Almost every mama I talk to says that she wants to have an unmedicated birth, or at least wants to get as far as she can without medication. Most of the time, that’s exactly what happens. My epidural rate is less than ten percent. As part of the support team, I give my word that I’ll pull out every tool I can to help. The question I am always sure to ask, though, is: “How will you let me know if you’ve changed your mind?”
Sometimes, this will catch someone off guard. Why would I ask about her changing her mind if I believe in her and will support her through her birth? The answer is simple. I ask so that I can be fully supportive. I want her to have the power to make her own decisions with this birth. Deciding to use or not use medication is her decision, not mine. I want her to have the freedom to say whatever she wants to, and do whatever she decides is right. Do I think she can do it without an epidural? Absolutely, I do. If natural birth was impossible, the human race would have died out long before now. But, when all is said and done, I want her to know that she did it for herself, not because of anything I said or did.
Every mama who has ever had a baby has reached that moment when she says, “That’s it. I’m done.” It might happen out loud (very loudly), or it might be only a passing thought in her head, but it does happen. It’s a very charged moment – it’s usually when she’s in the most short and intense part of the labor process, often right before her body begins to push. Physically, this is when contractions are the strongest, longest, and closest together they will be. Getting through them one at a time requires a lot of focused effort. Neurologically, this is when rational thinking part of the brain has shut down, to allow the hormones of labor to do their work. Emotionally, it’s the moment when she has reached the threshold of the only life she has known, and is at the no-turning-back point, stepping into the foreign territory of life as this new person’s mother. That’s a huge step, and it’s normal to have strong feelings of resistance, doubt, insecurity, and fear come up. I want a mama to have the safety and freedom to express her doubts and fears, to know that she is seen and heard, without holding back because she’s afraid that her desires for natural birth will no longer be supported. I want her to know that she can experience and release these feelings however she needs to, without anyone doubting her strength by offering drugs. If that means that she becomes silent and centered within herself, that’s wonderful, and if she instead chants, “Give me drugs!” and “What was I thinking?” through every contraction, so be it. Coping comes in many different forms. She is free to do whatever works for her.
I want every mama to have the autonomy of knowing that a natural birth is something she chooses to do. Nobody is forcing this on her. Knowing that this is her choice allows her to believe in herself and experience her own strength. Yes, it’s hard. It hurts, and it’s work. She can do it – she already is. Nothing she can say will make me doubt her ability to get through this. For me or for anyone else to say, “You know, you can have an epidural if you want to” undermines her own power. I won’t do that.
I also want her to know that she has the right to change her mind, and that if she does, she will not be judged, shamed, or abandoned. There are situations in which medications or anesthesia are exactly the right tool. That’s not all of the time, certainly, and probably not even most of the time, but there are circumstances when an epidural has made the difference between having a vaginal birth or having a cesarean.
Likewise, I will not stand in the place of telling someone that she cannot have anything she is asking for. I don’t control anyone else’s choices with her birth, ever. It would be nothing short of abusive to say, “No, you told me to tell you ‘no’ if you asked for medication. You said you didn’t really want it.” That would be my taking on a power that doesn’t belong to me in her birthing space.
So, we come up with a plan. I ask, “What do you want me to do if you say, ‘Give me drugs right this minute’? I already know that right now, that’s not the choice you prefer, and I will support you through every moment. I know you can do it. So, if you tell me that you’ve really changed your mind, what do you want me to do?” We talk over the possibilities. I can go get the nurse. I can offer to step out so she can talk it over with her partner. If she’s very close to giving birth, we might talk her through the necessary steps of making that decision, with the awareness that by the time all is said and done, her baby will likely be here. (That might sound like “ok, first the nurse will need to hook up your IV, and that will take about 20 minutes to complete, then they’ll call anesthesia. It’s about another 20 minutes to get the epidural in place…”) Would she like for me to empathize that this is hard, and tell her that she’s doing it just right? Would she like me to suggest something else? (“Let’s get through this one first, and get you in a better position. Then we can talk through it if you still want to, you just let me know.”) We might decide in advance on a way that she will let me know – a code word, a phrase – that she has 100% changed her mind and there’s no conversation to be had. (If a mama tells me “I’m at red”, it means “we’re not even talking about it, call someone in here now.”)
The benefit of having this conversation in advance is that once we’ve come up with this plan, we hardly ever have to put it into action. There’s a clarity that comes with the knowing that this birth belongs to her, that she’s calling the shots with her own body, and that her desires will be taken seriously. Thinking through the possibilities and having a contingency plan in place allows her to have the peace of mind that comes with knowing that she can change her mind if she wants to, and that will be respected. Then she is fully able to release, surrender, trust in the process, trust in her body, and get through it in the way that feels exactly right to her. As her doula, that’s the best I could wish for her.
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