I would not say I have a huge case study from which I am drawing my information here, but after a couple of years doing this doula gig I can with some confidence say this: epidurals are not bad. Pitocin is not evil. Cesareans are not evil. Used carefully and judiciously, they’re downright wonderful, in fact. I just came from an induction/epidural birth which was one hundred percent the right choice for that situation and which went so beautifully that the mom was sobbing in happiness afterwards. I could not have been more pleased that she and her baby and family got the delivery they wanted and needed- and it was all thanks to the infamous, dreaded Cascade of Interventions! Gasp.
I know that’s not very crunchy of me, but the fact is, I am not very crunchy. I’m not that kind of doula. One of the doctors I work with a lot here in town (and who has always been very nice and complimentary to me) admitted to me yesterday that when she first started as an OB she initially got a very bad taste in her mouth about doulas because she had worked with a group of very natural-birth-only type women who she claimed had been very rigid with their clients and interfering with the medical staff. I… am not that doula. For some women, maybe that’s the doula they’re looking for, and that’s fine, but it’s just not me.
I’m a tell-me-what-you-need-and-I’ll-try-to-give-it-to-you kind of doula. As long as you fully understand the ramifications of your decisions, I will support you one hundred percent and help facilitate those decisions… since it’s not my birth nor is it my baby. I think the only situation I could not handle is a planned, unassisted delivery (i.e. no medical help on hand, just me rubbing your back and diffusing oils, which is lovely, but isn’t going to do a damn thing if you suddenly have a placental abruption.) The legal ramifications of that scenario alone are enough to make me say, sorry, no.
I keep getting emails, in fact, from a production company making a series about people having nature births- i.e. midwife or unassisted births outdoors. Some people are going waaaaay outdoors- like, delivery on the beach, or in the mountains. While I can understand that in the perfect set of circumstances that could be amazing, I also have to admit that my first reaction was, “Are we giving birth or going on a nature retreat, people?” ‘Cuz, you know, both of those are cool experiences… but I’m not sure they always work well in conjunction.
I think it’s a very post modern and myopic phenomenon, the glamorization of things people used to do because they had no other option, not because they thought it was ideal or romantic or spiritual. And when it’s things like sewing your own clothes or baking your bread from scratch, rock on, do whatever makes you happy. You want to shun modern convenience and wipe your butt with leaves? Follow your bliss, darling. But. You CHOOSE to try to treat your kid’s serious disease with nothing but coconut oil and prayer? You CHOOSE to give birth on a hillside with no one but your husband and a couple of goats (and and of course a film crew)? I start giving you the side eye.
People USED TO DIE A LOT, GUYS. Of stupid crap from which they did not need to die, and it ticks me off when people talk disparagingly about medical interventions for which their great grandparents would have been so, so grateful. For which people in many countries right now would be so, so grateful. It is wonderful and something which should make us feel LUCKY, the accessibility of antibiotics and vaccines and painkillers in our society. Are they perhaps overused at this point? I think most people agree that they are, that we need to be more cautious in our enthusiasm for and reliance on drugs. But that doesn’t mean we need to chuck them to the wind and refuse them even when their pros vastly outweigh their cons.
So, do I then think every woman, or even most women, should therefore get an epidural? No. I personally think that in most spontaneous, straightforward and quickly progressing deliveries they can introduce complications that, for me anyways, wouldn’t be worth the pain relief. I’ve seen that they often don’t work as perfectly as people think they do- many moms have the impression that an epidural equals a pain free, hassle free experience, and that is almost always untrue. But I think that overall they are a wonderful, helpful tool that can make longer or more complicated deliveries go from sheer agony, or sheer exhaustion, to a pretty manageable and much more peaceful birth experience. There are definitely situations in which even I (who in general ascribe to the immortal words of Lady Antebellum: “I guess I’d rather hurt than feel nothing at all”) would choose an epidural in a heartbeat if it was available.
The point of this whole ramble though, is that as a doula it doesn’t matter whether it’s what I’d choose or not- I support every woman’s right to get one whenever she chooses, as long as she understands the possible ramifications. There is no black or white, right or wrong in birthing choices- as long as it is in fact the mom’s CHOICE, and it’s an informed one, then I support it all the way.
Each birth is different: every mom is in a different place mentally, physically and emotionally when she prepares to birth- this varies even from one pregnancy to another- and every delivery carries its own unique circumstances. As a doula my job is to assess all of that, to LISTEN to the feelings and concerns of each client and her partner, to make sure they know the pros and cons of each decision they make, and to help them feel confident and supported in those decisions.