Navigating the Epidural Dilemma

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 typical conversation about childbirth has been reduced to one topic: labor pain. In social media and blogs, as well as in social engagement or moms’ talks at the playground, we have reduced the conversation to labor pain, the fear of it, or coping with it. With labor pain being so central to our thought process about childbirth, no wonder expectant individuals are preoccupied with the decision about taking an epidural. The community of birth support pros manifests the same culture by constructing ‘Natural/Unmedicated Birth’ with “Medicated birth” and idealizing the first option, leading to many birth givers experiencing “negative emotions related to unmet expectations or a sense of personal failure when they as for an epidural (2018). The personal decision about coping with labor pain has social and emotional values attached, presenting individuals with ‘The Epidural Dilemma.’ This dilemma is genuine and can be navigated with prenatal coaching strategies.

Birth givers’ dilemma: What scares me more, labor pain or the potential risks of an epidural?

For many decades, maternal care agents have addressed labor pain by informing expectant persons prenatally. While agents believing in the superiority of unmedicated birth, like childbirth educators and doulas, inform expectant individuals about the evidential benefits of physiological birth and the risks associated with epidural, medical caregivers provide convincing evidence that epidural analgesia is safe. As a result,  expectant individuals are torn between two opposing bodies of evidence relating to labor pain. How will they navigate the dilemma of taking an epidural when clearly opposing approaches are backed by contradicting evidence?  

The Limitations of Informing about the Potential Risks

The practice of sharing evidence-based information about the risks associated with an epidural in childbirth is no more valuable than informing people about the dangers of sugar or not flossing our teeth. Everyone knows it, yet knowing it seems to play little role in people’s behavior. In addition, informing about epidurals has become obsolete when expectant people are overloaded with information. They get their information from Google searches and Social media. So how can we help birth clients navigate their decision-making process if not based on data? 

Clarifying the context of the conversation

Have you ever tried using coaching strategies prenatally to help expectant individuals navigate the epidural dilemma? You see, the context of the epidural conversation is not ‘pain medications‘ or ‘possible medical interventions in childbirth. The context of the epidural conversation is fear of labor pain, which is a mindset. Data can rarely lead to a shift in mindset since, for most birthing individuals, the fear outweighs the risks, hence the dilemma. So when childbirth educators and doulas inform about an epidural’s possible complications and risks, their students and clients are left in a pickle. “What scares me more, labor pain or the potential epidural risks?” They can be led to believe that their choice is between bad and evil. Whatever their decision will be, it is based on fear.

Adopting positive motivation

What we see here is a decision-making process led by negative motivation. In both cases described above, people are motivated by fear. Their motivation is to run away from something – either from pain or the risks involved with an epidural. A positive motivation would be if expectant individuals were to aspire for a specific experience or if they were motivated to achieve a desired goal. Negative incentives are weaker than positive ones, meaning that when individuals encounter challenges or hurdles, negative motivation doesn’t help them stand in their power and overcome the obstacles to meet their goals, whereas positive motivation does hold. To bring it home, during childbirth, birth givers will ask for an epidural as soon as the fear of labor pain is bigger and stronger than the fear of the potential risks associated with it.

The context of the epidural conversation is fear of labor pain, which is a mindset

How to coach around the epidural dilemma

Coaching is the process of helping individuals overcome internal resistance and perform at the peak of their abilities. It assumes clients’ competency and their inner knowledge of themselves. Therefore, informing plays a minimal role in this process. Instead, coaches inquire, reveal, clarify, explore options, and help their clients align their beliefs with their desired experiences and actions. Coaches trust their clients to have the answers within and perceive personal difficulties rather than lack of knowledge as the source of individuals’ struggles and challenges. For example, a possible coaching process around the dilemma of taking an epidural will includes the following steps:

  • Clarifying individuals’ perceptions of labor pain and all other pains.
  • Inquiring about beliefs – how did the person get to adopt this perspective? 
  • Assessing alignment between individuals’ concept of labor pain, coping with it, and their desired birth experience. If there is no alignment – meaning that their perception is not serving them well in achieving their desired birth, then the coach has to reflect on it and suggest exploring new perspectives.  
  • Exploring new ideas and perspectives, for example, by distinguishing truth from myth about labor pain in a way that will help them adopt a better view that will support and serve their desired experience. 
  • Designing a call for action – what must a person 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 emphasizing labor support techniques, or writing a birth plan and communicating it with their medical care provider.
  • Once the new perception is aligned with their goals and wishes for coping with labor pain, design an action plan to achieve the desired experience.
  • Assessing clients’ commitment levels to the action plan throughout the coaching process.  

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

Pregnant people can be indecisive regarding the epidural decision, leaving it open. After all, how can anyone commit to avoiding an epidural before they experience labor contractions and see if they can handle them? 

Sign up for the upcoming FREE 90-min webinar Navigating the Epidural Dilemma

Coaches model accountability to the process, regardless of the outcomes. And this is perfect for childbirth since it is so unpredictable! I often wonder how birth professionals became so rigid, 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? Instead of a rigid approach, coaches will be curious about their clients and ask them: Do you know what makes you leave it open? What scenarios is it open for? Being curious about this imaginary scenario your client fears is how you lead them to adopt a positive mindset and strategies for their coping actions.

The value of coaching for 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 instead empowers the client to speak their truths and their desires and trust themselves? This is the most significant value in integrating coaching principles and strategies into birth support. 

If you see the value in this new framework to birth support, I invite you to join the upcoming FREE 90-min webinar I’ll lead in recognition of World’s Doula Week, Navigating the Epidural Dilemma,  on Tuesday, March 28 at 10:30 am.
>>>Click here to register

Neri Life-Choma

DONA, epidural, prenatal

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