Navigating the Epidural Dilemma Before and During Childbirth

Written by Neri Life-Choma on February 23, 2021. Posted in Birth Support Coaching, Prenatal Support.

What’s the Epidural Dilemma?

Pregnancy and childbirth are the most profound experiences in human lives. It is the utmost transformation. However, in our culture, the conversation about these meaningful experiences has been reduced to one topic: labor pain – the fear of it, coping with it, and praising or cheering those who succeeded to avoid it and had a ‘Natural Birth’. The cultural idealization of those who gave birth using no pain medications has had its emotional toll on birth givers. A 2018 study found relationships between an increased chance to develop postpartum depression when birth givers took epidural to alleviate pain in childbirth and did not meet their goal to avoid it. These birth givers experienced “negative emotions related to unmet expectations or a sense of personal failure”. These findings suggest that decisions about coping with labor pain have social and personal values attached to them, presenting individuals with ‘The Epidural Dilemma’. This dilemma is fervent and can be navigated with coaching strategies.

The decision about coping with labor pain has social and personal values attached to it

For many decades, maternal care agents are addressing the topic of labor pain mainly in two ways – informing and supporting. Informing usually takes place prenatally. Childbirth educators and doulas are informing expectant individuals about the benefits of unmedicated birth and the potential risks of getting an epidural. On the other hand, medical caregivers are leaning toward providing proof that epidural analgesia is safe for both the birthing individual and the baby. Therefore, there is no gain or benefit for being with labor pain. For their part, labor pain is pathological as any other pain. In correlation, during the birth process, medical caregivers promote the use of epidural as a coping strategy, while doulas are providing labor support that relies on natural pain control techniques, such as breathwork, visualizations, hydrotherapy, positioning, acupressure, and more. Neither the birth support practitioners nor the medical agents have tried using coaching strategies prenatally to help expectant individuals navigate the epidural dilemma, as I’m about to suggest here.

The Limitations of Informing about the Potential Risks

The context of the epidural conversation is not ‘pain medications’, nor is it ‘possible medical interventions in childbirth. The context of the epidural conversation is the fear of labor pain. For most birthing individuals, the fear outweighs the risks, hence the dilemma. When childbirth educators and doulas inform individuals about the possible complications and risks of having an epidural, their students and clients are left in a pickle. “What scares me more, labor pain or the potential risks of epidural?” They can be led to believe that their choice is between bad and evil. Whatever their decision will be, it is based on fear. The motivation for their actions, in this case, is negative – running away from something, rather than a positive one – an aspiration or a goal. A decision to avoid an epidural that is based on a negative motivation is weaker than a motivation based on will and aspiration.

Individuals are left in a pickle: what scares me more, labor pain or the potential risks of epidural?

What should the coaching conversation around the epidural entail?

Clarifying individuals’ perception of labor pain and their ability to cope with it.
Inquiring about the sources of their beliefs – how did they get to adopt this perspective? Any birth stories of relatives, evidence-based resources? Past trauma that included pain?
Checking the alignment between individuals’ concept of labor pain and coping with it, and their desired birth experience. If there is a lack of alignment – meaning that their perception is not serving them well in achieving their desired birth, then you’ll have to reflect on it and suggest exploring their concept of labor pain. (The next step)
Exploring new ideas, such as distinguishing truth from myth about labor pain in a way that will help them adopt a better perspective. A perspective that will support and serve their desired experience.
Designing a call for action – what do they need to do to own this new perception? What actions can they take that will bring them closer to achieving their goal? Some possible examples are writing an affirmation and reciting it, enrolling in a childbirth education class that emphasizes labor support techniques, or writing a birth plan, and communicating it with their medical care provider.
Once the beliefs and perceptions align with their goals and wishes around labor pain, design an action plan to achieve the desired decision.
Assessing your client’s commitment level by holding them accountable to follow the action plan.

“I want to avoid taking an epidural, but I leave myself open to…”

Yes, I know. This is the most common scenario that you come across when you conduct the epidural conversation. And if you ask me, rightful so. How can anyone commit to not getting an epidural before they get to experience labor contractions and see if they can handle them or not?

Why do we cheer for those who went ‘naturally’ and subject those who change their mind during childbirth to self-criticism or judgment?

In coaching, we have a saying – be accountable to the process, regardless of the outcomes. I often wonder how birth professionals became so rigid, and sometimes even judgemental when holding birth givers accountable to avoid getting an epidural. In all other life situations, a change of mind when facing reality would be considered pragmatic. How is it different when we experience labor pain? Why do we cheer for those who went ‘naturally’ all the way and subject those who had a change of heart to self-criticism or judgment?

In terms of the coaching process, it is essential to clarify what is this opening about? Ask them: Do you know what makes you leave it open? What scenarios is it open for? Be curious about this imaginary scenario that your client fears will lead them to deviate from their decision and ask for an epidural. Go back to the coaching steps above and try to align the beliefs with their desires and actions. And always model flexibility and pragmatism, inspiring them to strive for an optimal decision and performance, regardless of the outcomes.

How do you clarify your clients’ context around labor pain?

Since clarifying your clients’ beliefs about labor pain is crucial to their ability to optimally navigate the epidural dilemma, it is only fair that I give you some tools to accomplish it. One strategy is to ask your client to write 3 to 5 statements that begin with ‘ Labor pain is …” while looking together at these statements, be curious and ask:

How did you reach this conclusion?
What proof do you have?
Does this perspective serve you? (alignment)
Is there a chance that your perception of labor pain is partially based on myths and false beliefs?
How does your current perspective on labor pain impact the choices you make?

The value of Coaching when Resolving the Epidural Dilemma

Does your perspective on labor pain serve you in achieving your desired birth experience?

Can you feel the lack of expectation or judgment of this type of conversation? Can you appreciate the intentional avoidance of any standard or expectations? Can you also appreciate the partnership position of the coach who doesn’t perceive themself as an expert, knowing what is best for the client or what an ‘ideal birth’ is, but rather see the client as an expert in their own lives, their truths, and their desires? This is the biggest value that I find in integrating coaching principles and strategies into birth support.

This blog post manifests core concepts and terms of transformational coaching. Coaching invites a change of perspective. Clients are led to form a new concept, clarify belief systems, goals, and motivations. In coaching sessions, clients adopt and practice new skills. They learn how to align their beliefs, goals, and actions. The coach in turn assesses the client’s level of commitment and strength of their convictions and accountability to the process rather than the outcomes. If you’re intrigued to learn how to provide transformational coaching for expectant and birthing individuals, visit my website.

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Neri Life-Choma

I am the founder of Birth Coach Method and am celebrating 20 years of leadership in the field of childbirth support. Throughout my career, I have been honored to provide doula support and teach childbirth ed. classes to hundreds of expectant couples, as well as to direct two birth resource centers. I am also a doula leader in my community in the South Bay area of Silicon Valley in California.

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