Tuesday, July 28, 2009

"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.


  1. Thanks for the link!
    It is hard to fathom why a pregnant woman would not want to take a CBE class. Some don't care, some have no time, some may deliver before they had the chance. I always encourage them!

  2. I had a friend who I offered her my Hypnobabies Classes. She wasn't interested. I could just sense she was going to have a fast birth. She DID and didn't have time for an epidural. She freaked out for about 15 minutes, refusing to push because she couldn't get the epidural. She finally pushed, the baby came out and she felt that awesome NCB high! She said had she not freaked out the baby would have been born 15 minutes earlier.

    I said, Maybe you can take Hypnobabies next time. Her response? I am just going to get to the hospital faster.

    Hmmmm, where is the logic in that?

  3. No problem RR, thanks for a great catalyst! And yes, it IS so hard to fathom. But the good news is that there really does seem to be a birth renaissance (a birth rebirth? Well, that may be the best way of putting it) going on right now - the more info out there the better. Which is why posts like yours can be so helpful, even if Mom is determined to get an epidural.

    Enjoybirth - that's quite the intuitive skillz you got there! I wonder how I could procure and hone such accurate labor-predicting ability . . . But yeah, seriously, I don't get that logic either. An epidural for 15 minutes?? Huh.

  4. A belated thanks for the link - I thought I had added you to my reader! That will be fixed today :-)

  5. I am blown away by women who refuse to push until they get their epidural... My thoughts run like this. 1) Our anaesthtists are highly unlikely to site one at that stage of the game. 2) HOW do you refuse to push? I couldn't have! and 3) Oh, Goddess, how sad that they feel cheated by not being drugged!

  6. This is one of the best things I have ever read that addresses the demand for epidurals. Good gosh. It makes so much sense of the split between women who plan (and thoroughly prepare) for natural childbirth and those who kind of stumble into it (and proceed to tell all their friends how hideous it is). Thanks!!

  7. Well, my pleasure! It was a revelation when it hit me, too. Had to share!

  8. I think it's great you post this stuff! We need more women to talk about what birth can be like that does not include epidurals, medicated, and cesarean sections. In our day and age, c-sections are accounting for close to half the births...and a lot of people think that the women have "natural birth" are the crazy hippies. LOL I always share your blog with others and just wanted to say thanks for doing such a good job!

  9. I was very lucky to have a natural hospital birth with my first baby (second, homebirth). I was also very lucky that I read "Natural Childbirth the Bradley way." The hospital "Lamaze" class ended up being more of a "hospital policy" class. "This is when you come to the hospital, this is what will happen, this is how an epidural works, you should get one....etc." The instructor joined in ridiculing and rolling eyes at myself and the other woman who inteded to deliver naturally. At one point, when one of us shuddered at the size of the epidural needle, she turned very angry, pointed her finger at us and said "Well, let me tell you one thing, you ladies who show up and refuse the epidural just because you're afraid of a needle are the ones who ALWAYS end up getting epidurals and C-sections!"

    Educate yourself! Hire a doula, or better yet, have your baby in the safety of your own home.

  10. Thanks, Anon & Anon! (And OY VEY on that instructor! I think most CBE's are wonderful, devoted people, but it just goes to show, it takes all kinds.)

    Perhaps I should promote myself and my peers as "Epidoulas"? To coin a term?

  11. another point about the epidural...it's sometimes worse than the labor pain. When I had mine after about 46 hours of laboring by myself (intent on having a NCB) when they wanted to try pit to move me along...I had uncontrollable shaking and tension in my neck and shoulders, preventing me from getting the much needed rest everyone was hoping the epidural would offer. Mine ended in a c-section (big surprise!) But I still tell people that the epi is not all it's cracked up to be! Never again...HBAC for me next time!

  12. I agree with thoughfulmama, the epidural can be SO MUCH WORSE than the labor pains. Mine gave me the "epidural shakes" the first time, along with causing me that nice traumatic cesarean. The second time it stalled my labor, made me bloat and itch, and ultimately I had to have it shut off so I could finish birthing. My epidural experiences were both awful, and I know I'm not alone. I'm frankly shocked anytime a hear of a woman who had a great epidural experience. They are very, very lucky.

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