More thoughts here on epidurals and pain relief. As a doula, I have seen women going through pretty horrific pain, pain that makes whatever 'intensity' I felt during my labor seem like ride on It's a Small World in Disneyland by comparison. I can see how a lot of women would opt out of it, and I can see how care providers also feel that an epidural is 'compassionate care'. Really, it is not an illogical decision. One mom of my NCB moms dealt with pain from an OP baby that required counterpressure with every contraction for about 8 hours. When pushing, the baby's skull pressed on a nerve as she descended through mom's pelvis that left mom literally screaming in agony and clutching her thigh with each push until that head was past the nerve. I have seen a mom on pit. make it through labor with no epidural, but in tears and crying for her mommy (who was there and did a great job supporting her daughter) and growling, "I want PAIN. RELIEF. NOW." all the way through her transition (which was thankfully only about 20 minutes) because she'd been going through one on top of the other contractions for three hours already. She used the tub for a good part of labor, and water is great for pain relief, but with the pitocin, she was just not getting a break. These two ladies though were very committed to NOT getting an epidural, and that commitment plus labor support is what got them through their labors. They had decided ahead of time that an epidural was just off the table for them, and they did it, and they were both very triumphant at the end. But if they had been in the "I will try to go natural, but an epi. isn't off the table," they would have gotten one. Granted I am a doula and my clients generally choose unmedicated birth as their preferred route, but the moms I have worked with who have gotten epis. have generally gotten them because of fatigue in a very long, slow labor, and it was a cost-benefit decision where the option was risking maternal exhaustion and a section or get some rest and birth vaginally.
And after seeing some births with epidurals and narcotic pain relief, yes, for sure, it's not "the ideal," but it has been okay. The births have still been very amazing, the moms have all been happy to meet their babies and elated that they gave birth. And granted, my sample size is relatively small, but not a single one of my mama-baby couples has had trouble with breastfeeding or bonding, not the ones who were born with mec. and whisked off to the NICU for monitoring for 3 hours, not the baby who got Narcan to reverse the effects of the Nubain her mom wanted, not the ones born to moms with epidurals. Yes, it's ideal not to have any meds. on board, but having an epidural doesn't automatically ruin the mother-baby relationship forever. If anything, I think having the babies taken from mom right after birth is more traumatic for all involved than when the baby is born with an epidural in place and is given to mom right away. And it is true that having pit., having narcotics, having an epidural, these all up the chances that baby will be born with a depressed affect and will need oxygen or monitoring, but two of my clients who had babies in the NICU had unmedicated births, so no drugs on board is also no guarantee that the doctors won't decide that baby for one reason or another needs to be taken from mom for breathing assistance or monitoring.
As an individual, I have strong preferences about how I birth and firmly held convictions about what is physiologically optimal for mama and baby. But as doula, I advocate only for clients to have safe, satisfying, empowering, wonderful births - as they define them. I do not advocate for any particular way to birth, and attending births has certainly given me a much more open mind about choices that other people make. Birth is profoundly affected by a woman's psychological and emotional state - it's as much in the head as it is in the body. The head is where pain becomes suffering, and it is often the head that throws up more roadblocks to labor progress than anything the body does or doesn't do. We cannot presume to know what is going on in another person's head or body, and we have to trust women to have their priorities straight and to know what will get them through birth in a way that will allow them to have autonomous and satisfactory experiences that leave them psychologically intact enough to be great mamas once their babies are here.