"Childbirth ed? Why bother? I'm getting the epidural!"

A few days ago, Public Health Doula wrote this excellent post: Don't Count on Your Epidural, which in turn was inspired by Reality Rounds' equally excellent post No Epidural for You, You Bad Girl, and I thought the lesson was too important to not pass it on. A snippet from the former:

This is something I wish more women understood. Just because you expect to get pain relief in labor, you may not get it. You may never get it: you may have a fast labor, or show up too late, or have to wait too long for the anesthesiologist and by the time he shows up the baby is crowning. (If he ever shows up.) You also might have to wait for hours. When you get one, your epidural may not work, or only work partially.

So why bring this up? An excerpt from the latter explaining the importance of childbirth education (I'm sure I'll start shortening it to its common moniker 'CBE' soon enough) no matter what you think your preference might be:

Whenever I lead my unit’s birthing tours, invariably the subject of pain relief comes up. “How long will it take to get my epidural?” (number 1 question). “If I want a natural childbirth, can I change my mind and get an epidural?” . . . I always recommend to all my birthing tour moms to take a natural childbirth class, even if they want an epidural the minute they are in labor. I do not recommend these classes based on any philosophical or scientific belief that natural childbirth is superior, but on a realistic knowledge that you are not guaranteed an epidural. Let me say it again, YOU ARE NOT GUARANTEED AN EPIDURAL. Those are tough words to hear when you have your heart set on an epidural. I tell those moms to take a class on natural methods of pain relief, because you can not predict how your birth will go. Having some alternative methods of pain relief, like the jacuzzi tubs we have in every labor room (I call them the aqua epidurals), or using imagery,or hypnobirthing, or whatever, will give you back a sense of control over the pain. I have no idea how many of these moms take my advice. My guess is not many.

And you never know - it's possible that, stalled in her desire for the epidural she thought she wanted and forced by circumstance to call upon her own resources (hopefully including a support system, whether it be spouse, family, doula, or all of the above), and due to the preparation she thought was superfluous at the time, some mothers might actually find that they are doing just fine on their own.

As I read these posts, another thought occurred to me. The women who don't take the advice to do any childbirth education classes, assuming they can get the epidural promptly and on demand, and then find themselves having to wait several hours or more (or not get it at all, occasionally), they have left themselves no other resources for dealing with the pain whatsoever. They may not know to get out of the bed, or change positions, or use focused breathing, or massage techniques, or using water if a tub or even a shower is available. It's even possible that they might not even be aware of how dramatically different the pain is with Pitocin for induction or augmentation.

Even without augmentation, labor pain may be exaggerated as a result of not knowing that it would be in their best interest to avoid protocols that force them to be supine and immobile - just to name a few out of a host of examples, can she get a saline lock instead of a full scale IV? Can she have intermittent monitoring with a Doppler rather than be strapped to a cEFM for the duration?

And therefore, their experience of "natural" childbirth is one of being a helpless, passive victim to intolerable pain . . . and on the cycle goes of another woman telling her friends and her sisters and her daughters and anyone else who broaches the topic with her how horrific labor pain is, and how any woman who doesn't want an epidural is insane, and the fear cycle is perpetuated further.

By now, readers surely have a sense of my own preferences, but I'll say it again: I totally support women in making different choices than I might, including epidurals or other analgesia - as long as they are informed choices. A woman who goes into labor without any childbirth education (and I would include independent reading as long as it's thorough; I don't necessarily think it HAS to be a formal class, though I do think it's a good idea for most, particularly for their first births) because she's heard from friends and has seen in a bunch of sitcoms how magical the epidural is, and assumes that she can get it with a snap of her fingers, rendering pain management a moot point - she is not making an informed choice. And that uninformed choice can unfairly influence others.