Hi Carmen,
That's great your goal is a vaginal birth and you're thinking of ways to get through it with an intact perineum.
I'll tell you my honest view of epidurals. I think they've become an accepted, sometimes even routine part of birth in many cultures. As Kirst observed, it's even considered the "first choice" in pain relief. This is not without a down-side tho. With an epidural, you often lose some of your best allies for an easier birth - gravity, mobility, privacy and the chance to get into a birth pool. So when it comes to pushing the baby out, you may end up unable to push very effectively, and less able to get into active, gravity-positive positions to push. This can lead to the need for a ventouse or forceps delivery, which can be quite damaging to the perineum through tearing or episiotomy; or caesarian. So the pros and cons need to be weighed carefully.
That's the advantage of other pain-management strategies in labour - if you can find other methods to get you through the toughest contractions of late first stage, you may be able to avoid the "cascade of interventions" which can leave you with damage to your body.
I do think that there are times when the judicious use of an epidural might just help a mother to avoid a caesarian, such as when the baby is in a tricky position. I'm not saying avoid epidurals no matter what. It's just that, as I once heard a wise Obstetrician say, "everything we do has side-effects - there's a down-side to every intervention". No intervention is always going to be superior to intervention, so it's best to use it wisely as a last resort after less invasive techniques have been tried for a while and given a chance to work.
I think also there's a cultural concept of avoiding pain. In most parts of our lives, avoiding pain & discomfort of any kind is desirable. Pain means something is wrong and it should be numbed and eradicated as much as possible. I think this approach is counter-productive when we take into birth, though. That's because if we try to eradicate or numb labour pain (which is a positive, healthy pain), the pay-off may be even more painful when we're recovering from a surgical birth. Some women even have lasting pain from the needle insertion site in their spine. So another possible approach, rather than seek to avoid labour pain, is to embrace it and go with it - as athletes too - they say, "no pain, no gain" and the pain is associated with effort, exertion and excellent performance. I think labour pain is the same - your body is working supremely well, and if you can go with it like a runner does, rather than try to numb it, stop it or avoid it, by doing the hard yards with that you may be able to damage that might cause you more pain and discomfort when you are recovering.
I think it would be more encouraging for you if your Ob was saying, "You are a strong healthy woman and you are capable of birthing your baby under your own power - we'll be there only if you really need us" rather than, "you'll probably need an epidural, the pain can be quite bothersome". I think she'd be givng you a clearer picture if she also added that the side-effects of an epidural can also be pretty bothersome for many women. I don't know too many cases where a woman went on to have a normal vaginal birth with an intact perineum after an epidural. For that, an un-numbed body and the ability to choose gravity-positive positions as your instinct guides you, may well be more conducive to your goals.
There are some awesome doulas (birth attendants) in Canada, I wonder if there are any in your area? They can be a good resource to have with you in the birth room.
One more thought - many women find giving birth in a pool of water is helpful for avoiding perineal tears.
I hope all goes really well for you Carmen. It's great that you are arming yourself with knowledge and making plans. Let us know how it all goes. Take care, hun.
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