Saturday, June 4, 2011

Why you still need to take a childbirth class if you're planning an epidural

I hear it all the time. "I hear childbirth classes are a waste of time. I know I'm going to get an epidural, so, what's the point?" Here are the reasons I think women who are planning on getting an epidural should take a childbirth class:

Take pain management into your own hands.

Most women will have to experience some labor before getting an epidural. You never know how long that will be. You may not be able to rely on an epidural to take away all of the pain because:
  • You may have a long, uncomfortable early labor. Some providers prefer to wait until active labor (usually 4cm+) when contractions are regular and strong before giving an epidural to reduce the risk of cesarean.
  • The anesthesiologist may not be immediately available when you ask for the epidural.
  • If your labor goes very quickly, there may not be time.
People always tell women who are planning natural childbirth that unexpected things happen, and it's important to be flexible, but no one seems to mention this to women planning epidurals--why not be prepared for natural childbirth, just in case? Pain management techniques taught in natural childbirth classes are often things you can do alone or with your partner, without having to rely on another person and you don't have to be in the hospital to use them--you can use them at home waiting for contractions to get regular, and in the car on your way to the hospital.

Epidurals Don't Always Work
Two of my first interviews with potential doula clients were with women who had negative epidural experiences where the epidural did not provide the pain relief they were looking for. These women had no other coping techniques prepared. They were both looking for a doula because they wanted other options for pain coping and were hoping to have natural childbirths rather than risk having a non-functional epidural again. I believe every woman who wants an epidural should be able to have one, and that it will work goes without saying, but this is not always what happens. If these women had prepared some natural pain reduction techniques, it is possible that their births would have been less traumatic

Also, it is important to take into consideration that pushing usually works best if the mom can feel something. Without some sensation, it is difficult to know when to push. The dose of the epidural is often turned down or off during pushing. It can be hard to know exactly how much medication is needed to achieve the right balance. If your goal is to feel nothing, an epidural may not actually live up to that promise.

A Good Childbirth Class Might Change Your Mind
I have said before that it is a common problem to "not know what you don't know." For the majority of my first pregnancy, I was absolutely positive that I wanted an epidural. I wasn't exposed to any good reasons why I might want a natural childbirth until late in that pregnancy. Once I discovered those reasons, I had an extreme paradigm shift. I had to scramble to try to prepare for a natural birth at the last minute. A good childbirth class will explain why many women consider natural childbirth desirable and help you gain confidence in your abilities not only to cope with labor, but also to make informed decisions for yourself and your baby.

What Makes a Good Childbirth Class?
In my opinion, you are not getting your money's worth if your childbirth class doesn't cover
  • the normal course of an undisturbed childbirth and why medically interfering in this process (to start labor, to speed labor, or to remove sensation) leads to the need for more and more medical procedures,
  • honest information about the benefits and risks of common obstetric interventions (such as pain medications, labor induction, labor accelerating medications, artificial rupture of membranes, restricting food and drink, intravenous fluids, continuous electronic fetal monitoring, episiotomy, etc.),
  • how to make sure your provider and place of birth will support you in the kind of birth you want,
  • your rights as a patient to informed consent for medical treatment and, in some cases, to refuse treatment,
  • more than one class period spent on pain management/reduction techniques. If you go over two or three breathing techniques and do one guided relaxation in class and then get a handout with some more ideas to practice at home, this is not enough!
Why not?
So, why not take a natural childbirth class? If you end up deciding to make natural childbirth your goal, the class will have given you valuable information and techniques to give you the best chance of meeting that goal. And if you decide you still want an epidural, you will be confident that you made that decision after truly considering all your options, and you will have good coping techniques to use in the time before you get the epidural, and to help you do the best you can if unexpected circumstances arise and the pain relief you want is not available to you.

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