number of nurses. But given the time that it took to deliver the baby, I'm also glad that he wasn't exposed to opioids for that long. Those were a long two days for me just being with her and must have felt like forever for her. She can be an amazingly strong willed woman and that's one of the many reasons why I love her very much and married her. The idea that she needs to suffer through pain to strengthen her for childrearing isn't just obscene, it's laughable.

My personal experience with midwives and the stories I have heard from friends have let me to conclude that midwives are often vehement dogmatists of the 'natural'-is-always-better school that is essentially antithetical to modern medicine.

Christian Science works well for people who are basically healthy. Likewise with midwives, who work well for people lucky enough to have a short, uneventful labor and a high pain threshold (or a short pain memory).

Midwives market themselves by emphasizing an inclination to avoid medication, which jibes well with most mothers' wish to protect their babies. But mothers often don't realize they have a philosophical difference with their midwife until they are 20 hours into labor, exhausted, and essentially at their mercy.

And don't even get me started on lactation consultants.

What intrigues me about this is the lack of mention that he's reflecting a biblical view. Genesis says that because of Eve's sin, she and her descendants must bring forth children in pain.

Interestingly enough, anesthesia for childbirth only became acceptable after Queen Victoria had it for one of her later births and declared that she wished she had had it for all the previous ones. Shows what women leaders can do! (Even Queen Victoria!)

First of all he's speaking not as a doctor but as a midwife. Big difference. Second, at least in this instance his gender is secondary since many, many women who advocate for unmediated childbirth -- including many of this guy's mentors, role models, and colleagues -- make *exactly* the same claims. The only difference being that he's somewhat less likely to find out for himself that women mainstream and alternative maternity-care providers who haven't or haven't yet been pregnant themselves.

Me? I'm a man so I'm not giving birth any time soon either. But I've spent enough time around pregnant women and their caregivers to at least be able to competently aggregate what everyone says about it. And I've never heard anyone say "pain prepares women for *nurturing their child*" who had any rational basis for saying so.

That said, a lot of the rest of what he said in his interview -- being fairly conventional wisdom about women having more successful outcomes when they exercise agency during labor and delivery -- is pretty great. Its a shame he brain-farted the little jewel of overboardedness everyone's quoting because it detracted from the rest of what he, and the movement of mostly women he's associated with, are generally advocating for.


Hmmmm, no. Pain is not good for anybody. The pain of childbirth is a byproduct of an uneasy evolutionary compromise between walking upright and giving birth to large headed babies. Unfortunately these exert different and contradictory selective pressures on the pelvis. In accomodating to the demands of childbirth, we have pervasive back, hip, and knee problems. In accommodating to upright walking, we have a pelvic opening which is too small for the infant's head to pass through, causing the pubic synthesis to separate (basically break) during childbirth. That is why it is so painful. IN other animal species there is ample room for the infant to pass through the pelvic opening without much stress.

One other thing, not so much for you, Lindsay, as just people in general who are involved in these perpetual debates: what's up with this tendency to dump on all midwives, or Ob/Gyns, or (!?!?) lactation specialists as if members of each group marches in lockstep? It's as silly as trolls who claim "the feminists" all think alike.

Hint: Our midwife delivered our Ob/Gyn's baby.


Figleaf, that's what I said in the post. If the midwife wants to make a scientific argument about why drug-free childbirth is safer, he's welcome to do so. In that case, he's discussing the facts as a healthcare professional and his gender doesn't make any difference.

However, I think it's inappropriate for him to be telling his patients and Daily Mail (Male?) readers that they ought to suffer because they need the pain to become responsible mothers. He's not a character coach, he's a midwife. It's the height of presumption for him as male healthcare professional to use his position of authority to moralize to women under the guise of professional advice. It's pretty sexist to assume that women as a group are insufficiently responsible unless they suffer in childbirth. What about the woman who says that she's plenty responsible already and would like the drugs?

Agreed about the doctor-midwife wars, figleaf. I admire all healthcare professionals who are pro-science and pro-woman. Each discipline has a lot to contribute from OBs and obstetric nurses to midwives and radical doulas. It makes me sad that medicine has historically sowed the seeds of its own marginalization with a stuffy, hierarchical, sexist culture that had nothing to do with good science or good patient care. I think a lot of the heat in these disputes is really about professions feeling threatened by each other and not about the merits of different kinds of care.

Sure, this midwife being male makes his claim more outlandish, but what is really objectionable is what Lindsay calls using "his position of authority to moralize to women under the guise of professional advice", not his lack of personal experience with labor.

Let me also add, because I do have a 'tendency to dump on' midwives and lactation consultants: (1) I recognize there are good ones mixed in and (2) Childbirth and childcare are so politicized that my attitude has arisen from the supreme difficulty I have had determining which of them give medical advice that is colored by their personal moral objectives.

That said, I also agree with Lindsay's last post about doctors having some responsibility for creating an environment that opens inroads for non-scientific 'professionals' with a strong patient focus.

Eek! I hope I didn't sound like I was excusing Denis Walsh. I'm just saying this particular ass-hattish position is by no means confined to male caregivers so it's a bit of a risk to key into the gender of *this particular* messenger.

"He's not a character coach, he's a midwife." Exactly! Just as birth shouldn't be routinely medicalized, neither should it be routinely "rite of passaged."

"What about the woman who says that she's plenty responsible already and would like the drugs?" Also yes! Since variation in outcome for natural and medically mediated childbirth is close to the margin of error for prepared individual (or, for that matter, unprepared ones) there's no reason on planet Earth not to let her decide how she wants to do it. Or to shame her with any of the 10,000 (conflicting!) variations on "UR doin it Wr0ng."

It's been a little while since I was immersed in baby wars discussion groups (I got my start online when my snoring conflicted with my partner's pregnancy-induced insomnia) but it seems like self-determination was just as big an issue in the old Soviet Union where policy subjected women in labor to general anesthesia and forceps as in Japan where women were routinely denied all medication.

Anyway, as you said at Dr. Tuteur's Skeptical OB, "What's sexist is the fact that Prof. Midwife has made a unilateral decision about what laboring women ought to do 'for their own good.'" At the end of the day it's the *unilateral* part, and the *for your own good* that needs to work regardless of the specific form it takes.


Logically, then, this midwife will refuse painkillers for his next root canal so that he gets the full "benefit" and so can be prepared for the responsibility of proper dental hygene? 'Cause otherwise, bull.

I forgo anesthesia when I get a filling at the dentist. I practice jujitsu. I have experienced far more pain at the dojo than at the dentist. I intensely dislike the numbness of anesthesia. I guess others like it more than I do. I have no doubt that childbirth hurts much, much more than getting a filling, but then comparing pain with someone else is a pointless exercise, is it not? There is no objective basis for comparison. I only feel my own pain. We don't have a pain meter.

My ex-wife birthed two children with midwives in attendance. She did not get an epidural either time. It was her free choice.

It seems to me that Mr. Walsh is echoing the message that Shannon Brownlee gave in her book "Overtreated," which was published in 2007. Namely, that too much medicine is not good. I don't recall her book causing a furious blog fisking anywhere. I have not read the book and I do not know if she discusses epidurals and childbirth. It is also obvious, but no one has mentioned it here, that Mom gets charged for the epidural. Childbirth in the hospital is damn expensive.

I will disagree emphatically with DrDick that pain is not good for anybody. I find this comment difficult to understand. Pain is a gift and an important part of life. If I cut my finger, pain sends me off to find a bandage. Neuropathy can lead to loss of digits or more. If my child is in pain, he'll let me know (and I want to know it). If I have a stress fracture in my tibia, pain can send me to seek medical attention. Etc. ...

In some ways this is a holdover. When anesthesia was first being introduced in the late 1700's, early 1800's a lot of doctors were against it. They thought it would hurt the patient since they thought pain was a necessary part of healing.

John P, there are necessary types of pain but there are also many types of unnecessary pain. There are a lot of people with chronic pain that can't do anything because of the pain. There are a lot of doctors who think they just have to endure it. Women don't need pain to tell them they're giving birth, so this isn't a necessary pain unless there are medical reasons.

I suppose pain is the punishing trial that turns you from a whore to a madonna.

Even if it were necessary for a woman to endure that pain so she's ready for the responsibility of having that child, why would she then have to go through it again in subsequent births?

She's already got the first baby, and responsibility for it. She doesn't need more preparation, does she?

"Namely, that too much medicine is not good."

Of course, too much medicine is not good. Too much medicine is TOO MUCH. That's a tautology. The disagreement is over what constitutes too much medicine.

The only thing the pain of childbirth prepared me for was to resent my baby and to regret having gotten pregnant!

It's bad enough to endure it without being told it's good for you.

He seems kind of like the "brain falls out" "open minded" type. Something tells me that "evidence based" does not quite mean what he thinks it means. So yeah, I'm sure he has plenty of supporting studies.

To give the guy the benifit of the doubt here, he was being quoted in the Daily Heil. Does anyone have an original source for his opinion? It is entirely possible that he is being quoted out of context, never said anything of the sort, or is in fact a fictional character that one of their hacks saw on the TV.

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