When is an Epidural the Right Decision?
When I first embarked on my journey as a mother and later as a midwife I entered into both worlds with the idealistic view that women did not need pain relief during their labours. I approached this topic from the very limited perspective that ‘if I could do it, any woman can’; that is, birth without medical intervention in the form of an epidural.
The Decision
While I was pregnant with my oldest, my greatest fear was the pain I would endure during labour. I had to face the inevitable…that my baby was coming out and it would be painful either way, whether I had him vaginally or via cesarean section.
I was terrified with what people were telling me about labour and birth. I could not even begin to fathom how my body could open up to allow the passage of my son without enduring the intolerable pain that my family and friends were describing with graphic detail. I was going to be scarred for life, disfigured, never to be the same again…and the one thing that could possibly allow me to experience labour with more comfort, the epidural was going to, as they described, give me incurable back pain for life!
I was young and innocent and was determined that I would face labour and birth with whatever strength I had no matter what….I gained comfort in the thought that I was not the first nor will I be the last woman to have a baby. Not all women had the epidural, and besides, labour may be painful, but it is temporary. Having incurable back pain on the other hand, was something I did not want to contend with for the rest of my life!
My motive talk led me to convince myself, and instruct my husband that no matter how much pain I was in, no matter how much I cried for the pain to be gone…no matter what…I did not want the epidural, and his responsibility was to make sure that I stuck to that plan.
The Inevitable Arrives
When my labour began, it was manageable at first, and my husband drove me to the hospital to be assessed. I was about four centimetres dilated and my contractions began to pick up. I was put on the fetal monitor (as was routine back then) and lay on my back in the hospital bed bracing myself for each wave of contractions. The contractions became stronger and longer soon after I was admitted to the hospital and I was finding it hard to breathe. I was in so much pain that I found myself wishing I could have an out-of-body experience.
Almost immediately I was begging for the epidural because the nitrous oxide was making me feel really ‘spaced out’. My husband took his responsibility seriously and despite his constant reminders of our unwritten pact, I signed the forms necessary to have the epidural.
While the nurse prepared to set up for the epidural, I got up to use the washroom. As I was emptying my bladder, I asked the nurse if it was ok for me to have a bowel movement. She looked at me with a sense of shock on her face and hurried me back to the bed. As I climbed back into the bed, she checked me to find that my son’s head was sitting right there, he was ready to be born. The nurse scrambled to set up the delivery table, and at the same time a flood of people rushed into the room. I pushed a couple of times and my son was born shortly after. Needless to say it was the most painful thing I had ever encountered. But I did it very quickly (it was a four hour labour from start to finish) and I got through it without the epidural (I did not have much of a choice in the matter of course…my son had his own agenda!).
Conspiracy Theorist
My three other labour experiences pretty much mimicked my first….fast and furious, and thankfully without complications. I began to truly believe that women who choose to have epidurals do not have the internal fortitude to bear the pangs of childbirth. With good labour support, a woman should be able to get through birth without medical intervention was my thought process. I began to believe that the epidural was a mechanism used by the medical establishment to keep women under their control. If women had the epidural, the doctor would be able to introduce other interventions that would ultimately take the power of control away from the woman. I mentally protested my perception of the injustice of the medical establishment, and when I could, I would try to convince my friends and family that the epidural was evil and unnecessary.
One Thought Leads to An Evolution…
Midwifery opened my mind to a whole new approach to childbirth. My vision of midwifery was that my idealistic view of birth would be affirmed and that my opposing and negative idea of obstetricians would be upheld. I was blessed to be able to share the birth experiences of my clients as they invited me into their care while I was learning as a student. I was able to witness the diversity of the birth experience and my outlook on birth and the importance of positive inter-professional relationships began to evolve and mature.
I began to see that I could not simply try to collapse every woman’s birth experience into my own. For some women birth is a challenging emotional experience, for others it is mostly challenging from a physical standpoint, and yet for many others, it is the two challenges that feed each other. I quickly learned that supporting women in childbirth did not always begin and end with a quiet whisper in the ear or a gentle massage on the back, or pouring water over a contracting belly. I began to vision birth as a means to an end and whatever women needed or wanted during their birth, I learned to respond to.
Witnessing many challenging births as a student opened my eyes to the realization that for some women, the epidural is a necessity. It may be that the pain of childbirth surfaced hidden emotions for a previous traumatic event, or it could be that the pain of childbirth would forever be impressed in their minds as a traumatic event if they were not able to have pain relief. For others the epidural was a means of allowing their bodies to relax enough to allow the baby to maneuver her way through the birth canal. The epidural is particularly useful when it comes to this latter point. Women who find themselves in labour for a prolonged period of time can benefit from the epidural when other methods of pain relief are no longer effective.
When a fetus is in the posterior position during labour (the fetal back lays against the mother’s back), the mother experiences significant back pain with each contraction. The best way to help relieve the back pain is by helping the fetus to rotate so that the back is towards the mother’s right or left side (encourage internal rotation). When the pain is too much, women naturally respond by tensing up their back and pelvic muscles. By tensing up these muscles, it is more difficult for the fetus to rotate, which may also affect the speed of dilation and impede the progress of labour.
With the help of not only my midwifery preceptors, but also the anesthesiologists and obstetricians I worked with, I was able to see the way that the epidural aided women during labour.
I began to explain to my clients (and still do) that the epidural is a tool that obstetricians use when women have prolonged labour due to a posterior fetal position to not only help facilitate fetal rotation, but to give women the chance to deliver their babies vaginally (if the labour is prolonged and the fetus does not rotate, then there is a higher chance that a woman may need to have a cesarean section or an operative vaginal delivery).
Yes there are risks involved in having an epidural, and yes it sometimes leads to having other interventions during labour, but when it comes to having ‘back labour’ it might be the one thing that helps enable a woman to deliver her baby vaginally. I have personally witnessed this positive effect, and now truly believe that when a woman is faced with this scenario (prolonged labour and/or posterior position), the benefits of the epidural may outweigh the risks of having it.
Having an epidural in no way means that a woman has failed at being a mother, nor does it indicate that she is weaker than those women who do not take the epidural. I was not a ‘super woman’ because I laboured ‘naturally’; I was fortunate enough to have had very fast labours. If however I experienced a prolonged labour coupled with intense back pain, I would invariably have taken the epidural and not felt shame in doing so.
My experience as a midwife continuously reminds me that labour is as diverse as the women experiencing it and so too is the perception each woman has of the pain she endures during it.
Do you have preconceived notions of the epidural or pain during labour? I would love to hear what you have to say!
Below you will find links to blogs and articles that I found spoke to my sentiments regarding labour pain and pain control options. Please check them out.
This article is a rather satirical and candid tale of attitudes towards pain during childbirth:
http://www.dailymail.co.uk/femail/article-1248317/When-did-giving-birth-competition.html
This link offers information explaining the physiological origin of pain during childbirth and alternatives to medical pain relief during labour: http://childdevelopmentinfo.com/child-development/preparing_for_birth/easing_labor_pain/
This Blog describes why this mother did not want to take the epidural. It is a nice approach to experiencing the pain of birth:
http://blogs.babycenter.com/mom_stories/11132012why-not-just-get-the-epidural/
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