Monday, February 25, 2013

Owning Pain

I had a conversation about epidurals with an OB friend of mine this weekend.  His thoughts were, "Sometimes I don't know if I should offer one or not."  I absolutely understand this conundrum of the primary caretaker in a hospital birth.  Firstly, it's assumed most people are going to want one at some point.  In hospital births in which people don't have a lot of support, it's rare to see those who intend unmedicated birth actually have one, especially for those women whose births end up being quite long.  So offering is reassuring and welcomed by the vast majority of women who birth in hospitals.

On the other hand, and I always really appreciate hospital staff members for this, many of them upon hearing a mother's plans for an epidural free birth don't wish to mention the epidural because they don't want to come off as interfering, or being one of "those" medical people who like to sell epidurals hard because they can't stand the idea of someone being in potentially a lot of pain.

My thoughts on the matter, and many natural birth advocates may disagree, are that it is absolutely fair for a medical person, upon arrival of a mother at a hospital in labour,  to explain that there IS pain relief in the form of a, b, c, d, and epidural.  Adding a, "I just want you to know in case you choose this, but that's all we'll say on it." would be great too.  Many are aghast when any mention of an epidural is made at all.  As doulas, it can be really frustrating to hear these words.  We jump to the thought that our vulnerable, paining client will hear this sweet phrase, then jump on the epidural bandwagon, only to feel disappointed in herself later.  But in a way, isn't this assuming that a mother will translate the epidural offer as a disempowering question?  Because you know, it isn't necessarily so. I've been asked if I wanted an epidural in my own hospital birth.  It did not make me want to have an epidural, even though I had been in labour for a couple of days.  When I decided to possibly consider epidural, it had nothing to do with peer pressure.  It came from my own core.  I gave birth before I decided, so I never did end up getting one, but had I chosen it, it would have come from a very informed and empowered place. I have seen many women asked if they want one, and those really into the process of normal, natural birth just don't seem to take it too seriously.

On of the reasons I think it is fair to provide a mother with the information that there are epidurals available in the hospital for her use if she wishes is because the caregiver's challenge  in a busy hospital is that they may not have the time it takes to really get to know the patient's wishes and the thoughts about those wishes the family/or friends present may harbour.  What pushes me over the line into the belief that an initial little epidural shpiel is not a terrible thing is that on occasion, the mother might be under the immense pressure of partner/family member/friend/even doula to NOT have an epidural at any cost.  I have been in many births where Grandma or Mother-in-Law or Husband or Girlfriend Who had her Own Natural Births were quite hostile about the idea of epidurals, and willing to project that hostility onto the caregivers just for doing their due diligence in mentioning the hospital's availability of pain relief.  Okay, true, usually it is the opposite...usually Moms want natural and the argument is FOR her to take the epidural (don't be a hero, yada yada).  But sometimes we have the mom who is not sure, or the mom who runs into real suffering and everyone else on the birthing team had a hard time surrendering to her desire for epidural.

To KNOW that someone in the hospital is on your side and supportive of your choice to eliminate pain is not a bad thing.  Yes, it IS a bad thing to have an epidural shoved down your throat every time you yell with a contraction.  That is not empowering.  But I don't think mentioning they exist before labour gets super charged is terrible at all.  There are women who come into the hospital with no prior prenatal care, perhaps new to the country, culture, and language, perhaps who have birthed previously in horrendous conditions.  I had one client who had birthed in another country and was absolutely traumatized by the cruelty she was subjected to.  She was in a room full of other birthing moms, the nurses kept telling her to shut up, that she couldn't move or make a sound, nor have anyone else there to support her.  Her thought was, "Well, I did it naturally last time, I can do it again this time."  As a doula, I talked to her about common hospital procedures, we talked about the epidural, and as always, outlined as best I could the risks and the benefits.  It didn't occur to her to think about epidural, due to her previous natural birth.  But when she went into labour, she was triggered into a post traumatic episode related to her prior birth years back.  When we got to the hospital it was casually  mentioned she could have an epidural if she wanted by the super friendly, supportive nurse.  My client looked surprised, regardless of what we had gone over prenatally.  As pain increased, her stress increased, no matter what I did.  She said to me, "Is it true I can just get pain relief if I want it?"  I said, "Absolutely.  You're doing great and your labour is progressing beautifully, by the way.  Would you like to try the shower?"   She said, "No, I want the epidural.  I remember what you told me about them.  I feel like I really need one."  And that was that.  When she got it, I saw a look of absolute peace.  She had space to process a lot of things from her last birth, and she found incredible healing in the ability to choose pain relief when in her past birth it wasn't an option.  I was glad for her.  She had a beautiful birth.  To know that a medical person supports the desire to help them out with pain can be a godsend to some.  It isn't for us to judge.

Now having said that, once the offer is out, it shouldn't be repeated a million times. Or rarely at all. THEN Mother's strength becomes compromised as she is repeatedly taken out of her reptilian brain, from which she may wail, cry and moan to help her through contractions, into questioning herself.."am i not doing well?  Am I bothering people?  Is something wrong?  Why do they tell me I need drugs?"  This comes from people outside her experience trying to own her personal process of birth in the guise of "saving".  Their thoughts might be, "She's not relaxing.  She's getting too tired.  I can't stand hearing those vocal expressions.  They make me uncomfortable and I need to DO something to get this woman to stop being a masochist.  Maybe someone is putting her up to this!"  But women in labour are generally pretty fierce, and even the shy ladies will start demanding an epidural if that's what they really want, so staff members generally don't need to press the epidural point. Women whose family members are against it will often simply refer back to the doctor's initial words and say, "They said I could take one." and feel more strength in their conviction to request it. Even if nobody offered a suffering lady drugs, if they are decided in using one, they will usually continue to ask for them. Of course, we do the doula if we know our clients desired an unmedicated birth and many women change their minds as they find their ways to cope, but you do come to a point where to try to sway a woman from what she clearly has gone hellbent on becomes an act of disrespect.  There is a line between supporting her original intentions to forcing her to own pain she truly doesn't want anymore.  I can't say I've had anyone say, "well, I ended up taking one because the staff mentioned epidural once when I arrived and it broke my resolve."   They took it because they wanted it.  No blame, no shame.  Or perhaps the continued, "are you SURE you don't want a nice, juicy epidural so you can sleep and have no more pain" song eroded their confidence after a while.  Those who take epidurals on their own steam usually don't regret them much.  Those who feel coerced often do.

I like using the analogy of running a marathon to illustrate to medical people not sure of when to intervene on the pain relief front.  How challenging it might be to a marathoner to instead of having the road full of people yelling, "You can DO it...here's water, high fives, gel snacks...you go, keep running, don't give up!" say, "Don't be a hero!  You have nothing to prove!  We'll put you in the wheelchair and you'll still get you to the finish line one way or another, it doesn't matter that you stop running!  The process doesn't mean anything. We can't stand to see your pain anymore."  And it IS pain.  My dear friend and colleague Sesch is a marathon runner and she tells stories of people yelling with pain, limping along during their runs.  She says she has seen women bleeding down their legs as their menstrual protection fails after hours running, people shitting themselves, and vomiting down the front of their shirts...but not stopping.  And what do we do for these pained runners when they pass we onlookers by?  We screech and cheer with pride and total encouragement.  The funny thing, is that thousands upon thousands of people are willing to put themselves through this marathon torture.  Seriously, spaces to run get sold out quickly, as they can only have a limited number of folks running giving the resources it takes to support an event like that.  So if we don't think about jumping in and saving the crazy marathon runner limping her way to the finish line, why are some so loathe to let the labouring woman just be and do her thing to get her finish line?  Yeah, it may involve some yelling, vomit, and poo, but the high at the end, (which is why most runners embark upon the marathon journey), is just so friggin' good for most.  You OWNED that body process, and rocked it how you wanted.  You are gloriously, and endlessly badass.  And birth for the most part is WAY healthier than a marathon run.

At the beginning of the marathon, people are made aware by the sponsors of where the stations are where they can stop for medical attention, what part of the road to go on if they need to walk, etc.  Then the gun goes off and the journey is up to them and what their bodies and minds allow them to do that day.  And they are cheered on and supported, through howling, limping dehydration and loss of control of bodily functions.  When they simply cannot run, walk, or crawl anymore, they stop and cry "Uncle".  It's all good. Those who can't stomach watching the show leave the event.  Sounds like this would be a reasonable recipe for birthing too.