Women in the Trenches

Sori went through intense treatments after a painful struggle with secondary infertility. “It felt like it took away from the humanity and normalcy of having a baby. After that, I really wanted a healing experience that would show me that my body still worked without all these medications.”

During her treatments, she was at the whims of doctors all the time. For the birth, she was terrified of the doctors making all the decisions about her body and her health.

She went without any medication. “It felt like I went deep into the depths of my soul and tapped into new reserves of strength to get through it.” When she held the baby after, she felt empowered and healed from so much of the difficulty beforehand. “If you get to the other side without one, you feel a crazy rush of happiness and strength,” she said.

“Truthfully,” says Toby, “I think of labor as my Olympic sport. It’s crazy hard but I have a high pain tolerance. Postpartum I kind of review how the birth went, and with every baby I get another chance to do it better.”

“I’m more afraid of not being in control,” Rachel, a mother of four, says. “I feel like I can control the pain this way, and I’m more in touch with my body without any drugs.”

Leah had a drastically different experience. She didn’t use any pain relief, and post-birth, she felt traumatized by the ordeal and struggled to immediately bond with her baby. “I felt wounded, and I just wanted to recover.”

She opted for an epidural for her next few children. Those times, she was more emotionally prepared to meet her babies. She was able to hold the baby right away and connect and love each one in a way that had been difficult with her first more painful experience.

Many other women extol the experience of their epidurals. “I honestly felt kind of dumb that I hadn’t gotten it earlier,” said one mother. Another wasn’t sure why she’d waited until her fifth baby to get one.

“My epidurals helped me move calmly and efficiently to reduce damage. I felt very in control,” one woman tells me.

Another takes a philosophical view. “I’m not going to lie. I don’t like pain! I’ve never considered going without one. Sure, there are risks, but there are also risks driving down the highway. Remember, Hashem is in control of everything!”

What’s noticeable with many women who did get epidurals was a sense of defensiveness. They provided an explanation, as though their decision required justification. “I had no choice that time. I didn’t plan for it to go that way.” Have you ever heard of someone justifying having anesthesia before having a root canal?

There is still this lingering taboo, this fear that we have betrayed some part of our womanhood in our unnatural deliveries. “I had four caesarean sections, and found myself explaining them away, too. I’d tell people, ‘There were unfounded concerns about baby size. My family history doesn’t lend itself to natural birth.’ In practice, I’ve been happy with the process and don’t regret it. There’s an emotional aspect, too, she says. A sense that I’ve missed out on a rite of passage.”

Tehila, now a grandmother who birthed several babies with an epidural and several without, shares this sense of loss. “With the epidural, I just sat there reading a book during the birth until it was go-time. It was painless and simple. But I felt kind of cheated, like I’d missed feeling the pain and getting the gratification of how that pain takes us to the end goal.” She compares it to the birth pangs of Mashiach, the constant building difficulties throughout history. “The relief at the end is so much greater when you go through that pain.”

But as Reena, who’s had children with and without an epidural, puts it, “I’m told that the prize is the same in both cases.”

Professionally, Yonah Chatzinoff has witnessed many births both with epidurals and without. In one area where she lived, there is a strong cultural taboo against epidurals. Her own first birth didn’t go as expected. She was married for several years before her first pregnancy, and by then, she knew exactly what she wanted: a natural birth, as intervention-free as possible, despite pregnancy complications from a chronic condition.

“From the beginning of my pregnancy until the end, I found myself on the defense against dubious and impatient doctors. During a long, slow induction, my doula suggested that I didn’t have a high enough pain tolerance for natural labor,” says Yonah. In the end, they decided that her best chance of avoiding surgery was to take an epidural. For three hours, she continued on without any idea what was happening. Once the baby dropped sufficiently, the doctor used a vacuum to deliver. “All I felt was relief that it was done,” Yonah reports. “But the next morning, I was disappointed with my birth experience. I was also taken aback at how, even as a practicing nurse and many years of experience an assertive patient, I’d been unable to advocate for myself in labor. I was determined to do something different going forward.

“My next birth was an unmedicated homebirth attended by midwives. It was shorter, shocking, and painful, but also validating and empowering. After delivery, I could stand and shower immediately. For the next few months, I walked around with a feeling of invincibility, amazed at what my body was capable of. For subsequent births, I’ve gone without an epidural despite complications and inductions — though I wouldn’t rule one out for a future long, hard labor! The ability to move during labor and immediately postpartum is a big motivator, and my pain tolerance isn’t so low after all!”

Pain as a Trophy

There are valid reasons to avoid the epidural — physical and emotional and spiritual. Many studies cite the possibility of prolonged, difficult labor — after all, without sensation in a woman’s lower body, there is no instinct at play during the birth. And for some women, it’s simply not an option when the process moves too quickly to consider an epidural.

At the same time, many women feel empowered or accomplished by enduring the pain of childbirth. Humanity has a complex relationship with pain, one where we reject and avoid physical discomfort but also hold it high as a trophy, an achievement of something we have worked through.

Childbirth is a special time for tefillah, for atonement and renewal. The Gemara in Berachos 5a suggests that suffering, too, is a kaparah. Suffering cleanses our sins and atones for them. Our forefather, Avraham, is famous for his ten nisyonos, tests of suffering specifically to illustrate Hashem’s love for him. We return to the dawn of time: At the onset of history, Adam and Chava are cursed with difficult labor; Adam’s is that of the endless drudgery of the workday, and Chava’s is that of childbirth. Pain, in order to create life. What is Iyov’s suffering if not a display of Hashem’s regard for him?

Then again, the Gemara in Berachos also tells the story of Rabi Yochanan, who suffered dearly in his life and spoke of how he felt love within it. But when he and a student went through sicknesses, both of them expressed that they did not want the suffering or its reward.

There is pain in life, but it isn’t forbidden to deal with it. We were cursed with mortality after Adam and Chava’s sin, as well, but we all do our best to navigate around that curse and look to the refuos that Hashem offers us. In Igros Moshe, Rav Moshe Feinstein responds to a question about whether buying life insurance displays a lack of bitachon. Of course not, he writes. Who created the concept of life insurance? We don’t accept the world as it is and shrug it off as the Will of Hashem. Hashem’s Will allows for us to make the necessary hishtadlus.

At the same time, there’s an undeniable emotional aspect to childbirth that means, for many women, that suffering isn’t unbearable. The pain is what makes the experience transcendent for many women, what makes them feel strong and capable in the most difficult of all tasks: delivering and rearing a child.

All About Autonomy

There is much debate and shame around this topic in the frum community. While many of the women interviewed were a little apologetic and relieved about their epidurals, the ones who’d eschewed the epidurals were passionate advocates of natural births, insisting it makes the birth experience more authentic and meaningful and bonding with their newborn more natural. “Some of what they said was off-putting,” says Bashie, who only experienced caesarean sections. “I always felt I bonded with my children from the moment of birth, regardless of my immobility and the operating table beneath me, and I have never felt as though childbirth has meant less because of it.”

“I think there’s an ideological reason for the natural-birth advocates’ passion,” suggests Yonah. “In hospitals, women who choose to go without medications or surgical options are often forced to advocate for themselves against seasoned doctors and nurses. They’re fighting a dual battle in the birthing room. And in successful cases, they emerge triumphant, with their baby as the reward alongside the vaunted natural birth.”

Ultimately, the deciding factor of a happy, fulfilling experience of childbirth has little to do with the pain she does or doesn’t experience. “From my experience, if a woman wants to do it without an epidural, she can have a pleasant and positive experience,” says Yocheved, a doula who has worked with women with varying birth plans. “It empowers her and she can see that she’s capable of doing something hard and new.”

But Yocheved also sees that when a woman plans for an epidural and arrives at the hospital too late to get it, the experience is a mixed bag. “Sometimes she’s traumatized because her plans haven’t worked out and she doesn’t know how to process it.” Suddenly, the birth is overwhelming and difficult. “They’re just not able to make space for something so extreme. It’s too much for them.”

In the end, though it takes many forms and invites many arguments, it really is all about autonomy. It’s about a woman’s sense of empowerment within the birthing room: to control her comfort and level of awareness; to prioritize her bonding with the baby after birth with whichever method she thinks is ideal; and to embrace the pain or to eschew it. Ff

Pain Relief Options

Not all pain treatment in childbirth is equal. Many women lean toward noninvasive methods, like nitrous oxide (laughing gas), which is self-administered and reduces anxiety while taking the edge off pain. Some side effects include dizziness and nausea, but they’re generally mild. Warm birthing pools are also a mainstay: They help with mobility, contribute a sense of relaxation, and help produce endorphins that can lessen your pain. Getting in a tub can sometimes slow down contractions, but getting back out usually allows them to restart.

Analgesic medicines can be injected into a vein or muscle to dull discomfort during labor. They aren’t going to stop the pain, but they’ll lessen it, and allow a woman to rest in early labor. Local anesthesia will numb a small part of the body and block pain in that spot when it comes to an episiotomy or repairing a tear. But the most popular and by far the most effective treatment for pain during labor is an epidural.

In an epidural, a thin tube or catheter is inserted into the back just below the spinal cord. It remains there throughout the labor process, allowing you to get additional doses of medication as the pain increases. It doesn’t always work perfectly at first. Around 12 percent of women do not experience full pain relief, but generally there is improvement with repositioning and adjusting the catheter. In case of an emergency caesarean section, stronger medication can be given through the same catheter. Because epidurals are invasive, they do have a greater risk of side effects, including itching, epidural-related fever, and postpartum backache or headache. Epidurals cause numbness from the waist down (the degree of numbness can vary by dosage) while allowing the mother to remain awake and alert.

A spinal block is similar, but it’s given with a much smaller, thinner needle, and with a smaller dose of drugs. It’s usually only given once during labor and will offer instant relief, but it’s only good for an hour or two.

A Combined Spinal-Epidural block offers the best of both — immediate relief, like a spinal block, and the continuous relief of the epidural. It’s also known as a walking epidural, because the combination allows for smaller doses of medication, so there’s more feeling and movement in the lower half of the body during labor and delivery. (Though there still won’t be much walking for logistical reasons!) A good anesthesiologist can adjust the dose so you won’t feel much pain, but you’ll have enough sensation to retain control of position and movement during the rest of the process.

More than 60 percent of women who give birth in the United States have an epidural or a spinal block during labor. Over the last few decades, anesthesiologists have tweaked their protocols to improve the epidural experience. Women are less likely to experience severe drops in blood pressure or complete numbness and immobility, which decreases the risks of further complications. A Cochrane review analyzed studies with a total of over 11,000 participants and found that epidural-type methods meant much less intense pain than other medications, and women who used them were more satisfied with their pain relief.

“When I accompany friends planning to get an epidural, I encourage them to wait until active labor to decrease the need for further intervention,” says Yonah. “It keeps the labor from stalling early on and allows mothers to move around, helping the baby to get into the appropriate position for birth,” she explains. “From what I’ve seen, if women are able to use non-pharmaceutical methods near the beginning of labor, rather than moving straight to the epidural, they set themselves up for a more successful delivery.”

Yonah Chatzinoff, RN, WHNP-C, a mother of six, is passionate about educating and empowering frum women. Yonah lives in Israel, where she serves as a health consultant. She can be contacted through Mishpacha.

(Originally featured in Family First, Issue 953)