labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, February 2, 2009

Have It Your Way

I think there is a common misconception about midwives and epidurals or IV medications during labor. I think many people believe that midwives want (and perhaps force upon) women to go completely unmedicated and stay away from epidurals. Or that women who go to midwives have to go unmedicated. Neither is true in most cases. Of all the midwives I've met or worked with, I can't think of anyone as an "unmedicated birth pusher". I even had one preceptor who said that after she had her own children she suddenly couldn't understand women who wouldn't be open to pain relief.

I personally feel that a great birth is what the woman wants. Some women want the traditional midwife birth- unmedicated, no epidural- and they are very happy with that. Others are open to how things go- and either get an epidural, or use IV medications- and are very glad they did that to help them. And others want an epidural right away- and are very happy with their birth when they get to have an epidural. Should I tell them that what they want is wrong because of what I believe? No.

But I do want one thing: please be educated about your options.

It does bother me that women don't take any childbirth classes or read any books because their sister, friend, mother, etc, said just get the epidural because birth is not possible without one. They come in thinking the epidural will be immediate and are unaware that there are risks involved with the procedure. They are completely ignorant to other methods of laboring, like use of a jacuzzi, or being out of bed, or even a birth ball.

On the other hand, it has happened that a woman comes in saying quite defiantly that she wants an unmedicated birth, has done a lot of prep during her pregnancy to be ready for an unmedicated birth who then ends up begging for medication or an epidural during her labor. Perhaps this is where some take it that midwives push unmedicated birth on women, because most will discuss her original wishes with her, suggest another measure like a new position, a massage, the jacuzzi, you name it, before you go on to medication. Because you know that this woman has worked so hard towards an unmedicated birth, you want to help protect that for her, and perhaps using something else can help her get over the sudden panic that she needs medication or an epidural. But if she is still asking after she tries something else, then so be it.

I think most midwives are totally fine with whatever women want for their births when it comes to pain control. I know I am. I just want women to be educated about what their options are and not just taking an epidural or medication because someone said they should or couldn't birth without it.


Heather the Mama Duk said...

Homebirth midwives definitely are drug-free no matter what (provided the birth doesn't end in a transfer, of course) midwives ;P But then, those of us who go to homebirth midwives do that on purpose.

Amy said...

I had two unmedicated precipitous births - one was naturally begun, one was induced (cytotec/water breaking due to intrahepatic cholestasis of pregnancy and pregnancy-induced high blood pressure). I really wish that it had been made more clear that by the time I really needed help with the pain, it was almost over. Of course, my births were 3 hours and 45 minutes from start to finish, and 1 hour and 9 minutes from water-breaking to finish, so maybe other women experience it differently, but it would've been nice to know that what felt unbearable meant that I was almost done.

I also wish they'd listened, the second time, when I said I felt pushy. I had done it before, I knew what was going on. I ended up screaming at my sister to go get the doctor because the nurse wasn't listening to me! Then she checked, and had to turn on the lights and sirens, which meant I had a much larger audience for the birth than I had wanted. There is no pain worse, during labor, than the pain of being forced to "breathe through it" because the doctor isn't ready yet. Next time I'm just going to push when I feel like it, doctor or not.

Amy @

Jenna said...

I agree! The midwives I work with right now are great on *going with the flow* and giving the Mom the birth she wants, and giving lots of information. I did, however, work with midwives in the past who were very, well, mean to their patients who decided to go medicated instead of "natural". There are even some midwives who make patients sign pain agreements saying they will not have an epidural or pain medication during labor, in order to come to their practice! So, there are all kinds out there. I am so happy with the ones I work with now! I am happy to be able to work with and try to give every woman I help thru labor the birth they want and the birth that works best for them!

delilah said...

Amen! I couldn't agree more. I wanted to go natural until I went completely insane with pain, and then I was really thankful for the fentanyl, and for a midwife who talked me out of an epidural to protect my original wishes.

delilah at

evil cake lady said...

I totally agree. Women need to know what it is they are asking for, non-medicated birth or not. There are pros and cons to everything!

Sheridan said...

I think some have similar thoughts about doulas. I totally agree with you. That is why I love to teach Hypnobabies. To educate moms about their choices, the pros and cons and to give them tools to hopefully have a comfortable unmedicated birth.

As their doula I will support them in whatever they choose at during their birth. It is their birth after all. I do agree though that if they have prepared so much for an un-medicated birth, I do encourage them to press forward.

Anonymous said...

I can't totally imagine needing pain relief. i've had two home births. My first experience I had really hard back labor. Thankfully only about 6 hours of it because my entire labor wasn't like that.

my second i took a childbirth education class called Hypnobabies. Which is not only a complete childbirth education course but they teach pain elimination through Hypnosis.

I had a wonderful! dare i say enjoyable!! birth.
i'll be using Hypnobabies from now on!

Renee said...

I planned an unmedicated birth, but after a day of labor I hit the wall and got the drugs. So I think I see both sides. I just wish more women would give themselves a chance to try it natural and belive that they can do it, instead of letting our culture's idea of birth inherently being bad, scary, and painful keep them from beliving in how strong they really are.

Labor Nurse said...

Renee, well said.

HamiltonDoula said...

As a doula, I get the same misconception. I try to be very clear up front about two things: one, adding stimuli to a stable system will destabilise it - so know what yo are willing to risk and two, if you tell me you want an epidural, I will help you get your epidural, but if you tell me you "can't do it" or any of the other common phrases uttered so often in late active phase or transition, I'm going to interpret that to mean, "this isn't presently working, so let's change it up". Unfortunately, some nursing staff interpret the last statement as "I want an epidural" and mishandle the situation.

Amy said...

I had a midwife, and an epidural. I read books, took classes, talked to people, and felt very confident in my desire for an epidural. I had a fabulous birth experience.