Elevating The Natural Vs. Epidural Conversation: An Interview With Erica Lyon

Erica Lyon has been working with expectant parents for 17 years.

This week I’m launching a series of interviews with my mentors in the field of pregnancy and birth. I’m thrilled to start it off with childbirth educator Erica Lyon. Here she’ll answer questions such as: What makes for a positive birth experience? And what are the biggest misconceptions about birth?

Erica is one of the great forces in childbirth education in the last twenty years. She’s universally admired in the birthing community in New York. Prior to founding the Realbirth center in 2003, she was the education coordinator at the Elizabeth Seton Childbearing Center. She’s the author of The Big Book Of Birth, an indispensable guide for expecting parents and she’s currently the consulting education director Tribeca Parenting, where I teach.

What makes her so special is a combination of knowledge, compassion, humor and an unflinching faith in common sense. Every time I hear her speak all the various brouhahas over birth fade into faint background noise, and what is really happening to pregnant women and expecting couples comes to the fore. She’s a mentor and an inspiration to teachers like me, but most of all to expectant parents.

Why do we need childbirth education?

Childbirth education isn’t about going to class and learning some magic thing (like a breathing technique) that is going to make this experience all better. It’s about processing the realities of what happens in labor, and how we will grow and shift so that we become confident that we can cope with and handle what may come in all its possible aspects. While one will/should learn practical pain coping skills, showing up in a room full of other pregnant couples due at the same time allows us to focus–either consciously or unconsciously–to process our life changing. A huge part of the value for the expectant student is the commitment and willingness to show-up, something that will translate very well in the long term weathering of being a parent.

You’ve been doing this for years so surely you know the answer to the big question: Should I get the epidural?

How could I know what is best for you? No one knows how your labor will be (including your doctor or midwife). It is up to the individual woman to decide what her best coping strategy will be based on her own experiences. However, for the woman who is drawn to a natural birth, I would want to reassure her it is completely doable with a normal labor.

Pain is subjective, contextual and personal—all of us cope in different ways in life and labor. One can’t sum up epidural use in a simple benefit risk box because for some women the possible side effects warrant coping with the contractions and for others the pain relief is the primary need.

The natural vs. epidural conversation needs to be elevated—this isn’t about how as women we cope, this is about a larger issue of how much control and choice we have—or don’t have—in the process.

I’ve heard complaints that childbirth classes end up making women feel guilty or like failures if they get pain medication or c-sections. That’s no fun. What’s going on here?

Many childbirth educators work from a place of believing that if they give a woman enough information she will make the decision that the educator thinks is best—doctors and midwives and many clinicians do this as well. A truly educated and experienced health educator in this field no longer cares what you do, she only cares about her students’ compassionate growth and ability to participate in their own care. Its not empowering to be told how to do something. It’s empowering to make conscious decisions and receive support for them and realize one’s own potential by doing that.

Do you believe, as some childbirth educators so, that without fear there is no pain?

No, this concept judges women. It creates an idea that if one just does enough “emotional work” somehow she won’t have pain. While some do have a “pain -free” experience it is much more practical to plan/accept that some level of pain may be part of the process. Furthermore, many women birth without fear all the time and it still hurts, so it seems an unfair set-up to me for most women. If she happens to be one who has the pain-free experience then great.

So what makes for a positive birth experience?

Being loved and respected when you are so vulnerable and dependent on those around you.

What are some of the biggest misconceptions among your students about what will happen in childbirth?

That it will be short, that tearing is the worst thing ever, that husbands/partners will be grossed out or turned off or useless, that the epidural makes it totally a pain free experience, that providers who are dismissive and brief are the standard (and that they won’t be like that in labor), that this is the worst pain one will ever feel, that she will be in control during the labor.

What are the more common concerns of the pregnant women in your classes?

How much is it going to hurt and for a how long? Will I need a c-section? What if I tear or poop? Will I be okay? Will my baby be okay? Will my partner be able to handle it?

What are some of the more common concerns for expecting dads?

How can I be supportive? What am I really in for with this? How can I help her when I feel helpless? What if I don’t feel bonded with the baby? I’ve heard there’s no sleep and no sex—help! I want to be an involved dad—define that please so I understand my parameters and expectations.

Have the needs and concerns of your students in New York changed over the years since you started teaching in 1994? If so, what do you think is responsible for the shift?

In the 17 years I have been teaching I have seen induction rates increase, epidural use increase, c-section rates increase, liability premiums increase and fear of straightforward vaginal birth increase—by both doctors and couples. What primarily concerns me is the pressure that I see doctors and midwives working under-they cannot afford to practice good and patient medicine. This has eroded the patient-provider relationship and is creating a crisis in terms of losing great doctors and midwives. It’s currently not a sustainable model as it’s causing serious medical harm to our mothers and babies and both providers and parents feel helpless to stop it.

Here’s Erica talking on about how to look for a good childbirth education class.

And here’s a link to the Childbirth Education Association Of Metropolitan New York, CEA/MNY, where Erica served as president for four years and where I became certified as a teacher.


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