Friday, April 29, 2011

"Why Don't You Just Take the Epidural?"

Firstly, before anyone decides this is a rant against epidurals, let me explain. I am emphatically NOT anti-epidural. You cannot work in birth for nearly two decades and be anti-epidural. Just because I'm a doula, the very word conjuring up images of bowls of organic granola lovingly moistened by the milk of the goat who lives in my back yard, do not assume I am all about all natural birth all the time. Ultimately, I am about whatever works and women's choices. Just to be clear.

Before exploring some of the questions I've heard people ask in response to the shocking idea of natural birth, let me defend the poor old epidural for a moment. Everyone who has worked in a hospital birthing culture for a reasonable amount of time has seen how an epidural can potentially and sometimes even miraculously restore morale and labour efficiency to a woman who has been labouring hard for a long time with the discouraging news that she is not opening. We all have stories of women who stayed at home for a couple of days with contractions strong enough to make them vocalize loudly. You know, the kind that look like the baby should be coming soon but just isn't, so they decide at their limit to accept an epidural when they find out that the three centimetres dilated cervix their doctors told them they had 2 days before they even went into labour has not budged in the 72 hours of minute long contractions every few minutes they've been having. And then boom, she goes to 10cm in 30 minutes after a break in pain. Could it be there was a real physiological need for the epidural and its benefits of relaxation? Maybe. Could it have been a psychological thing? Perhaps. Could this be a product of our enculturation? Sure, why not? Regardless, it worked, and the baby came vaginally, an epidural being less of a risk and less of an invasive intervention than abdmonial surgery. So let us give credit where it is due and a round of applause to this brilliant invention that can and does help some mothers' births proceed a little more normally sometimes. Sure, most babies would come out given enough time. But in cases like that you might start to ask "at what cost?" Sometimes, one might need to admit that in the the odd case the benefit of an epidural outweighs the risks of a labour continuing the way it is. Sometimes no matter what stops the support team pulls out to help labour progress more normally, from emotional support to comfort measures, to maternal positioning, to bodywork, to homeopathy, to down and dirty emotional/spiritual excavation, our efforts do not magically produce a baby. Nobody is to blame. And you can look for the "whys" and "wherefores" all you want, but in that moment that's not necessarily the healing thing to do. In these cases, sometimes the epidural is the most compassionate and effective healing tool.

It is also important to emphasize that doulas are not anti-intervention, they are pro choice. If a woman is truly and fully informed of the risks and the benefits of routine epidural (those risks can be found within seconds on the internet for those not in the know) yet in spite of that knowledge still claims she will want an epidural because she knows herself and her relationship to pain, then it is not our business to judge her. Sometimes getting to the bottom of what is often fear helps her to move through that desire and she ends up birthing perfectly normally. Sometimes not. It is our job to support her with as much love and enthusiasm as someone going for those natural births we tend to like. It is simply not true that a woman will only choose a routine epidural out of ignorance and an unwillingness to let go of a sense of control and propriety. You still grunt, cry, bleed, and poop with an epidural...sometimes for longer than you would without it. Yet even when this is explained, some still want it. I tell women it is totally normal to bellow up a storm while in good labour, that of COURSE it's fine and even desireable to make some noise, as how would you and a baby, if you found yourself accidentally birthing in the forest, keep those blood thirsty carnivores away without your yells scaring the crap out of them? Even with that doula-logic instilled, some still want that epidural. Fair enough. Everyone has their reasons, and everyone deserves to have their decisions understood and respected when it comes to pain relief in labour. I do my best to educate, and if we want to remain in the spirit of true empowerment, we stand by the choices our clients make for their coping methods. Period.

So I just want to take a moment to explore the question, "Why don't you just take the epidural?"

Here are some of the thoughts I've heard people express on the subject.

1) "If there is all this pain relieving technology out there, why wouldn't you just take the epidural?" It is understandable that most people in our western birthing culture cannot understand why on earth a woman would want to go through that pain when they didn't have to. The spirit of this question is usually meant with compassion, an expression of curiosity around the idea of why one would choose to take the pain filled jourey of childbirth as opposed to the much more comfortable one.

This speaks to a fundamental lack of understanding of the benefits of natural childbirth. The pain is not just some inconvenient by-product of the process, it is what helps to conduct the flow of hormones. You contract, you hurt, you get more oxytocin, you hurt even more, and so on. If you're feeling okay and nobody is bugging you, this flow is usually not interrupted and the baby is born. If it is constantly interrupted by routines and a demand on the intellectual as opposed to mammalian part of your brain (like timing contractions, grrr, and strident heart monitoring protocols), things may feel more painful and be less effective. And the opposite can be true in some cases as well. Birth can be fickle and it can not give a crap about what's going on externally. It is too unpredictable to pin down. Contrary to popular belief, I have not seen this pain phenomenon make women automatically turn into crazed evil banshees, lashing out at their partners for ever having impregnated them. That's media education for you. For the most part, if the mother feels safe and well supported, I usually see the oxytocin make them behave very lovinginly and trustingly, and sweetly spoken. Even at 9cm of dilation, the vast majority of women are grasping me tightly, apologizing for possibly having hurt me, murmuring how glad they are I'm there, and I kid you not, I have even been told "I love you" on more numerous occasions than you would believe in such an intensely painful situation.

My neighbour has the mouth of truck driver, God love 'er. Her husband was terrified she would totally alienate the hospital staff when the pain of labour hit and made her start swearing a blue streak. Well, wouldn't you know, labour came, she did it naturally, and all her words were sweet and grateful. Not that labouring women don't let out a few choice curse words here and there...sure they do and that is fantastic. It's good to vent now and then. They get pissed off that the baby's not coming quickly enough or bummed out when someone is not doing what they need them to even though she has told them five times. But that brief annoyance is usually not directed at anybody in the anger you might expect of someone in a lot of pain. Put it this way, I have been hugged 99% more times than smacked while helping someone in labour, so, given the intensity of the sensation (been there, so I know what I'm talking about), you've got to figure the hormones must have some effect on that.

This oxytocin, when the baby and then placenta comes out, is as it's peak. The whole room seems jacked up to the hilt on the stuff. It's beautiful. When the baby arrives, usually most of the pain is gone immediately, relief sets in, and in a couple of days when the body memory fades, women say, "Oh my God, that was AMAZING! I would do that again." It is discombubulating if you're not aware of the beauty and power of natural birth, even when it looks INTENSE. You might think the mother is some kind of masochist given what you've just see her go through. But regardless, they usually do go on and do it naturally again if they've done it before. I have. Four times. In spite of the yelling and feeling like you'll never make it. In spite of sensation that makes you think you will never be able to contain it in one little body. In spite of the exhaustion, shaking, and nausea. In spite of the nine months of pregnancy challenges and discomforts. You most likely choose to do it that way again if it worked out for you before. And hey, even women who have had really tough, intervention filled experiences usually give birth again, many, even though they may have been those ones stuck for days at 3 cm with howler contractions and no progress, go into it the next time with the intent of doing it naturally.

So why do some women choose to do it naturally, whether they are first timers, have had a natural birth before, or have had terrible experiences before? It's not just because of the known health benefits of not messing with this particular blue print Nature has given to us if it's not warranted, but I guess because at the end of a good birthing journey, there's a body knowing, a deep soul intuition, a flash of motherwit if you will, that occurs when a birth has gone normally. It bestows upon your being a sense of rightness. In spite of all the judgements of "you're crazy." It just feels...right. It is what glory feels like. Labour is not something you love while you're doing it most of the time. You love it when it's done. It is at the same time the hardest and the best day of your life. Up and down, ebb and flow, effort and rest, give and take, scream and love.

2) "You wouldn't have root canal without anesthesia, would you? Why on earth would you have a baby without drugs if it hurts that much?"

This analogy bugs me to no end. It's stupid, even though it's asked if YOU'RE stupid. Sorry to those who like to use it. Root canal is a procedure dealing with a pathology. In your mouth. Someone is doing it to you to help you with something in you that is sick, impacted, and potentially rotten. If you want to put the intended nature of that question into its proper context, you should ask, "You wouldn't have a Cesarean without anesthesia, would you? So why would you have a vaginal birth naturally if it hurts so much?" But then you'd sound like a total tool, as the intention of Cesarean is to quickly remove a baby from a mother if one or both of them is in mortal danger (well, that's what it used to be for, anyway); normal vaginal birth is...well, normal, even with the level of pain usually involved.

Women have been birthing for a scabillion years. In fact, you, yes you, would not be here today if you did not come from ancestors who, from the beginning of time, birthed vaginally without epidurals. Even if your great grandmother and mother had a little help, or you were conceived in a petrie dish, it still means that (at least up 'til a couple of generations or so ago) you come from a line that can be drawn back to the dawn of birthing humanity in which they rocked birth old school. Yeah, we may have lost a mom here and there along the way. The benefit of living in the now is that maternal death happens less frequently in developed countries (though with all the stats on the impact of all this surgical birth on maternal health, even that is seeming sketchy). You may have lost a lot of great great great uncles and aunts over time. But you are here. How many births have occured in your ancestral line to get YOU here? Millions? Is this not a testament to the birth giving brilliance of your Grandmothers' bodies? And if you want to use the evolution/big fetal head argument on me, you're barking up the wrong tree. The poor old decrepit female pelvis is probably not to blame for what seems to be more difficult births and all these interventions to save us from the pain and death invading us from all sides. It's probably a combo of fear, enculturation, detachment from our bodies, sitting on our butts all the time, pain management messing with our hormones and muscles, birthing positions that are antithetical to simple mechanics, lack of real emotional support as everyone pays more attention to drama and danger, and a bunch of numerous other things I'll just get too mad about if I start writing about them now. The point of the whole "root canal/childbirth" analogy is that it needs to be put to rest because it is just an insult to one's intelligence and a spitting on the honour of our Grandmothers.

3) "Isn't wanting to give birth naturally just a display of feminine machismo?"

I have sat outside rooms beside a couple of male doctors, with the woman inside the room yelling and keening with her birthing pains, ask me that very question. I am not picking on male doctors, as I have known women to say this too...about other women. This feels even worse to me. Anyway, in these cases, I could sense the doctor was having a hard time not wanting to save the woman from what clearly sounded like abject suffering. The tension from hearing these sounds when there is a perfectly good Epidural Man walking around the hallways administering sweet pain relief can be a lot for many people, medical or otherwise, and they start to wonder as their stress builds, "well, if it really hurts that much, isn't kind of stupid to suffer like that? She can't give birth with all that tension. She's hurting herself and the baby. This is all ego based posturing so everyone can tell her what a hero she is afterwards." I invite those with this belief to reclaim their projections. Part of them is saying, "I want you to end your pain because I can't handle it." Trust me from many years of working with natural birth when I say that the most hard core natural birther will call for help when she has reached her limit. No thoughts of heroism intrude upon a woman who is in truly dysfunctional labour. It is obvious in one's deepest core that something isn't working that great. She stops being all trance-y and stoned with the contractions and the bad kind of adrenaline starts working, and she starts getting more intellectual about things. I myself have been in that space wondering, "hmmmm...I may need to think about plan B". We don't push ourselves to the limit or go about trying to prove a point at all cost. Nobody wants to put their babies or themselves at true risk. We push ourselves to the limit because we're handling it and we're strong, thank you very much.

Let us be clear about one thing. We as a culture use the phrase, "you don't have to be a hero" to women who state their intentions to have a natural birth. What we really mean is "don't be a martyr". A hero shines in beneficence and helps heal our world on various levels. Is it wrong to be a hero, for ourselves, for our babies? Is it wrong to want to create new legacies for our future birthing daughters and to embody the magnificence of normal birth to caregivers who rarely see it? Is it wrong to want to be a pioneer again? Is it wrong to want to reclaim a little faith in our bodies our culture views as defunct? Does that warrant this judgement of intended machoism? Is this how resentful people are of women who want to have natural births, that they will think them as megalomaniacs for going through the pain involved? If we were quiet about the pain would they feel differently? A martyr is someone who dies for her cause. I have never ever known a woman who would not throw herself on the floor and subject herself to unanesthetized surgery if there was evidence her baby was in immediate danger. This is not to say people don't sometimes make bad choices. It happens. But if we're talking about owning the sensations of labour, if a woman is paining, it doesn't mean she's dying, it means she is expressing a tremendous amount of raw, natural power. She is WORKING it. And if you can't stand the heat, you should get the hell out of the kitchen. When she's labouring she needs support and encouragement like the marathon runner who is at mile nineteen and all systems look to be shutting down. She doesn't need jugement about her intentions. Trust that if she can't take it or if there's danger, she'll do what she needs to do. That whole "feminist machismo" assumption is one of the most disempowering things I have ever heard, and it speaks of how little we regard the process that gets us here and those who have laboured to do so in heroic, miraculous grace. It speaks of a woman's intentions to experience birthing pain as misguided, and of not being smart enough and too stubborn to seek help when needed. Shame on us.

To be honest, there IS a tremendous ego boost to having birthed naturally. Huge. But it's a healthy one, not the macho kind. After that baby has come out naturally and you realize you did it all on your own steam you usually feel like a consummate badass. And is that so wrong? You haven't done it at anyone's expense, in fact, it has contributed to your and your baby's health. Shouldn't it be okay to feel great about that? In my doula logic I believe the confidence boost a woman receives from either having a great normal birth, or a difficult birth in which she may have needed interventions for but gave what she felt was her all, is one of the best springboards from which to leap into motherhood. Motherhood is joyful and amazing, but it's hard. And it's forever. To start out that relationship feeling like you can do anything, gives you RESOURCES. There is no Epidural Fairy who comes in the middle of the night to save your ass when your nipples hurt and the baby is waking up for the fifth time in a row. You are struggling, but you remember: you have given birth. You can do anything.

I ran into another neighbour of mine walking with her toddler and her new baby. Her first birth had been very long and she had had an epidural. She felt like she did great, but was a bit disappointed how it turned out. She wasn't sure she wanted to try it naturally again, but ended up doing so.

Lesley: "Jen, you had your baby! That's so great! How did it go?"

Jen (beaming): "I did it NATURALLY!"

Lesley: "Yay, that's fantastic, good for you! Do you feel like a rock star?"

Jen: "I AM a rock star. I feel like I could fly".

Enough said. "In glory and awe I have given birth, and found therein, my Self, my Child, and my God." -Kim Miller