Every Intervention is a Tool: Epidural

There are only two bad reasons to get an epidural:
1. Because someone else says you have to.
2. Because you don’t believe you can birth without one.

The decision to get an epidural during labor is a personal one, influenced by factors that come with lived experience, as well as ones that show up during birth. While natural birth experiences are often celebrated, it’s essential to recognize that every pregnancy and birth journey is unique, and there are situations where getting an epidural is absolutely the right call. There is no reason to fear or morally oppose epidural anesthesia–it is a neutral tool that can be used to improve birth outcomes.

As a newer doula–and someone who had always wanted an unmedicated birth, but instead opted for the epidural all four times–I believed that it was the folks who’d physically prepared their body for birth that were able to push through without pain relief. But that theory was never borne out: healthy clients who worked out before and all during pregnancy, attended prenatal yoga and childbirth classes, and used a birth ball could still end up in extreme agony, and clients who’d prepared nothing more than a playlist (and hired a doula) were able to put their headphones on, find their flow, and surrender to the process, resulting in lovely unmedicated birth.

So then I began to wonder: what goes into the ideas of a “pain threshold” and “pain tolerance”? A whole lot, it turns out. It’s far more mental, hormonal, and genetic than it is physical, and 40 weeks is not enough time to radically change it. Yet I had clients who’d feel like they’d “tapped out” if they opted for the epidural. Even I would feel like I’d failed them somehow if I wasn’t able to help them stick it out. But a key part of my training was assessing the difference between a positive experience of coping through something challenging, and a detrimental experience of inescapable suffering. There was no way to predict with certainty which path a client’s birth would follow, without knowing and addressing a lifetime of experiences and conditioning, as well as their genetic makeup. Clearly above my pay-grade.

The understanding that has come after a decade in doula work is this: an epidural is a tool. We use it when we need it, but not just because someone said we can’t birth without it. I specialize in strategies to help avoid situations where we need an epidural, or to maximize the benefits of mobility by delaying getting one. I am overjoyed when someone who wants an unmedicated birth gets that experience. I also know that a positive birth is the result of using the right tools in the right ways at the right times.

Let’s talk about situations in which an epidural is the best tool available:

Prolonged labor.

Labor can sometimes be really long, leading to exhaustion and reduced ability to cope. Sometimes the final weeks of gestation have already left the birthing person sleep-deprived and low on energy. In cases of prolonged labor or exhaustion, an epidural can offer much-needed pain relief, allowing the birthing person to rest and conserve energy for the later stages of labor. By alleviating pain and providing a sense of relaxation, an epidural can help maintain stamina and facilitate a smoother birthing process. This can make the difference between a vaginal birth and a cesarean in the pushing stage.

Managing pain.

Labor pain can vary greatly from person to person, and some individuals may experience intense and overwhelming sensations based upon how baby is positioned and the way their body processes oxytocin. It’s crucial to prioritize the well-being and comfort of the birthing person. Plenty of people have walked away from a fully unmedicated birth with trauma from overwhelming pain that wasn’t managed. If the pain becomes unmanageable or interferes with their ability to cope, opting for an epidural can allow them to regain a sense of control and focus on the birthing process with greater clarity, improving birth satisfaction.

Helping baby move down.

Sometimes the tension in the body during labor is so great that it limits labor progress. Most of what you learn in any childbirth class is how to release that tension in between contractions. It’s why we focus so heavily on breathing techniques during labor. But sometimes that tension builds up as resistance to prolonged pain, and we find ourselves a little stuck. I have found that at times like this, an epidural is the best option for letting tension go so that those tissues can soften. We often see progress pick up after and epi and some good rest.

Blood pressure issues.

Did you know that an epidural can lower blood pressure? Most of the time that’s not something we want, but conditions such as high blood pressure, preeclampsia, or fetal distress may necessitate medical intervention, and an epidural is a viable option for managing concerns and calming the body while ensuring the well-being of both the parent and the baby.

You need or want a cesarean birth.

This may seem obvious, but it’s actually such an important role that an epidural plays in allowing the birthing person to endure major abdominal surgery while remaining awake and alert to meet their baby. For so many, needing a cesarean would be devastating if it meant they couldn’t experience those first few moments.

History of trauma.

For individuals who have had a history of trauma, the fear and anxiety associated with labor can be overwhelming. An epidural can offer a sense of reassurance and comfort, enabling the person to approach their current birth with greater ease and emotional well-being.

Literally just because you want one.

You get to decide what experiences will be most rewarding to you. You get to decide where to spend your energy. Parenthood is all about these choices, and one of the most important things you can gain from your birth experience is the confidence to say: “This is what’s right for me and my child.”

What is my doula or support person doing while I have an epidural?

A. Helping you get into optimal positions as your body continues to labor.

B. Making sure you and your providers stay on the same page, even if plans have changed.

C. Grabbing a meal or catching up on sleep so you can have fresh support when things pick back up.

D. Watching your favorite show with you while you reset your headspace.

E. Talking you through all of the ways you’ve rocked your birth so far, and getting you hyped for pushing!

It’s so valuable to spend time considering what kind of birth experience you would like to have, and then to work to achieve your goals. Being educated about and open to all tools makes it possible to make impactful decisions that lead to a more positive experience, even if they ultimately alter your birth plan. A doula gets that and will help you prepare, while leaving all options open and decisions up to you.

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