Pain meds or no pain meds? Such a big question, not always easily answered. There is a wide spectrum of answers/philosophies on this subject. From the pregnant woman’s perspective, she can fall anywhere on the spectrum. From one end: “Absolutely not, no meds at all, don’t even offer!”, to the other: “Definitely! Can I go ahead and get the epidural at 37 weeks, just to be sure?”. Or maybe somewhere in between.
I’ve been thinking about this lately in terms of how the laboring woman’s attitude about pain medication affects my role as a doula. If any of my doula friends out there read this, I’d love to know what you think…
It’s easy to fulfill my role as a doula when a woman has decided ahead of time that she wants a natural, no-intervention, no pain meds birth – that’s usually the reason she has hired me and she clearly wants to be dependent upon my help. When she is faced with the most difficult parts of labor and begins to doubt her ability to complete the task at hand (and most, if not all women do have those doubts) she turns to her doula for help, happy and willing to receive it.
It’s also pretty easy to fulfill my role as a doula when a woman has decided ahead of time that she knows she wants an epidural as soon as possible. She has probably hired me knowing that, since she can’t get the epidural at 37 weeks, she will have a little coping to do before she gets to the point that the epidural is available. When she is faced with pain and difficulty, she turns to her doula for help until the relief she is seeking from the epidural arrives – and she is happy and willing to receive it.
The biggest challenge comes when the woman goes into to labor undecided – usually she is decidedly undecided (she is leaving her options open). In this situation, when she gets to that crucial moment, where things get really difficult and she doubts her abilities, she usually opts for the meds (that’s been my experience so far, as a doula and with my own births – when you allow yourself the option for meds, you usually take that option). So, at this point, when she thinks she can’t cope anymore and wants pain relief, she begins to see my efforts to help her cope as a form of sabotage – sabotage of her efforts to obtain medication. As if I’m trying to help her cope because I don’t believe she needs medication or because I’m trying to talk her out of it. Of course, that’s not my intention – I’m just trying to help her cope until she receives the medication she is asking for, but it can easily be misinterpreted (thinking clearly and rationally while in labor is not always possible). This misunderstanding can make it really difficult for me to do my job!
What I’ve finally figured out is that a conversation needs to be had well before this moment. A conversation about trust – I need to assure my client that I am there for her no matter what she decides. I am there to support her, not to achieve my own goals or agenda. I am there to help her have the experience that she wants and she can trust that my efforts to help her cope and stay in control are just that. I’m not trying to trick her into having an unmedicated childbirth – I’m just trying to help relieve her pain until she gets the meds that she wants. And I’ll still be there to help and serve her throughout her labor and delivery and beyond. Trust is crucial! A pregnant woman and her partner are putting a great deal of trust in their doula – one of my biggest goals is to always be trustworthy.
I agree that it is a conversation to be had before labor begins! I also think it is good to explain that the feeling of not being able to cope is absolutely normal and expected and does not mean that pain medication should be the next step. It’s a matter of pushing through that doubt and getting to the next level.
Agreed! Pushing through that doubt, taking it one contraction at a time, proving to herself that she can survive each one, one at a time, is crucial. Also, my experience has been that when mom gets to the point where she really feels she can’t take anymore, oftentimes she’s almost done! Thanks for your input, Gillian.