To Epidural or Not Epidural
Monday, October 13, 2025
This might be obvious to you, but it dawned on me recently that controlling behavior is usually a response to fear. I talk a lot about control when I’m teaching about epidurals at Birthsmarter. But connecting control to fear is new for me—and it makes total sense.
Here’s what I’ve seen over the years:
Why do people get an epidural?
There are pregnant people who plan ahead of time to use an epidural—not because they’re worried about their pain tolerance, but because they want to feel _in charge_ of their experience. I’ll often say to our students: “I get it! You haven’t spent 30-some-odd years becoming this capable version of themselves just to go into labor and start ‘howling at the moon.’” No way. These folks want to stay rational, composed, predictable. They want to stay a version of themselves they recognize. They want to avoid feeling overwhelmed, powerless, broken open… _scared_.
There are also people who plan ahead of time to _avoid_ getting an epidural. They want an unmedicated birth experience. And when you dig a little deeper, it doesn’t take long to see that they, too, want to stay in control—to navigate labor on their terms and avoid being poked, prodded, or swept onto what can feel like a medical conveyor belt toward dilation. They want labor to go well, the way they’ve heard it can and maybe even “_should.”_ They want to plan for the best and hope nothing goes wrong.
It’s freeing to see how both approaches are rooted the same desire. The desire to stay in control. The desire to avoid fear.
And, it’s disappointing that even after you reading all the books and hiring the best doula, you can’t control how your birth is going to unfold. (Believe me, we tried! Read Tina's birth story, my birth story, our student Minaz’s birth story).
Teaching about epidurals through the lens of our shared humanity—rather than as a moral stance on pharmaceutical intervention—is incredibly important. It gives people options without judgment or shame. And in a country straining under “us vs. them” mentalities, finding common ground anywhere we can feels vital.
Birth choices can be deeply charged. We’re seeing now, more than ever, how any decision related to women’s health becomes politicized. So while it might seem small, personally, we want to give people more freedom to choose; and systemically, we hope to dismantle the false binary of “medicated” versus “unmedicated”—a decision people often feel pressured to declare _before_ they’ve ever experienced a contraction. How could anyone possibly know ahead of time what will make sense? Especially when that binary starts to feel like a moral compass or an identity marker before parenthood has even begun.
I fundamentally believe that growing and birthing a baby is one of the coolest things a human can do—but giving birth is a lot like jumping waves in the ocean. When it goes well, it’s the greatest feeling in the world. And while you can take every precaution, the sea is going to do what the sea is going to do. There’s almost nothing more powerful, or unpredictable, than an ocean current. You don’t have to be fearful, but it makes sense to feel humble and be prepared to pivot quickly.
That’s what childbirth education is for: reducing fear by giving you a framework for how to ride the waves. Teaching people how babies are born—and how to work _with_ the process—is what decreases fear. We can’t control labor, but we can learn about it in ways that make us feel less scared. We can choose providers we trust to keep us and our babies safe.We can build teams around us that make us feel safe. We can learn what to expect and what might help us cope. And in that safety and trust, we can make flexible, grounded decisions in the moment.
Birth planning isn’t about deciding _whether or not_ to get an epidural. Birth planning is about asking yourself, _what’s scary?_ Sometimes those fears are too big to name at first—but facing them directly, without guilt or shame, is how you begin to loosen their grip. From there, you can figure out what you might need to feel safer.
Feeling safe doesn’t mean controlling every sensation or outcome. Feeling safe means you can lead yourself through birth—make informed choices, advocate for yourself, and respond with confidence when things don’t go exactly as planned.
And specifically, when we’re thinking about epidurals: instead of focusing on _if,_ join us for class to truly understand labor physiology and medical interventions so you can learn _how and when_ an epidural might be a good choice—and how to make it go well if you decide you’d benefit from one.
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