Navigating the Epidural Dilemma Before and During Childbirth

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 are promoting 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?

  1. Clarifying individuals’ perception of labor pain and their ability to cope with it.
  2. 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?
  3. 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) 
  4. 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. 
  5. Designing a call for action – what do they need to do in order 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.
  6. Once the beliefs and perceptions are aligned with their goals and wishes around labor pain, design an action plan for achieving the desired decision. 
  7. 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.

Is COVID-19 Doulas’ Opportunity to Achieve Work-Life Balance?

Is COVID-19 Doulas' Opportunity to Achieve Work-Life Balance featured image

Some of the most heartbreaking news that doulas received along with the outbreak of COVID-19 was that we are banned from hospitals. Many of us were already committed to couples and families that we have come to love and care for, and with the increased level of uncertainty and fear, we knew that our clients needed us even more. As the numbers of COVID-19 cases continue to increase, it becomes clear that this crisis might last as long as a year or even more, raising a growing concern about doulas’ source of income. As upsetting and tormenting as this ban might be, the current crisis bears an opportunity; an opportunity to achieve work-life balance.

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How to Provide Hands-Off Labor Support During a Time of Social Distancing?

In light of the current social distancing imposed on us due to COVID-19, Birth Coach Method is giving away free access to lesson #4 of the Birth Support Coaching Course-‘Prenatal Coaching’! We hope that it will help you as you keep providing valuable and necessary support for expectant individuals using online communication platforms (Facetime, Zoom, etc.) 

Birth workers are mastering strategies that relieve fear and doubt!

Our lives have been changing rapidly lately. In the past few weeks, the whole world has been reacting to COVID-19 with our fight-or-flight (FOF) response. Being alert and living every day on our survival mechanism might be as dangerous as the virus itself, if not more dangerous. We, birth workers, are experts in preventing or reversing the FOF response that leads to labor arrest. We are experts in managing the fear of pain and of what’s unpredictable or unknown. Psychotherapists might help their patients cope with anxiety and fear in a process that lasts weeks, months or years. However, we, birth workers, are first responders specializing in saving people from fear and doubt.    

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From Prenatal Yoga Poses to Desired Birth Visions

Prenatal yoga instructors, you are first in line

Out of all the birth support professionals, prenatal yoga instructors probably are the ones to begin supporting expectant individuals the earliest along their journey of pregnancy and childbirth.  From a coaching perspective, I see it as a huge advantage, so if you’re a prenatal yoga instructor, you can make miracles leading and empowering expectant mothers to strongly hold not only yoga poses but important convictions about their childbirth experience.  Just like the practice of yoga helps individuals to connect with their breath and their body, coaching strategies help them connect with their beliefs, inner truth, values, and needs.

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The Birth Plan from a Coaching Perspective

Is birth plan the goal or the strategy? 

When birth workers, such as doulas and childbirth educators, first envisioned the birth plan in the eighties, the main idea was to help expectant parents prepare for the physical and emotional aspects of the birth process, explore how they want various situations handled during their actual birth, and provide a tool for parents to communicate with each other, their care provider, and the hospital staff prior to the birth (Simkin, 2007; Simkin & Reinke, 1980). As sometimes happens, the mean comes to be associated with the goal, and as such, expectant couples and some birth workers, associate writing the birth plan with achieving it. This association may evoke some unexpected outcomes: 

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The Art of Coaching for Childbirth -New Printed Guide

You wished for a guide like this one, right?  

Scroll down to read the reviews  

The Art of Coaching for Childbirth is a practical guide inspiring every professional in the field of birth support to integrate the coaching principles, strategies, and relationships into their practice. From one blog post to another, and throughout my webinars, the coaching method has become a paradigm shift in the field of childbirth support. It has drastically changed the conversation from teaching about childbirth to individually coaching birth givers toward optimally performing throughout their journey of pregnancy and childbirth. Birth Coach Method has inspired birth doulas to shift from telling clients what they think is the best experience to asking questions, listening and exploring their belief system about childbirth, about themselves and their bodies, their strength and more.

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Evidence in Support of Coaching for Childbirth; Reporting from the Field

Everyone is talking about coaching for childbirth; join the discussion!

There is a buzz!!! “Coaching for childbirth is what everybody is talking about,” I was told a couple of weeks ago, when Betsy Schwartz invited me to co-host Birth Blab, and the Birth Lady,  Michal Klau-Stevens Joined us.  The intuitive concept of coaching for childbirth, which I began developing two years ago, has evolved into a powerful method with solid theory and a substantial variety of techniques and exercises practiced by more and more doulas. The more doulas join the new paradigm of coaching for childbirth, the more evidence is being accumulated in support of the tremendous benefits of this practice.

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Evidence-Based Studies on the Side of Birth Support Coaching

Are there any studies about the benefits of coaching for health improvement?

While working on my new certification course, Coaching for Pregnancy and Birth, I researched studies that will provide the scientific data to support what I already knew – coaching provides the most beneficial strategies to lead expectant couples toward a healthy and satisfying journey of pregnancy, birth and early postpartum. I assumed that the best research strategy would be found in the field of health and wellness coaching,  which has been growing rapidly over the years as more people have become conscious of their health and well-being, and guess what – I was right!

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Does Birth Activism Lead Expectant Individuals to Demand Better Maternal Care?

Recently I watched the movie ‘Trial of Labor’, and listened to the stories of three women who wished for a VBAC (Vaginal Birth After Cesarean). It made doubt the approach we, birth activists, take in our efforts to improve maternal care. Especially our continuous attempts to educate and empower expectant individuals by pointing out the flaws of the medical system and its representatives.

What did birth activism look like in the 90s?

I gave birth to my oldest child in 1995. I often say that she was my muse since my first pregnancy and birth experience led me to pursue a career in the field of birth support. I was lucky to go through this journey in the 1990s, as it seems that these years offered women a wealth of information about natural childbirth: Barbara Harper first published Gentle Birth Choices in 1994, the same exact year that Michel Odent published his book – Birth Reborn. Janet Balaskas published Active Birth in 1992, and Marshal H. Klaus published Mothering the Mother in 1993. Henci Goer closed the 1990s by publishing The Thinking Woman’s Guide to a Better Birth in 1999. All of these authors were, and still, are my teachers and mentors, not to mention idols.

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