Midwife charged in DC? Karen Carr, CPM...

[Anonymous]

Anonymous wrote:

I see this a lot, and it really confuses me. Do you know any OB/GYNs personally? Why do you think that they have less experience with unmedicated nonsurgical birth than a CNM? Have you looked at OB/GYN residency requirements? OBs have attended tons and tons of births, and since CS accounts for ~1/3 of all births (and a much lower percentage of first-time deliveries), of course they have extensive experience with unmedicated nonsurgical birth. All things being equal, OBs prefer uncomplicated vaginal deliveries. They're easier, the mothers tend to go home quicker, and the OB gets a comparable amount of money for less work. Of course, if the OB specializes in high risk pregnancies then she probably doesn't see as many "uncomplicated" deliveries, but I don't think you're referring to that population.

I'm not the PP but I do know ob/gyns. Many of your assumptions are off-base. The c-section rate of 1/3 does not mean that 2/3 of births are unmedicated. The epidural rate is very high, 95% or higher with hospital births. Mid wives only see epidurals if they deliver in a hospital setting so mid wives see far more natural births than ob/gyns. Residents may see barely any during their training despite seeing hundreds of patients. Many FTMs do not realize though that providing labor support is the nurses job not the ob/gyn's job. Your ob/gyn is not trained to provide support throughout labor not do they do this with you. They are trained to monitor looking for signs of pathology or fetal/maternal stress. They are trained to deliver or "catch the baby". They are trained to intervene with surgical or pharmacological treatments if the need arises. They are trained as surgeons. Finding an ob/gyn who is supportive of natural child birth means finding one who will sign off things like intermittent monitoring, drinking or eating during labor, being more flexible about the clock but it is still unlikely that this ob/gyn will be with you the whole time.

The nurses are expected to be the support person but the nurses may or may not be accepting of this role for various reasons. Older school nurses were not trained to support natural childbirth and old habits die hard in nursing. They may want you in bed while a different nurse who believes in natural child birth may do everything she can to keep you moving, offer different positions etc. Staffing affects this too as supporting a women through labor is time intensive. If the nurse has a large patient load, she is going to prefer that women get an epidural and do not need support. You may luck out and get a great nurse on a slow day or you can bring a doula to support you if you want to maximize your chance for having a natural birth. Nurses are not supposed to "catch the baby" so the pushing and delivery stage goes back to the ob/gyn.

Mid wives are responsible for prenatal care, supporting the mom throughout labor, and performing the delivery. The continuity of care and the time spent with the mother along with training on how to manage pain and labor throughout the process but the patients of midwives at an obvious advantage in achieveing natural childbirth.

Please provide a citation for your 95% epidural rate claim- everything I've read puts the estimate at ~85% at the very most, and probably closer to 75%.

And before, you said that you were looking for an unmedicated, non-assisted birth. Now you're throwing all of these other things into it- type of monitoring, eating/drinking, letting labor go on longer than generally recommended, personal support... I don't classify all of these things as "natural" or "unnatural," but you obviously have a very set view of how labor should go, and the type of "support" you want from your caregiver. That's great- that's why there are lots of different "birth philosophies" held by providers. But if you're talking about CNMs, they also do their training in hospitals, and I would certainly hope that "They are trained to monitor looking for signs of pathology or fetal/maternal stress. They are trained to deliver or "catch the baby". They are trained to intervene with ... pharmacological treatments if the need arises." The difference is that OBs train longer and with more complex cases, and they can use surgical techniques if needed. If some CNMs stay by the patient's side for however many hours of labor, and the patient wants that, then great- it's a good match. But none of that means that OBs just want to make everyone have an epidural and then leave them alone for hours.

Again, do you know any OB/GYNs? Many of the things you're saying about the residency training are hugely different from the training the OB/GYNs receive at my hospital.

[Anonymous]

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I see this a lot, and it really confuses me. Do you know any OB/GYNs personally? Why do you think that they have less experience with unmedicated nonsurgical birth than a CNM? Have you looked at OB/GYN residency requirements? OBs have attended tons and tons of births, and since CS accounts for ~1/3 of all births (and a much lower percentage of first-time deliveries), of course they have extensive experience with unmedicated nonsurgical birth. All things being equal, OBs prefer uncomplicated vaginal deliveries. They're easier, the mothers tend to go home quicker, and the OB gets a comparable amount of money for less work. Of course, if the OB specializes in high risk pregnancies then she probably doesn't see as many "uncomplicated" deliveries, but I don't think you're referring to that population.

I'm not the PP but I do know ob/gyns. Many of your assumptions are off-base. The c-section rate of 1/3 does not mean that 2/3 of births are unmedicated. The epidural rate is very high, 95% or higher with hospital births. Mid wives only see epidurals if they deliver in a hospital setting so mid wives see far more natural births than ob/gyns. Residents may see barely any during their training despite seeing hundreds of patients. Many FTMs do not realize though that providing labor support is the nurses job not the ob/gyn's job. Your ob/gyn is not trained to provide support throughout labor not do they do this with you. They are trained to monitor looking for signs of pathology or fetal/maternal stress. They are trained to deliver or "catch the baby". They are trained to intervene with surgical or pharmacological treatments if the need arises. They are trained as surgeons. Finding an ob/gyn who is supportive of natural child birth means finding one who will sign off things like intermittent monitoring, drinking or eating during labor, being more flexible about the clock but it is still unlikely that this ob/gyn will be with you the whole time.

The nurses are expected to be the support person but the nurses may or may not be accepting of this role for various reasons. Older school nurses were not trained to support natural childbirth and old habits die hard in nursing. They may want you in bed while a different nurse who believes in natural child birth may do everything she can to keep you moving, offer different positions etc. Staffing affects this too as supporting a women through labor is time intensive. If the nurse has a large patient load, she is going to prefer that women get an epidural and do not need support. You may luck out and get a great nurse on a slow day or you can bring a doula to support you if you want to maximize your chance for having a natural birth. Nurses are not supposed to "catch the baby" so the pushing and delivery stage goes back to the ob/gyn.

Mid wives are responsible for prenatal care, supporting the mom throughout labor, and performing the delivery. The continuity of care and the time spent with the mother along with training on how to manage pain and labor throughout the process but the patients of midwives at an obvious advantage in achieveing natural childbirth.

Please provide a citation for your 95% epidural rate claim- everything I've read puts the estimate at ~85% at the very most, and probably closer to 75%.

And before, you said that you were looking for an unmedicated, non-assisted birth. Now you're throwing all of these other things into it- type of monitoring, eating/drinking, letting labor go on longer than generally recommended, personal support... I don't classify all of these things as "natural" or "unnatural," but you obviously have a very set view of how labor should go, and the type of "support" you want from your caregiver. That's great- that's why there are lots of different "birth philosophies" held by providers. But if you're talking about CNMs, they also do their training in hospitals, and I would certainly hope that "They are trained to monitor looking for signs of pathology or fetal/maternal stress. They are trained to deliver or "catch the baby". They are trained to intervene with ... pharmacological treatments if the need arises." The difference is that OBs train longer and with more complex cases, and they can use surgical techniques if needed. If some CNMs stay by the patient's side for however many hours of labor, and the patient wants that, then great- it's a good match. But none of that means that OBs just want to make everyone have an epidural and then leave them alone for hours.

Again, do you know any OB/GYNs? Many of the things you're saying about the residency training are hugely different from the training the OB/GYNs receive at my hospital.

Not the PP you're responding to this time, but the one you were responding to last time. You're talking to at least 2 different people (me and someone that is not me but who is on the same "side" of this chat), so keep in mind that I only speak for myself.

You're right. I do not know any OBGYNs personally. I know doctors from other specialties and knew them during their OB rotations. I also know nurses who work in L&D, women who have had hospital births with OBGYNs, midwives and doulas. (Which obviously tells you pretty clearly where I'm coming from )

I think we are talking about a bunch of different things such that we no longer are clearly articulating what we're disagreeing about.

I am not anti-doctor or anti-hospital. I'm not anti-epidural, though I didn't want one myself, and I'm not anti-C-section either, though I do believe that there are more sections happening than necessary. When most people talk about having "a natural birth", they are talking about things like not having constant electronic monitoring and being allowed to change positions and push when they want to push and eat if they want to eat. Maybe that's not what you're talking about, but the reason that so many of those things appear in "natural birth plan" templates all over the internet is that prohibiting those things IS standard policy in a lot of hospitals. It might not be the policy at the hospital where you work. It might not be the policy at the hospital where the OBGYNs you know work. But it IS the policy at other hospitals.

As for the 95% epidural rate, I think that the PP was referring to in this area, but it's possible that she was also talking about a particular hospital. I was told by the birth center I delivered at that that epidural rate at AAMC (which is not *in* DC proper but still in the area) is about 98%. This was in December 2009. The answer was provided in response to a question from someone else in the audience about the birth center's transfer rate and the C section rate of their transfer hospital.

[Anonymous]

My cousin is an l&d nurse at Reston hospital and
she told me their epidural rate is 95% (but
also that most who want a natural childbirth don't
choose to deliver at Reston.) fwiw.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

What are these intended to show? These are a comparison between vaginal births (with no distinction made between medicated and unmedicated), and c-sections.

[Anonymous]

Today Karen Carr, worked out a plea deal. She will have no jail time. She will just have to pay fines. I'm livid.

[Anonymous]

One thing I will say as someone who had one unmedicated birth and one epidural is that after the catheter associated with the epidural, my crotch really really hurt in a way that it didn't after the unmedicated birth. It is hard to say which was worse overall. I really didn't want that catheter, since I peed right before getting the epidural, and pushed my son out 40 minutes later, and was annoyed that it caused so much discomfort in the weeks to come.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008 ) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

What are these intended to show? These are a comparison between vaginal births (with no distinction made between medicated and unmedicated), and c-sections.

They are intended to show that the acute pain of labor, like all other severe acute pain, can lead to chronic pain. This was to address the poster who claimed that there was no risk to forgoing pain medication during labor, and that mothers who do get pain medication should admit that they're making a selfish choice. It's very interesting that this "pain medication is selfish" debate only seems to take place with labor pain (and not, say, pain associated with sports injuries).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008 ) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

What are these intended to show? These are a comparison between vaginal births (with no distinction made between medicated and unmedicated), and c-sections.

They are intended to show that the acute pain of labor, like all other severe acute pain, can lead to chronic pain. This was to address the poster who claimed that there was no risk to forgoing pain medication during labor, and that mothers who do get pain medication should admit that they're making a selfish choice. It's very interesting that this "pain medication is selfish" debate only seems to take place with labor pain (and not, say, pain associated with sports injuries).

That's because pain medication for sports injuries does not affect a growing baby (unless the woman is pregnant while taking them) - and one who is working to be born. There are all kinds of medications that pregnant women don't take during pregnancy - why is it different during labor? Anyone who says that epidural medications don't cross the placenta is deluding themselves.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008 ) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

What are these intended to show? These are a comparison between vaginal births (with no distinction made between medicated and unmedicated), and c-sections.

They are intended to show that the acute pain of labor, like all other severe acute pain, can lead to chronic pain. This was to address the poster who claimed that there was no risk to forgoing pain medication during labor, and that mothers who do get pain medication should admit that they're making a selfish choice. It's very interesting that this "pain medication is selfish" debate only seems to take place with labor pain (and not, say, pain associated with sports injuries).

Um, yeah. The study you quoted does not actually discuss chronic pain in vaginal w/epidural and vaginal w/out. It was c-section vs. vag. Since most vaginal births are done with epidurals, the study does nothing to show that epidurals improve chronic pain outcomes. And, I never suggested mom's who chose epidurals were being selfish? Not once. I don't believe it at all. I do believe that pain is something that can be addressed in a number of ways, and that medication that masks pain is the most aggressive way to do it and not always necessary. It's smart to think about if you're planning to deliver vaginal. I prefer to feel the pain because I feel more in control. It's different for everyone. You're being awfully defensive.

[Anonymous]

"pain medication is selfish" debate

Well, lots of things you can do during pregnancy are "selfish" to some extent. Drinking soda, eating chocolate etc. are not the best things in the world for the baby.

[Anonymous]

goodness, I don't think anyone here said pain meds are selfish. This thread has gone south, finally, after two weeks. What does this have to do with the Carr case?

[Anonymous]

Anonymous wrote:goodness, I don't think anyone here said pain meds are selfish. This thread has gone south, finally, after two weeks. What does this have to do with the Carr case?

This is the quote in question:

The benefits can outweigh the risks when it makes it possible for you to have a vaginal birth when you otherwise couldn't, or when it is used for a c-section. But outside those scenarios lets not kid ourselves - when you got an epidural you risked your baby's health for your own comfort. So don't judge the poor mother who lost her child so harshly -- any one of us could have lost a child because of a decision we made to make us more "comfortable".

And the connection to the Carr case seems to be that since Carr (and her client) took such a huge risk with an AMA primip breech homebirth, that anyone who criticizes her but has had an epidural is a hypocrite, since of course all risks are equal.

[Anonymous]

well, that's just ridiculous. there are risks inherent in every decision, it's a trade off. my reason for forgoing an epidural actually has a lot of "selfish" reasons behind it I suppose...though I'm not sure that I'm putting my baby at risk by NOT getting one...maybe, if I have a really long labor and a bad position and am not pushing effectively because of exhaustion I could have avoided...anyway... The main reason I'm not getting one is because I don't want to damage my vag by pushing when I shouldn't. The rest of the benefits are gravy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.

Eisenach et al. (Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008) recently compared the occurrence of chronic pain after cesarean section and after vaginal delivery. For this prospective, longitudinal cohort study, 1288 women were enrolled. The prevalence of severe acute pain within 36 h postpartum in the vaginal delivery group was found to be 10.9% and persistent pain after 8 weeks was found to be 9.8%. Severity of acute postpartum pain was independently related to the risk of persistent postpartum pain, whereas no relation was observed concerning mode of delivery. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain. Interestingly this study also showed that patients with severe acute postpartum pain had a three-fold increased risk of postpartum depression compared with those with mild postpartum pain.

In an American study (Pan PH, Smiley R, Lavand'homme P, et al. Chronic pain after delivery: is it different between vaginal and operative deliveries? Anaesthesiology 2007), chronic pain after cesarean section and vaginal delivery were compared and no difference was found. The incidence of pain at 8 weeks was nearly 10%, regardless of mode of delivery, with half of those having activities of daily living affected by pain. Independent predictive variables for chronic pain at 8 weeks post delivery were age, cigarette smoking and rate of treatment of postdelivery pain after vaginal delivery.

In a study from Finland of 438 women (Kainu JP, Sarvela J, Tiippana E, et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 2010), persistent pain was mild in 55% of the women in both groups (vaginal and CS, although the CS group had a higher rate of mild pain), and intense or unbearable in four women after cesarean sections and in six women after vaginal births. Persistent pain was significantly more common in women with previous pain, previous back pain and any chronic disease. The women with persistent pain recalled significantly more pain on the day after cesarean section and vaginal birth than those who did not report persistent pain.

These studies are about pain *after* childbirth. I don't see how getting pain medication or not *during* childbirth would affect pain afterwards, unless it is true that getting an epidural is more likely to lead to tearing/episiotomy.

FWIW, I had two unmedicated births (one long in a hospital with an OB, one short at home with a midwife), and after neither did I need anything stronger than advil. Many people I know who got epidurals needed/took narcotics.