The rate of epidurals in my hospital is around 80 percent. This week, I was caring for a patient who’d delivered her first baby without an epidural and was now in labor with her second. I pro-actively told her nurse not to give her an epidural even if she asked for it—just to call me and I would come and talk to her. The nurse seemed appalled that I wouldn’t respond immediately to a request for an epidural. But I knew what was going to happen—my patient would get to the transition phase of labor (in which women feel panicky) and she’d say she didn’t feel she could do it, and before I’d hear about it, the nurse would call the anesthesiologist who would gladly come in and place an epidural for labor pain relief.
Generally (but not always) if you can do your first labor without drugs, the others are easier. This one wasn’t so easy. The baby was facing up, and the pushing was painful and took longer than expected. I know she had second thoughts about natural childbirth as the labor wore on. If I hadn’t been there, I have no doubt the nurse would have “felt sorry” for her and encouraged her to get an epidural. But the next day, I asked this patient if she was sorry that she didn’t end up getting an epidural; she said no, she was glad, because she felt so great afterwards, and the baby was so alert and nursed so well. Her husband was awfully proud of her too.
You don’t run a marathon with the goal of avoiding discomfort, and some mothers-to-be want to experience childbirth as women have experienced it for millennia. Natural childbirth isn’t for everyone, but I wish the healthcare team, in our wisdom, could individualize care, and rather than responding reflexively that epidural anesthesia is the answer to everyone’s labor pain, target our support measures to the desires of the laboring woman.
What does this mean for a mother-to-be? Talk to your doctor or midwife, take a tour of your labor unit, talk to your support team, and try to set the scene for the sort of labor you hope to have. Labor is unpredictable, and will probably not go exactly as expected. But preparation: educational, psychological, and logistical, can help shift the odds towards whatever you consider ideal.