The Gift of a Guilt-Free Epidural

This was overwhelmingly the tone epidural advice was given to me with—‘Sure, it works, but do you really need it?’

This is Fear and Loathing in Utero, a monthly column by Maggie Tokuda-Hall on the magical experience that pregnancy is “supposed to be,” and the major sources of anxiety she wants to address while it’s happening.

On the third session of our birth class, the instructor asked those of us who were comfortable to volunteer and tell everyone about the worst pain of our lives.

One father-to-be told us about his kidney stones. Another about breaking his leg. As the only female volunteer, I recounted my story of ovarian torsion. For each of the stories the instructor wrote key words down on a white board under the categories of duration, and emotional and physical reactions to the pain. What did it feel like? Stabbing or dull? How did YOU feel? Panicked, or despairing?

Then she went through each of the words and compared them to childbirth. It won’t last a week, she’d say, and she’d cross that line out to indicate that this particular descriptor did not apply to childbirth. Or, It doesn’t feel like stabbing, it’s more like intense pressure. I watched as my list had word after word crossed out, and my confidence grew. This whole labor thing wasn’t going to be so bad after all. I’d been through worse. I probably wouldn’t even need an epidural. This was the point, after all, to bolster our confidence heading into labor. It was very effective.

In the final session of class, the instructor pulled one of the fathers to the center of the room. Using pieces of string and tape she showed us all the myriad of places wires and sensors and catheters would be attached if we were to get an epidural. You can’t walk once it’s in, she warned us. You’ll be bedbound. The father-to-be sat very still as more pieces of string were attached to him. There were about ten. We all laughed. So many wires! We couldn’t imagine.

Getting an epidural was an option that the instructor said could be necessary, and that we shouldn’t feel guilty taking. But she said this couched in a thousand reasons not to take it. And this was overwhelmingly the tone epidural advice was given to me with—Sure, it works, but do you really need it?

So even before I showed up at the hospital at forty weeks and five days pregnant for my scheduled induction, I suspected that I might be able to get through it with just the nitrous to soothe my anxiety. I told the doctor, my doula, the nurses, and anyone who cared to listen that my plan was to go as long as I could without an epidural, and I received universal approval. As a sucker for best practices, this seemed like the right attitude to have, and I was very pleased with myself for having made the “right” choice.

I have never been more stupendously wrong in my life.

When the pitocin drip failed to make my cervix progress past the three centimeters I’d arrived at the hospital dilated with, my doctor made the decision to pop my water bag to move things along. I’d been in labor for about ten hours by then, so this made sense to me. And up to that point the pain had been manageable—no part of me had even considered an epidural or even the nitrous yet, since I was handling it through all the ways my birth class had prepared me for. Moving around. The bath. Low, throaty moans. A three-hour-long YouTube video of Tibetan throat singing monks. I was, by my own measure, fucking killing it.

But.

The instant the doctor broke my water bag, everything changed. I felt like I was being ripped from the inside out, and in one desperate moment I actually heard myself yelling “Oh no!” as though there’d been some sort of accident. For the record, it did not feel like “intense pressure.” It felt like being torn, like flesh being rent. I had never felt any pain like it, as acute and as terrifying. Knowing after each contraction that another was coming filled me with anxiety so thick I could taste it, coppery and sick on my tongue. The pain was terrible, but the panic was worse. Nitrous did nothing to manage it.

Getting an epidural was an option that the instructor said could be necessary...But she said this couched in a thousand reasons not to take it.

After an hour of this, I requested an epidural. Two more contractions without it, the doula suggested. I got through one more, then stated—somewhat less cautiously—that I wanted an epidural. As soon as possible.

Even as I asked for it, I felt conflicted. Not whether or not I wanted it—I was sure I wanted it. But whether or not I was doing something wrong, something foolish and weak. But the pain, and worse, the fear of the pain, was enough to override these concerns. The anesthesiologist arrived within twenty minutes or so, and the delicate process of putting in the epidural started.

You have to hold perfectly still as the injection is made into your back, even through contractions. I was told this is because there’s a 1/4000 chance you could be paralyzed by the procedure. But if that were true, epidurals would be considered much more risky. This was math I had not done at the time, and, anyway, I didn’t give a shit. I didn’t care about anything except the promise of relief.

The first epidural (for reasons still unclear both to me and the anesthesiologist) only worked on the right side of my body. This isn’t normal, but not so rare as to be shocking. All bodies are different, the anesthesiologist said with a shrug. I was delighted, even as my doctor expressed concern and called the anesthesiologist back. Even partial relief was intensely soothing—less so physically than emotionally. Halving the pain made anticipating it less horrific. Still, a second epidural had to be done. And even though this supposedly upped my chances from 1/4000 to 1/2000, I happily complied. The many foretold wires and catheters were attached to my body. The preponderance of them was not nearly as absurd or uncomfortable as it seemed they would be in birth class—I didn’t even notice them. The limit of not being able to walk around was similarly irrelevant. All I wanted to do was rest. The relief was so intense I was giddy with it, and my husband asked the doctor if I was getting high off the meds.

An epidural doesn’t mean you don’t feel contractions. You do. And there’s no getting past the fact that you’re pushing a baby’s head through a hole that is much smaller than the circumference of a baby’s head. It hurts, intensely, even with the epidural. But it hurts in a way that isn’t frightening. It allows you to focus on the task at hand—which is pushing. And pushing is no fucking joke. It’s like a workout beyond your ability that you’re not allowed to stop. And even if I didn’t feel the perineal tearing the next day, I felt the intense pressure that caused it as my baby boy slipped into the world.

One of the chief arguments against inductions and epidurals is that your body will not release the correct amount of oxytocin (the so-called “love hormone”) after the baby is born, and as a result you will not bond with your baby correctly and breastfeeding will be difficult and you’ll be a terrible mother and your child will never call you on Mother’s Day and they’ll become a Republican. Or whatever. I can assure you, that’s bullshit.

The oxytocin rush is real. It’s real enough that I could not see through the haze of joy and overwhelming love to feel panicked about the fact that he was born with his cord wrapped around his neck, that he wasn’t breathing correctly at first. I was also unbothered by the fact that my placenta would not come out, that I was hemorrhaging, and that after stitching me back up, my doctor had to stick her entire hand inside of me like I was a defective bloody muppet and yank my placenta out as an emergency measure.

The oxytocin rush is real. It’s real enough that I could not see through the haze of joy and overwhelming love.

All I could see was my little boy. All I could feel was a love for him, and my husband, and my mother, that was so universal that it eclipsed anything else, anything frightening, anything not quite right. And I am sure that having relief from the worst pain of my life helped that be true.

Noah was born on February 17th, 2020. Since then, thanks to the outbreak of Covid-19, many birthing people will not be allowed to have their partners accompany them into labor. This is a terrifying and sad thing, and the longer we do not successfully shelter in place and socially distance, the more birthing people will be affected by this policy.

And so especially for those parents, I hope they are not shamed away from an epidural. For many patients, self-advocating is hard work, and when experts try to deter them from comfort measures, like an epidural, they’ll listen whether it’s in their best interest or not. This makes having labor support people in the room all the more important. Labor is frightening enough, even without preexisting anxiety, and even with the comfort of your loved ones.

But the pain can be managed, and should be managed without guilt.