I don't know why I couldn't get epidurals off the brain last night, probably the conversation I had with a wonderful friend walking home from School Information Night. Too often I feel that if I can just find the right way to put things, the perfect example, people will understand my point of view on an issue. Not that they have to agree with me, but they will say, "oh, I see what you are trying to say, that makes sense." Of course I cause myself a lot of grief with this particular way of looking at the world, but I must admit, I am quite satisfied with the latest gimic I used in my prenatal yoga class. It wasn't my idea, a friend and fellow midwifery apprentice suggested it, took me a bit to figure out how to pull it off, but it worked!
So here's what I did. At some point in the class I have the women kneel, tuck their toes under, and then sit back on their heels (yes, it puts a LOT of pressure on those tucked toes, if this is easy for you, wait a minute, it probably won't be after awhile). The pain caused by sitting on your tucked toes simulates a contraction, and I help the moms work through the pain using different breathing techniques, etc. It was the last class and we have been working on this for awhile so I had them sit through a couple minute and thirty second contractions instead of the usual minute contractions. On the last "contraction," as I could see the face grimacing begin and sense the shooting pain that was going through each mom's toes, I pulled out a bottle of Vodka and offered everyone a shot.
The first reaction, every mom burst into laughter. Lesson one, humor can be a life-saver in labor. Each mom stayed on her tucked toes and laughter rolled through the room. The moms returned to sitting as I explained the second reason for offering the shot. Pregnant moms should take the same wariness of having drugs in yoga class into the delivery room. Is there a difference between having a shot or two of vodka at 36 weeks pregnancy or an epidural when you are only 3 centimeters dilated?
If you absolutely must get the epidural, choose it only if the benefits outweigh the risks. In my opinion, the biggest risk is ending up with a cesarean for failure to progress or an OP baby that fails to rotate and can't find his way out because you have lost your mobility. Once you have assessed that you really need an epidural to relax and give birth, FIRST make sure that:
- you are at least 5 centimeters dilated (not 4-5 but a solid 5)
- the baby is at 0 degrees station
- the baby is in a favorable position for birth
Finding out the baby's position is going to be the hardest task ahead of you. Chances are you might have a resident laboring with you because your doctor is in the OR performing a cesarean. A resident is probably not going to be able to tell you your baby's position. In this case, WAIT. You don't want to get an epidural only to find that your baby is asynclitic or OP. These positions require a mobile mom to facilitate turning the baby or, if the baby won't turn, finding the position that increases the width of the pelvis/hip squeezes etc., so that the baby can be born in the position he/she is in. Yes you can turn a baby once the mom has had an epidural but you need a labor doula who knows her stuff and a partner and their job is a HECK of a lot harder with the epidural in place (the Labor Progress Handbook by Penny Simkin and Ruth Ancheta can show you how.)
Here is a link that offers some more ideas for giving birth successfully with an epidural:
Giving birth successfully with an epidural is a LOT of work. I would argue that it requires having a doula present who knows her stuff because your hospital is most likely not going to have the time or the resources to provide you with a doctor who can hang out with you during your entire labor, catch a poorly positioned baby, and make sure all goes smoothly.
So if you can do it without the epidural, I say GO FOR IT. The the rewards are worth it. Stay tuned for a clip of an AMAZING birth video tomorrow. You only see the kind of glee and ecstasy shown by the mom in this video in normal, unmedicated birth.
That said, I it is definitely not useful to be completely against the use of drugs in labor. There are times when an epidural might mean the difference between having a vaginal birth or a cesarean, in which case, go for the epidural. I know a mom, for example, who had incredible sciatica during labor. The intense pain of sciatica, which was far worse than labor pain, prevented her body from softening and opening up. A light epidural helped her get some relief and birth her baby. Do your research and choose a provider who will not push an epidural on you unless he/she feels it is TRULY necessary in your case.