An epidural is a tiny plastic catheter that is threaded into the epidural space in the lower part of your spine and left there until your baby or babies are born. When used during labor, it delivers a continual flow of a cocktail of medications that will inhibit your ability to feel your contractions, which can be a real Hail Mary for many people. It’s not 100% effective for everyone. Some laboring moms still feel some pressure, and some people even have breakthrough points of actual discomfort, but most are pleasantly relieved.
Is a doula in your birthing plan? Check out our post, Doulas Are For Partners, Not Just Birthing Mothers
To Epidural or Not?
Childbirth is a complicated subject because bodies are a complex subject. It’s also hard to make decisions about our bodies before we have given birth, because most of us have never considered or tested what the outer limits of our coping skills might be.
As doulas, we don’t have an opinion whether laboring moms get an epidural or not. We are your cheerleader, advocating for your needs and are there to elevate your decision-making process by helping you to gain access to evidence-based information. However, we also believe that there is a sweet spot for when to get an epidural. Enter the Strategic Epidural conversation.
What is a Strategic Epidural?
A strategic epidural is different than your normal epidural decision-making process in that you, the birthing person, are encouraged to consider a few key variables. Questions to ask are:
How are you coping?
How is your mental and physical health?
How far along you are in your labor if you are laboring yet at all?
Many factors go into making a sound and firm decision. And this one should be no exception. Whatever you decide will be unique to you and this particular labor. No judgment, ever.
This Expert’s Advice on an Epidural
My soundest piece of advice for those of you who are looking for minimal intervention beyond the epidural is to wait as long as you can to get one. Here is why. Labor requires strong contractions, gravity, movement, and at least two happy bodies that are willing to keep doing the work (we see you, multiples families!) in order to get babies down and out through the vagina. And to get into active labor, for most of you, your brain needs to know what your uterus is up to. When contractions are smaller and shorter, your brain may not continue to make oxytocin, the hormone we need that generates contractions, with an epidural blocking a weaker signal. A weak signal means less oxytocin. So, when you get an epidural on the early side, you often need more medication like Pitocin (a synthetic of the oxytocin hormone that makes the uterus contract over time in a more robust way) and IV fluids to keep things moving.
Now, does that mean if you find your contractions have started to feel overwhelming, you shouldn’t get some relief? Not at all. You get that epidural. Your mental health is everything.
When an Epidural Should Be Considered
There are reasons outside of just wanting or not wanting an epidural to get one or to choose not to. Most common reasons for a big fat yes are exhaustion from labors that are taking a long time to progress, artificially initiated labors (medical inductions), and something we call holding.
Holding is a term we use when laboring people stop dilating during the process. Sometimes a person can start to clench the pelvic floor so tightly that they can stop the baby from engaging the cervix. This happens for a variety of reasons, including exhaustion, mental blockages, and more.
Sometimes an epidural can offer a wearied laboring person a good catnap or two (never expect to get a long deep sleep in a hospital). Most importantly, it can work as a necessary reset so that laboring moms can then release their pelvic floor and allow their bodies to have a baby. The body is so incredible!
Check-In With Your Doctor
If you are taking blood thinners or you struggle with a low blood-clotting factor, speak with your doctor or midwife about your options. Some people have a big fear of things in their bodies. Honor this concern and weigh your options.
Education is everything. There are many excellent resources online to help you make informed decisions. Check out evidencebasedbirth.com, take a childbirth education class if that is something you have access to and hire a doula! There are doulas and classes out there for everyone. Cost does not have to be prohibitive for you to have the care and information you deserve.
The information provided in this article is food for thought and your right to have access to this knowledge. How it informs and what your decision is, is totally up to you.