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Keen Doula Care Houston, TX

Wanting vs needing pain meds in labor

Deciding on how to manage the sensations of labor is probably the most discussed topic surrounding childbirth. Do you want an epidural? Do you want a natural birth? Do you need a childbirth class? Which one should you take? Do you need a few classes? Should you give birth in the hospital, birth center, or at home? How you plan to manage the sensations of labor determines where you give birth. You can't get an epidural at home!

I work with clients who have a variety of goals and needs for their births. Just how no two people are alike, no two births are alike. That is the beauty and wonder of birth. Most clients who seek my services desire to have a natural childbirth. While there are different definitions of what constitutes "natural," most people who approach me want two things:

1. To avoid a Cesarean
2. To avoid pain meds

Many of my clients use pain meds in labor, so I want to share some thoughts about this.

Sometimes a person might NEED pain meds in labor. Some examples might include:

1. Needing a surgical birth
2. An inability to cope with the sensations of labor despite trying a multitude of comfort measures
3. A persistent cervical lip and a cervix that starts to swell despite doing all the tricks in the book
4. Exhaustion (i.e. hasn't slept days and labor has been taking a really long time)
5. Client says so

Let me say a note about #5.

I am a professional believer in you, you are capable-er, you are a badass-er, the bomb dot com-er, you are strong enough-er, I know you can do this-er, these doubts are part of the process-er, you've got this-er, let's try something else-er. I am an encourager and confidence instiller. I am a believer in your strength despite what others in the room, yes, even sometimes YOU, think. When they doubt, when even YOU begin to doubt, I believe. I never stop believing.

But I have a confession to make. It is very difficult for me to turn that off. I will encourage. I will suggest other things. But I will never say that I think you need pain meds. I will never suggest it. You probably asked me not to mention pain meds anyway. You hired me to be the one person to never ask you, "Are you suuuuure you don't want an epidural?" And I truly believe deep down to the core of my being that you don't need one.

That is, until you tell me you do.

Here's my promise to you, amazing clients. I will never ever ever stand between you and receiving pain meds if that is what you want. I might have a few tricks up my sleeve to help you get back in your groove if you hit a wall, but if you say you're done, I believe you. I support you. And I do NOT judge you. Please know that. And I am not disappointed in you. I am not disappointed in myself either. I would not put that burden on you. I understand that your choices are not a reflection of me or my skill as a doula. They're your very own unique and wonderful choices. They belong to you.

Sometimes a person might WANT pain meds in labor. Here are a few examples:

1. Natural birth is not appealing. Like, at all.
2. Goals change
3. More painful than expected
4. Sleep deprivation
5. Client says so

I don't know about you, but it is hard for me to say that I want something. I feel selfish, and I struggle about my wants and needs. I have a feeling many others might understand. But let me say this.

Wanting pain meds in labor is a good enough reason to have them. 

It is ok to have them even if you don't need them. It really is ok. Just like you don't have to justify or explain your reasons for wanting a natural birth to anyone, you do not need to justify your reasons for wanting pain meds to me or anyone else. I trust you to know what is best for you. I want you to have a satisfying birth experience, however that looks for you.

I've been around long enough to see that instincts are a wonderful thing. Even if those instincts say, "I need to go to the hospital now even though it is still really early and we planned to labor at home as long as possible" or "I think I should be induced even though we were planning a home birth" or "I think I would like an epidural even though I appear to be coping well and took all the birth classes and read all the books and hired a doula."

So if you decide in labor that you need or even want pain meds as part of your experience, I promise to support you. I promise to remain by your side. I promise not to judge. I promise not to question your choice. I promise to continue providing the same unwavering and compassionate support as always.

Doulas and Birth Outcomes

When I first became a doula six years ago, I thought my job was to help improve birth outcomes. 

Everything I read about doulas boasted the same stats:

• 50% reduction in cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 30% reduction in pain medication use
• 40% reduction in forceps delivery
• 40% reduction in oxytocin (pitocin) use

These stats come from the book Mothering the Mother by Marshall Klaus, John Kennell, & Phyllis Klaus and were listed on most of the material about doulas I could get my hands on at the time. 

As a new doula, I thought my job was to help people have natural births. 

After all, one of the first bits of advice people receive after proclaiming they want a natural childbirth is, "Hire a doula!"  People were coming to me because they wanted natural births, and, by golly, I wanted to help them have natural births!

Early on, I started to notice something. Not everyone who said they wanted to have a natural childbirth during our interview ended up wanting one once they were in labor. At first, I took this as a personal failure. I thought, maybe if I were a better doula, maybe if I had more experience, maybe if I had said that one thing or tried that one position, they would have had their natural birth. I started to learn that wanting a natural birth is not always enough, and that sometimes, birth does not go how we hope or plan despite our best efforts to do "everything right."

Then I took my Birth Boot Camp DOULA training and learned something that would forever change the way I thought about what it means to be a doula.

I learned during my training that doulas are not responsible for birth outcomes.

I breathed out a huge sigh of relief - one that I had been holding in for years. Something clicked for me. I realized that I was actually doing a good job as a supportive doula even though my clients were having all kinds of births, not just natural births. I am ashamed to admit that I couldn't understand why they were so happy when I often didn't help them achieve the natural births they said they wanted.

They seemed to understand something that I didn't.

So what are doulas for if they don't help improve birth outcomes?

Support. Unconditional, non-judgmental support.

Doulas help you remember your options when others are telling you what decisions they think you should make.

Doulas help you gather as much information as you want or need when others give unsolicited advice. Or not enough advice.

Doulas stand by your side no matter what you decide when others tell you they would "never do that."

Doulas understand the art of holding space when others want to take up space.

Doulas know who the awesome and supportive care providers are. 

Doulas have a unique point of view because they often attend births in hospitals, birth centers, and homes.

Doulas encourage your partner to participate to their own level of comfort when everyone else forgets they exist. Or expects them to do everything.

Doulas won't mind if you burp, yell, make tons of noise, make no noise, forget to say "excuse me," or "thank you."

Doulas are the ones who give you a foot massage or a scalp rub or offer kind words as you prepare for your Cesarean birth.

Doulas are the ones who offer a cool breeze or take a quick picture or offer an encouraging word as you push your baby into the world.

Doulas know when to be quiet, when to talk, when to touch, when to step back, when to suggest, when to listen, when to offer....

Doulas remind you how amazing you are when others may forget this is a once in a lifetime experience for you.

Doulas ask, "How would YOU like to do this? What would work for YOU?"

Doulas instill confidence when others instill fear.

Doulas remind you that you CAN when others say you CAN'T.

Doulas are a great addition to your birth team, but can't guarantee any certain birth outcome. Doulas are there for informational, physical, emotional, and relational support. While doulas can't determine birth outcomes, they can and do help make the birth experience more satisfying and enjoyable. In short, they help make your birth experience better.