Birth Has Become More Painful For Babies

Ironically, in the hands of 20th-century physicians, birth itself has become more painful for babies. Generally, doctors have not been concerned about babies' pain. They have been more concerned about fetal distress (heart rate fluctuations signaling distress) than about neonatal distress.
1. The pain of hospital birth. In the last half century, hospital birth has become the standard birth for the majority of Americans. From a baby's point of view, it is a new type of childbirth characterized by a series of painful routines surely not designed with sentient babies in mind. Sources of pain include: scalp wounds for electronic monitoring and blood samples during labor, forceps extraction (made more frequent now by epidural anesthetics), extreme spacial disorientations, being held upside down by the heels, frigid scales and utensils in a room 20 degrees lower than the womb, bright lights, noise, heel lancing, vitamin injections, astringent eye medications, irritating wiping and washing, sudden separation from their mothers, and banishment to a nursery of crying babies, all of it distinctly painful and upsetting and a flagrant violation of the baby's senses. Obstetricians defend all these practices, calling them necessary and "the best of care."
2. Pain in the womb. Even prior to birth, conditions exist which can provoke crying. When air is available to the fetal larynx, it is possible to hear a cry. "Squalling in the womb" (known as vagitus uterinus) is a dramatic signal of fetal pain, rare but well documented over many years.44,45,46 Virtually all modern cases of fetal crying are subsequent to obstetrical manipulation: tests, versions, deliberate rupture of the amniotic sac, and attachment of scalp electrodes or taking scalp blood while the baby is still in the birth canal. The fact that 20% of these squalling babies die is testimony to the meaning and the urgency of their cries.47
3. Pain of Neonatal Intensive Care. Premature and dangerously ill newborns face pain and peril trying to complete gestation in a neonatal intensive care unit.43,49,50,51 For a comprehensive review of the many stresses babies face in this man-made womb, see Gottfried and Gaiter, 1985.52
Pain is a way of life as babies are tied or immobilized while breathing tubes, suction tubes, and feeding tubes are pushed down their throats.53 Tubes, needles, and wires are constantly stuck into them; their delicate skin is easily burned with alcohol prior to venipuncture or accidentally pulled off when adhesive monitor pads are removed.54,55 The need for gentle and maternal interactions with the babies is only partly met.56,57,58 Psychological strategies and principles of care, urgently needed in this intense, technological environment, are slowly making an appearance.59,60,61
NICU graduates are not necessarily healthy. Mortality and morbidity are high. They suffer emotionally,62 cognitively,63 and in their neuromotor development.64 Life in a neonatal intensive care unit is a mixed blessing,65 and presents agonizing problems of public policy and medical ethics.66
4. Pain of Surgery Without Anesthesia. Hospitalized newborns, from preemies to babies up to 18 months of age, have been routinely operated upon without benefit of pain-killing anesthesia. This has been the practice for decades but was unknown to the general public until 1985 when some parents discovered that their seriously ill premature babies had suffered major surgery without benefit of anesthesia.67,68,69,70,71,72 Up to this time, babies were typically given a form of curare to paralyze their muscles for surgery, making it impossible for them to lift a finger or make a sound of protest!
Jill Lawson reported that her premature Baby, Jeffrey, had holes cut in both sides of his neck, another in his right chest, an incision from his breastbone around to his backbone, his ribs pried apart, and an extra artery near his heart tied off. Another hole was cut in his left side for a chest tube, all of this while he was awake but paralyzed! The anesthesiologist who presided said, "It has never been shown that premature babies have pain."73
Mrs. Lawson was describing the most common surgery done on premature babies, thoracotomy for litigation of the patent ductus arteriosus, which experts taught could be "safely accomplished with oxygen and pancuronium as the sole agents.74 After the parents told their story with the help of nation-wide television, radio, and print media, the ethics of these practices was seriously discussed for the first time.75,76,77,78,79 Resisting change, some doctors continued to argue that "following major operations, most babies sleep," and that "all we need to do is feed them..."80
Surveys taken of policies and practices of infant surgery in the United Kingdom and the United States revealed ambivalence about whether infants really needed anesthesia or would be endangered by it.81,82 Although some hospitals reported twenty years of successful use of anesthesia with infants,83 surveys of common practice revealed infrequent use of anesthesia, under-utilization of anesthesia, and the lack of policies on the subject.84,85
Key medical objections to infant anesthesia - that it was (a) unnecessary and (b) dangerous - were resolved by the brilliant research of Kanwal Anand and colleagues at Oxford from 1985 to 1987. Making precise measurements of infant reactions to surgery, they proved that the babies experienced pain, needed and tolerated anesthesia well, and had probably been dying of metabolic and endocrine shock following unanesthetized operations.86,87,88
When these findings arrived in the midst of the parent rebellion, official bodies of physicians began to acknowledge the need for change and promised to five neonates the same consideration in surgery as they gave to other patients,89 ending 140 years of discrimination. This was a milestone, but not a guarantee. We have no way to predict just how many doctors and hospitals actually follow these policies. Historically, announcement of new policy by a guild has not always affected the practice of individual members.90