Last week, Margaret Wente from the Globe and Mail wrote an article about the nightmare gender gap in Canada. She concluded by saying:

Unfortunately, these issues won’t be honestly addressed so long as the old-time dogma maintains its stranglehold in academe, labour groups and public discourse. It’s hard to change the conversation when the oppression of women is such a good racket.

Then today, she wrote a column called Why are bloggers male? and said:

Men clearly have an urge to blog that women lack. Like extreme snowmobiling, the blogosphere is dominated by men. Not many women are interested enough in spitting out an opinion on current events every 20 minutes.

…

Sarah and I believe the urge to blog is closely related to the sex-linked compulsion known as male answer syndrome. MAS is the reason why guys shoot up their hands first in math class. MAS also explains why men are so quick to have opinions on subjects they know little or nothing about.

I’m no stranger to having guys try to mansplain things to me, but I certainly don’t think women are lacking in opinions or in a willingness to share them. I do, however, have a partial explanation for that nightmare gender gap Wente was talking about.  When influential women are ignorant to the numerous women’s voices on the Internet (check out the entire BlogHer community and then some), when the voices of many women are dismissed as endearing, cute and girly, and when the voices of those women who are most oppressed are ignored altogether, that gender gap is perpetuated.

Thank you, Margaret, for proving your own point about how hard it is to change the conversation.

Update: On Friday, March 19, 2010 at 12:00pm EST, Tamara Plant (from MOM Magazine) and I will be taking on Margaret Wente in a live chat on the Globe and Mail’s website. See Women Bloggers Take on Margaret Wente and join in! I hope you’ll come back here afterward to share your perspectives on the discussion.

A Canadian report was released looking at the impact of free formula on breastfeeding rates. At parentcentral.ca, Laurie Monsebraaten and Noor Javed wrote about the study in Free formula spoils breastfeeding:

Almost 40 per cent of new mothers leave the hospital with free infant formula, a recipe for spoiled breastfeeding according to a new Toronto Public Health report.

Women who didn’t receive the free samples were 3.5 times more likely to be breastfeeding exclusively after 2 weeks, said Breastfeeding in Toronto, Promoting Supportive Environments, released Tuesday.

The study, conducted in 2007 and 2008, found that of 1,500 first-time mothers surveyed, 39 per cent were given formula at hospital discharge. As a result, many of these women stopped breastfeeding sooner than those women who weren’t given formula.

These numbers are astounding, considering that 90% of Canadian women who give birth initiate breastfeeding. If we assume that the 10% that went straight to formula got a handout, then that means that almost 1/3 of women who do initiate breastfeeding are leaving the hospital with formula samples.

Overall, by 3 months:

• 32% are exclusively formula feeding
• 16% are combination feeding (some breast, some formula)
• 52% are exclusively breastfeeding

I am willing to concede that some of the mothers that leave the hospital with formula samples may not have overcome their breastfeeding difficulties even if no sample had been offered. That said, the combination of the high number of women receiving free formula when discharged and the likelihood that they will break into that sample by the two week mark is likely a strong contributor to the significant drop between breastfeeding initiation and continued exclusive breastfeeding.

According to the  parentcentral.ca article:

“They give it to the women ‘just in case’,” she said. “But the real message is that you will probably fail… and one bottle leads to another.”

The Toronto East General Hospital is the only baby friendly hospital in Toronto, canceled its contract for free formula in 2005 to comply with the baby friendly requirements and the WHO International Code of Marketing of Breast-Milk Substitutes.  Since they do not get the formula for free from formula companies, they need to actually assess whether a mom needs the formula, instead of handing it out ‘just in case.’

Other countries with a larger percentage of baby friendly hospitals than we have in Canada and the United States also have higher breastfeeding rates.  I think one of the many things that needs to be done to give moms the best chance possible of being successful at breastfeeding is to ensure that they aren’t being sabotaged from Day 1. Don’t you?

Note: source for all statistics on Canadian breastfeeding rates is the Maternity Experiences Survey from 2006/2007.

Image credit: D-Arb on flickr

Is this how the world sees moms? It is how the New York Times sees them.

Jennifer Mendelsohn wrote an article in the New York Times on mom bloggers, called Honey, Don’t Bother Mommy. I’m Too Busy Building My Brand. I thought about writing a parody about journalists in response to it. But then I reconsidered. I realized that I do not need to diminish others in order to prove my own worth.

There are good journalists and there are bad journalists. There are journalists who do nothing more than turn around stuff written by public relations staff and there are journalists who do investigative journalism and cross-check their sources. There are journalists who write about things I consider frivolous and boring and there are journalists who write about issues I think are of critical importance.

The same is true in the blogging world. The blogs that I find interesting, intriguing, thought provoking or therapeutic, someone else might find boring, stupid or threatening. The blogs other people find interesting, I may find boring, frivolous or unethical corporate shills.

We are a diverse community. Diverse enough that there are moms who write about making crafts, tutus, felt food, or slings. There are moms who write about natural birth, potty training, sleep, and postpartum depression. There are also moms who write about corporate ethics, politics, feminism, health care issues, nutrition, social media, and more.

I don’t think it is any more appropriate to poke fun at moms writing about teaching your baby to read or hiding vegetables in their children’s food, than it would be for me to poke fun at journalists who think that this spring’s latest lipstick shade or some celebrity’s extramarital affairs are worth writing about (despite the fact that they make me yawn and roll my eyes).  If there is an audience, it is worth writing about and in the world of blogs, there doesn’t even need to be an audience for it to be worthwhile since just the therapeutic act of getting your thoughts down on the screen may be enough for some bloggers.

So when Jennifer Mendelsohn wrote an article peppered with mommy stereotypes in a tone that seemed to belittle the work of mom bloggers (although I hope and suspect that isn’t what she intended to do), it is no wonder that there was a rash of protest. Every writer chooses the wrong words sometimes. I know I do. But I don’t have an editing team to catch me before things go public. The New York Times does and this article should not have been printed without some significant revisions.

Here are some of the fabulous voices on this article, ones that demonstrate a thousand times over the greatness of moms who blog:

• Newspaper Bias Against Mom Bloggers (Kelby Carr): Kelby (also known as Type A Mom) writes about the condescending and insulting tone the article uses to describe mom bloggers. She points out that mom blogging is an industry, not just “something we cute adorable widdle mommies do to share diaper stories” and that there are a number of reasons why we are being marginalized by traditional media.

• Honey, Don’t Bother Mommy. I’m Writing a Mildly Annoyed Letter to the New York Times (Mom101): Liz suspects that Jennifer’s intent probably wasn’t to slight mom bloggers, but that many will not “get much past the opening snark, which continues to affirm all the negativity surrounding the word mommyblog.” At the end of her post she links to some of the many diverse voices and issues that can be found in the mom blogging community.

• This is kyriarchy in action: the New York Times on “Mommy bloggers” (Raising My Boychick): Arwyn takes things beyond the analysis of Type A Mom and Mom 101 and addresses the fact that while some moms are being belittled in this article, others who don’t fit the stereotype described in this article are being ignored altogether.

• Mommy is Busy Blogging (Motherlode): Lisa from NY Times very own mommy blog put up a brief post about the article. There isn’t much to the post, but there is plenty to read in the comments if you are interested in a rather diverse set of opinions on this article.

• Don’t Bother Mommy She’s Rabid Right Now (Jessica Gottlieb): Jessica writes about the value of blog conferences like Bloggy Boot Camp and muses about what Lisa Belkin’s (from NY Times Motherlode) thoughts on the article might be.

• An Open Letter to the New York Times About Mom Bloggers, Women Writings & the Universe (PunditMom): Joanne, one of my BlogHer 10 co-panelists, wrote that she is “so weary of [the New York Times] attempts to marginalize women writers online who happen to be mothers” that she almost didn’t write her post, but she did because she wants to change the landscape so that her daughter won’t have to fight the same battle we are fighting. She breaks down the language and content of the post and wonders whether primarily male-attended conferences would have received the same type of condescending coverage.

• NY Times Not So Mind Blowing Expose of the Mommy Bloggers (Momma in the Fog): Priscilla  writes that the article seems a bit confuses as to what its point and angle is, but that ultimately it “shows how very unprogressive our thinking is these days if we are still unable to talk about female industriousness outside of the typical stereotypes — the gold digger, the career ‘bitch’ and the vapid homemaker. Let’s call someone a hooker and call it a day.”

• NY Times Article About Mommy Bloggers (The Secret is in the Sauce): The organizers of Bloggy Boot Camp compiled a list of some of the posts about the New York Times article (some of which I’ve included here and others that I didn’t have a chance to read yet).

• Thank you, NY Times, for reminding me why I blog (Sharing the Journey):  The author of this blog about life after postpartum depression writes a sarcastic response to the article which completely overlooked many of the motives that she and other moms have for blogging.

• Why did you start blogging? My views on the New York Times article (Little Tech Girl):  Little Tech Girl talks about how some moms have found a way to make some money online while still caring for their family and questions why “when dads bring home work, they are committed and career driven, when a mom does it, she is neglecting her family.”

• An Australian Fringe Dweller (Good Goog): Zoey wrote that she is somewhat removed from the situation, as an Australian blogger, but that she found it off-putting nonetheless. She delves into some of the particularly colourful and not-so-helpful comments on the story.

• Excuse Me New York Times, Don’t Bother Me. Because You’re Absolutely Fucking Right, I’m Building My Brand (Uppercase Woman): Cecily writes about the New York Times history of marginalizing women writers and notes that even if they do not recognize their worth, companies do.

• Honey, Don’t Bother Daddy. I’m Too Busy Building My Brand (Hoyden About Town): Lauredhel does a genderflip of Mendelsohn’s article, which clearly points out how ridiculous it sounds.

• Bette Nesmith Graham, Mommy Bloggers and the NY Times (The Smartmama): Jennifer tells the story of a “mommy” business later sold to a major corporation for $47.5 million.  Can you guess which one? The point being that to dismiss and belittle this “diverse group of very powerful, very passionate, very invested, very active women” would be a huge mistake.

• A Blog of One’s Own (Child Wild): Sierra, who also responded to the article in a post on Babble’s Stroller Derby, writes about the hard work mom bloggers do and the difference they are making in the world.

• She is Vast, And She Contains Multitudes (Her Bad Mother): Catherine writes about how the important advocacy work she is doing for her sick nephew Tanner was belittled in the article, about how diverse mothers are,  and also about the silliness of the big (male-dominated) SXSW conference that she just attended.

• Tear Down that Wall? (Work. Life. Balance): Chrysula writes about the expectation that we will have clearly delineated lines between our professional and personal lives and about the trend away from that towards a more integrated life.

Rather than just complaining, I’d like to put a challenge out. Is there a journalist who would like to write an article for a mainstream paper that would present a balanced view of mom bloggers? Or is there a mainstream paper out there that would like a writer who could write one (because I know a few people who could take that on). Let me know.

After posting about Disney princesses yesterday, I was chatting with Rebecca from A Little Bit of Momsense and she pointed out that she was She-Ra for Halloween when she was little. I responded saying that I was once Wonder Woman. The conversation got me thinking about the female heroines of my youth and I realized that none of them are the Disney Princess types. Sure, I liked Snow White, but it was the story that intrigued me and not the Snow White character in particular (I loved the dwarfs!). I also played with typical girl toys like My Little Ponies and Strawberry Shortcake, but I would say that the majority of my childhood media influences were either strong heroines or were male. Not all of my  heroines are the perfect feminist ideal, but they are certainly not the typical princess type that is so popular today. Here is a sampling…

She-Ra – Princess of Power

Yes, she’s a princess, but certainly not your typical Disney Princess.

Wonder Woman

Nancy Drew

ShellyS on flickr

Pippi Longstocking

Caitlin Ryan on Degrassi Junior High and Degrassi High

Charlie’s Angels

Ramona Quimby

Elizabeth Wakefield from Sweet Valley

Peppermint Patty from Charlie Brown

The girls from the Facts of Life

I loved the girls from the Facts of Life, except the pretentious Blair of course.

Velma and Daphne from Scooby Doo

Lisa Simpson

Note: Most of these images and the corresponding links are from Amazon because I was having trouble finding good Creative Commons images of the heroines of my youth and Amazon provided a good alternative. Clicking on the links and purchasing the products from Amazon does provide me with a much appreciated yet small affiliate payment.

My partner is a stay-at-home dad and he sometimes fills me in on the deep conversations he has during the day with our little girl. Ones like this:

Emma: Daddy, what are you thinking about?

Daddy: I’m thinking about putting the tiles on the backsplash. What are you thinking about?

Emma: I’m always thinking about princesses.

Such is the life of an almost three year old girl.

As a thirty-something feminist, I don’t expect to spend a lot of my time thinking about princesses. But these days, it does seem like I’m spending a lot of time thinking about them. From princess books, to princess movies, to princess birthday parties and princess pretend play, princesses are invading my home, my life and my thoughts. As if that wasn’t enough, when I try to escape into the world of adult conversation and news, I find princesses, princesses, and lots more princesses.

I don’t really like princesses. At least not the popular image of a princess. I don’t like how focused they are on their looks. I don’t like that their life’s goal is to meet and marry a rich and handsome prince. I don’t like their completely impractical clothing. I don’t like the fact that every single girl in Julian’s preschool class was a princess for Halloween. I don’t like the entitlement attitude. I don’t like the lavish lifestyle. I don’t like the snobbery. I don’t like the daintiness.

Since I’m not a huge princess fan, you would think I would welcome news from Disney that it is trying to make its next big animated movie less princess-focused. But I don’t. At least not the way they are doing it. According to the Los Angeles Times article “Disney restyles ‘Rapunzel’ to appeal to boys“:

After the less-than-fairy-tale results for its most recent animated release, “The Princess and the Frog,” executives at the Burbank studio believe they know why the acclaimed movie came up short at the box office.

Brace yourself: Boys didn’t want to see a movie with “princess” in the title.

This time, Disney is taking measures to ensure that doesn’t happen again. The studio renamed its next animated film with the girl-centric name “Rapunzel” to the less gender-specific “Tangled.”

But that isn’t all. In addition to changing the name of the movie, they also introduced a new male character, an infamous bandit Flynn Rider just to appeal to boys. A character that isn’t there in the original. The New York Review of Books A Girl in the Tower article on Rapunzel stories explains:

In the Grimms’ tale of “Rapunzel” (though not in the Pentamerone), the prince is a fairly ineffective figure. After he climbs Rapunzel’s hair into the tower and is confronted by the witch, he jumps from the window in despair and is blinded by thorns. Both he and his beloved then wander about alone in misery for several years, but at last they are reunited and when Rapunzel’s tears fall on his eyes his sight is restored.

The NPR’s blog on this topic, called “Dear Disney: Boys Aren’t Stupid, But Renaming ‘Rapunzel’ Is” explains that other Disney princess movies like the Little Mermaid did fine at box offices [emphasis mine]:

There are princess characters who do just fine with boys, but I think the word “princess” now carries an implication of passivity and romantic fixation and therefore a lack of interest that Disney has created, not discovered.

The blog post goes on to explain that Alice in Wonderland is expected to do well despite not being called Hatter! and that Up would probably not have failed if Russell had been a girl instead of a boy.

I recognize that Disney’s primary goal is profit and not ensuring an appropriate cultural education for my children, but I wish that instead of keeping the princess and adding a “cool guy” on top, that Disney would think about what role it can play in deconstructing gender stereotypes and showing girls that they don’t have to be princesses and boys that they don’t have to be charming machos. As a feminist, I don’t object outright to girls wanting to pretend that they are princesses, but I do object to them being consistently brainwashed with the princess mentality. As a pacifist, I don’t object outright to kids playing with swords and guns, but I do object to them being consistently brainwashed into thinking that violence and war is a way to solve problems. We need some balance. Balance that allows all kids to experiment, use their imagination, and have fun without being told “girls don’t do this” and “boys don’t do that“.

My challenge to Disney: Instead of thinking about how to appeal to girls and appeal to boys, think about how you can create strong characters that help to break down the gender stereotypes you’ve invested so much money into building.

Image credit: Express Monorail on flickr

Language is a powerful thing. I sometimes object to other people’s choice of words. They sometimes object to mine. We let words impact us and give them power they may or may not have earned. There are words that cut like a knife and words so powerful and so objectionable that they really shouldn’t be used. Yet they are thrown around lightly. Nazi is one. Retard is another.

March 3rd was National Anti R-Word Day. My friend Ellen, who previously wrote a guest post here called How you should treat my child with special needs, wrote about it in her post One of the most awful words on the planet. The discussion in the comments was interesting and one commenter asked how replacing the word “retarded” with another one was going to do anything. Ellen replied that no one is suggesting the r-word be replaced with anything else.  She is right, but at the same time the word retarded has become such a huge part of so many people’s vocabulary, that I think they do need something to replace it.

So, I wrote an epic comment outlining exactly what I thought the r-word should be replaced with. Ellen turned it into a guest post on her blog. I hope you’ll take a moment to read it:

On alternatives to the r-word

I hope you’ll read it and comment over on Ellen’s blog if you have something to add to the conversation.

I far too often hear “but I don’t want my children to see THAT” in people’s objections to nursing in public.  I think we need our children to see more of THAT.

Instant Classic by G.J. Charlet III on flickr

Moeder en kroost by inferis on flickr

Be a mentor!

Most days, I’m proud to be Canadian. Whether I’m talking about our health care system, our maternity and parental leave programs, feminist leaders, or other topics close to my heart, my country usually makes me proud (even if it isn’t perfect). Today, however, my heart sunk. I was hit with bad news and then slapped with some more. I was disgusted by my country.

Association for Research on Mothering: CLOSED

I am a mother. I am a feminist. Despite not currently being enrolled at a university, I consider myself an academic and a researcher. I love the Association for Research on Mothering. I love what it stands for. I love its books. I love its journal. I love the fact that it brings thought leadership to the important role that mothers play in society.

Today, I learned that it is closing next month. York University, where it is located, is continuing to refuse to provide any base funding to the association and no one else is stepping up to provide it a home either. You can read the details in a letter from Dr. Andrea O’Reilly over on the Parentopia blog.

I am so much in shock over this that I can’t come up with anything intelligent to say about it, but I am devastated. I own a couple of the books published by Demeter Press and had put the rest of them on my Christmas wish list this past year. They are apparently going to be going on sale at a discount on their website and I plan to buy each and every one that I don’t own already.

But I’m disappointed that there will no longer be a place to bring together the important research on mothering and to foster the research and thinking on this topic. I’m heartbroken that I may never get to read some of the forthcoming books, like Mothering Canada (Spring 2010),  Disability and Mothering (Spring 2010), Giving Breast Milk (Spring 2010), The M Word: Real Mothers in Contemporary Art (Fall 2010), You Say You Want a Revolution: The 21st Century Motherhood Movement (Fall 2010), The Palin Factor: Politican Mothers and Public Motherhood in the 21st Century (Fall 2010), Adoption and Mothering (Spring 2011), Latina/Chicana Mothering (Fall 2011), Queering Parenting (Spring 2012), Living Feminism Through Mothering (Spring 2012), and Being a Mother Academic: Theory and Narrative (Spring 2012).

Is there someone out there who can save the Association for Research on Mothering? Please tell me there is. This is too precious to lose.

Mention of Gay Rights in Immigrant’s Guide: REMOVED

Homosexuality was decriminalized in Canada in 1969. Gay rights are protected under our Charter of Rights and Freedoms. Same-sex marriage was legalized in 2005. But shhhhhh…..don’t tell the immigrants. Today CBC reported that Jason Kenny, a Conservative Member of Parliament and current Immigration Minister removed all references to gay rights in the study guide for new immigrants who are learning about Canada in preparation for their citizenship exam.

According to the CBC’s article Gay rights section nixed for immigrant’s guide:

Internal documents show an early draft of the guide contained sections noting that homosexuality was decriminalized in 1969; that the Charter of Rights and Freedoms forbids discrimination based on sexual orientation; and that same-sex marriage was legalized nationally in 2005.

But Kenney, who fought same-sex marriage when it was debated in Parliament, ordered those key sections removed when his office sent its comments to the department last June.

Senior department officials duly cut out the material — but made a last-ditch plea with Kenney in early August to have it reinstated….In the end, however, Kenney’s view trumped that of the bureaucrats. The 63-page guide, titled Discover Canada: The Rights and Responsibilities of Citizenship, was released with fanfare last November and contains no mention of gay and lesbian rights.

While Canada welcomes the diversity that immigrants bring to this country, there are certain core values that we will not compromise on. The rights of all Canadians, especially minorities, are protected under our Charter of Rights and Freedoms. Ensuring that immigrants are aware not only of their own rights but of the rights of everyone they share this country with is key to achieving harmonious diversity. The removal of those sections amounts to silencing or hiding the rights of Canada’s gay and lesbian communities. This is yet another example of the Harper government’s further attempts to marginalize what it considers to be “fringe groups“.

I’m disgusted and I won’t shut up

I’m disgusted by the announcement on the Association for Research on Mothering. I’m disgusted by the removal of references to gay rights in the immigration guide. I’m disgusted, disgusted, disgusted. Will you join me in expressing your disgust?

Ugh.

I won’t stand by and watch Stephen Harper’s Conservatives continue with their plans to marginalize what they consider to be “left-wing fringe groups” (yup, people like women, gays, minorities, people with disabilities, francophones, or basically anyone who isn’t an English speaking heterosexual white male).

I’ll continue to express my disgust here on this blog and I’ll stand up to tell you all more about why I do this and why you should too when I speak about being a Radical Blogging Mom with Joanne Bamberger (Pundit Mom) and Stephanie Roberts (Picture Hope) at BlogHer 10 in New York this summer.

When people talk about baby-led weaning, they are usually referring to the method of introducing solid food that involves introducing finger foods and allowing the baby to decide what and how much to eat, rather than the parents spoon feeding baby food. Over time, feedings at the breast are gradually replaced with self-feeding of the same types of solid foods eaten by the rest of the family.

But breastfeeding is about more than just food. So in families that have chosen child-led weaning, meaning that the child (not the mother) decides when to stop nursing, the gradual process of weaning involves not only introducing other forms of food, but also other forms of comfort.

In our family, our babies were always nursed to sleep. That meant that I, as the nursing mom, lay down with them at bedtime and nursed them until the gulps turned to flutters and they drifted off to sleep. I could then sneak out and go about the rest of my evening. If I wasn’t there, Daddy would do, but their preference was always to nurse to sleep.  We never pushed or forced independent sleep, knowing that like eating, walking, talking, reading and so many other things, they would one day be able to do it on their own. It might require some guidance and some reassurance, but certainly not force.

As it happens, both of our children were ready to give up nursing to sleep before they were ready to give up having a parent present at bedtime. Nursing is a powerful sleep tool and our kids needed something to replace it. Something that would help them go off smiling and secure into the Land of Nod. They didn’t stop nursing at bedtime all at once. It happened gradually. With both of them, they went from nursing to sleep to nursing at bedtime but not falling asleep while nursing.

So then what do you do with a still awake child that has finished nursing?

In our case, in child-led fashion, each of our kids decided for themselves what comfort they needed that would help them doze off. With Julian, it was an involved process. He wanted his back rubbed while being sang to. The Thomas the Tank Engine theme song, the Elmo Song, the Wheels on the Bus, over and over and over again. He wasn’t always quick to fall asleep and I would find myself drifting away mid-song as I tried to get him to sleep. With Emma, who is now just shy of three years old and only nurses at bedtime about every third night or so, the request is clear and simple: “Mommy, cuddle my bum.”

So I cuddle. Because she wants me to, because it comforts her, and because one day she won’t want me to anymore.

Photo credit: ibu menyusui on flickr

A 2009 study called Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system by Ning Liu MB, MSc et al concluded that in Canada “the use of labor epidural analgesia is decreased with decreasing neighborhood economic and education levels.” Or, in plain language: rich highly educated women are more likely to get an epidural than poor less educated women. Those are facts which are supported by an excellent data set. I won’t argue with the facts [edited to add screen capture of basic results set].

However, I take issue with some of the study’s assumptions and the conclusions drawn by some of the researchers involved. From the start, the study presents the use of epidurals as the smart choice, referring to the increased use of epidurals as “1 [sic] of the most significant achievements of modern obstetric practice.” The whole study seems to question whether women of lower socioeconomic status are just not smart enough to understand how great epidurals are.

Education level could influence a patient’s acceptance of epidural analgesia.26 We speculate that in our study women from a high-education neighborhood may have had more knowledge about labor epidural and considered that it could alleviate pain more effectively. These women could then be more likely to accept epidural when clinicians recommended it to them, or they request the service themselves.

Despite conceding some cultural reasons for some women refusing epidurals, ultimately, they seem to conclude that if you are educated about epidurals you will make the smart choice and get one. If you are not educated about epidurals, you will not know what a wonderful thing you are missing out on.

The pros and cons of epidurals

I think the first mistake the study’s authors made was to assume that getting an epidural is a smarter choice than not getting an epidural.  There are both pros ans cons to epidural use during birth. According to Sam Leeson, a doula with babyREADY in Toronto in her post on epidurals:

PROS
May offer pain relief
May offer mom the chance to rest
May be medically necessary

CONS
May not work the way mom wants
Mom will be unable to get up to urinate
Some moms complain of long-term back ache at the epidural site**
May slow labour
May drop mom’s blood pressure (an IV will be administered)
May increase the need for surgical interventions (i.e. vacuum, forceps, episiotomy and/or caesarean section)
Will increase the risk of tearing
May give mom a spinal headache
May affect the baby
May result in an allergic reaction to the narcotic (mom would need more medication)
Is cumulative (results in increasing physical disconnection the longer it is in place)
Limits options of positions for pushing in second stage labour

There is a detailed examination of the pros and cons of epidural use, giving a full explanation of these factors, in Weighing the Pros and Cons of the Epidural by renowned childbirth education expert Penny Simkin. In her article she concludes that:

The childbirth educator’s duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows.

When women are well informed, they will consider the information, along with other factors – such as their fears, self-perceptions, their goals for their birth experiences, their support system – and make the most suitable decision.

This is a reasonable, balanced conclusion. Assuming that an epidural, which has many risks including increasing the likelihood of need for other birth interventions (each of which carries its own risk), is a better smarter choice is inappropriate. Assuming that the decision to refuse an epidural is something that only uneducated or unaware women do, is insulting.

A brief tangent on inductions, epidurals and c-sections

One of the key risks of epidurals that is mentioned above is the likelihood that an epidural will result in the need for additional interventions, like a c-section. But often the story doesn’t start with the epidural. Experts say that a lot of women are induced unnecessarily just because they have passed an arbitrary date by which the obstetrician thought they should have given birth. In an article about Canada’s increasing c-section rate, this logic is questioned:

Today in Canada, one in five women who gives birth in hospital is induced.

What doctors fear are stillbirths. But alarmed by the rising rates of inductions, the Society of Obstetricians and Gynecologists of Canada recently urged doctors not to consider an induction until a woman is at least one week past her due date.

Claudia Villeneuve says that women are getting induced “if they’re two, three, four days overdue.”

“Inductions are rampant,” says Villeneuve, president of the International Cesarean Awareness Network of Canada. “You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start.”

The “humane” thing is to offer an epidural, she says. With an epidural, a woman can’t feel pain in the lower half of her body. But epidurals slow labour, sometimes so much that labour stops. “Now you have to get this baby out,” Villeneuve says. Two-thirds of first-time C-sections are done for “failure to progress.”

Interestingly, despite this logical explanation for part of the increase in the c-section rate, one of the authors of the study this post is about (the one about how smart women get epidurals), Dr. Mark  Walker, is quoted in the same article as saying that “We don’t know what the ideal rate [of c-sections] is. I think it’s fair to assume it’s lower than where we are now.” (note: the WHO says it shouldn’t be higher than 15 percent and Canada’s c-section rate is 29 percent).

An alternate hypothesis

Back to the epidural study. In addition to rejecting the authors’ assumption that an epidural is a smart choice, I also reject their conclusion that education level is what causes women of higher socioeconomic status to  have a higher epidural rate.

**WARNING: Evidently from the comments so far my attempt to facetiously poke fun at myself and my socioeconomic cohort in the next paragraph was a complete failure. Please take it with a grain of salt or feel free to join in telling me what a jerk I am while I ponder whether I want to keep writing at all if there is no room for a bit of sarcasm and creative license here and there to make a point (going to keep writing…and keep learning). **

Instead of saying that rich educated women are making the “smart” choice by getting an epidural, I’d be more likely to say that women with perfectly manicured nails, pretty shoes, and a white collar job in the city who have never done a day of manual labour in their lives or endured any type of hardship are more likely to be unwilling or unable to endure the pain of childbirth than rural blue collar working women with practical shoes, callouses on their hands and whose life experience has taught them how to fight and endure. That is, of course, a generalization since not all rich educated women chose to have epidurals and not all poor uneducated women refuse them. However, I think it is a more likely explanation for the difference in epidural rates across socioeconomic groups than the one the authors of the study put forth.

Or, if I am wrong and women of higher socioeconomic status are truly choosing epidurals because they think it is the smarter, safer choice, then we need to seriously reconsider how women are educated about epidurals and find ways to ensure more of them learn about the risks of epidurals and are given the confidence in their body’s ability to birth a baby and to endure the pain of childbirth.

My experience: I had an epidural for my first birth because I was “educated” about the “benefits” of the epidural and scared of the pain. I ended up spending a very uncomfortable night, lying on my back, waiting for my baby to be born. I needed a nurse to tell me when to push and for how long.  They had to use the vacuum extractor to get my baby out (and I’m very lucky that is all they had to use). For my second birth, I refused the epidural because I was educated about the risks of an epidural. I was able to labour in whichever position was most comfortable for me, which mostly meant standing up and using gravity to help move things along.  I was able to feel when it was time to push and knew how long and how hard to push because my body told me and not because a nurse was counting for me.

Image credit: mangpages on flickr