Epidural

When epidural analgesia was first commonly used for pain relief in laboring women in the 1970s, it was an infusion into the spinal cord of a relatively large dose of an anesthetic drug such as lidocaine. The effect blocked pain and all movement from the waist down. Since the mid-1990s, epidurals have been reformulated to try to achieve what Dr. William Camann, head of obstetric anesthesiology at Brigham and Women's Hospital in Boston and co-author of "Easy Labor," calls ideal pain relief during labor: a mixture of drugs that blocks pain nerves while leaving the motor nerves responsible for movement mostly unaffected.

When epidural analgesia was first commonly used for pain relief in laboring women in the 1970s, it was an infusion into the spinal cord of a relatively large dose of an anesthetic drug such as lidocaine. The effect blocked pain and all movement from the waist down. Since the mid-1990s, epidurals have been reformulated to try to achieve what Dr. William Camann, head of obstetric anesthesiology at Brigham and Women's Hospital in Boston and co-author of "Easy Labor," calls ideal pain relief during labor: a mixture of drugs that blocks pain nerves while leaving the motor nerves responsible for movement mostly unaffected.

Re "Childbirth Anesthesia Refusals Spur Probe," June 14: Your article regarding an anesthesiologist's refusal to provide childbirth anesthesia fails to explain a number of important considerations. First, there are viable alternatives to epidural analgesia, including administration of intravenous narcotics and pudendal nerve block. Second, you fail to point out that an epidural anesthetic may last as long as 24 hours (or longer) and an anesthesiologist will need to remain readily available for this patient.

Clippers forward Al-Farouq Aminu has seen his playing go up the last three games, and he knows the reason is not so much about his abilities with the ball in his hands. "Coach always said, 'Defense is going to get you out on the court,' " Aminu said. The 6-foot-9 rookie has averaged 27 minutes the last three games. He is averaging 11 points and six rebounds in that stretch, while giving the Clippers a threat from beyond the three-point line. But it's the things he has done at the other end that have Coach Vinny Del Negro running Aminu onto the floor.

So Sheryl Clark is "appalled" ["Epidurals' Costs Should Not Be Paid," Letters, June 27] because a class-action lawsuit has been filed in the case of low-income women who were denied epidurals during childbirth. Seems to me her indignation is misplaced. There would have been no basis for such a lawsuit if certain greedy anesthesiologists (already one of the highest-paying specialties in the medical field) had not demanded hundreds of dollars in cash upfront from these unfortunate women to begin with.

In response to the media's interpretation on the Medi-Cal patient who was denied an epidural and your June 16 editorial, I feel a physician's viewpoint is necessary. As an obstetrician, I deal with patients of all socioeconomic classes. Many patients who are paying cash for their pregnancy and delivery, or those with traditional or private provider organization insurance, will try and deliver without an epidural to decrease expenses. An epidural is an elective procedure, so doctors should not be forced to provide this service.

It wasn't all that long ago that childbirth was painful. Extremely painful. But in a phenomenon rich with social, political and economic overtones, childbirth in America has shifted dramatically to the quest for comfort. So strong is the trend toward the use of anesthesia--particularly the epidural--that even well-reasoned questions regarding the appropriateness and downside to pain relief are not dampening the enthusiasm.

Following revelations that doctors at Northridge Hospital Medical Center demanded cash from poor women in labor before providing a common form of anesthesia, federal health regulators have begun a sweeping audit of the hospital's practices and records.

Clippers forward Al-Farouq Aminu has seen his playing go up the last three games, and he knows the reason is not so much about his abilities with the ball in his hands. "Coach always said, 'Defense is going to get you out on the court,' " Aminu said. The 6-foot-9 rookie has averaged 27 minutes the last three games. He is averaging 11 points and six rebounds in that stretch, while giving the Clippers a threat from beyond the three-point line. But it's the things he has done at the other end that have Coach Vinny Del Negro running Aminu onto the floor.

In reference to your Aug. 28 story about the Legislature outlawing any denial of labor pain relief: This all can be traced back to a few years ago, when MediCal wanted to improve pregnancy care from the awful system of using only county hospitals. Officials improved reimbursement rates to hospitals and obstetricians; access to better care happened! They sort of forgot about anesthesia. It would seem appropriate to also provide reasonable anesthesia reimbursement as the way to fix the recurring problems of access to labor pain relief.

Pregnant women can be given a low-dose epidural early in labor without raising their chances of a caesarean section, according to a study that could change the way obstetricians practice and make childbirth less painful. The finding could lead doctors in the U.S. to consider offering early epidurals to hundreds of thousands more women in first-time labor each year.

Spencer Tunick is realistic about his ultimate goal in life: "I shouldn't be so confident that I can get the entire country naked," he says with a shrug. The photographer has become well known for organizing dozens to thousands of nude volunteers into "performances" in which they are grouped together, usually prone, to form a new shape; his photos are records of these events. Tunick is the perfect protagonist for tonight's PBS program "Skin" (8 p.m.

Like many mothers-to-be, Kristine Lain really wanted a natural, medication-free childbirth. And like many women who have endured labor, she now wonders what ever possessed her. "I definitely wanted to try for the natural experience," said Lain, the mother of two with another one on the way. "I thought, somehow, that the experience would be more real, that with an epidural I wouldn't have the same emotional connection to my baby." Lain, 32, now laughs at her earlier notions.

I feel compelled to respond to Dorothy McEwan's letter ["Epidural Critic's Anger Is Misplaced," Letters, July 11]: Although attempts to obtain cash payments from Medi-Cal patients for epidural services is improper, this practice was certainly the exception rather than widespread, and it is unfair to characterize anesthesiologists as "greedy" for expecting fair and reasonable compensation for professional services rendered. The placement of an epidural catheter and management of epidural anesthesia require fundamental medical knowledge and considerable skill and training.

So Sheryl Clark is "appalled" ["Epidurals' Costs Should Not Be Paid," Letters, June 27] because a class-action lawsuit has been filed in the case of low-income women who were denied epidurals during childbirth. Seems to me her indignation is misplaced. There would have been no basis for such a lawsuit if certain greedy anesthesiologists (already one of the highest-paying specialties in the medical field) had not demanded hundreds of dollars in cash upfront from these unfortunate women to begin with.

I was appalled by the article "Women Denied Epidurals File Class-Action Lawsuit" [June 17]. These women did not pay a dime for their state-of-the-art health care, while our hospitals are closing due to lack of funds. Insured patients are charged at least 35% more for their care to make up for the cost of treating uninsured and indigent patients. Now we taxpayers will have to provide the cost of legal representation and whatever settlement or damages are assessed by these women on public assistance.

I feel compelled to respond to Dorothy McEwan's letter ["Epidural Critic's Anger Is Misplaced," Letters, July 11]: Although attempts to obtain cash payments from Medi-Cal patients for epidural services is improper, this practice was certainly the exception rather than widespread, and it is unfair to characterize anesthesiologists as "greedy" for expecting fair and reasonable compensation for professional services rendered. The placement of an epidural catheter and management of epidural anesthesia require fundamental medical knowledge and considerable skill and training.

Eight women who say they were denied or forced to pay cash for anesthesia during childbirth have filed a class-action lawsuit against several Southern California hospitals alleging violations of the state's consumer protection laws. The suit claims that several hospitals, including Northridge Hospital Medical Center and the medical group contracted to provide anesthesia services there, have unfair business practices.

Women who were attended by doulas, experienced laywomen who provide comfort and information during childbirth, are significantly less likely to require epidural anesthesia and are more likely to rate the birth experience as positive than women who don't have such support, according to a study by researchers at Kaiser Permanente Medical Care Program in San Francisco. Nancy P.