It can be difficult for partners and practitioners to know when a mother is seriously requesting and an epidural or when her request for an epidural is really a request for more or different support.
It’s not unusual for a mother to begin to doubt her ability to continue to labour when she is feeling challenged. For a woman who already feels in pregnancy that an epidural would be supportive for her, the type of support around if and when an epidural is used is more clear than for the mother who hopes to put it off or not to have it at all.
This is a brief summary/guide for partners to better navigate the moment(s) that an epidural is requested by the labouring mother.
When does she ask for an epidural?
1. She’s saying it because it feels better to say it
Some women will ask for an epidural during a contraction and may not remember that they asked for it later. This is a time when saying she wants an epidural is a part of her coping – it feels better to say it but she’s not actually ready for it. If this is the case, partner may help her cope through the rest of her contraction and then check in with her once it’s over without using the word epidural. For example: “Is what I’m doing still working for you?” or “Do you feel drawn to doing anything else right now?”
If she brings up an epidural in between contractions she may be more serious, but if she hasn’t realized that she asked for it, then the next thing to do is to let the rest of your health care team know that she’s mentioning the epidural because it’s a part of her coping and she’s not yet ready for it.
2. She thinks she might want it but is not sure…
If a woman starts to ask for it in between contractions (and she has told you that she wants to labour as long as she can without one) then this is the time to start offering her different ways of coping, especially if her requests are followed by things like “but I don’t know, I don’t want to give up or disappoint you.”
Our natural instinct to these phrases are to reassure. Partners often start telling a labouring mom that it doesn’t matter if she has an epidural and that she should have one if she’s ready. While this reassurance comes from a good place (and it’s true!), in a moment where that mom feels vulnerable, this reassurance can feel like convincing.
Instead, you might say something like “Ok but you’ve told me that you’d like to push it off as long as possible. We haven’t tried the shower yet, let’s try that for 3 contractions and see where you are then…”
You might try offering her different ways of coping a number of times and simply continuing to change what you’re doing may help her get to the end of her birth. However, some women will shift from this stage of “I think I might want it but I’m not sure!” to being more serious. So how might you know when that shift has happened?
3. She’s really ready for it!
If it’s still not clear if she’s really ready for one or would like to continue changing ways of coping use the Stop Light Metaphor:
Red = Saying “I want an epidural” feels good but I still don’t want one.
Yellow = I’m starting to want one but could keep going if you help me cope differently
Green = I’m ready for an epidural, please take me seriously.
And finally, if a woman has really not wanted to have an epidural, it may make a difference for her to have a vaginal exam before her decision in case she’s quite far along and that is the reason that her labour feels so intense.
* * *
The intention of this interpretation is not to prevent a woman from having an epidural if she wants one, but rather to ensure that should she decide to have one, it’s at a time when she is absolutely sure that she’s ready for it. In doing this, we minimize the likelihood that she’ll look back on this moment with regret (“I think I might have been able to keep going”). Instead, when she feels to her core that she’s ready for an epidural, then that feeling of surety stays with her even through postpartum. So that even if she wasn’t planning on having an epidural she has a greater sense of self-acceptance when she remembers how right it felt to her in that moment.
Supporting during these phases can be very difficult for partners. Please share this information with your partner and work out a method of support that you feel would work for you. Of course, if any part of this guide isn’t clear or you have other questions about epidurals, please be in touch!