Spotlight on Female Delivery Pain

Spotlight on Female Delivery Pain: 

How painful it is to be a woman

She leaped from the building with the child in her womb.

Puerpera Ma Yushang in Yulin did not survive 11 hours of childbirth pain. She brought the most extreme pain human beings need to bear into the public eye——birth pains.

The pain of childbirth is often the first step for many women to become moms. Lu Chenchen is an athlete who didn’t think about having a normal birth when she had her baby. Her mother, who gave birth to her by cesarean, shared the same advice with her daughter, who was about to give birth. “It is painful the same anyway, and when the time comes, if you can’t deliver by normal labor, you still have to have a cesarean.” After giving birth, the sharp pain haunted Lu Chenchen; she could not hold the phone and was not in the mood to post on social media to celebrate the occasion. After leaving the delivery room, Lu Chenchen could not hold back her tears.

After the cesarean section, the nurse came over to drain the malodorous fluid, and once she pressed down, Lu Chenchen screamed out, grabbing the bed rail, sweating straight. “I was in so much pain that I went numb.” 

The nurse said, “You can’t shout. Your stomach will become very big when the air comes in.” Lu Chenchen slowed down for a while, covered his mouth, and nodded at the nurse, signaling he was ready. Her mother, standing aside, cried. “She also had a C-section; she knows how horrible it was.” Lu described cesarean as “like a knife on top.” The pain of childbirth filled her body, and Lu Chenchen had no strength.

Zhou Jing has experienced such pain. She is an obstetrics and gynecology nurse who has witnessed the pain of too many women in labor, and when it was her turn, she felt scared and chose to have a cesarean section. The next day, when Zhou Jing got out of bed and walked, the pain was sharp through her body. She felt frightened for a moment; her whole stomach fell, and her internal organs didn’t feel like hers.

Such pain is often long and intense. In the U.S. McMill Pain Questionnaire, childbirth is ranked as the most intense pain a woman can experience, worse than toothache, back pain, and pain from deep lacerations. One survey reported that 60% of first-time mothers described contraction pain as “unbearable, unbearable, and extremely intense.”

Can women avoid such pain?

After the Yulin maternal jumping incident, the “Epidural delivery” topic quickly emerged.

Click the link above to experience women’s pain in childbirth through an audio form.

Additional burden

Epidural delivery, also known as “analgesic delivery,” emphasizes using anesthesia and other means to reduce pregnant women’s pain. Dr. Nie, an obstetrician from Fengcheng People’s Hospital in Jiangxi Province, said that the most widely used method of analgesia in China is the intraspinal nerve block, injecting anesthetic into a pregnant woman’s lumbar spine. “The effect of the surgery varies from person to person, and being completely painless is just an idealized state.”

But, according to statistics released by the U.S. medical establishment, 85 percent of women with an epidural delivery will be pain-free, and 12 percent will experience appropriate relief. “The average pregnant woman will experience 80 to 90 percent less pain an epidural delivery.” Dr. Nieh said.

The popularity of epidural delivery in China is more “heartbreaking” than physical pain.

In 2004, out of an average of 20 million births annually in China, only about 10,000 had cumulative access to pain-free childbirth. The number was less than 1 %. This rate is 85% in the United States and 90% in the United Kingdom.

At the same time, epidural delivery is excluded from the separate charge items audited by the price department. Hospitals can only charge for the anesthesia drugs and equipment used to implement the epidural delivery at a price. In contrast, medical services and manual labor cannot be charged reasonably and legally.

Currently, there is no uniform pricing for epidural delivery in China. According to some public hospitals’ pricing, epidural delivery costs about RMB 1,500-2,500, depending on the delivery time. Only a few regions have included epidural delivery in their medical insurance. In Guangzhou, more than 2,000 yuan for epidural delivery can only be reimbursed as 700-800 yuan. In Sanya Maternal and Child Health Hospital, epidural delivery costs about 3,800 yuan, of which more than 1,600 yuan for anesthesia is not reimbursed by medical insurance. The rest is then returned according to the terms of medical insurance.

In March of this year（2020）, the Office of the National Health and Wellness Commission issued a List of Hospitals for epidural delivery. The authority identified 913 hospitals and required that these hospitals popularize epidural delivery, and the rate of it should exceed more than 40% by the year after.

These 913 hospitals are mainly city and county hospitals, while far beyond the list are the 36,000 township health centers and 630,000 village health clinics scattered all over the countryside. These locations serve 560 million rural people but lack policy and technical support for epidural delivery.

According to the National Bureau of Statistics, rural residents’ per capita disposable income in 2018 was about 15,000 yuan, and the per capita healthcare expenditure of rural residents in a year was 1,240 yuan. A single use of epidural delivery technology equals a year’s healthcare spending for rural people. Such technology seems unusually remote for rural women, given the realities.

In rural areas, where economic and technical conditions are unavailable, most women remain out of the “painless wall.”

Anesthesia fears and the lack of anesthesiologists

After the Yulin maternity crash, the National Health Construction Committee promoted epidural delivery nationwide, selecting hospitals with obstetrics and anesthesiology consultation subjects at the second level and above as pilots.

Nearly a year after the pilot project, Dr. Nie, on the front line of clinical work, said only 15 percent of mothers in her hospital in the significant county city of Sanbei would choose “pain-free delivery” to welcome their children.

“Most families still worry that an epidural delivery will harm the fetus and the mother.” Dr. Nie said, “For pregnant women, an epidural delivery is just a pain relief with anesthesia based on a normal delivery.”

In response to the rumor that “epidural delivery affects children’s intelligence,” Dr. Nie said that the local anesthesia technology is used for labor analgesia, and the amount of medicine entering the spinal canal is only a few milligrams and micrograms. The anesthesia is in the area below the mother’s navel, not directly through the mother’s veins. After the drug is absorbed into the mother’s circulation, the amount absorbed through the placenta is minimal and has no adverse effect on the fetus.

But, anesthesia is a big issue when promoting epidural delivery.

At present, there are only 90,000 anesthesiologists in China. According to the ratio of 2.4 anesthesiologists per 10,000 people in Europe and the United States, the shortage is as high as 300,000-500,000 in China. Under the premise that medical resources are insufficient and anesthesiologists are already overloaded, general hospitals and medical staff lack the motivation to promote this service.

“It’s not a technical difficulty; the anesthesia is not considered high.” Dr. Nie explained, but the reality of the trouble in front of pregnant women and anesthesiologists was too much.

The delivery room for epidural delivery needs to be equipped with midwives, obstetricians, neonatologists, and anesthesiologists 24 hours a day. However, many hospitals do not have a resident anesthesiologist in the obstetrics and gynecology department. 

Once there is an emergency, doctors have to rush from one ward to another, and the 10-minute travel time plus the time it takes for the anesthesia to take effect is enough to put a woman’s life at risk. On top of that, the hours of delivery test everyone’s energy, requiring regular rounds and monitoring by anesthesiologists and midwives. And in terms of economic benefits, the gain is far less than a single surgery. Economically, it is not cost-effective.

Duan Tao, former director of Shanghai No. 1 Maternal and Child Health Hospital, said, “If you look at it from the patient’s point of view, you won’t feel that it’s not cost-effective.” In his opinion, epidural delivery is a means of analgesia and “accident insurance.” Some mothers have accidents such as uterine prolapse and rupture during labor. If they have a base of vertebral anesthesia and analgesia, they can be immediately transferred to a cesarean section to minimize the risk to the mother and child.

But the actual decision is still in the hands of the newborn’s family.

Mothers are great even when they don’t suffer pain.

“The shortage of anesthesiologists, the operation of epidural delivery, these problems are all ‘solvable’ problems.” Dr. Nie said, “But the women themselves do not want to give birth painlessly, and there is nothing we can do about it.”

What are the actual thoughts of the mothers-to-be, anyway?

Cheng Tian is a “three high” mother (high maternal age, high position, high stress) who voluntarily gave up epidural delivery. She refused the doctor’s recommendation of “C-section” and “epidural delivery” and welcomed her baby most naturally.

The unfavorable condition of “three highs” made her suffer for more than ten hours than ordinary pregnant women. While recalling the severe pain during delivery, she still felt terrified but did not regret choosing a natural, expected delivery.

“It is said that natural childbirth is better for the baby’s future growth.” She said: “It’s not directly mentioned in the book, but experienced elders all say so.”

She admits that the scientific nature of this information is open to question, but most mothers “would rather believe it than not believe it.”

Unlike other surgical procedures, pregnancy and childbirth are listed under the " family " category rather than “medicine and illness,” according to customary scholar Chen Xixiang. The inherited meaning behind it makes modern women return to traditional family narratives.

Although scholars have repeatedly called for the formation of modern Chinese childbirth behavior to be separated from the traditional social customs of “family” and enter the process of the current healthcare system, the reality is that traditional businesses are challenging to be stripped away. Even mothers who believe in “science” will inevitably have to rest for six months after delivery.

Childbirth in China is, therefore, a long game of traditional customs v.s. modern science. The child is the mother’s greatest weakness, and when a pregnant woman needs to compromise with tradition and science, “Feelings of pain” is often the first thing to be sacrificed.

In countless literary works eulogize motherhood, “pain” is often given another meaning. When Cheng Tian talked about her “pain for more than ten hours before giving birth,” she couldn’t help but show her pride. The sacrifice of mothers is undoubtedly worthy of praise, but the more “pain” mothers suffer, the more remarkable; such logic is also somewhat pathological.

The root of this problem may also lie in the “status of women.”

“Because it’s female.”

In 2007, UN Under-Secretary-General Migiro asked: Would the world stand idly by if men died in childbirth?

The Lancet points out the reason for this: in most societies, people come up with reasons why women should suffer in childbirth and reject any efforts to make the process safer. After anesthetics were developed, they were denied to women in labor for decades because women were taken for granted for their suffering.

Zhang Meng is a mother of a three-year-old child. When she gave birth, very few hospitals used epidural delivery. When she talked about the “pain,” one of her classmates took it for granted and said, “All women go through this pain during childbirth, without exception.” But Zhang Meng didn’t think so. Epidural delivery, a mature and safe technology, has not been open to women and is not covered by health insurance in China. “I think it’s something very inhumane.”

The event of childbirth made her aware of the extra burden and pain that gender differences bring to women. She realized that what hurts more than the pain of delivery is the reality of bias: the pain of childbirth is something women take for granted and must endure.

On March 30, 1842, Crawford W. Long used ether anesthesia for the first time in surgery. But, the invention of anesthesia was not immediately applied to women in childbirth. Five years later, James Young Simpson, the world’s first person in obstetric 

anesthesia, predicted, “It is futile for the medical community to oppose the use of labor analgesia, and labor analgesia will happen sooner or later.” But this “sooner rather than later” was 100 years too late.

Even in the United States, maternal mortality remained high throughout the 19th and early 20th centuries. During World War I, more American women died in childbirth than American men killed in battle.

Zhang Meng recalled an article she had read before discussing why epidural delivery had not been implemented in China, and the final answer was, “Because women do not decide it.” Speaking here, Zhang Meng got a little excited and raised her voice a bit.

“They don’t look at it from a woman’s point of view. Many people think you have to be in pain to have a baby, and you used to have to be in pain to have surgery, and when there was no anesthesia, you had to suffer it, right?”

In the 1920s - 1940s, with the feminist movement, women turned their attention to the medical treatment of pregnant women. Women in the United States and the United Kingdom launched social activities to demand that all women have access to this humane form of childbirth. According to statistics released by the U.S. medical establishment, 85 percent of women who have an epidural delivery will have no pain, and 12 percent will have an appropriate level of relief.

In the 1940s, research on epidural delivery gradually advanced in Europe and the United States: Epidural analgesia was first used in obstetrics by Robert Hingson. American anesthesiologists established the Apgar scoring system in 1953. The American Society of Obstetric Anesthesia and Perinatology was founded in 1968. The American College of Obstetrics and Gynecology called for anesthesiologists to enter the delivery room in 1971. Delivery analgesia was widely practiced in American hospitals in the 1980s. Between 1981 and 1997, epidural analgesia was used for 2/3 of all deliveries in major hospitals throughout the United States.

Two years after obstetricians were told in July 2004, “It is inhumane to watch a woman experience delivery pains that have proven harmful.” Restrictions on intravesical labor analgesia early in labor were repealed in the United States. Anesthesiologists in the United States became integral to the labor and delivery room.

The Pulitzer Prize-winning book The Other Half of the Sky mentions that globally, the number of women who die in childbirth daily is equivalent to the number of passengers on five Boeing 747s. The World Health Organization estimates that 536,000 women died during pregnancy in 2005 or delivery, with one maternal death every minute. Such deaths have barely decreased in 30 years.

The needle is sterilized, toweled, inserted into the gap at 2/3 of the maternal lumbar spine, and crossed the transverse ligament to reach the epidural space. Then, a transparent catheter is inserted, and an anesthetic is injected.

After 10 minutes, the pain began to decrease.

This is the beginning of painlessness and can be the beginning of delivery.

The project also contains:

Causes of Dysmenorrhea for Women Explanation Video: https://mp.weixin.qq.com/s/XtBZc8CQsDoS3f8_1uNgIg

This article was first published on Jizhe（The student platform of the School of Journalism and Communication of Jinan University）

Original article link: https://mp.weixin.qq.com/s/ZkV_rCH5A-c4gNepU7i96g

Produced by：Di Cui，Yanyun Xu，Yubing Xia，Yang Yu