I just attended a beautiful birth (whenever I am not blogging, it usually means I am attending a birth, and then catching up on sleep). I don't usually attend births where the mom has decided from the get-go that she will choose an epidural but if my intuition says go for it, I make an exception for some couples/moms and of course for VBACers (moms pursuing vaginal birth after cesarean). This birth clarified my reasons for being choosy about the moms I work with and affirmed that though I am definitely not a fan of epidurals (primarily because they are abused) in some cases they are appropriate and don't always seem to impede the bonding process between mom and baby.
Mind you, this is purely speculative, I have only recently started down the path to midwifery, but I have been thinking a lot about a recent blog, where I posted a quote from Dr. Sarah Buckley about the effect of epidurals on mom's hormones. Dr. Buckley hypothesizes (see referenced blog entry) that even when feeling returns in an epidural, mom might miss out on that cocktail of hormones that help with bonding. Now I haven't talked things over with the mom at yesterday's birth yet but I know when those hormones are present and when they aren't. As I mentioned in that blog post, I missed out on the cocktail of hormones because I stayed behind to clean up in a hospital transport. But there was NO mistaking the presence of hormones at this birth. I was fighting hard to keep back the tears as I felt the waves of hormones wash over me, through me and wrap around the room and mom looked ecstatic (of course baby went right to mom's chest and chord was not clamped until it stopped pulsating). I have to speculate that perhaps if you back off on the epidural and feeling is allowed to return (which we did in this birth) that those stretch receptors do indeed send the message to the brain to release those good end of birth drugs.
So why am I so "choosy"? I guess deep down inside, and I am being completely honest, it is because I get very frustrated with our culture's tendency to choose the option that represents instant self-gratification over the option which is harder thing but is better for us/our kids in the long run. The best example that comes to mind has nothing to do with birth but perhaps it will resonate with some of you moms out there. You are at a friend's house (this just happened to me by the way, sigh) for lunch and after several warnings your child continues to misbehave (harshly pinching her brother, screaming and yelling etc.). After you have issued your call for better behavior, your child will no doubt insist that she should have YET another chance. You can A, give her another chance (easier for you, you get to stay and enjoy lunch and chat with your friend) B, say, I am sorry, you have had your chances and were informed of the consequences, we are going home, and then promptly leave, or C, can bribe your child with icecream if they behave and stay. Too often I see parents choosing option A or C.
When it comes to the epidural I think moms are too quick (and this is reinforced by the medical industry) to opt for the comfortable option of an epidural (but later wonder why they end up with the fourth degree tear or have trouble bonding with baby or why they have trouble breastfeeding etc. etc. etc.). Mom chooses the easiest/best option for her but not the best option for baby. Yesterday's birth represented a beautiful compromise. Mom chose what was best for mom AND baby. Mom spent most of her labor upright using gravity to help her body open and got the epidural 12 hours after labor had begun, as she was nearing transition. Mom also backed off on the epidural when it was close to pushing time so that she could feel the stretching and the contractions for more effective pushing. I ask that the moms I work with seek to be fully informed, primarily because informed moms, after carefully processing what they have learned about birth, tend to instinctively choose the option that is best for mom AND baby.