Not Mother Nature's Way

Kelly Zehfuss was more than ready to be a mom. The 34-year-old Chicagoan had taken birthing classes, coached two friends through labor and read enough books to "keep the publishing industry alive," she jokes. A marathon runner and health nut, Zehfuss always planned to have a natural birth. But after 14 hours of intense labor, she started throwing up and became dehydrated. Her doctor induced labor and gave her an epidural, a spinal anesthetic that deadens sensation from the waist down. Soon after, her daughter, Anja, was born.

Zehfuss isn't the only new mother to have a little extra help during labor. For decades, childbirth educators have urged women to get through the pain without drugs. The idea was that it's better for both mother and child to go natural. But a recent study by the University of Colorado School of Medicine found that from 1981 to 1997, the number of women in large hospitals who had spinal injections during labor tripled, from 22 percent to 66 percent. In smaller regional hospitals, the figure doubled, from 21 percent to 42 percent.

Some of these women, like Zehfuss, get epidurals only after complications. Others choose drugs from the start. That's partly because smaller dosages developed in the last five years are considered much safer than the traditional injections; they're called "walking epidurals" because patients can get up soon after giving birth. But doctors say women's attitudes have changed, too. "I think there's a trend away from the culture of a few years past, when natural childbirth was very important to women," says Dr. Fredric Frigoletto, head of obstetrics at Massachusetts General Hospital. Now, he says, his patients "don't want pain with their baby."

It's a trend that concerns advocates of natural childbirth. "We have a culture that pops a pill whenever we feel pain," says Susan Moray, a midwife in Portland, Ore. "People don't think that pain could be good, or productive." Moray claims that women who give birth without drugs have more alert babies, less postpartum depression and more confidence about parenting.

Although most doctors say epidurals are very safe, there is some risk. Studies by Dr. Ellice Lieberman, associate professor of obstetrics at Harvard Medical School, and her colleagues at Boston's Brigham and Women's Hospital found that women who get the shots are five times more likely to have fever during labor, which increases the chances that their babies will be treated for a blood infection. They also spend, on average, an hour longer in labor and are more likely to have their babies delivered by forceps or vacuum.

Women who've given birth naturally say they feel in control. Nancy Giampietro, 37, of Evanston, Ill., says taking showers and walking helped her withstand the pain of 24 hours of labor before the birth of her daughter, Olivia. "It's a great experience," she says. "If I had another child, I would totally want another natural birth."

But the pressure to go without drugs can lead some women to feel they've failed if anything goes wrong. Monica Stakebake, 27, a mother of four in Salt Lake City, regrets that complications forced an emergency C-section during the birth of her first son, Eric Jr. "I felt let down that I wasn't able to have him vaginally," she says. "It made me feel less of a woman."

Mothers who've taken advantage of painkillers resent the notion of childbirth as a competition. "If there was a medication out there that would help me get through this easier, I wanted it," says Leslee Finn, 38, a mother of three in North Easton, Mass. She calls the epidurals she received with her babies "humane."

Zehfuss didn't have much of a choice about an epidural because her doctor had to induce labor. But women without complications should have the final say, argues Maureen Cody, executive director of the Maternity Center Association, a nonprofit group. No labor is more "legitimate" than another, she says. "Birth is a very individual experience, and it's incumbent upon providers to let women make an educated choice."

Keep an open mind: you never know how you're going to feel in the delivery room. Tammy Moniz of Honolulu stayed away from epidurals during the births of all five of her children. "I was afraid of side effects," she says. "But I've been blessed with good labors, not intense ones that last hours." And if they'd been longer? "I probably would've been screaming, 'Gimme the shot!' "