The Empowering Epidural

Empowerment - making one stronger and more confident, especially in controlling their life and claiming their rights.

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Let's get one thing straight from the start - noone can empower another person when it comes to the humanistic experience of empowerment. Empowerment is, by definition, one finding ones own strength. So, I cannot empower you... but, you making a choice that feels good and resonates within you can be empowering to you. It is your power of making that choice that feels good. 

I am a huge advocate of low intervention, no pain medication birth. In healthy and low risk birth, less intervention (medications, tools, equipment, etc..) means less inherent risk. But just because I believe in that truth does not mean that it is going to be true for every birthing journey. Not every birthing journey stays healthy and low risk, not every birthing journey couldn't benefit from weighing the pros and cons of an intervention and erring on the side of the intervention. So, that is where we start. 

The Empowering Epidural

I always start with the nitty gritty. Epidurals, like all interventions, should be used as tools to achieve a desired outcome.  In prenatal appointments, I provide women with a sheet that details the risks involved with getting an epidural. In childbirth classes, we role play getting an epidural and all that comes with it. Each time, I tell women 'this is not to scare you, this is to give you information about a procedure that you might decide you want, or your birthing journey might require you to get'. 

So let's talk about that some, shall we? 

B*E*S*T Doula Service has an epidural agreement very like my own that I give to clients. You can see it here. I love that they outline what will be required if you choose an epidural vs what might happen with the epidural. This is very important information to share with clients because it takes the 'I didn't know' and the 'if I'd only known' out of the experience. I cover with them: 

• It will require continuous fetal monitoring
• It will require at least one IV bag of fluids to be given prior to getting the epidural
• It will require a blood pressure cuff to read your BP every 15-30 minutes (depending on the hospital's protocols)
• It will require that a pulse oximeter to be placed on your finger for at least 30 minutes during administration
• It will require that your partner and doula leave the room for administration (in nearly all area hospitals)
• It will require a urinary catheter to be administered (depending on the hospital, some leave it in, others empty your bladder and then remove it. It may increase your risk of UTI or bladder infection, require antibiotics, or cause trauma to the urethra).
• It will restrict your mobility during labor. Depending on other possible risk, you will be limited to the bed, and perhaps your back. 
• It will provide a level of numbness... some women it fully numbs them to the point they cannot move their bodies from the ribcage and down without assistance, some women can feel quite a bit of discomfort even after the epidural and move without assistance).
• It will deprive both baby and you of your natural production of endorphins, which allow for both of you to cope with pain (both during labor and you, postpartum).

That way, if their organic experience requires, or they request, an epidural, they know this information and nothing surprises them about it. We also talk about the possible risks, so that they can fully accept them, weighing the pros and cons in the moment having already read and understood the possible risks, and make an empowered choice free of the fear of unknowns. 

Another thing I always suggest is watching one. Why? Well, for the same reason we encourage women to watch birth: it takes the mystery out of the experience. 

When might a woman choose an epidural? 

• For pain management - some women simply want to have that control over their experience. Although the control over pain requires they relinquish control over their bodies and their functions, many women accept this and feel this is  best suited for their needs. 
• For emotional and mental clarity - some women who have had sexual trauma or birth trauma in their past prefer to labor and birth with an epidural. We talk through their desires, including the fact that it might be triggering based on it taking away mobility and possibly requiring mom to feel 'tied down' and on her back. If she feels confident about the choice, we usually try to move the equipment and tubes/wires all onto one side of the bed so that she can feel less restrained. 
• For rest - a number of women cope marvelously well with labor and only even consider an epidural to rest... this is usually the case when she is going on days without sleep. 
• For a reset - this would be the case when moms labor pattern becomes 'dysfunctional' from maternal exhaustion (cntx space or stop, sometimes with ROM, but stay intense, usually after long early labors, and dilation stalls along with it). In certain situations mom and her provider might feel an epidural combined with pitocin will be the best thing to get her a vaginal birth.
• As a tool for vaginal birth - if the woman is unable to relax her legs and pelvic floor to allow for dilation to occur, or if she is beginning to run a fever and, although contractions are strong and dilation is occurring, she needs baby to be born sooner than later and opts for a more aggressive augmentation, she might choose an epidural as a tool to help her achieve a vaginal birth. 

In all of these situations a woman can feel empowered that she chose an epidural that fit her needs for her birthing time when she is fully educated and understands the possible outcomes, and the desired results. 

The one situation where I find women routinely don't feel good about their choice? 

• For fear - fear of the future (how much longer will this take? I don't think I can do this much longer), of the pain (how much more painful is this going to get, I can't take too much more painful), fear of an intervention (I heard pitocin is horrible, if we add that, I can't do it... I can't stand those cervical checks, one more and I want an epidural), or of the experience (if it feels like this now, how will it feel later? My friend told me pushing felt this way and that's scary to me). 

In these cases, we try to get to the root of these fears and dispel them. I remind them that any choice made in fear is not a good choice, even if you would make the same choice without fear. So we attempt work through that fear to see if they still feel the same about the intervention afterward. 

Have you had an empowering epidural? Did you experience an un-empowering epidural? Do you know what might have made the experience better or helped you make a different choice?